Long-Term Outcomes of Acute Irritant-induced Asthma

Malo, Jean‐Luc; L’Archevêque, Jocelyne; Castellanos, Lucero; Lavoie, Kim; Ghezzo, Heberto; Maghni, Karim

doi:10.1164/rccm.200810-1550oc

Cited by 97 publications

(112 citation statements)

References 32 publications

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“…In humans, chlorine concentrations as low as 10 ppm can overcome upper airway defense mechanisms and penetrate into lower respiratory structures (12,13). Several studies suggest possible long-term airway hyperresponsiveness, obstructive ventilatory impairment, reactive airway dysfunction syndrome, or reduction in residual volume after acute exposure (14)(15)(16)(17). Schwartz and colleagues (18) reported initial airway obstruction for 20 construction workers acutely exposed to chlorine gas.…”

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Lung Function before and after a Large Chlorine Gas Release in Graniteville, South Carolina

et al. 2016

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Rationale: On January 6, 2005 a train derailment led to an estimated 54,915-kg release of chlorine at a local textile mill in Graniteville, South Carolina.Objectives: We used the employee health spirometry records of the textile to identify enduring effects of chlorine gas exposure resulting from the incident on the lung function of workers employed at the textile mill.Methods: Spirometry records from 1,807 mill workers (7,332 observations) were used from 4 years before and 18 months after the disaster. Longitudinal analysis using marginal regression models produced annual population mean estimates for FEV 1 , FVC, and FEV 1 /FVC ratio. Covariate adjustment was made for sex, age, smoking, height, season tested, technician, obesity, season 3 year interactions, and smoker 3 year interactions. The increased prevalence of mill workers having accelerated FEV 1 decline was also evaluated after the chlorine spill. Measurements and Main Results:In the year of the accident, we observed a significant reduction in mean FEV 1 (-4.2% predicted; P = 0.019) when compared with the year before the incident. In the second year, partial recovery in the mean FVC % predicted level was seen, but the cohort's average FEV 1 /FVC ratio continued to decrease over time. Severe annual FEV 1 decline was most prevalent in the year of the accident, and independent of mill worker smoking status. Conclusions:The Graniteville mill worker cohort revealed significant reductions in lung function immediately after the chlorine incident. Improvement was seen in the second year; but the proportion of mill workers experiencing accelerated FEV 1 annual decline significantly increased in the 18 months after the chlorine incident.

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Lung Function before and after a Large Chlorine Gas Release in Graniteville, South Carolina

et al. 2016

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“…Humans exposed to high levels of chlorine develop acute lung injury, but most individuals recover from these acute effects (17,43). However, additional follow-up studies suggest the existence of a subset of exposed individuals who experience chronic impairment of pulmonary function, which may include airway hyperreactivity, airway obstruction, or decreased residual volumes (1,18,23,33). Long-term effects of chlorine inhalation have been studied in the context of acute irritant-induced asthma (2,23).…”

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confidence: 99%

“…However, additional follow-up studies suggest the existence of a subset of exposed individuals who experience chronic impairment of pulmonary function, which may include airway hyperreactivity, airway obstruction, or decreased residual volumes (1,18,23,33). Long-term effects of chlorine inhalation have been studied in the context of acute irritant-induced asthma (2,23). Patients who developed irritant-induced asthma as a result of chemical exposure (most commonly chlorine) had evidence of airway obstruction, fibrosis, and hyperreactivity (1,4,11,37).…”

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Differential susceptibility of inbred mouse strains to chlorine-induced airway fibrosis

Chen

Schlueter

et al. 2013

American Journal of Physiology-Lung Cellular and Molecular Phys

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Mo Y, Chen J, Schlueter CF, Hoyle GW. Differential susceptibility of inbred mouse strains to chlorine-induced airway fibrosis. Am J Physiol Lung Cell Mol Physiol 304: L92-L102, 2013. First published November 21, 2012 doi:10.1152/ajplung.00272.2012.-Chlorine is a reactive gas that is considered a chemical threat agent. Humans who develop acute lung injury from chlorine inhalation typically recover normal lung function; however, a subset can experience chronic airway disease. To examine pathological changes following chlorine-induced lung injury, mice were exposed to a single high dose of chlorine, and repair of the lung was analyzed at multiple times after exposure. In FVB/NJ mice, chlorine inhalation caused pronounced fibrosis of larger airways that developed by day 7 after exposure and was associated with airway hyperreactivity. In contrast, A/J mice had little or no airway fibrosis and had normal lung function at day 7. Unexposed FVB/NJ mice had less keratin 5 staining (basal cell marker) than A/J mice in large intrapulmonary airways where epithelial repair was poor and fibrosis developed after chlorine exposure. FVB/NJ mice had large areas devoid of epithelium on day 1 after exposure leading to fibroproliferative lesions on days 4 and 7. A/J mice had airways covered by squamous keratin 5-stained cells on day 1 that transitioned to a highly proliferative reparative epithelium by day 4 followed by the reappearance of ciliated and Clara cells by day 7. The data suggest that lack of basal cells in the large intrapulmonary airways and failure to effect epithelial repair at these sites are factors contributing to the development of airway fibrosis in FVB/NJ mice. The observed differences in susceptibility to chlorine-induced airway disease provide a model in which mechanisms and treatment of airway fibrosis can be investigated. acute lung injury; airway hyperreactivity; basal cells CHLORINE IS A WIDELY USED industrial chemical and is one the top ten chemicals produced by gross weight (9). Chlorine gas is considered a chemical threat agent and is a highly toxic respiratory irritant that when inhaled causes cellular injury, alveolar-capillary barrier disruption, inflammation, pulmonary edema, and, at very high levels of exposure, death (9,21,39,44). Human exposure to chlorine has occurred from both intentional and accidental releases of chlorine (9,17,33,41,43). Humans exposed to high levels of chlorine develop acute lung injury, but most individuals recover from these acute effects (17, 43). However, additional follow-up studies suggest the existence of a subset of exposed individuals who experience chronic impairment of pulmonary function, which may include airway hyperreactivity, airway obstruction, or decreased residual volumes (1,18,23,33). Long-term effects of chlorine inhalation have been studied in the context of acute irritant-induced asthma (2, 23). Patients who developed irritant-induced asthma as a result of chemical exposure (most commonly chlorine) had evidence of airway obstruction, fibrosis, and hyper...

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“…The employees with RADS and borderline RADS need continued medical follow-up by a physician. In one previous study of persons diagnosed with RADS, more than half continued to report symptoms and one third required medication years after their diagnosis [Malo et al 2009]. RADS has been associated with decreased quality of life and increased depression and anxiety [Malo et al 2009].…”

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confidence: 99%

Evaluation of health effects of a chlorine gas release in a poultry processing plant - Arkansas.

2013

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Long-Term Outcomes of Acute Irritant-induced Asthma

Abstract: This study provides the first evidence of significant long-term impact of acute IIA on various outcomes.

Cited by 97 publications

References 32 publications

Lung Function before and after a Large Chlorine Gas Release in Graniteville, South Carolina

Lung Function before and after a Large Chlorine Gas Release in Graniteville, South Carolina

Differential susceptibility of inbred mouse strains to chlorine-induced airway fibrosis

Evaluation of health effects of a chlorine gas release in a poultry processing plant - Arkansas.

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