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J Appl Physiol 86: 1984-1993, 1999;
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Vol. 86, Issue 6, 1984-1993, June 1999

Longitudinal distribution of chlorine absorption in human airways: comparison of nasal and oral quiet breathing

Vladislav Nodelman and James S. Ultman

Biological Transport Dynamics Laboratory, Department of Chemical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802


    ABSTRACT
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

The fraction of an inspired chlorine (Cl2) bolus absorbed during a single breath (Lambda ) was measured as a function of bolus penetration (VP) into the respiratory system of five male and five female nonsmokers during both nasal and oral breathing at a quiet respiratory flow of 250 ml/s. The correspondence between VP and specific anatomic landmarks was found for each subject by a combination of acoustic reflection and nitrogen washout measurements. For both nasal and oral breathing, Lambda  reached ~0.95 at the distal end of the upper airways and reached 1.00 within the lower conducting airways. The values of a regional mass transfer parameter computed from the Lambda -VP data indicated that the resistance to Cl2 diffusion in the airway mucosa was negligible compared with the diffusion resistance in the respired gas. Changing the peak inhaled Cl2 concentration from 0.5 to 3.0 parts/million did not significantly affect the distribution of Cl2 absorption, suggesting that the underlying mass transport and chemical reaction processes were linear with respect to Cl2 concentration.

air pollution; inhalation toxicology; lung dosimetry; regional uptake; mass transfer coefficient; conducting airways


    INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

CHLORINE (Cl2) is a reactive oxidant gas used in the large-scale production of chlorinated hydrocarbon solvents, polyvinyl chloride plastics, and pharmaceuticals, in the bleaching of paper, and in the disinfection of drinking and swimming pool water. The average Cl2 level in contemporary occupational settings is mandated to be 0.5 parts/million (ppm) or less over an 8-h workshift (1). This is less than the 1-3 ppm range in which people first perceive irritation of their eyes or respiratory tract (18). This is also below the Cl2 concentrations at which respiratory effects have been observed in short-term laboratory exposures of healthy people. For example, during 8-h controlled exposures of young adults to 1 ppm Cl2, there was clearly a decrement in forced expired lung function and in airway resistance that could persist for as long as 24 h. These responses were not nearly so definite during exposure to 0.5 ppm Cl2, however (22). In a more recent laboratory investigation in which healthy adults were exposed to Cl2 at concentrations of 0.5 ppm or less for 6 h on 3 consecutive days, no changes were found in forced expired lung function or in biochemical markers of airway inflammation and epithelial permeability (5).

Over their entire lifetime, people might experience long-term cumulative Cl2 exposure leading to irreversible tissue damage and functional impairment, even at concentrations below 0.5 ppm. To investigate this possibility, female and male B6C3F1 mice as well as F344 rats were exposed to Cl2 concentrations of 0.4-2.5 ppm for 6 h/day, 5 days/wk (3 days/wk for female rats) for up to 2 yr (28). Exposure-dependent nonneoplastic lesions were detected at all Cl2 concentrations, were confined to the nasal cavities of both rodents, and were most severe in the anterior nose. Respiratory and olefactory epithelial degeneration, septal fenestration, and secretory cell metaplasia were some of the Cl2-induced histological changes that were observed even at an exposure concentration of 0.4 ppm. In a similarly designed study in which rhesus monkeys were exposed to Cl2 concentrations of 0.1-2.3 ppm for up to 1 yr (11), nonneoplastic nasal lesions were only observed at the highest exposure concentration. As in the rodents, the severity of the lesions decreased with distal distance into nasal cavities. Although lesions in the monkeys were milder than in the rodents, the lesions in the monkeys penetrated beyond the nose into the trachea.

To utilize these observations in the prediction of health effects on people, one must understand the factors that influence the severity and spatial distribution of Cl2-induced tissue damage. One of these factors is the regional pattern of Cl2 absorption. Because Cl2 is a highly soluble gas, its principal site of absorption is most likely the upper airways, the same airways in which the majority of Cl2-induced lesions have been observed in animal studies. Moreover, a progressive loss of Cl2 from the inhaled gas stream as it passes over more and more airway surface is a logical explanation for the anterior-to-posterior attenuation of lesion severity observed in monkeys as well as in rodents. The deeper penetration and less severe tissue responses in monkeys may have resulted from slower Cl2 absorption in their larger-diameter airways and may also have been related to the fact that primates can breathe in an oronasal fashion whereas rodents are obligate nasal breathers.

The purpose of the present study was to observe the longitudinal distribution of Cl2 absorption in intact human airways during quiet breathing by employing the noninvasive bolus inhalation method that was previously developed for ozone (O3), another oxidant gas that can pollute inhaled air (8). This first required that the inhalation apparatus be modified so that it could deliver Cl2 boluses and could continuously monitor Cl2 concentration. By using the modified apparatus, bolus measurements were compared during nasal and oral breathing to determine whether the site of air access influenced the penetration of Cl2 beyond the upper airways. To investigate the possibility of nonlinear chemical reaction effects in the airway mucosa, bolus measurements were also made at different peak inhaled Cl2 concentrations. The resulting Cl2 distribution data were referenced to specific anatomic landmarks by using upper airway and total conducting airway volumes measured in each subject with acoustic reflection and nitrogen-washout methods, respectively.


