Longitudinal monitoring of lung injury in children after acute chlorine exposure in a swimming pool

Am J Respir Crit Care Med. 2006 Sep 1;174(5):545-9. doi: 10.1164/rccm.200509-1392OC. Epub 2006 Jun 8.


Rationale: Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage.

Objectives: 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.

Main 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).

Conclusion: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Accidents
  • Child
  • Chlorine / toxicity*
  • Environmental Exposure / adverse effects*
  • Female
  • Forced Expiratory Volume
  • Humans
  • Leukotrienes / metabolism
  • Longitudinal Studies
  • Male
  • Nitric Oxide / metabolism
  • Respiratory Distress Syndrome / chemically induced
  • Respiratory Distress Syndrome / metabolism*
  • Respiratory Distress Syndrome / physiopathology*
  • Swimming Pools
  • Uteroglobin / metabolism
  • Vital Capacity


  • Leukotrienes
  • SCGB1A1 protein, human
  • Nitric Oxide
  • Chlorine
  • Uteroglobin