{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T02:08:15Z","timestamp":1774663695372,"version":"3.50.1"},"reference-count":22,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[1994,4]]},"abstract":"<jats:p>OBJECTIVE--The admission to hospital of three construction workers with acute respiratory distress caused by inhalation of chlorine gas prompted the inspection of a building site located in a kraft pulpmill. The accidental emissions had taken place in the bleach plant and the construction workers assigned there were surveyed to uncover possible large scale health effects. DESIGN AND PARTICIPANTS--A questionnaire was presented to 281 workers (participation rate = 97%); 257 workers reported an average of 24 exposure episodes to chlorine and derivatives over a three to six month period. The air monitoring data available from the pulpmill's industrial hygienist were not useful in linking specific events reported by the workers to environmental conditions in the bleach plant. RESULTS--Over 60% of the workers described a characteristic flu like syndrome that lasted for an average of 11 days and was exacerbated by new bouts of exposure. Irritation of the throat (78%) and eyes (77%), cough (67%), and headache (63%) were the most often reported symptoms. Shortness of breath was reported by 54% of the participants and was not associated with age, smoking state, or history of asthma or chronic bronchitis. First aid self referral was associated with significantly greater reporting of most symptoms, including dyspnoea and cough. A significantly greater proportion of workers in the dyspnoea group had gone at least once for first aid care after a gassing incident (64% as opposed to 48%, p = 0.008). Throat irritation and cough persisted for mean intervals of eight and 11 days respectively. A flu like syndrome lasted for an average of 20 days. Seventy one subjects were considered to be a moderate to high risk of having persisting respiratory symptoms. CONCLUSION--Throat and eye irritation as well as cough and flu like symptoms are frequent occurrences after repeated accidental inhalation of chlorine. Subjects who consulted first aid care stations after a gassing incident are more likely to have persisting dyspnoea.<\/jats:p>","DOI":"10.1136\/oem.51.4.219","type":"journal-article","created":{"date-parts":[[2008,12,17]],"date-time":"2008-12-17T00:14:48Z","timestamp":1229472888000},"page":"219-224","source":"Crossref","is-referenced-by-count":32,"title":["Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: I. Exposure and symptomatology."],"prefix":"10.1136","volume":"51","author":[{"given":"J P","family":"Courteau","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Cushman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"Bouchard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Qu\u00e9villon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Chartrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Bh\u00e9rer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1994,4,1]]},"reference":[{"key":"ref_1","first-page":"26","article-title":"Prevalence of chronic respiratory disease in a pulp mill and a paper mill in the United States","volume":"24","author":"Ferris, B.G.; Burgess, W.A.; Worcester, J.","year":"1967","unstructured":"Ferris BG, Burgess WA, Worcester J. Prevalence of chronic respiratory disease in a pulp mill and a paper mill in the United States. BrJInd Med 1967;24:26-37.","journal-title":"BrJInd Med"},{"key":"ref_2","first-page":"127","article-title":"Mortality and morbidity in a pulp and a paper mill in the United States: a ten year follow up","volume":"36","author":"Ferris, B.G.; Puleo, S.; Chen, H.Y.","year":"1979","unstructured":"Ferris BG, Puleo S, Chen HY. Mortality and morbidity in a pulp and a paper mill in the United States: a ten year follow up. BrJ Ind Med 1979;36:127-34.","journal-title":"BrJ Ind Med"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1080\/00039896.1984.10545858","article-title":"Respiratory health at a pulpmill in British Columbia","volume":"39","author":"Enarson, D.A.; Maclean, L.; Dybuncio, A.; Chan-Yeung, M.; Grzybowski, S.; Johnson, A.","year":"1984","unstructured":"Enarson DA, Maclean L, Dybuncio A, Chan-Yeung M, Grzybowski S, Johnson A, et al. Respiratory health at a pulpmill in British Columbia. Arch Environ Health 1984; 39:325-30.","journal-title":"Arch Environ Health"},{"key":"ref_4","first-page":"321","article-title":"Chlorine poisoning [editorial]. Lancet","volume":"1","year":"1984","unstructured":"Chlorine poisoning [editorial]. Lancet 1984;1:321-2."