    METHODS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Subject population. Five healthy male and five healthy female nonsmokers participated in this investigation. After reading an explanation of the study, each subject completed an informed consent form, a medical questionnaire, and a standard spirometry test to determine his or her forced vital capacity (FVC) and forced expired volume in 1 s (FEV1). Each subject was selected without regard to body size and was included in the study only if he or she met the following criteria: was between 18 and 40 yr old; had not smoked within the past 3 yr; had no history of hay fever, asthma, allergic rhinitis, chronic respiratory disease, or cardiovascular disease; had not used medication within 1 wk of the experiment; was not exposed to air pollution on a daily basis; did not swim more than once a week in a chlorinated swimming pool; and had an FEV1-to-FVC ratio >75% of the predicted value (12). Each female participant provided menstrual information, was administered a human chorionic gonadotropin-urine pregnancy test (QuickVue, Quidel) at the beginning of the session, and was excluded from the study if this information suggested that she was pregnant. All procedures were approved by the Institutional Review Board of the Pennsylvania State University.

Instrument development. The design and performance of the bolus inhalation system as configured for O3 measurements were described in detail in previous publications (8-10). The apparatus originated from a breathing assembly that contained an injection port connected to an O3 bolus generator, a pneumotachometer to monitor respired flow, and a sampling port connected to a fast-responding O3 analyzer. For the present study, a new breathing assembly, Cl2 bolus generator, and fast-responding Cl2 analyzer were constructed. To minimize absorption of Cl2, the internal surfaces of these devices were fabricated of Teflon, wherever possible.

The breathing assembly (Fig. 1, 1-3) consisted of a specially machined Teflon tube that incorporated a mild Venturi-type constriction (Fig. 1, 1). The distal end of the breathing assembly could be fitted with one of two breathing fixtures (Fig. 1, 2). One fixture was a flexible plastic mouthpiece, and the other was a nasal cannula. The nasal cannula was composed of a rigid plastic manifold holding a pair of flexible rubber connectors that provided a comfortable but tight fit with both nostrils. The internal volume of each breathing fixture was 20 ml. Located near the distal end of the breathing assembly was a 1/8-in. Swagelock fitting connected to the inlet metering valve of the Cl2 analyzer. Located near the proximal end of the breathing assembly was a 1/4-in. Swagelock fitting that was connected to the Cl2 bolus generator. The proximal end of the breathing assembly was fitted with a pneumotachometer (Fig. 1, 3) for monitoring respiratory flow.


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Fig. 1.   Bolus apparatus. 1-3, Breathing assembly: 1, custom-made PTFE (Teflon) breathing tube; 2, custom-made PTFE breathing fixture adapter connected to either a flexible mouthpiece (Hans Rudolph) or a nasal cannula (Nellcor Puritan Bennett); 3, linear screen pneumotachometer (R4500C, Hans Rudolph). 4-9, Bolus generator: 4A and 4B, 3-way subminiature PTFE solenoid valves (series 1, General Valve); 5A and 5B, pressure regulators (series 18, Ralph Hiller); 6, flowmeter with needle valve (series VFB, Dwyer Instruments); 7, custom-made 1.5-inner-diameter × 5-in.-long PTFE diffusion chamber; 8, Cl2 permeation device, 0.2-10-cm-long (Vici Metronics); 9, 1/8-in.-inner-diameter PTFE hold-up tube (Berghoff/America), respectively. 10, Data-acquisition system: analog-to-digital interface and relay control (570DAS, Keithley) and computer workstation (386SX, Datel).

The bolus generator (Fig. 1, 4-9) utilized a diffusion chamber (Fig. 1, 7) containing a Cl2 permeation tube (Fig. 1, 8) to produce a chlorinated airstream. The outlet of the diffusion chamber was connected to a pair of three-way solenoid valves (Fig. 1, 4A and 4B) that were separated by a Teflon hold-up tube (Fig. 1, 9). When these valves were in the electrically "off" position, as shown in Fig. 1, chlorinated air continuously flowed through the hold-up tube to an exhaust. To produce a bolus, the valves were simultaneously energized by a data-acquisition system (Fig. 1, 10) such that clean air bypassed the diffusion chamber and all the chlorinated air in the hold-up tube was rapidly propelled into the subject's breathing tube (Fig. 1, 1). To precisely measure the Cl2 distribution within the airways, boluses with a small volume of ~10 ml and reproducible Cl2 concentration distributions were necessary. This was achieved by employing a volume of 10 ml for the hold-up tube, a duty cycle of 20 ms for energizing the solenoid valves, and a pressure of 30 psi (Fig. 1, 5B) for propelling the bolus. The peak Cl2 concentration of the boluses could be conveniently regulated by adjusting the flow rate of clean air (Fig. 1, 6) entering the diffusion chamber.

