Published ahead of print on June 8, 2006, doi:10.1164/rccm.200509-1392OC
© 2006 American Thoracic Society doi: 10.1164/rccm.200509-1392OC
Longitudinal Monitoring of Lung Injury in Children after Acute Chlorine Exposure in a Swimming PoolDepartment of Pediatrics, University of Padua, Padua; and Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology, and Health Sciences and National Institute of Occupational Safety and Prevention Research Center, University of Parma, Parma, Italy Correspondence and requests for reprints should be addressed to Eugenio Baraldi, M.D., Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy. E-mail: baraldi{at}pediatria.unipd.it Rationale: Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage. Objectives: To assess lung function and potential lung damage pathways in the acute phase and longitudinally over a 15-mo follow-up after acute chlorine exposure. Methods: Ten previously healthy children were accidentally exposed to chlorine gas at a swimming pool because of an erroneous servicing procedure. The fraction of nitric oxide in exhaled air (FENO), exhaled breath condensate compounds, and serum Clara cell–specific protein CC16 were repeatedly measured. Main results: In the acute phase, all patients had respiratory distress (one child required mechanical ventilation) and reduced lung function (median and interquartile range: FVC, 51 [43–60]% predicted; FEV1, 51 [46–60]% predicted). This was accompanied by low FENO (4.7 [3.9–7.9] ppb), high exhaled breath condensate leukotriene B4 (LTB4) levels (24.4 [22.5–24.9] pg/ml), and increased serum CC16 levels (mean ± SEM, 23.4 ± 2.5 µg/L). Lung function returned to normal in 15 d (FVC, 97% predicted [82–108], and FEV1, 92% predicted [77–102]). FENO reached normal values after 2 mo (12.6 [11.4–15] ppb), whereas LTB4 levels were still increased (12 [9.3–17.1] pg/ml). Conclusion: Children acutely exposed to chlorine in a swimming pool presented a substantial lung function impairment associated with biochemical exhaled breath alterations, represented mainly by an increase in LTB4 and a reduction in FENO. Although lung function and FENO improved within a few weeks, the increased levels of exhaled LTB4 persisted for several months.
Key Words: chlorine inhalation • exhaled breath condensate • exhaled nitric oxide • pneumoproteinemia • pulmonary function This article has been cited by other articles:
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