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Respiratory Diseases in Firefighters and Fire Exposers

Article information

J Korean Med Assoc. 2008;51(12):1087-1096
Publication date (electronic) : 2008 December 31
doi : https://doi.org/10.5124/jkma.2008.51.12.1087
Tae Hoon Jung, MD
Division of Respiratory Disease, Kyungpook National University College of Medicine, Korea. thjung@knu.ac.kr

Abstract

With the increasing use of synthetic chemical based products in building construction in recent decades, there has been growing concern over the health hazards to firefighters and fire exposers from the inhalation of the toxic components of smoke. Toxic combustion products can have profound effects on the respiratory system, causing symptoms, physiologic changes, and chronic diseases. Prompt evaluation is important and should include chest films, pulmonary function testing, arterial blood gas analysis, and bronchoscopy. Positive findings require aggressive management with adequate oxygenation, ventilation, pulmonary toilet, and fluid resuscitation. Clinicians caring for individuals who have sustained inhalation damage to their respiratory tract need to comprehensively understand the mechanisms, natural history, management, and prevention of acute inhalation injury, so that they can help individual patients recover without serious complications.

Keywords: Fire; Firefighter; Smoke inhalation; Lung injury

References

1. Rabinowitz PM, Siegel MD. Acute inhalation injury. Clin Chest Med 2002. 23707–715.
2. Saffle JR. The 1942 fire at Boston's Cocoanut Grove nightclub. Am J Surg 1993. 166581–591.
3. Cha SI, Kim CH, Lee JH, Park JY, Jung TH, Choi WI, Choi WI, Han SB, Jeon YJ, Shin KC, Chung JH, Lee KH, Kim YJ, Lee BK. Isolated smoke inhalation injuries: acute respiratory dysfunction, clinical outcomes, and short-term evolution of pulmonary functions with the effects of steroids. Burns 2007. 33200–208.
4. Haponik EF. Clinical smoke inhalation injury: pulmonary effects. Occup Med 1993. 8430–468.
5. Young CJ, Moss J. Smoke inhalation: diagnosis and treatment. J Clin Anesth 1989. 1377–386.
6. Trunkey DD. Inhalation injury. Surg Clin North Am 1978. 581133–1140.
7. Summer W, Haponik E. Inhalation of irritant gases. Clin Chest Med 1981. 2273–287.
8. Alarie Y. Toxicity of fire smoke. Crit Rev Toxicol 2002. 32259–289.
9. Clark WR. Smoke inhalation:diagnosis and treatment. World J Surg 1992. 1624–29.
10. Heimbach DM, Waeckerle JF. Inhalation injury. Ann Int Med 1988. 171316–1320.
11. Lee-Chiong TL Jr. Smoke inhalation injury, when to suspect and how to treat. Postgrad Med 1999. 10555–62.
12. Clark CJ, Pollock AJ, Reid WH, Campbell D, Gemmell C. Role of pulmonary alveolar macrophage activation in acute lung injury after burns and smoke inhalation. Lancet 1988. 2872–874.
13. Lykens MG, Haponik EF, Meredith SH, Bass DA. Survival after acute thermal inhalation injury: Clinical and BAL predictors. Am Rev Respir Dis 1992. 145417.
14. Bullard JE, Koepsell TD, Rivara F. Association of smoking and alcohol drinking with residential fire injuries. Am J Epidemiol 1992. 13526–34.
15. Choe JY, Cho YG, Kweon S, Lee WS, Jung TH. Arterial blood gas analyses in patients with acute carbon monoxide poisoning. Korean J Med 1989. 36247–253.
16. Fogarty PW, George PJ, Solomon M, Spiro SG, Armstrong RF. Long term effects of smoke inhalation in survivors of the King's Cross underground station fire. Thorax 1991. 46914–918.
17. Lund T, Goodwin CW, McManus WF, Shirani KZ, Stallings RJ, Mason AD Jr, Pruitt BA Jr. Upper airway sequelae in burn patients requiring endotracheal intubation or tracheostomy. Ann Surg 1985. 201374–382.
18. Park GY, Park JW, Jeong DH, Jeong SH. Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest 2003. 123475–480.
19. Tasaka S, Kanazawa M, Mori M, Fujishima S, Ishizaka A, Yamasawa F, Kawashiro T. Long-term course of bronchiectasis and bronchiolitis obliterans as late complication of smoke inhalation. Respiration 1995. 6240–42.
20. Wright JL. Inhalational lung injury causing bronchiolitis. Clin Chest Med 1993. 14635–644.
21. Boulet LP. Increases in airway responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma. Chest 1988. 94476–481.
22. Liu D, Tager IB, Balmes JR, Harrison RJ. The effect of smoke inhalation on lung function and airway responsiveness in wildland fire fighters. Am Rev Respir Dis 1992. 1461469–1473.
23. Banauch GI, Alleyne D, Sanchez R, Olender K, Cohen HW, Weiden M, Kelly KJ, Prezant DJ. Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. Am J Respir Crit Care Med 2003. 16854–62.
24. Baud FJ, Barriot P, Toffis V, Riou B, Vicaut E, Lecarpentier Y, Bourdon R, Astier A, Bismuth C. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 1991. 3251761–1766.
25. Clark CJ, Campbell D, Reid WH. Blood carboxyhaemoglobin and cyanide levels in fire survivors. Lancet 1981. 11332–1335.
26. Barie PS, Wu W, Hariri RJ, Halebian PH, Shires GT. Alterations of pulmonary gas exchange after superimposed carbon monoxide poisoning in acute lung injury. Surgery 1994. 115678–686.
27. Texidor HS, Rubin E, Novick GS, Alonso DR. Smoke inhalation: radiologic manifestation. Radiology 1983. 149383–387.
28. Freitag L, Firusian N, Stamatis G, Greschuchna D. The role of bronchoscopy in pulmonary complication due to mustard gas inhalation. Chest 1991. 1001436–1441.
29. Jung TH. Practical bronchoscopy. Korean J Med 1998. 55738–751.
30. Whitener DR, Whitener LM, Robertson KJ, Baxter CR, Pierce AK. Pulmonary function measurements in patients with thermal injury and smoke inhalation. Am Rev Respir Dis 1980. 122731–739.
31. Jung TH. Interpretation of spirometry and flow-volume curve. Tuberc Respir Dis 1991. 38413–430. (Korean).
32. Rogers SN, Benumof JL. New and easy techniques for fiberoptic endoscopy-aided tracheal intubation. Anesthesiology 1983. 59569–572.
33. Navar PD, Saffle JR, Warden GD. Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg 1985. 150716–720.
34. Davies LK, Poulton TJ, Modell JH. Continuous positive airway pressure is beneficial in treatment of smoke inhalation. Crit Care Med 1983. 11726–729.
35. Venus B, Matsuda T, Copiozo JB, Mathru M. Prophylactic intubation and continuous positive airway pressure in the management of inhalation injury in burn victims. Crit Care Med 1981. 9519–523.
36. Robinson NB, Hudson LD, Riem M, Miller E, Willoughby J, Ravenholt O, Carrico CJ, Heimbach DM. Steroid therapy following isolated smoke inhalation injury. J Trauma 1982. 22876–879.