Because the inner surfaces of the mouthpiece and nasal cannula were constructed of plastic, they might absorb Cl2 before the inhaled bolus reached the respiratory tract. To check this possibility, the breathing assembly was alternatively fitted with the oral and the nasal fixture, and clean air was supplied to the open end of the pneumotachometer at a flow of 150 ml/s. The concentration of Cl2 was monitored immediately proximal to the breathing fixture as six boluses were separately injected into the breathing assembly. The Cl2 concentration was then monitored just distal to the fixture as six additional boluses were injected. By integrating the resulting Cl2 concentration curves, the mass of Cl2 entering (proximal sampling) and the mass exiting (distal sampling) the fixture were determined. A two-tailed t-test indicated no significant difference (P > 0.05) between these two sets of measurements for either fixture. Therefore, Cl2 absorption by either the mouthpiece or nasal cannula was unlikely, even at the relatively low airflow of 150 ml/s that exaggerated the contact time of Cl2 boluses with the breathing fixtures.

The fast-responding Cl2 analyzer developed for this study (19) was based on the principle of thermionic ionization. The commercial detector used in the analyzer consisted of an electrically heated catalytic cathode that ionized Cl2 to Cl- and a metallic anode that functioned as an electron collector when biased at a positive voltage relative to the cathode. At a sample inlet flow of 600 ml/min, the analyzer had a sensitivity of 3 pA ppm, a minimum detection limit of 0.04 ppm, a 10-90% step-response time of 80 ms, and a delay time of 100 ms. The static calibration of the instrument was linear for Cl2 concentrations from 0.03 to 4.0 ppm and was insensitive to variations in temperature, CO2 concentration, and humidity that normally occur in respired air.

In addition to Cl2, the thermionic detector could ionize chlorinated vapors such as chloroform, methyl chloride, and carbon tetrachloride (17). Therefore, chlorinated vapors originating from either endogenous Cl2 metabolism (4, 13, 23) or the reaction of inhaled Cl2 with airway mucosa could be wrongly interpreted as expired Cl2. To check this possibility, the chemical composition of expired breath was measured in three male and two female subjects while they breathed clean air or chlorinated air. In each measurement, 1 liter of slowly expired air was collected in a 9 × 9-in. Teflon bag (F5009009, Eagle Picher). The bag was then connected to a gas chromatograph mass spectrometer (5890IIGC/5792A MSD, Hewlett-Packard) with a Nafion drying tube (MD-070-48F, Perma Pure). The chromatograph utilized a capillary column with a high affinity for halogenated organic compounds (2-4154, Supelco). Cryofocusing at the sample inlet of the instrument and again at the head of the chromatographic column concentrated the condensable components of the expired breath sample to achieve a minimum detectable limit of ~0.001 ppm (8533 Cryo-concentrator, Graseby-Nutech).

One expired breath sample was collected immediately after clean air breathing for 2 min, and three replicate breath samples were obtained at the end of a 2-min exposure to 0.5 ppm Cl2. Chlorinated vapors were found in only 2 of the 20 expired breath samples collected from the 5 subjects. In both cases, the concentration of the chlorinated compound in the breath sample was on the order of 0.002 ppm. Because the minimum detection limit of the thermionic ionization analyzer was 10 times larger than this, expired chlorinated compounds were unlikely to affect the Cl2 bolus measurements.

Bolus inhalation measurements. All 10 subjects participated in a 2- to 4-h session in which bolus measurements were made during nasal and oral quiet breathing. The subject was seated comfortably on a stool, wore noseclips during oral breathing, and maintained a closed mouth during nasal breathing. To carry out a bolus test breath, the subject donned the mouthpiece or nasal cannula, activated the inhalation apparatus by depressing a handheld switch, and inhaled beginning at functional residual capacity while viewing a computer monitor on which the integrated pneumotachometer signal (i.e., the respired volume) was displayed in real time. The subject controlled his or her breathing so that the respired volume signal followed a predrawn pattern corresponding to equal inspiratory and expiratory flows of 250 ml/s and a tidal volume of 500 ml. At a predetermined time during inhalation, the data-acquisition system automatically injected a 10-ml Cl2 bolus into the inspired airflow.

Penetration of the bolus into the respiratory system could be systematically varied from breath to breath by changing the bolus injection time relative to the time that the subject was supposed to switch from inhalation to exhalation. The earlier the injection time relative to the end of inhalation, the greater the penetration of the bolus distal to the airway opening. Throughout a test breath, the Cl2 analyzer and pneumotachometer voltage outputs were continuously recorded on a computerized data-acquisition system at a sampling rate of 200 Hz. The system was also used for triggering the bolus injection valves, integrating the pneumotachometer output to obtain respired volume, and displaying the respired volume on the breathing monitor. The subject took 2-3 test breaths/min, and a collection of 50-70 breaths between bolus penetrations of 0-200 ml constituted a complete experiment.

Three experiments were conducted during the bolus inhalation session: oral breathing with a peak inhaled Cl2 concentration (Cmax) of 3.0 ppm; nasal breathing with a Cmax of 3.0 ppm; and nasal breathing with a Cmax of 0.5 ppm. To avoid possible systematic errors associated with Cl2 preexposure, the sequence in which the experiments were carried within a session was randomized for each subject. In addition, bolus test breaths were arbitrarily carried out at progressively increasing penetration in some experiments but at progressively decreasing penetration in others. In all experiments, a test breath was deemed acceptable if the subject could maintain an average respiratory flow within ±15% of 250 ml/s.

