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Chemical pneumonitis

 

Definition

Chemical pneumonitis is inflammation of the lungs or breathing difficulty due to inhaling chemical fumes, or aspirating (breathing in and choking on) gastric acid from the stomach, mineral oil, gasoline, or other damaging chemicals.

Causes

Many household and industrial chemicals are capable of producing both an acute and a chronic form of inflammation in the lungs. Acute chemical pneumonitis causes swelling of the lung tissue, movement of fluid into the air spaces in the lung, and less ability to absorb oxygen and get rid of carbon dioxide. In severe cases, death may result from lack of oxygen reaching the tissues (hypoxia).

Some of the most common dangerous, inhaled substances include:

  • Chlorine gas (during use of cleaning materials such as chlorine bleach, in industrial accidents, or near swimming pools)
  • Grain and fertilizer dust
  • Noxious fumes from smelting, welding, or other metal work and the production of solvents and pesticides
  • Smoke (from house fires and wildfires)

Chronic chemical pneumonitis can occur after only low levels of exposure to the irritant over extended periods of time. This causes inflammation and may bring on fibrosis (scarring) which decreases the ability of the lungs to get oxygen to the body and release carbon dioxide as waste, and stiffening of the lung. Unchecked, this condition may ultimately lead to respiratory failure and death.

Symptoms

Acute:

  • Air hunger (feeling that you cannot get enough air)
  • Cough
  • Difficulty breathing
  • Possibly wet or gurgle sounding breathing (abnormal lung sounds)
  • Unusual sensation (possibly burning feeling) in the chest

Chronic:

Signs and tests

The following tests help determine how severely the lungs are affected:

Support Groups

Expectations (prognosis)

The outcome depends on the chemical agent involved, the severity of exposure, and whether the problem is acute or chronic.

Calling your health care provider

Call your health care provider if you have trouble breathing after inhaling (or possibly inhaling) any substance.

Complications

Respiratory failure and death can occur.

Treatments

Treatment is focused on reducing symptoms. Oxygen therapy may be helpful. Corticosteroids may be given to reduce inflammation. Antibiotics are usually not helpful or needed.

Prevention

Household chemicals should be used only as directed and always in well-ventilated areas. Never mix ammonia and bleach together.

Work rules regarding breathing masks should be followed and the appropriate breathing mask should be worn. People who work near fire should take care to limit exposure to smoke or gases.

Be careful about giving mineral oil to anyone who might choke on it (children or the elderly).

Don't siphon gas or kerosene.

References

Mofenson HC, Caraccio TR, McGuigan M, Greensher J. Medical toxicology: ingestions, inhalations, and dermal and ocular absorptions. In: Rakel RE, Bope ET, eds. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 291.


Review Date: 8/29/2008
Reviewed By: Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, WA; Benjamin Medoff, MD, Assistant Professor of Medicine, Harvard Medical School, Pulmonary and Critical Care Unit, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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