Annals of Occupational and Environmental Medicine

Research Article

Acute respiratory symptoms and evacuation-related behavior after exposure to chlorine gas leakage: Sung-Woo Han, Won-Jun Choi, Min-Kee Yi, Seng-Ho Song, Dong-Hoon Lee, Sang-Hwan Han; Ann Occup Environ Med 2016;28:29. Published online July 4, 2016; DOI: https://doi.org/10.1186/s40557-016-0115-2

Background

A study was performed on the accidental chlorine gas leakage that occurred in a factory of printed circuit boards manufactured without chlorine. Health examination was performed for all 52 workers suspected of exposure to chlorine gas, and their evacuation-related behaviors were observed in addition to analyzing the factors that affected the duration of their acute respiratory symptoms.

Methods

Behavioral characteristics during the incidence of the accidental chlorine gas leakage, the estimated time of exposure, and the duration of subjective acute respiratory symptoms were investigated. In addition, clinical examination, chest radiography, and dental erosion test were performed. As variables that affected the duration of respiratory symptoms, dose group, body weight, age, sex, smoking, work period, and wearing a protective gear were included and analyzed by using the Cox proportional hazard model.

Results

Of 47 workers exposed to chlorine gas, 36 (77 %) developed more than one subjective symptom. The duration of the subjective symptoms according to exposure level significantly differed, with a median of 1 day (range, 0–5 days) in the low-exposure group and 2 days (range, 0–25 days) in the high-exposure group. Among the variables that affected the duration of the acute respiratory symptoms, which were analyzed by using the Cox proportional hazard model, only exposure level was significant (hazard ratio 2.087, 95 % CI = 1.119, 3.890). Regarding the evacuation-related behaviors, 22 workers (47 %) voluntarily evacuated to a safety zone immediately after recognizing the accidental exposure, but 25 workers (43 %) delayed evacuation until the start of mandatory evacuation (min 5, max 25 min).

Conclusions

The duration of the subjective acute respiratory symptoms significantly differed between the low- and high-exposure groups. Among the 27 workers in the high-exposure group, 17 misjudged the toxicity after being aware of the gas leakage, which is a relatively high number.

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Case Report

Acute health effects of accidental chlorine gas exposure: Joo-An Kim, Seong-Yong Yoon, Seong-Yong Cho, Jin-Hyun Yu, Hwa-Sung Kim, Gune-Il Lim, Jin-Seok Kim; Ann Occup Environ Med 2014;26:29-29. Published online October 1, 2014; DOI: https://doi.org/10.1186/s40557-014-0029-9

Abstract PDF PubReader ePub

Objectives

This study was conducted to report the course of an accidental release of chlorine gas that occurred in a factory in Gumi-si, South Korea, on March 5, 2013. We describe the analysis results of 2 patients hospitalized because of chlorine-induced acute health problems, as well as the clinical features of 209 non-hospitalized patients.

Methods

We analyzed the medical records of the 2 hospitalized patients admitted to the hospital, as well as the medical records and self-report questionnaires of 209 non-hospitalized patients completed during outpatient treatment.

Results

Immediately after the exposure, the 2 hospitalized patients developed acute asthma-like symptoms such as cough and dyspnea, and showed restrictive and combined pattern ventilatory defects on the pulmonary function test. The case 1 showed asthma-like symptoms over six months and diurnal variability in peak expiratory flow rate was 56.7%. In case 2, his FEV1 after treatment (93%) increased by 25% compared to initial FEV1 (68%). Both cases were diagnosed as chlorine-induced reactive airways dysfunction syndrome (RADS) on the basis of these clinical features. The most frequent chief complaints of the 209 non-hospitalized patients were headache (22.7%), followed by eye irritation (18.2%), nausea (11.2%), and sore throat (10.8%), with asymptomatic patients accounting for 36.5%. The multiple-response analysis of individual symptom revealed headache (42.4%) to be the most frequent symptom, followed by eye irritation (30.5%), sore throat (30.0%), cough (29.6%), nausea (27.6%), and dizziness (27.3%).

Conclusions

The 2 patients hospitalized after exposure to chlorine gas at the leakage site showed a clinical course corresponding to RADS. All of the 209 non-hospitalized patients only complained of symptoms of the upper airways and mucous membrane irritation.

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Acute respiratory symptoms and evacuation-related behavior after exposure to chlorine gas leakage
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Case Report

Two cases of anosmia suspected to be caused by chronic chlorine exposure in cleansing works: Sung mo Ku, Hyun joo Kim; Korean Journal of Occupational and Environmental Medicine 2005;17(2):155-159. Published online June 30, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.2.155

Abstract PDF

OBJECTIVES
We report two cases of anosmia that were suspected to be caused by chronic chlorine exposure in cleansing works METHODS: We examined the cases in order to assess the work-relatedness of their anosmia. We conducted olfactory threshold test and olfactory perception test repeatedly at one-month intervals. Using ion chromatography, we analyzed the detergent that the workers had been using for several years before their olfactory function decreased.
RESULTS
A 59-year-old male who had worked in a cleansing process for 10 years (1983-1993) and a 58-year-old female who had worked in the same process for 8 years (1987-1995) were diagnosed with anosmia. The cause of the anosmia was presumed to have been the chlorine gas that was generated from the process of heating the detergent-dissolved water, in which chloride was detected.
CONCLUSIONS
This is the first report on anosmia due to chronic chlorine exposure. Greater attention needs to be focused on the prevention of anosmia because there are many workers who have been exposed to chlorine gas in chlorine treating and generating processes.

Citations

Citations to this article as recorded by

Occupational Neurological Disorders in Korea
Eun-A Kim, Seong-Kyu Kang
Journal of Korean Medical Science.2010; 25(Suppl): S26. CrossRef

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Case Report

Reactive Airways Dysfunction Syndrome (RADS) Due to Chlorine Gas Exposure: Kyung Jong Lee, Yi Hyeong Lee, Jae Bum Park, Kwang Ho Kim, Ho Keun Chung; Korean Journal of Occupational and Environmental Medicine 1997;9(1):12-16. Published online February 28, 1997; DOI: https://doi.org/10.35371/kjoem.1997.9.1.12

Abstract PDF: Reactive airways dysfunction syndrome (RADS) is a syndrome as a persistent bronchial hyperreactivity with asthmatic dyspnea which occurs after one or more inhalation exposures to a high concentration of irritant gasses, smokes or vapors in subjects who had preciously had no respiratory disease. We report a case of a 34 years old female worker suffering from reactive airways dysfunction syndrome who had been taking charge of guest room cleaning at a condominium. 7 months before, she inhaled high concentration of chlorine gas in confined and poor ventilated working space of bathroom at the condominium. As she was washing a bathroom with a bleaching agent (6 % sodium hypochlorite) without dilution, dyspnea, dizziness, headache, nausea, and coughing developed after work. She still suffer from dyspnea and coughing. All functional tests were normal except for methacholine challenge test which reveals bronchial hyperreactivity. She has some symptoms of dyspnea and coughing when exposed to perfume, cold air, and heavy work.

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