Anatomic measurements. The anatomy of the respiratory system of each subject was characterized by measurements of FVC by using a forced spirometer (model 110 automated spirometer, CDX), and dead space (VD) by using a previously described nitrogen-washout apparatus (3). In addition, the nasal volume (VNS), oral volume (VOR), and pharyngeal volume (VPH) of each subject were determined by an acoustic reflection apparatus. The value of FVC represented the average of the highest two of three forced expired measurements, VD was the average of 5-7 washout measurements, and VNS, VOR, and VPH were each determined as the average of six acoustic reflection measurements.

The commercially available acoustic reflection apparatus (Eccovision Acoustic Rhinometry-Pharyngometry System, Hood Laboratories) consisted of two acoustic wave tubes, one fitted with a rubber mouthpiece and used to obtain oropharyngeal geometry and the other fitted with a rubber nosepiece and used to obtain unilateral nasopharyngeal geometry. During an acoustic measurement, a subject was seated comfortably on a stool and either grasped the mouthpiece or placed the nosepiece adjacent to one nostril. In the case of the nasal measurements, a small amount of petroleum jelly was applied to the tip of the nosepiece to ensure a good seal with the external nares. The subject was instructed to maintain an upright posture and perform a slow expiration while relaxing the glottis. In each measurement, a pulse of white noise was generated in the wave tube, propagated into the subject's airways, and was partially reflected because of changes in the cross-sectional area of the airway. The incident and reflected sound were monitored with microphones and then converted to a cross-sectional area vs. distance function by using a proprietary computer algorithm.

The length of the nasal cavity and the length of the nasopharynx were estimated from two points of minimum cross section in the nasal area-distance function as previously illustrated by Swift and Proctor (24) (Fig. 2A). Similarly, the length of the oral cavity including the oropharynx and the length of the hypopharynx were estimated from two points of minimum cross section in the oral area-distance function, as previously shown by Fredberg and associates (7) (Fig. 2B). The volumes of the left and right nasal cavities were determined by integrating each nasal area-distance function over the length of the nasal cavity. The volume of the nasopharynx was calculated as an average of the values obtained by integrating the two nasal area-distance functions over the length of the nasopharynx. The value of VNS was then calculated as the sum of the volumes of the nasal cavities and the nasopharynx. The value of VOR was obtained by integrating the oral area-distance function over the length of the oral cavity including the oropharynx, and the value of VPH was obtained by integrating the oral area-distance function over the length of the hypopharynx. Because VD measurements were made during oral breathing, the volume of a subject's lower conducting airways, VLA, was computed as (VD - VOR - VPH).


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Fig. 2.   Representative acoustic reflection measurements. Area-distance profiles of left nasopharyngeal airways (A) and oropharyngeal airways (B) in 1 subject.

Analysis of bolus inhalation data. The integrals (MI and ME), means (VP and VB), and variances (sigma 2Isigma 2E) of the inhaled and the exhaled portion of each test breath were obtained by numerical integration of the Cl2 concentration data with respect to respired volume as illustrated in Fig. 3. These moments were then interpreted as follows: absorbed fraction (Lambda ; i.e., 1 - ME/MI) was the amount of pollutant absorbed during a single respiratory cycle relative to the inhaled amount; penetration volume (VP) represented the mean airway volume that would be reached by inhaled Cl2 molecules relative to the gas-sampling point if no absorption had occurred; breakthrough volume (VB) symbolized the mean airway volume traversed by unabsorbed Cl2 molecules that reached the gas-sampling point during expiration; and dispersion (sigma 2; i.e., sigma 2E - sigma 2I) was a measure of the longitudinal mixing of the unabsorbed Cl2 molecules. A more quantitative definition of these variables can be found elsewhere (8).


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Fig. 3.   Representative bolus test breath. Respired volume axis is obtained by integrating repiratory flow relative to end inspiration. The physical interpretation of the integrals (MI, ME), means (VP, VB), and variances (sigma 2I, sigma 2E) of the inhaled and exhaled portions of the curve are given in the text.

By viewing VP as an independent variable that characterized the spatial excursion of an inhaled bolus into the respiratory system, the distributions of Lambda , VB, and sigma 2 with respect to VP were considered to be the primary dose-distribution information retrieved with the bolus inhalation method. The Lambda -VP distribution for a particular subject during one of the three experimental conditions is illustrated in Fig. 4. To determine the pooled Lambda -VP, VB-VP, and sigma 2-VP distributions for all subjects at each experimental condition, the Lambda , VB, and sigma 2 values collected from all test breaths were sorted into 10-ml increments of VP and averaged. The overall SE of each average, including both between-subject and within-subject variations, was computed as previously specified by Kabel and associates (10).


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Fig. 4.   Regression of diffusion model to Cl2 distribution data obtained during nasal breathing in 1 subject. Each point represents absorption fraction (Lambda ) obtained from a bolus test breath; smooth curve, splined regression of these data according to Eq. 1. Because of extensive absorption in nasal cavity and pharynx, data were insufficient to determine a mass transfer parameter in lower conducting airways. VP 0, VP 1, and VP 2: boundaries of airway compartments as specified in Fig. 5.