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Copyright © 2008 Korean Medical Association

Figure 1

Figure 1

Temporal evolution of smoke inhalation can be characterized by acute and chronic effects upon airways and lung parenchyma. Acute respiratory injuries may resolve completely or, less often, lead to permanent dysfunction (4).

Figure 2

Figure 2

Laryngoscopic findings 3 (A); 16 (B); and 78 (C) days after extubation, showing posterior commissure stenosis (arrow) of the vocal cords, with anterior adhesion (arrowhead) (3).

Figure 3

Figure 3

Bronchial soot (A) on bronchoscopy and bronchial casts (B) removed from one fire victim (3).

Table 1

Signs and symptoms of toxicity of reduced levels of oxygen due to fire conditions (6)

Table 1

Table 2

Evolution of parenchymal responses to experimental smoke inhalation (4)

Table 2

Table 3

Pulmonary responses to smoke inhalation (4)

Table 3

*Observations in animal models and humans

Table 4

Anatomic classifcation of acute smoke Inhalation (4)

Table 4

*Usual early after smoke inhalation

†Often delayed onset

‡Thermal as well as chemically medicated injury

Table 5

Effccts of carbon monoxide poisoning (5)

Table 5

Effccts of carbon monoxide poisoning (5)

Table 6

Clinical diagnosis of acute smoke inhalation injury (4)

Table 6

Table 7

Basic therapeutic priorities in patients with acute smoke inhalation (4)

Table 7