Longitudinal Monitoring of Lung Injury in Children after Acute Chlorine Exposure in a Swimming Pool

• DOI: 10.1164/rccm.200509-1392oc
• Publication Date: 2006-06-09T01:29:14Z
• Authors: Gea Bonetto; Massimo Corradi; Silvia Carraro; Stefania Zanconato; Rossella Alinovi; Giuseppina Folesani; Liviana Da Dalt; Antonio Mutti; Eugenio Baraldi
• Keywords: Adult; Male; Leukotrienes; Respiratory Distress Syndrome; chlorine inhalation; exhaled breath condensate; exhaled nitric oxide; pneumoproteinemia; pulmonary function; Vital Capacity; 610; Environmental Exposure; Nitric Oxide; 3. Good health; 618; 03 medical and health sciences; Swimming Pools; 0302 clinical medicine; Accidents; Forced Expiratory Volume; 617; Humans; Uteroglobin; Female; Longitudinal Studies; Chlorine; Child

Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage.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.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 (Fe(NO)), exhaled breath condensate compounds, and serum Clara cell-specific protein CC16 were repeatedly measured.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; FEV(1), 51 [46-60]% predicted). This was accompanied by low Fe(NO) (4.7 [3.9-7.9] ppb), high exhaled breath condensate leukotriene B(4) (LTB(4)) levels (24.4 [22.5-24.9] pg/ml), and increased serum CC16 levels (mean +/- SEM, 23.4 +/- 2.5 microg/L). Lung function returned to normal in 15 d (FVC, 97% predicted [82-108], and FEV(1), 92% predicted [77-102]). Fe(NO) reached normal values after 2 mo (12.6 [11.4-15] ppb), whereas LTB(4) levels were still increased (12 [9.3-17.1] pg/ml).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 LTB(4) and a reduction in Fe(NO). Although lung function and Fe(NO) improved within a few weeks, the increased levels of exhaled LTB(4) persisted for several months.