},{"issue":"99","key":"ref_5","first-page":"374","article-title":"Late evaluation of pulmonary function after acute exposure to chlorine gas","volume":"1969","author":"Weill, H.; George, R.; Schwartz, M.; Zuskind, M.","unstructured":"Weill H, George R, Schwartz M, Zuskind M. Late evaluation of pulmonary function after acute exposure to chlorine gas. Am Rev Respir Dis 1969;99:374-9.","journal-title":"Am Rev Respir Dis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1080\/00039896.1971.10665950","article-title":"Clinical, roentgenologic, and physiologic effects of acute chlorine exposure","volume":"23","author":"Kaufman, J.; Burkons, D.","year":"1971","unstructured":"Kaufman J, Burkons D. Clinical, roentgenologic, and physiologic effects of acute chlorine exposure. Arch Environ Health 1971;23:29-34.","journal-title":"Arch Environ Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/00007611-198201000-00007","article-title":"Pulmonary function changes after acute inhalation of chlorine gas","volume":"75","author":"Ploysongsang, Y.; Beach, B.C.; DiLisio, R.E.","year":"1982","unstructured":"Ploysongsang Y, Beach BC, DiLisio RE. Pulmonary function changes after acute inhalation of chlorine gas. 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Chest 1990;97:820-5.","journal-title":"Chest"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1378\/chest.88.3.376","article-title":"Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures","volume":"88","author":"Brooks, S.M.; Weiss, M.A.; Bernstein, I.L.","year":"1985","unstructured":"Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest 1985;88: 376-84.","journal-title":"Chest"},{"key":"ref_13","first-page":"473","article-title":"Reactive airways dysfunction syndrome. Case reports of persistent airways hyperreactivity following high-level irritant exposures","volume":"27","author":"Brooks, S.M.; Weiss, M.A.; Bernstein, I.L.","year":"1985","unstructured":"Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome. Case reports of persistent airways hyperreactivity following high-level irritant exposures. J Occup Med 1985;27:473-6.","journal-title":"J Occup Med"},{"key":"ref_14","first-page":"1","article-title":"Definition and classification","volume-title":"Asthma in the workplace","author":"Bernstein, D.I.; Bernstein, I.L.; Malo, J.L.; Chan-Yeung, M.","year":"1993","unstructured":"Bernstein DI, Bernstein IL, Malo JL, Chan-Yeung M. Definition and classification. In: Bernstein IL, ChanYeung M, Malo JL, Bernstein DI, eds. Asthma in the workplace. New York: Marcel Dekker, 1993:1-4."},{"key":"ref_15","first-page":"890","article-title":"Long-term effects of exposure to sulfur dioxide","volume":"128","year":"1983","unstructured":"Harkonen H, Nordman H, Korhonen 0, Winblad I. Long-term effects of exposure to sulfur dioxide. Am Rev Respir Dis 1983;128:890-3.","journal-title":"Am Rev Respir Dis"},{"key":"ref_16","first-page":"389","article-title":"Airway obstruction due to inhalation of","volume-title":"ammonia. Mayo Clin Proc 1983; S8","author":"Flury, K.E.; Ames, D.E.; Rodarte, JR, Rodgers; R.","unstructured":"Flury KE, Ames DE, Rodarte JR, Rodgers R. Airway obstruction due to inhalation of ammonia. Mayo Clin Proc 1983;S8:389-93."},{"key":"ref_17","first-page":"67","article-title":"Reversible airways obstruction and interstitial pneumonitis due to acetic acid","volume":"46","author":"Rajan, K.G.; Davies, B.H.","year":"1989","unstructured":"Rajan KG, Davies BH. Reversible airways obstruction and interstitial pneumonitis due to acetic acid. Br J Ind Med 1989;46:67-8.","journal-title":"Br J Ind Med"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1378\/chest.94.3.476","article-title":"Increases in airways responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma?","volume":"94","author":"Boulet, L.P.","year":"1988","unstructured":"Boulet LP. Increases in airways responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma? Chest 1988;94:476-81.","journal-title":"Chest"},{"key":"ref_19","first-page":"239","article-title":"Persistent reactive airway dysfunction syndrome after exposure to toluene diisocyanate","volume":"47","author":"Luo, J.C.; Nelsen, K.G.; Fischbein, A.","year":"1990","unstructured":"Luo JC, Nelsen KG, Fischbein A. Persistent reactive airway dysfunction syndrome after exposure to toluene diisocyanate. BrJ Ind Med 1990;47:239-41.","journal-title":"BrJ Ind Med"},{"key":"ref_20","first-page":"71","article-title":"First-aid reports of acute chlorine gassing among pulpmill workers as predictors of lung health consequences","volume":"20","author":"Salisbury, D.A.; Enarson, D.A.; Chan-Yeung, M.; Kennedy, S.M.","year":"1991","unstructured":"Salisbury DA, Enarson DA, Chan-Yeung M, Kennedy SM. First-aid reports of acute chlorine gassing among pulpmill workers as predictors of lung health consequences. AmJIInd Med 1991;20:71-81.","journal-title":"AmJIInd Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1164\/ajrccm\/143.1.74","article-title":"Lung health consequences of reported accidental chlorine gas exposures among pulpmill workers","volume":"143","author":"Kennedy, S.M.; Enarson, D.A.; Janssen, R.G.; Chan-Yeung, M.","year":"1991","unstructured":"Kennedy SM, Enarson DA, Janssen RG, Chan-Yeung M. 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