Exposure
- Ore Refining
- Mining
- Portland Cement Manufacturing
- Industrial Exposure: accidental release of sulfur dioxide gas
- Sulfur Treatment of Fruit
- Pulp Paper Processing: acute releases may occur on a background of low-level chronic exposure
- Refrigerant: sulfur dioxide was used in the past
Physiology
- Sulfur Dioxide Inhalation
- High Water Solubility -> immediately affect upper airways and conjunctiva
- Sulfur Dioxide Increases Airway Epithelial Permeability: may allow direct stimulation of airway smooth muscle or stimulate parasympathetics (with resulting bronchoconstriction)
- Chronic bronchitis: may be seen in dogs after exposure to SO2
Diagnosis
- FOB: may be necessary to rule out airway injury
Clinical Manifestations
Pulmonary Manifestations
Bronchiolitis Obliterans (BO) (see Bronchiolitis Obliterans, [[Bronchiolitis Obliterans]])
- Epidemiology
- Reports of US soldiers from Iraq/Afghanistan with BO who were in proximity to a fire in a sulfur mine in 2003 (that produced high ambient air levels of sulfur dioxide, a known cause of BO), exposure to dust storms, exposure to incinerated solid/human waste, and/or exposure to combat smoke [MEDLINE]
(delayed onset of pulmonary injury is unusual)
- Irritation of Mucous Membranes (see Cough, [[Cough]])
- Reactive Airway Dysfunction Syndrome (see Reactive Airway Dysfunction Syndrome, [[Reactive Airway Dysfunction Syndrome]])
- Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
- Pathology: diffuse alveolar damage
Treatment
- Steroids: may be benficial in acute lung injury, but unproven
References
- Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med. 2011 Jul 21;365(3):222-30. doi: 10.1056/NEJMoa1101388 [MEDLINE]