Reliability of lung function parameters in determining small airways dysfunction 7-9 years after a high-concentration chlorine gas exposure

Summary: Epithelial plasticity has been suggested in lungs of mice following genetic depletion of stem cells but is of unknown physiological relevance. Viral infection and chronic lung disease share similar pathological features of stem cell loss in alveoli, basal cell (BC) hyperplasia in small airways, and innate immune activation, that contribute to epithelial remodeling and loss of lung function. We show that a novel lineage of distal airway secretory cells, intralobar serous (IS) cells, are activated to assume BC fates following influenza virus infection. Nascent BC differ from pre-existing BC by high expression of IL-22ra1 and undergo IL-22-dependent expansion for colonization of injured alveoli. Resolution of virus-elicited inflammation resulted in BC>IS re-differentiation in repopulated alveoli, and increased local expression of antimicrobial factors, but failed to replace normal alveolar epithelium. Epithelial plasticity therefore protects against mortality from acute respiratory viral infection but results in distal lung remodeling and loss of lung function.

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Progressive Vocal Cord Dysfunction Subsequent to a Chlorine Gas Exposure

Journal of Voice ◽

10.1016/j.jvoice.2005.04.003 ◽

2006 ◽

Vol 20 (2) ◽

pp. 291-296 ◽

Cited By ~ 9

Author(s):

Patrick F. Allan ◽

Sahar Abouchahine ◽

Lee Harvis ◽

Michael J. Morris

Keyword(s):

Vocal Cord ◽

Vocal Cord Dysfunction ◽

Chlorine Gas ◽

Gas Exposure

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Body mass index status and peripheral airway obstruction in school-age children: a population-based cohort study

Thorax ◽

10.1136/thoraxjnl-2017-210716 ◽

2018 ◽

Vol 73 (6) ◽

pp. 538-545 ◽

Cited By ~ 12

Author(s):

Sandra Ekström ◽

Jenny Hallberg ◽

Inger Kull ◽

Jennifer L P Protudjer ◽

Per Thunqvist ◽

...

Keyword(s):

Body Mass Index ◽

Lung Function ◽

Airway Obstruction ◽

Body Mass ◽

Overweight And Obesity ◽

School Age Children ◽

Childhood And Adolescence ◽

Small Airways ◽

Cross Sectional ◽

The Impact

BackgroundFew large prospective studies have investigated the impact of body mass index (BMI) on lung function during childhood.MethodsUsing data collected between 2002 and 2013, we analysed associations between BMI status and lung function (assessed by spirometry) from 8 to 16 years, as well as cross-sectional associations with small airway function (impulse oscillometry) at 16 years in the BAMSE cohort (n=2889). At 16 years, cross-sectional associations with local and systemic inflammation were investigated by analysing FENO, blood eosinophils and neutrophils.ResultsOverweight and obesity at 8 years were associated with higher FVC, but lower FEV1/FVC ratio at 8 and 16 years. In boys, but not girls, obesity at 8 years was associated with a further reduction in FEV1/FVC between 8 and 16 years. In cross-sectional analyses, overweight and obesity were associated with higher frequency dependence of resistance (R5–20) and larger area under the reactance curve (AX0.5) at 16 years. Increased blood neutrophil counts were seen in overweight and obese girls, but not in boys. No association was found between BMI status and FENO. Persistent, but not transient, overweight/obesity between 8 and 16 years was associated with higher R5–20 and AX0.5 and lower FEV1/FVC (−2.8% (95% CI −4.1 to −1.2) in girls and −2.7% (95% CI −4.4 to −1.1) in boys) at 16 years, compared with persistent normal weight.ConclusionIn childhood and adolescence, overweight and obesity, particularly persistent overweight, were associated with evidence of airway obstruction, including the small airways.

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High Concentration Of Plasma Soluble CD40 Ligand Is Associated With Impaired Lung Function And Alveolar Structural Destruction

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a4555 ◽

2012 ◽

Author(s):

Ayako Shigeta ◽

Yuji Tada ◽

Koichiro Tatsumi

Keyword(s):

Lung Function ◽

Cd40 Ligand ◽

High Concentration ◽

Soluble Cd40 Ligand ◽

Impaired Lung Function

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

Pulmonary Medicine ◽

10.1155/2013/325869 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Pallavi P. Balte ◽

Kathleen A. Clark ◽

Lawrence C. Mohr ◽

Wilfried J. Karmaus ◽

David Van Sickle ◽

...

Keyword(s):

South Carolina ◽

Pulmonary Disease ◽

Mass Casualty ◽

Mass Casualties ◽

High Concentration ◽

Disease Patterns ◽

Chlorine Gas ◽

Disease Pattern ◽

High Concentrations ◽

Gas Inhalation

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.

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Short- and long-term effects of diving on pulmonary function

European Respiratory Review ◽

10.1183/16000617.0097-2016 ◽

2017 ◽

Vol 26 (143) ◽

pp. 160097 ◽

Cited By ~ 8

Author(s):

Kay Tetzlaff ◽

Paul S. Thomas

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Ambient Pressure ◽

Small Airways ◽

Long Term Effects ◽

Cold Temperatures ◽

Factors Associated ◽

Stress Changes ◽

The Impact

The diving environment provides a challenge to the lung, including exposure to high ambient pressure, altered gas characteristics and cardiovascular effects on the pulmonary circulation. Several factors associated with diving affect pulmonary function acutely and can potentially cause prolonged effects that may accumulate gradually with repeated diving exposure. Evidence from experimental deep dives and longitudinal studies suggests long-term adverse effects of diving on the lungs in commercial deep divers, such as the development of small airways disease and accelerated loss of lung function. In addition, there is an accumulating body of evidence that diving with self-contained underwater breathing apparatus (scuba) may not be associated with deleterious effects on pulmonary function. Although changes in pulmonary function after single scuba dives have been found to be associated with immersion, ambient cold temperatures and decompression stress, changes in lung function were small and suggest a low likelihood of clinical significance. Recent evidence points to no accelerated loss of lung function in military or recreational scuba divers over time. Thus, the impact of diving on pulmonary function largely depends on factors associated with the individual diving exposure. However, in susceptible subjects clinically relevant worsening of lung function may occur even after single shallow-water scuba dives.

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