Am. J. Respir. Crit. Care Med., Volume 160, Number 4, October 1999, 1232-1237

Longitudinal Assessment of Airway Caliber and Responsiveness in Workers Exposed to Chlorine

DENYSE GAUTRIN, CHRISTOPHE LEROYER, CLAIRE INFANTE-RIVARD, HERBERTO GHEZZO, JEAN-GUY DUFOUR, DENISE GIRARD, and JEAN-LUC MALO

Department of Chest Medicine, Hôpital du Sacré-Coeur, University of Montreal, Montreal; Joint Departments of Epidemiology and Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal; and Occupamed, Trois-Rivières, Quebec, Canada

This longitudinal study (1992-1994) was performed to determine the relation between accidental chlorine exposure and changes in lung function and airway responsiveness in 239 workers in a metal production plant. These workers had taken part in a cross-sectional survey in 1992. In both the initial and the follow-up surveys, history of exposure to chlorine ("puffs"), accidental chlorine inhalation reported to the first-aid unit (gassing incidents), and of chronic symptoms were documented; spirometry and methacholine challenge tests were performed. At follow-up, 211 workers (88.3%) were seen. In workers with 20 pack-years or more of cigarette smoking, the fall in FEV₁ was associated with having had a gassing incident during the follow-up period; the fall in FEV₁/FVC (%) was predicted by the number of puffs causing mild symptoms between the two assessments. An increase in airway responsiveness (PC₂₀ decrease > 1.5-fold) was present in 19 workers; it was associated with accidents reported to the first-aid unit during the previous 2 yr (OR: 5.9, 95% CI: 1.1 to 32.3). These findings suggest: (1) an effect on airway function related to the estimated number of puffs with mild symptoms and gassing incidents, mostly among smokers; (2) a detectable increase in airway responsiveness associated with gassing incidents.

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