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Pulmonary Medicine
Volume 2013, Article ID 325869, 7 pages
Research Article

The Immediate Pulmonary Disease Pattern following Exposure to High Concentrations of Chlorine Gas

1Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Room 210, Columbia, SC 29208, USA
2Medical University of South Carolina, 135 Cannon Street, Suite 405, P.O. Box 250838, Charleston, SC 29425, USA
3Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 301 Robison Hall, 3825 De Soto Avenue, Memphis, TN 38152, USA
4Asthmapolis, 612 W. Main Street, Suite 201, Madison, WI 53703, USA
5Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2100, New Orleans, LA 70112, USA

Received 11 September 2013; Accepted 4 November 2013

Academic Editor: Andrew Sandford

Copyright © 2013 Pallavi P. Balte et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.