Longitudinal Monitoring of Lung Injury in Children after Acute Chlorine Exposure in a Swimming Pool

Bonetto, G.; Corradi, Massimo; Carraro, Silvia; Zanconato, Stefania; Alinovi, Rossella; Folesani, Giuseppina; Dalt, Liviana Da; Mutti, Antonio; Baraldi, Eugenio

doi:10.1164/rccm.200509-1392oc

Cited by 75 publications

(66 citation statements)

References 25 publications

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“…Secondly, chronic low-grade exposure to chlorine derivatives may be related to the observed increased levels of exhaled LTB 4 in elite swimmers [4]. This observation is also supported by the findings in children accidentally exposed to chlorine, with development of respiratory symptoms, lung function impairment and exhaled breath alterations, represented mainly by an increase in LTs and a decrease in FeNO [8]. If this is the case, new therapeutic approaches that, in addition to inhaled corticosteroids, would target the 5-lipoxygenase pathway could have a role attenuating the neutrophilic airway inflammation in swimmers with asthma.…”

Section: To the Editorsmentioning

confidence: 72%

“…This blanket statement assumes a homogeneity to idiopathic NSIP and idiopathic UIP that is contrary to the evidence. The idea of a distinct clinical phenotype for idiopathic NSIP is supported by demographic, serological and survival differences seen when IPF and idiopathic NSIP patients are compared [4][5][6], and by the differences, not similarities, seen in gene expression profiles (six of 10 published NSIP profiles are distinct from UIP while four are similar) [7,8].…”

Section: To the Editorsmentioning

confidence: 99%

See 1 more Smart Citation

Competitive swimmers with allergic asthma show a mixed type of airway inflammation

Moreira¹,

Delgado²,

Palmares³

et al. 2008

European Respiratory Journal

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Section: To the Editorsmentioning

confidence: 72%

Section: To the Editorsmentioning

confidence: 99%

Competitive swimmers with allergic asthma show a mixed type of airway inflammation

Moreira¹,

Delgado²,

Palmares³

et al. 2008

European Respiratory Journal

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“…Similar results were recently published by a German group 22 . In addition, Bonetto et al 23 reported on lung function and possible lung injury pathways in the acute phase and during a 15-month follow-up in a group of children after accidental acute chlorine exposure in a swimming pool. Right after the accident, the authors found substantial lung function impairment associated with increased leukotriene levels in exhaled breath condensate, reduced exhaled NO (measured at 50 ml/sec), and increased serum Clara cell protein (CC16) values (a sign of injury of the lung epithelial permeability barrier).…”

Section: Respiratory Effects Of Acute Chlorine Exposurementioning

confidence: 99%

“…Although lung function and exhaled NO improved within a few weeks, the levels of exhaled leukotriene B 4 remained high for several months, suggesting a neutrophilic inflammation despite the lack of any respiratory symptoms and the normalization of lung function parameters. 23 …”

Section: Respiratory Effects Of Acute Chlorine Exposurementioning

confidence: 99%

Swimming pool, respiratory health, and childhood asthma: Should we change our beliefs?

Uyan

Carraro

Piacentini

et al. 2008

Pediatric Pulmonology

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Summary. Swimming is often recommended as a sport because of its several benefits to health. It is also recommended in asthmatic children as a sport with a lower potential for prompting exercise-induced asthma. However, there is growing interest in the potentially harmful effects of repeated respiratory tract exposure to chlorinated products and the problem of possible swimmingrelated health hazards is gaining importance at international level. It is already known that acute exposure to chlorine gas as in swimming pool accidents causes lung damage and also that elite swimmers may have increased airway inflammation and bronchial hyperreactivity, probably as a result of repeated exposure to chlorine derivatives. Recently some studies have been conducted to investigate whether repeated exposure to chlorine by-products in recreational swimmers might also lead to lung damage. In addition, some studies have been lately published on the even more debated issue of the possible harmful effects of baby swimming on respiratory health. This article reviews and discusses data from the literature on the effects of chlorine derivatives in different categories of people routinely attending swimming pools. The need for longitudinal studies is emphasized to definitely clarify any role of chlorinated swimming pool attendance in the development of asthma in recreational swimmers.

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“…Considering the large blood‐tissue exchange surface area of lung tissues, serum CC16 is almost solely derived from the respiratory tract and is, therefore, considered lung‐specific. Increased circulating CC16 levels have been observed in patients with pulmonary injuries caused by inhaled ozone, chlorine, and LPS 7, 8, 9. It has been suggested as a disease marker for pulmonary sarcoidosis, chronic obstructive pulmonary disease, and severe chest trauma 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with acute respiratory distress syndrome

Lin

Zhang

Wang

et al. 2017

Clinical Laboratory Analysis

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BackgroundAcute respiratory distress syndrome (ARDS) is a critical condition characterized by bilateral pulmonary infiltrates and severe hypoxemia. This study aimed to evaluate the diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with ARDS.MethodsIn this retrospective observational study, 83 patients with ARDS and 129 non‐ARDS patients on ICU admission were enrolled. The differences in serum CC16 and other laboratory indicators between two groups were analyzed. The sensitivity, specificity, positive and negative predictive values, and accuracy of CC16 as a diagnostic marker on ICU admission were determined by receiver operating characteristic (ROC) curve analysis. The correlation between serum CC16 levels and the severity of ARDS as quantified by PaO2/FiO2 ratio were further assessed. CC16 levels were compared between survivors and non‐survivors. The relationships between CC16 levels and duration of ICU and hospitalization were evaluated.ResultsThe serum CC16 levels in ARDS patients were significantly higher than that in non‐ARDS patients (54.44±19.62 vs 24.13±12.32 ng/mL, P=.001). ROC analysis showed that the sensitivity, specificity, positive predictive value, and negative predictive value were 90.4%, 79.8%, 74.2%, and 92.8%, respectively, when the cut‐off value was set at 33.3 ng/mL. CC16 levels were correlated with the severity of ARDS. The serum CC16 levels were significantly greater in non‐survivors than in survivors from the ARDS group. CC16 levels were associated with ICU stay but not hospital stay.Conclusions CC16 may serve as a diagnostic and stratification marker for ARDS. However, it provided limited prognostic information for ARDS.

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Longitudinal Monitoring of Lung Injury in Children after Acute Chlorine Exposure in a Swimming Pool

Cited by 75 publications

References 25 publications

Competitive swimmers with allergic asthma show a mixed type of airway inflammation

Competitive swimmers with allergic asthma show a mixed type of airway inflammation

Swimming pool, respiratory health, and childhood asthma: Should we change our beliefs?

Diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with acute respiratory distress syndrome

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