Compartmental analysis and the overall mass transfer coefficient. In modeling Cl2 absorption, the respiratory system was subdivided into nasal-oral (N/O), pharyngeal (PH), lower airway (LA), and respiratory air space (RA) compartments (Fig. 5). Longitudinal position was specified by the penetration VP of a bolus distal to the Cl2-sampling point. The N/O compartment was bounded at its proximal end by the volume of the breathing fixture (VP 0 triple-bond  VBF) consisting of the nasal cannula during nasal breathing and the mouthpiece during oral breathing. The PH compartment was bounded at its proximal end by VP 1 triple-bond  (VBF +VN/O), where VN/O triple-bond  VNS during nasal breathing and VN/O triple-bond  VOR during oral breathing. The LA compartment was bounded at its proximal end by VP 2 triple-bond  (VBF + VN/O + VPH), and the RA compartment was bounded at its proximal end by VP 3 triple-bond  (VBF + VN/O + VPH + VLA).


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Fig. 5.   Compartment airway model. Conducting airways are divided into 3 compartments, and longitudinal position within this model is specified by VP (definitions of VBF, VN/O, VPH, and VLA appear above abbreviations).

The transport of a solute from respired gas to adjacent tissue may be characterized by an overall mass transfer coefficient (K) representing the absorption rate normalized by the solute concentration in the gas phase and by the surface area through which the solute is absorbed (25). In situations where the surface area is not known, a surface-to-volume ratio a is customarily introduced such that Ka is the absorption rate normalized by solute concentration and the volume of the gas-filled conduit. The diffusion model published by Hu and associates (9) was utilized to estimate the values of Ka in the N/O, PH, and LA compartments. The model predicts a Lambda -VP distribution given by the following formula

ln (1 − &Lgr;) = − (2/<A><AC>V</AC><AC>˙</AC></A>)[(<IT>Ka</IT>)<SUB>N/O</SUB>(V<SUB>P</SUB> − V<SUB>P0</SUB>) + <IT>I</IT><SUB>1</SUB>(&Dgr;<IT>Ka</IT>)<SUB>PH</SUB>(V<SUB>P</SUB> − V<SUB>P1</SUB>) + <IT>I</IT><SUB>2</SUB>(&Dgr;<IT>Ka</IT>)<SUB>LA</SUB>(V<SUB>P</SUB> − V<SUB>P2</SUB>)] (1)

where V is the respiratory flow rate, (Delta Ka)PH triple-bond  [(Ka)PH - (Ka)N/O] represents the change in Ka between the PH and N/O compartments, and (Delta Ka)LA triple-bond  [(Ka)LA - (Ka)PH] represents the change in Ka between the LA and PH compartments. The I1 and I2 indicator variables are defined as follows: I1 is unity if VP > VP 1 and is zero otherwise, and I2 is unity if VP > VP 2 and is zero otherwise. The principal assumptions in this model were that Cl2 absorption is a quasi-steady-state process, Ka is constant within a compartment, and that longitudinal transport of Cl2 in the gas phase by longitudinal dispersion can be neglected in comparison with transport by longitudinal convection. The factor of two multiplying the right-hand side of Eq. 1 accounts for the fact that the Cl2 bolus must pass over the airway surface twice, once during inhalation and again during exhalation.

To estimate the values of (Ka)N/O, (Delta Ka)PH, and (Delta Ka)LA, a splined least squares regression of each subject's Lambda -VP data to Eq. 1 was separately performed for each of the three experiments (Fig. 4). The parameters V, VNS, VOR, VPH, and VLA were fixed at those values measured for the subject of interest. Values of Lambda  > 0.96 were not used in the regression because they resulted from measurements of expired concentration that were near the resolution of the Cl2 analyzer. Furthermore, when Lambda  increased above 0.96 before a bolus could penetrate halfway through a compartment, the corresponding Ka value was disregarded.

Once the regressions were completed, the fraction of inhaled Cl2 absorbed within each of the four compartments (Delta Lambda ) was determined. In particular, values of Lambda  at the proximal boundaries of the PH, LA, or RA compartments were computed by using Eq. 1 with the estimated values of Ka. The value of Delta Lambda was then calculated as the difference between Lambda  at the distal and proximal boundaries of the compartment of interest.

Unpaired comparisons of anthropometric characteristics between the male and female subjects, of compartmental volumes, and of Delta Lambda values were performed by using two-tailed Student's t-tests. Paired comparisons of Ka at different experimental conditions were made when values were available in the same group of subjects. Otherwise, the comparisons of Ka were unpaired. In all cases, the difference between two parameter values were considered to be significant if the probability that they were the same was <0.05.


    RESULTS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Characteristics of subjects. All the subjects were physically fit individuals; their anthropometric characteristics are summarized in Table 1. Although the men were generally older, taller, heavier, had larger FVC, and had larger VD than did the women, only the difference in weight was statistically significant (P = 0.007). Compartment volumes of the subjects are summarized in Table 2. Mean values of VNS were similar, VOR was somewhat smaller, and VPH was considerably larger in the men than in the women. The mean value of VNS in the subject population as a whole was somewhat smaller than the corresponding value of VOR. Of these diferences in average compartment volumes, only the gender difference in VPH was statistically significant (P < 0.001).

