title: Longitudinal monitoring of lung injury in children after acute chlorine exposure in a swimming pool.
abstract: BACKGROUND
  Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage.
  
  
  OBJECTIVE
  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 (Fe(NO)), exhaled breath condensate compounds, and serum Clara cell-specific protein CC16 were repeatedly measured.
  
  
  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; 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy. baraldi@pediatria.unipd.it.
authors.forename: Gea
authors.initials: G
authors.lastname: Bonetto
authors.forename: Massimo
authors.initials: M
authors.lastname: Corradi
authors.forename: Silvia
authors.initials: S
authors.lastname: Carraro
authors.forename: Stefania
authors.initials: S
authors.lastname: Zanconato
authors.forename: Rossella
authors.initials: R
authors.lastname: Alinovi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Folesani
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
authors.forename: Antonio
authors.initials: A
authors.lastname: Mutti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
mesh_terms: D000059:Accidents; D002648:Child; D002713:Chlorine / Q000633:toxicity*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D015289:Leukotrienes / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000139:chemically induced / Q000378:metabolism* / Q000503:physiopathology*; D013551:Swimming Pools; D014598:Uteroglobin / Q000378:metabolism; D014797:Vital Capacity
chemical_list: D015289:Leukotrienes; C556389:SCGB1A1 protein, human; D009569:Nitric Oxide; D002713:Chlorine; D014598:Uteroglobin