title: The Immediate Pulmonary Disease Pattern following Exposure to High Concentrations of Chlorine Gas.
abstract: Background. Classification of pulmonary disease into obstructive, restrictive, and mixed patterns is based on 2005 ATS/ERS guidelines and modified GOLD criteria by Mannino et al. (2003), but these guidelines are of limited use for simple spirometry in situations involving mass casualties. Aim. The purpose of this study was to apply these guidelines to patients who underwent simple spirometry following high concentration of chlorine gas inhalation after a train derailment in Graniteville, South Carolina. Methods. We retrospectively investigated lung functions in ten patients. In order to classify pulmonary disease pattern, we used 2005 ATS/ERS guidelines and modified GOLD criteria along with our own criteria developed using available simple spirometry data. Results. We found predominant restrictive pattern in our patients with both modified GOLD and our criteria, which is in contrast to other chlorine exposure studies where obstructive pattern was more common. When compared to modified GOLD and our criteria, 2005 ATS/ERS guidelines underestimated the frequency of restrictive disease. Conclusion. Diagnosis of pulmonary disease patterns is of importance after irritant gas inhalation. Acceptable criteria need to be developed to evaluate pulmonary disease through simple spirometry in events leading to mass casualty and patient surge in hospitals.
authors.affiliation: Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Room 210, Columbia, SC 29208, USA.
authors.forename: Pallavi P
authors.initials: PP
authors.lastname: Balte
authors.affiliation: Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Room 210, Columbia, SC 29208, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Clark
authors.affiliation: Medical University of South Carolina, 135 Cannon Street, Suite 405, P.O. Box 250838, Charleston, SC 29425, USA.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Mohr
authors.affiliation: Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 301 Robison Hall, 3825 De Soto Avenue, Memphis, TN 38152, USA.
authors.forename: Wilfried J
authors.initials: WJ
authors.lastname: Karmaus
authors.affiliation: Asthmapolis, 612 W. Main Street, Suite 201, Madison, WI 53703, USA.
authors.forename: David
authors.initials: D
authors.lastname: Van Sickle
authors.affiliation: Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2100, New Orleans, LA 70112, USA.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Svendsen