Published ahead of print on June 8, 2006, doi:10.1164/rccm.200509-1392OC Am. J. Respir. Crit. Care Med., Volume 174, Number 5, September 2006, 545-549 A more recent version of this article appeared on September 1, 2006
Submitted on September 7, 2005 Longitudinal Monitoring of Lung Injury in Children following Chlorine Exposure in a Swimming PoolGea Bonetto1,1 Department of Pediatrics, University of Padova, Padova, Italy, 2 Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy; National Institute of Occupational Safety and Prevention Research Center at the University of Parma, University of Parma, Parma, Italy, 3 Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy * To whom correspondence should be addressed. 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-month follow-up after chlorine exposure. Methods: Ten previously-healthy children were accidentally exposed to chlorine gas at a swimming pool due to an erroneous servicing procedure. Exhaled nitric oxide (FENO), exhaled breath condensate (EBC) compounds and serum Clara cell 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 IQR: FVC 51% pred. [43-60], FEV1 51% pred. [46-60]). This was accompanied by low FENO (4.7 [3.9-7.9] ppb), high EBC leukotriene B4 (LTB-4) levels (24.4 [22.5-24.9]pg/mL) and increased serum CC16 levels (mean±SE 23.4±2.5 µg/L). Lung function returned to normal in 15 days (FVC 97% pred. [82-108] and FEV1 92% pred. [77-102]). FENO reached normal values after 2 months (12.6 [11.4-15]ppb), while LTB-4 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, mainly represented by an increase in LTB-4 and a reduction in FENO. While lung function and FENO improved within a few weeks, the increased levels of exhaled LTB-4 persisted for several months. Key words: chlorine inhalation, pulmonary function, exhaled nitric oxide, exhaled breath condensate, pneumoproteinemia
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