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Chronic Cough and Dyspnea in Ice Hockey Players After an Acute Exposure to Combustion Products of a Faulty Ice Resurfacer

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Abstract

The aim of this study was to characterize pulmonary function and radiologic testing in ice hockey players after exposure to combustion products of a faulty ice resurfacer. Our patients were 16 previously healthy hockey players who developed chronic cough and dyspnea after exposure. Symptom questionnaires, pulmonary function tests (PFTs), bronchoprovocation testing, cardiopulmonary exercise testing, high-resolution computed tomography (CT) imaging, and impulse oscillometry (IOS) were all used. A normal group was used for PFTs and IOS controls. Patients had onset of cough within 72 h of exposure. Ninety-two percent complained of dyspnea, 75% chest pain, and 33% hemoptysis. Eight percent were initially hospitalized for their symptoms. Eighty-five percent were treated with systemic steroids and 39% with inhaled bronchodilators. Six months postexposure, 54% complained of cough and 46% complained of dyspnea on exertion. All patients had normal PFTs; 8.3% had a significant bronchodilator response. All had normal exercise tests (mean VO2max = 90 ± 3% predicted) and chest CTs. With IOS, 80% had a significant bronchodilator response (decreased resistance > 12% and SD score > 1; mean change = 21.1 ± 9.9%, mean SD score = 3.1 ± 2.5). No correlation existed between changes in resistance or reactance and spirometric values. Patient symptoms correlated significantly with bronchodilator response on IOS resistance (R = 0.61, p = 0.03). More than 50% of patients exposed to the combustion products of a faulty ice resurfacer remained symptomatic six months after exposure. Despite persistence of symptoms, conventional pulmonary function tests and radiologic evaluation did not reveal airway abnormalities. IOS showed evidence of increased airway resistance and small-airway disease, which correlated with patient symptoms.

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References

  1. American Thoracic Society, American College of Chest Physicians (ATS/ACCP) (2003) Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167:211–277

    Article  Google Scholar 

  2. Bergh U, Thorstensson A, Sjodin B, et al. (1978) Maximal oxygen uptake and muscle fiber types in trained and untrained humans. Med Sci Sports 10(3):151–154

    PubMed  CAS  Google Scholar 

  3. Blomberg A, Krishna MT, Bocchino V, et al. (1997) The inflammatory effects of 2 ppm NO2 on the airways of healthy subjects. Am J Respir Crit Care Med 156:418–424

    PubMed  CAS  Google Scholar 

  4. Blomberg A, Krishna MT, Helleday R, et al. (1999) Persistent airway inflammation but accommodated antioxidant and lung function responses after repeated daily exposure to nitrogen dioxide. Am J Respir Crit Care Med 159:536–543

    PubMed  CAS  Google Scholar 

  5. Brauer M, Spengler JD (1994) Nitrogen dioxide exposure inside ice skating rinks. Am J Public Health 84:429–433

    PubMed  CAS  Google Scholar 

  6. Centers for Disease Control (CDC) (1984) Carbon monoxide intoxication associated with use of a gasoline-powered resurfacing machine at an ice-skating rink—Pennsylvania. MMWR Morbid Mortality Wkly Rep 33(4):49–51

    Google Scholar 

  7. Centers for Disease Control (CDC) (1986) Carbon monoxide exposures at an ice skating rink—Colorado. MMWR Morbid Mortality Wkly Rep 35(27):435–6, 441

    Google Scholar 

  8. Centers for Disease Control (CDC) (1992) Nitrogen dioxide and carbon monoxide intoxication in an indoor ice-arena – Wisconsin 1992. MMWR Morbid Mortality Wkly Rep 41:383–385

    Google Scholar 

  9. Centers for Disease Control (CDC) (1996) Carbon monoxide poisoning at an indoor ice arena and bingo hall—Seattle, 1996. MMWR Morbid Mortality Wkly Rep 45(13):265–267

    Google Scholar 

  10. Chinet T, Pelle G, Macquin-Maner I, et al. (1998) Comparison of the dose-response curves as obtained by forced oscillation and plethysmography during carbachol inhalation. Eur Respir J 1:600–605

    Google Scholar 

  11. Crapo RO, Casaburi R, Coates AL, et al. (2000) Guidelines for methacholine and exercise challenge testing. Am J Respir Crit Care Med 161:309–329

    PubMed  CAS  Google Scholar 

  12. Frampton MW, Morrow PE, Cox C, et al. (1991) Effects of nitrogen dioxide exposure on pulmonary function and airway reactivity in normal humans. Am Rev Respir Dis 143:522–527

