Phosgene-induced acute lung injury (ALI): differences from chlorine-induced ALI and attempts to translate toxicology to clinical medicine

Clinical and Translational Medicine

Table 1 Salient markers of acute respiratory tract injury of phosgene and chlorine in rats

	Phosgene	Chlorine
Subjective symptoms	Absent	Eye and airway irritation
Sensory irritation-URT	Absent	Marked
Bronchial airway injury	Minimal, if any	Marked
Surfactant deterioration	Marked	Dose-dependent
Sensory irritation-LRT	Marked	Dose-dependent
Alveolar macrophage injury	Marked	Dose-dependent
Pulmonary vascular dysfunction	Marked	Dose-dependent
Cardiopulmonary dysfunction	Marked	Marked
Early lung edema	Extreme doses	Dose-dependent
Onset of lung edema	Maximum 15–20 h	Instant
Primary countermeasure	Lung edema	Lung edema & obliterating airway injury
Secondary countermeasure	Rapid recovery	Lingering airway injury
Clinical guidance on inhaled dose	Phosgene dosimeters	Environmental analyses (if available)
Prognostic approaches	Hemoglobin, eNO, eCO₂	Irritation severity, fibrin

URT upper respiratory tract, LRT lower respiratory tract, eNO exhaled nitric oxide, eCO ₂ exhaled carbon dioxide