                              
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Table 1.   Characteristics of the subject population


                              
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Table 2.   Compartment volumes in individual subjects

There was a large intersubject variability in all the compartment volumes listed in Table 2. As one would expect, VD was a good predictor of VLA in the different subjects (coefficient of determination adjusted for number of subjects: r2 = 0.71) but was not a predictor of VNS, VOR, and VPH (r2 = 0.00, 0.00, and 0.03, respectively). Whereas VD as well as VNS were somewhat correlated with weight (r2 = 0.28 and 0.27, respectively), VOR was not correlated with weight (r2 = 0.00). The value of VD was strongly correlated with height (r2 = 0.81), but neither VNS nor VOR was correlated with height (r2 = 0.03 and 0.00, respectively). Finally, there was no correlation between VNS and VOR (r2 = 0.00).

Cl2 absorption. The Lambda -VP distributions pooled for all participants at each of the three experimental conditions (i.e., oral breathing, Cmax = 3.0 ppm; nasal breathing, Cmax = 3.0 ppm; nasal breathing, Cmax = 0.5 ppm) are given in Fig. 6. In general, the inhaled Cl2 boluses were completely absorbed at a VP of ~80 ml, which was immediately distal to the upper airways. Considering the magnitude of the SE bars on these graphs, there appears to be little difference between the Lambda -VP distributions during oral and nasal breathing. On the other hand, decreasing Cmax from 3.0 to 0.5 ppm appears to increase the absorbed fraction of Cl2 at VP below 60 ml, which is within the hypopharynx. The VB-VP and sigma 2-VP distributions pooled for all participants during oral and nasal breathing at Cmax = 3.0 ppm are given in Fig. 7. The relationship between VB and VP is similar for both modes of breathing, with oral values of VB being somewhat larger than nasal values at VP > 10 ml. Values of sigma 2 appear relatively insensitive to VP, with oral values being somewhat larger than nasal values at VP < 70 ml.


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Fig. 6.   Pooled Lambda -VP distributions for 10 subjects. A: nasal and oral quiet breathing at a peak inhaled Cl2 concentration of 3.0 parts/million (ppm). B: nasal quiet breathing at peak inhaled Cl2 concentrations of 3.0 and 0.5 ppm. Vertical bars, overall SE because of within-subject and between-subject variations.



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Fig. 7.   Pooled VB-VP and sigma 2-VP distributions for 10 subjects. Nasal and oral quiet breathing at a peak inhaled Cl2 concentration of 3.0 ppm. Error bars are defined as in Fig. 6.

Table 3 summarizes the mass transfer parameters that were calculated from an individual regression of each subject's Lambda -VP distribution. The (Ka)NS averaged for all subjects was significantly larger (P = 0.04) than (Ka)OR. On the other hand, there was not a significant difference (P = 0.97) between the average (Ka)NS obtained when Cmax was 0.5 ppm and that when Cmax was 3.0 ppm. Although the data were insufficient to calculate (Delta Ka)PH in some of the subjects, there was nevertheless a consistent trend of negative values at all three experimental conditions, indicating that Ka decreases between the nasal or oral cavity and the hypopharynx. The values of (Ka)PH determined by summing the average values of (Delta Ka)PH and (Ka)N/O were 1.5 s-1 during oral breathing of 3 ppm Cl2 boluses; 1.1 s-1 during nasal breathing of 3 ppm Cl2 boluses; and 1.6 s-1 during nasal breathing of 0.5 ppm Cl2 boluses. This suggests that mass transfer in the hypopharynx was not markedly affected by the mode of breathing or the inhaled Cl2 concentration. Because of extensive absorption of Cl2 in the NS and OR compartments, there were insufficient Lambda -VP data in the LA compartment to evaluate (Delta Ka)LA in any of the subjects.

                              
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Table 3.   Compartmental mass transfer parameters in individual subjects during quiet oral and nasal breathing with peak inspired chlorine concentration of 0.5 and 3.0 ppm

The Delta Lambda for Cl2 in the three conducting airway compartments is given in Fig. 8. Nearly all of the inspired Cl2 was absorbed in the upper airways, and ~90% of the inspired Cl2 was absorbed in the nose or mouth of all the subjects. This result was independent of the mode of breathing and of Cmax.


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Fig. 8.   Pooled compartmental Cl2 absorption for 10 subjects. Each histogram level (Delta Lambda ) represents the difference between Lambda  on the corresponding compartment boundaries. Values of Delta Lambda for respiratory air space compartment were 0 for all subjects. Error bars are defined as in Fig. 6.


    DISCUSSION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

One purpose of this research was to determine the principal site of Cl2 uptake in the respiratory system. From the bolus inhalation measurements, it is clear that nearly all of the Cl2 inhaled during quiet breathing is absorbed in the upper airways, whether the nose or the mouth is the site of air access. In reaching this conclusion, we relied on measurements of VOR, VNS, and VPH measured by acoustic reflection. The average volume of the nasal cavity, between the nares and the entrance to the nasopharynx, was found to be 23 ml. This is within the range of 20-32 ml reported for the nasal cavity volume by two other research groups who used computerized tomography and magnetic resonance imaging scans in a total of eight subjects (16). The average ± SD volume of the oral cavity between the lips and the entrance to the hypopharynx was found to be 54 ± 20 ml, which is consistent with the values of 41 ± 9 and 50 ± 10 ml previously reported for acoustic reflection and oropharyngeal cast measurements, respectively (10).

