Hindawi Publishing Corporation Pulmonary Medicine Volume 2013, Article ID 325869, 7 pages http://dx.doi.org/10.1155/2013/325869 Research Article The Immediate Pulmonary Disease Pattern following Exposure to High Concentrations of Chlorine Gas Pallavi P. Balte, 1 Kathleen A. Clark, 1 Lawrence C. Mohr, 2 Wilfried J. Karmaus, 3 David Van Sickle, 4 and Erik R. Svendsen 5 1 Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Room 210, Columbia, SC 29208, USA 2 Medical University of South Carolina, 135 Cannon Street, Suite 405, P.O. Box 250838, Charleston, SC 29425, USA 3 Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 301 Robison Hall, 3825 De Soto Avenue, Memphis, TN 38152, USA 4 Asthmapolis, 612 W. Main Street, Suite 201, Madison, WI 53703, USA 5 Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2100, New Orleans, LA 70112, USA Correspondence should be addressed to Pallavi P. Balte; balte.p@gmail.com Received 11 September 2013; Accepted 4 November 2013 Academic Editor: Andrew Sandford Copyright © 2013 Pallavi P. Balte et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Classiication of pulmonary disease into obstructive, restrictive, and mixed patterns is based on 2005 ATS/ERS guidelines and modiied GOLD criteria by Mannino et al. (2003), but these guidelines are of limited use for simple spirometry in situations involving mass casualties. Aim. he purpose of this study was to apply these guidelines to patients who underwent simple spirometry following high concentration of chlorine gas inhalation ater 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 modiied GOLD criteria along with our own criteria developed using available simple spirometry data. Results. We found predominant restrictive pattern in our patients with both modiied GOLD and our criteria, which is in contrast to other chlorine exposure studies where obstructive pattern was more common. When compared to modiied GOLD and our criteria, 2005 ATS/ERS guidelines underestimated the frequency of restrictive disease. Conclusion. Diagnosis of pulmonary disease patterns is of importance ater 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]. he health efects 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 ater 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) laboratories for interpreting PFTs [15]. hese guidelines are based on avail- ability of plethysmography to determine total lung capacity (TLC). On the other hand, Mannino et al. used a modiication of the Global Initiative for Chronic Obstructive Lung Disease