Schwartz D A, Smith D D, Lakshminarayan S
Pulmonary Disease Division, University of Iowa, Iowa City.
Chest. 1990 Apr;97(4):820-5. doi: 10.1378/chest.97.4.820.
Twenty previously healthy individuals were accidentally exposed to high concentrations of chlorine gas in 1975. Pulmonary function tests were performed on these individuals on several occasions over the next 12 years. On average, each subject was followed up for 8.5 years and 13 of the 20 exposed persons were tested 12 years following the exposure. Pulmonary function tests obtained one day following the accident were most notable for the high prevalence of airflow obstruction and air trapping. Over the ensuing years, the airflow obstruction persisted; however, the high prevalence of air trapping resolved. Of note, the prevalence of a low residual volume consistently increased during the follow-up period (p less than 0.001) and at year 12, 67 percent of those tested had residual volumes below 80 percent of their predicted value. We also found that five of 13 subjects tested at year 12 had an increase in airway reactivity (greater than 15 percent decline in FEV1) to inhaled methacholine. Those individuals with reactive airways were older (p = 0.004) and had more marked airflow obstruction (p = 0.03) and air trapping (p = 0.03) immediately following the exposure. These data suggest that exposure to high concentrations of chlorine gas may result in long-term pulmonary complications that are characterized by a reduced residual volume. Unfortunately, these data preclude us from determining whether the chlorine exposure led to the development of airway reactivity or the presence of reactive airways accounted for the air trapping that was observed following the exposure to chlorine gas.
1975年，20名此前身体健康的个体意外暴露于高浓度氯气中。在接下来的12年里，对这些个体进行了多次肺功能测试。平均而言，每位受试者随访了8.5年，20名暴露者中有13人在暴露后12年接受了测试。事故发生后一天进行的肺功能测试中，气流阻塞和气体潴留的高患病率最为显著。在随后的几年里，气流阻塞持续存在；然而，气体潴留的高患病率得到了解决。值得注意的是，在随访期间，低残气量的患病率持续增加（p<0.001），在第12年，67%的受测者残气量低于预测值的80%。我们还发现，在第12年接受测试的13名受试者中有5人对吸入的乙酰甲胆碱气道反应性增加（FEV1下降超过15%）。那些气道反应性高的个体年龄较大（p = 0.004），暴露后立即出现更明显的气流阻塞（p = 0.03）和气体潴留（p = 0.03）。这些数据表明，暴露于高浓度氯气可能导致以残气量减少为特征的长期肺部并发症。不幸的是，这些数据使我们无法确定氯气暴露是否导致了气道反应性的发展，或者气道反应性的存在是否是暴露于氯气后观察到的气体潴留的原因。