Another purpose of this study was to compare Cl2 uptake by the nose and the mouth. Because (Ka)NS is ~25% larger than (Ka)OR, the absorption rate of Cl2 per unit volume of airway lumen is somewhat larger for the nose than for the mouth (Table 3). The nose has a smaller volume than the mouth (Table 2), however, so that (KaV)NS is only ~5% larger than (KaV)OR. It can be concluded that the total absorption rates for the nose and mouth are similar. A third purpose of this research was to examine the influence of inhaled Cl2 concentration on airway absorption during nasal breathing. The fact that (Ka)NS retained the same value when Cmax was changed from 0.5 to 3.0 ppm (Table 3) indicates that the dissolution, diffusion, and chemical reactions governing Cl2 uptake from respired gas to the nasal mucosa are all linear processes.

The continuous inhalation of Cl2 is the theoretical equivalent of inhaling a train of Cl2 boluses that is introduced between the beginning and the end of inspiration. The absorption distribution that applies during continuous exposure can therefore be estimated by integrating the Lambda -VP bolus distribution. To a first approximation, the change in bolus absorption Delta Lambda is an estimate of Cl2 absorption within a particular airway compartment during continuous exposure. This approximation is valid when tidal volume is much larger than VP at the proximal end of the compartment of interest. This is always the case for the N/O and PH compartments and is usually true for the LA compartment. Judging from the results of this study, 95% or more of continuously inhaled Cl2 is absorbed in the upper airways that consist of the N/O and PH compartments (Fig. 8).

Cl2 undergoes a rapid and reversible hydrolysis in aqueous solutions according to the following chemical reaction
Cl<SUB>2</SUB> + H<SUB>2</SUB>O ⇌ Cl<SUP>−</SUP> + HOCl + H<SUP>+</SUP> (2)
This reaction has an equilbrium constant with the following value at 25°C (27)
10<SUP>−pH</SUP>[Cl<SUP>−</SUP>][HOCl]/[Cl<SUB>2</SUB>] = 5 × 10<SUP>−4</SUP>(mol/l)<SUP>2</SUP> (3)
where [Cl-] and [HOCl] indicate the molar concentrations of the chloride ion and hypochlorous acid in the aqueous phase, respectively, and [Cl2] is the concentration of Cl2 in dissolved form. For mucus that has a [Cl-] of ~0.16 mol/l (14) and a pH of ~6.6 (2), Eq. 3 indicates that the concentration of Cl2 in hydrolyzed form ([HOCl]) is 120,000 times [Cl2]. In other words, the effective solubility of Cl2 between the respired gas and mucus phase is five orders of magnitude larger than the physical solubility. This large effective solubility explains why >95% of inhaled Cl2 was absorbed in the upper airways. Moreover, the linearity of the equilibrium relationship between [HOCl] and [Cl2] that occurs when pH and [Cl-] are fixed is consistent with the observation that (Ka)NS did not depend on the peak inhaled Cl2 concentration.

As Cl2 absorbs into an airway, it encounters a diffusion resistance created by a respiratory gas boundary layer and a second diffusion resistance imposed by the surrounding mucosa. Because of the large effective solubility of Cl2, the diffusion resistance in mucus and tissue should be minimal, and gas absorption should be limited primarily by the convection and diffusion processes in the respired gas phase. If this is true, then the overall mass transfer parameter Ka should be similar in value to the gas-phase mass transfer parameter kga. To make this comparison, the gas-phase mass transfer coefficient kg was computed by applying the heat-mass transfer analogy to an empirical correlation developed from heat transfer measurements on casts of the upper airways (20)
<IT>k</IT><SUB>g</SUB> = <IT>m</IT>(<IT>d/D</IT><SUB>g</SUB>)<SUP><IT>n</IT>−1</SUP>(<A><AC>V</AC><AC>˙</AC></A>/<IT>A</IT>)<SUP><IT>n</IT></SUP> (4)
where m and n are empirical constants that have respective inspiratory values of 0.028 and 0.854 in the nose and 0.035 and 0.804 in the mouth and respective expiratory values of 0.0045 and 1.08 in the nose and 0.0006 and 1.269 in the mouth; Dg is the binary diffusivity of Cl2 in air, which was estimated to be 0.13 cm2/s (25); d is tracheal diameter, which is ~1.8 cm (26); and A is the mean tracheal cross-sectional area, which is ~2.6 cm2 (26). From previously published anatomic data, the surface-to-volume ratio a was estimated to be 9.2 cm-1 in the nose (16) and 1.7 cm-1 in the mouth (21).

On the basis of these estimates, the predicted kga averaged over inspiration and expiration at a V of 250 ml/s were 7.7 s-1 in the nose and 1.0 s-1 in the mouth. The kga value predicted for the nose is within the intrasubject range of (Ka)NS values from the bolus experiments (i.e., 5.0-8.1 s-1), supporting the conclusion that gas-phase diffusion is the rate-limiting step in the overall absorption process. However, the kga predicted for the mouth is much below the range of (Ka)OR deduced from the bolus study (i.e., 2.9-6.5 s-1). This result cannot be explained by the influence of a mucosal resistance that would cause kga to be larger, not smaller, than (Ka)OR. The result is possibly due to a difference in the mouth opening and tongue placement of the cadaver casts used to obtain kg and a compared with the mouth and tongue orientations of the subjects who breathed through a mouthpiece during the bolus experiments.

