Medication Summary
No antidote for chlorine gas is available. Instead, the goal of pharmacotherapy is to reduce morbidity and prevent complications. Beta-agonists, although not well studied in humans, have been widely used for the management of respiratory symptoms in chlorine gas exposure, and they have demonstrated efficacy in animal models. They should be considered a first-line agent in the setting of chlorine gas exposure and respiratory symptoms or signs.
Beta2 Agonists
Class Summary
Beta2 agonists act on beta2 receptors to relax bronchial smooth muscle and thereby increase airway diameter. These agents have little effect on cardiac muscle contractility.
Albuterol (Proventil HFA, Ventolin HFA, ProAir HFA, VoSpire ER)
Albuterol is a beta2-agonist useful for treatment of bronchospasm. It is the preferred choice for initial treatment because of its rapid onset of action.
Terbutaline
Terbutaline is a selective beta 2-agonist that relieves bronchospasm by acting on beta 2 receptors to relax bronchial smooth muscle.
Anticholinergics, Respiratory
Class Summary
Believed to work synergistically with bronchodilators.
Ipratropium (Atrovent)
Inhibits secretions from some respiratory mucosa; historically atropine was used in asthma, but ipratropium has fewer adverse effects.
Xanthine Derivatives
Class Summary
These agents were historically used to treat asthma but lost favor because of their toxic effects and narrow therapeutic windows. They have largely been displaced by newer agents.
Theophylline (Theo 24, Elixophyllin, Theochron SR)
Theophylline is believed to potentiate exogenous catecholamines, stimulate endogenous catecholamine release, and relax the diaphragmatic musculature.
Local Anesthetics, Amides
Class Summary
Inhaled topical anesthetics have been used to reduce cough and may reduce pain associated with chlorine inhalations.
Lidocaine (Xylocaine)
Lidocaine stabilizes neuronal membranes by inhibiting the ionic fluxes required for initiation and conduction of impulses. When administered by nebulizer, lidocaine acts in areas exposed to chlorine injury.
Corticosteroids, Inhalants
Class Summary
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli. In animal models of chlorine gas exposure, inhaled corticosteroids have been shown to improve respiratory function. Their exact mechanism of function in chlorine gas exposure is unclear.
Budesonide inhaled (Pulmicort Flexhaler)
Inhaled budesonide is a second-line agent for use in moderate-to-severe chlorine exposures.
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Chest radiograph of a 36-year-old chemical worker 2 hours postexposure to chlorine inhalant. She had severe resting dyspnea during the second hour, diffuse crackles/rhonchi on auscultation, and a partial pressure of oxygen of 32 mm Hg breathing room air. The radiograph shows diffuse pulmonary edema without significant cardiomegaly. Used with permission from Medical Aspects of Chemical and Biological Warfare, Textbook of Military Medicine. 1997: 256.
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A section from a lung biopsy (hematoxylin and eosin stain; original magnification X 100) from a 36-year-old chemical worker taken 6 weeks postexposure to chlorine. At that time, the patient had no clinical abnormalities and a partial pressure of oxygen of 80 mm Hg breathing room air. The section shows normal lung tissues without evidence of interstitial fibrosis and/or inflammation. Used with permission from Medical Aspects of Chemical and Biological Warfare, Textbook of Military Medicine. 1997: 256.