    PubMed  CAS  Google Scholar 

  13. Frampton MW, Boscia J, Roberts NJ, et al. (2002) Nitrogen dioxide exposure: effects on airway and blood cells. Am J Physiol Lung Cell Mol Physiol 282:L155–L165

    PubMed  CAS  Google Scholar 

  14. Gibbons RJ, Balady GJ, Beasley JW, et al. (1997) ACC/AHA Guideline for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 30:260

    Article  PubMed  CAS  Google Scholar 

  15. Hedberg K, Hedberg CW, Iber C, et al. (1989) An outbreak of nitrogen dioxide-induced respiratory illness among ice hockey players. JAMA 262(21):3014–3017

    Article  PubMed  CAS  Google Scholar 

  16. Kakinoki Y, Ohashi Y, Tanaka A, et al. (1998) Nitrogen dioxide compromises defense functions of the airway epithelium. Acta Otolaryngol Suppl 538:221–226

    Article  PubMed  CAS  Google Scholar 

  17. Karlson-Stiber C, Hojer J, Sjoholm A, et al. (1996) Nitrogen dioxide pneumonitis in ice hockey players (Case Report). J Intern Med 239(5):451–456

    Article  PubMed  CAS  Google Scholar 

  18. Levesque B, Dewailly E, Lavoie R, et al. (1990) Carbon monoxide in indoor ice skating rinks: evaluation of absorption by adult hockey players. Am J Public Health 80:594–598

    PubMed  CAS  Google Scholar 

  19. Lung Function Testing: Selection of reference values and interpretative strategies. Am Rev Respir Dis (1991) 144:1202–1218

    Google Scholar 

  20. Malek MH, Berger DE, Housh TJ, et al. (2004) Validity of VO2max equations for aerobically trained males and females. Med Sci Sports Exerc 36(8):1427–1432

    Article  PubMed  Google Scholar 

  21. Morris JF (1976) Spirometry in the evaluation of pulmonary function. West Med 125:110–111

    CAS  Google Scholar 

  22. Morris JF, Koski A, Johnson LC (1971) Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 103:57–67

    PubMed  CAS  Google Scholar 

  23. Oostveen E, MacLeod D, Lorino H, et al. (2003) The forced oscillation technique in clinical practice: methodology, recommendations, and future developments. Eur Respir J 22:1026–1041

    Article  PubMed  CAS  Google Scholar 

  24. Pelham TW, Holt LE, Moss MA (2002) Exposure to carbon monoxide and nitrogen dioxide in enclosed ice arenas. Occup Environ Med 59(4):224–233

    Article  PubMed  CAS  Google Scholar 

  25. Ramirez RJ, Dowell AR (1971) Silo-filler’s disease: nitrogen dioxide-induced lung injury. Ann Intern Med 74:569–576

    PubMed  CAS  Google Scholar 

  26. Roseland M, Bluham G (1999) Health effects resulting from nitrogen dioxide exposure in an indoor ice arena. Arch Environ Health 54:52–57

    Article  Google Scholar 

  27. SensorMedics (1988) Pulmonary utilities operator’s manual: predicted normal equations. Yorba Linda, CA: SensorMedics

    Google Scholar 

  28. Sioarkar G, Mayers I, Edouard L, et al. (1993) Toxic effects from nitrogen dioxide in ice-skating arenas (Case Report). Can Med Assoc J 148:1181–1182

    Google Scholar 

  29. U.S. EPA (2000) Air quality criteria for carbon monoxide. Washington, D.C.: U.S. Environmental Protection Agency, Office of Research and Development. Publication No. EPA-600/8-90/045F

  30. VanNoord JA, Clement J, Van de Woestijne KP, et al. (1989) Total respiratory resistance and reactance as a measurement of response to bronchial challenge with histamine. Am Rev Respir Dis 139:921–926

    CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA

    Erika S. Kahan, Ubaldo J. Martin, Steve Spungen, David Ciccolella & Gerard J. Criner

  2. Department of Pulmonary and Critical Care Medicine, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite 785, Philadelphia, Pennsylvania, 19140, USA

    Erika S. Kahan

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  1. Erika S. Kahan
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  2. Ubaldo J. Martin
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  3. Steve Spungen
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  4. David Ciccolella
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  5. Gerard J. Criner
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Correspondence to Erika S. Kahan.

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Kahan, E.S., Martin, U.J., Spungen, S. et al. Chronic Cough and Dyspnea in Ice Hockey Players After an Acute Exposure to Combustion Products of a Faulty Ice Resurfacer. Lung 185, 47–54 (2007). https://doi.org/10.1007/s00408-006-0094-0

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  • DOI: https://doi.org/10.1007/s00408-006-0094-0

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