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. 1. Introduction Chlorine gas is one of the most commonly used industrial chemicals and is a potential weapon of mass destruction [1–8]. The health effects of chlorine inhalation depend on chlorine concentration and duration of exposure. If inhaled in low concentration (<50？ppm) chlorine gas is known to cause mild irritation of mucus membranes, coughing, choking, and shortness of breath [9, 10]. Exposure to high concentrations (>50？ppm) may damage the lower respiratory tract and lung parenchyma causing complications such as rapid development of interstitial pneumonia, pulmonary edema, and death due to progressive respiratory failure [9–11]. Several studies have shown decrease in lung function after acute inhalation of chlorine gas, but very few studies attempted to determine pulmonary disease pattern in these patients [11–14]. Although obstructive pulmonary disease was most commonly observed in all these studies, restrictive and mixed pulmonary disease were also seen in a few studies [12–14]. At present, 2005 ATS/ERS task force guidelines based on NHANES III data are considered the “gold standard” and are used universally to provide guidance to physicians and hospital based pulmonary function tests (PFTs)
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