Relationship between lung inflammation, changes in lung function and severity of exposure in victims of Bhopal tragedy.
Vijayan, V.K.; Sankaran, K.
European Respiratory Journal; 1996; 91; 1977-1982.
The world's worst chemical industrial disaster, which occurred at Bhopal on 2-3 December 1984, resulted in considerable respiratory morbidity in the exposed population. Therefore, a study was planned to evaluate the relationship between lower respiratory tract inflammation, lung function and severity of exposure.
Sixty patients exposed to methyl isocyanate and presenting with respiratory symptoms were studied using bronchoalveolar lavage (BAL) 1-7 years after the accident. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ). An index of severity of exposure was derived retrospectively on the basis of the acute symptoms in the victims themselves or the occurrence of death among their family members.
Total lung inflammatory cells (p < 0.01) and absolute numbers of macrophages (p=0.01) and lymphocytes (p < 0.05) increased as severity of exposure increased. FEV 1 /FVC % (p=0.05) was also significantly lower as severity of exposure increased. Moderately exposed subjects had significantly lower FEV 1 /FVC% (p <0.05) compared to those mildly exposed.
In nonsmokers, BAL neutrophils, both percentage and absolute numbers, showed significant negative corrleations with FEV 1 % predicted (r s =-0.350, p < 0.05; and r s =-0.374, p < 0.01, respectively). Neutrophil percentage was negatively correlated with FEV 1 /FVC% (r s =-0.378; p < 0.01). Absolute lymphocytes had significant negative corrleations with FVC% pred (r s =-0.318; p < 0.05). Macrophages had significant positive corrleations with FVC % pred (r s =0.322; p < 0.05) and FEV 1 % pred (r s =0.433; p < 0.01). Radiographic abnormalities (International Labour Organization (ILO) classification) were associated with decline in FEV 1 % pred (p < 0.05).
This study suggests that pulmonary function abnormalities occur in gas-exposed subjects as a consequence of an abnormal accumulation of lung inflammatory cells (lymphocytes and neutrophils), and that the intensity of lung inflammation and reduction in pulmonary function are greater in severely exposed subjects. As it has been observed that decline in pulmonary function is associated with radiographic abnormalities, there is a suggestion that injury following toxic gas exposure can lead to irreversible lung damage.
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