Nitrogen Dioxide—Induced Respiratory Illness in Ice Hockey Players

D. Patrick Ford, MD, MPH; Nathaniel Rothman, MD, MPH
JAMA. 1990;263(22):3024. doi:10.1001/jama.1990.03440220046023.
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To the Editor.—  Hedberg et al1 recently reported on an epidemiologic investigation of an outbreak of nitrogen dioxide— induced illness in a group of high school ice hockey players. The results of both early (within 10 days of last exposure) and late (2 months after last exposure) follow-up spirometric testing were presented for exposed and unexposed athletes. Hedberg et al concluded that there were no differences in the five lung function indexes, either between exposure groups or between early and late follow-up. We tested this conclusion for the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1 /FVC), since acute exposure to nitrogen dioxide has been reported to cause an obstructive lung-function pattern.2We combined the singly and multiply exposed hockey players (Table 3 of the article) into one exposed group, because even a single exposure to nitrogen dioxide levels in the arena


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