Longitudinal monitoring of lung injury in children after acute chlorine exposure in a swimming pool.
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.
Bonetto
Gea
G
Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy. baraldi@pediatria.unipd.it.
Corradi
Massimo
M
Carraro
Silvia
S
Zanconato
Stefania
S
Alinovi
Rossella
R
Folesani
Giuseppina
G
Da Dalt
Liviana
L
Mutti
Antonio
A
Baraldi
Eugenio
E
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
D015289:Leukotrienes; C556389:SCGB1A1 protein, human; D009569:Nitric Oxide; D002713:Chlorine; D014598:Uteroglobin