Chronic cough and dyspnea in ice hockey players after an acute exposure to combustion products of a faulty ice resurfacer

Abstract

The aim of this study was to characterize pulmonary function and radiologic testing in ice hockey players after exposure to combustion products of a faulty ice resurfacer. Our patients were 16 previously healthy hockey players who developed chronic cough and dyspnea after exposure. Symptom questionnaires, pulmonary function tests (PFTs), bronchoprovocation testing, cardiopulmonary exercise testing, high-resolution computed tomography (CT) imaging, and impulse oscillometry (IOS) were all used. A normal group was used for PFTs and IOS controls. Patients had onset of cough within 72 h of exposure. Ninety-two percent complained of dyspnea, 75% chest pain, and 33% hemoptysis. Eight percent were initially hospitalized for their symptoms. Eighty-five percent were treated with systemic steroids and 39% with inhaled bronchodilators. Six months postexposure, 54% complained of cough and 46% complained of dyspnea on exertion. All patients had normal PFTs; 8.3% had a significant bronchodilator response. All had normal exercise tests (mean VO2max = 90 +/- 3% predicted) and chest CTs. With IOS, 80% had a significant bronchodilator response (decreased resistance > 12% and SD score > 1; mean change = 21.1 +/- 9.9%, mean SD score = 3.1 +/- 2.5). No correlation existed between changes in resistance or reactance and spirometric values. Patient symptoms correlated significantly with bronchodilator response on IOS resistance (R=0.61, p=0.03). More than 50% of patients exposed to the combustion products of a faulty ice resurfacer remained symptomatic six months after exposure. Despite persistence of symptoms, conventional pulmonary function tests and radiologic evaluation did not reveal airway abnormalities. IOS showed evidence of increased airway resistance and small-airway disease, which correlated with patient symptoms.