Previous bolus measurements indicated that O3 had a Lambda  value of 0.8 in the nasal cavity and 0.5 in the oral cavity (10). The Lambda  value for Cl2 in the present investigation was ~0.9 in both the nasal and oral cavities. The smaller absorbed fractions of O3 relative to Cl2 may be due to the fact that O3 does not hydrolyze in mucus. In other words, the solubility of O3 may be sufficiently low that the diffusion resistance of O3 through the mucosa influences the overall absorption process. In addition, because Cl2 absorption is similar in the mouth and nose but O3 absorption is less in the mouth than in the nose, it appears that the mucosal diffusion resistance of O3 is greater in the mouth than in the nose.

The toxicity of Cl2 is mediated locally by HOCl, which may disrupt the integrity and increase the permeability of the epithelium (6), and by an increase in H+, which may decrease blood pH, provided that a sufficient dose of Cl2 is absorbed (29). Cl2 also reacts with the sulfhydryl groups of the amino acid cysteine, thereby inhibiting various enzymes (6, 15). Because this study revealed that almost all inhaled Cl2 was absorbed in the nose during nasal breathing and the mouth during oral breathing, it is reasonable to conclude that the upper airways are the most likely site of long-term Cl2-induced tissue damage in humans. This is consistent with the findings in laboratory animals that lesions due to the chronic inhalation of Cl2 are confined primarily to the nasal cavities (11, 28).

One of the general limitations of the bolus inhalation method is a lack of spacial resolution because of the finite width of the bolus. The bolus is most narrow when it enters the respiratory system but becomes progressively more dispersed by longitudinal mixing throughout the test breath. The fact that VP 0, the intercept of the Lambda -VP distribution with the abscissa, is less than the 20-ml volume of the nonabsorbing breathing fixture (Table 3) is a symptom of this limitation. In other words, if the width of the bolus had been zero, then Lambda  would rise above zero only when VP was greater than VBF. Because the bolus had a finite width, however, a portion of the bolus penetrated into the respiratory system even when its center of mass was located at values of VP < VBF. This artifact can lead to an incorrect interpretation of the Lambda -VP distribution. For example, it appears in Fig. 6A that Cl2 absorption at low VP is somewhat more efficient during oral than nasal breathing. In fact, because bolus dispersion is greater during oral than nasal breathing (Fig. 7A), VP 0 is less during oral than during nasal breathing (Table 3), and the Lambda -VP distribution for oral breathing is shifted to the left of that for nasal breathing. Judging from the values of (Ka)NS and (Ka)OR that are based on the slopes of the Lambda -VP data, it appears that the absorption efficiency in the nose is actually greater than in the mouth. The same logic applies to the effect of Cmax on Cl2 absorption. From Fig. 6B, it appears that absorption is more efficient at a Cmax, of 0.5 ppm than at a Cmax of 3.0 ppm, whereas the values of (Ka)NS indicate that there is actually no significant difference.

An important consideration in any dosimetric process is whether the initial uptake of a pollutant causes some disturbance in the chemical or physiological state of the respiratory system that induces a subsequent change in the uptake. For example, exposure to Cl2, whether continuously or by multiple bolus breaths, can result in the accumulation of Cl2 in mucus, with a concomitant decrease in the absorption rate. To test for such an effect, one subject nasally inhaled a series of 3-ppm boluses once every five breaths for 1 h at a VP target level of 40 ml, corresponding to the posterior nasal cavity. A linear regression of Lambda  against time had a small coefficient of determination (r2 = 0.03) and a slope that was not significantly different from zero. It can thus be concluded that the bolus inhalation method provides a time-invariant measure of Cl2 absorption.

Although no statistically significant gender differences in the values of Ka and the values of Delta Lambda were uncovered, this study lacked sufficient power to conclude with high probability that Cl2 absorption is the same for men and women. In particular, the probability of falsely concluding that there was no gender difference was ~0.9. To reduce this probability of making a type II error to a more reasonable level of 0.2 would have required that 10 female and 10 male subjects be tested. Nevertheless, the apparent lack of a gender difference in Cl2 absorption is consistent with the previous finding for O3 absorption that Ka was related to gender only insofar as the smaller conducting airway volumes of the women produced larger values of Ka than for the men (3). In the case of Cl2 that was primarily absorbed into the N/O compartment, one would expect (Ka)N/O to be negatively correlated with VN/O, irrespective of gender. This expectation was met for the mouth but not for the nose (Fig. 9). It may be that the shape of the oral cavity was more similar from person to person than was the shape of the nasal cavity and/or that flow patterns in the mouth were more similar among different subjects than in the nose.


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Fig. 9.   Correlation of mass transfer parameter Ka for individual subjects against their VN/O values. Data were obtained at a maximum inspired Cl2 concentration of 3.0 ppm during quiet oral (A; r2 = 0.71) and nasal (B; r2 = 0.15) breathing. Nasal inhalation measurements obtained at a maximum inspired Cl2 concentration of 0.5 ppm (data not shown) showed a lack of correlation similar to B.

The breakthrough volume VB and dispersion sigma 2 are indirectly affected by the absorption process. Because it represents the average airway volume from which unabsorbed Cl2 molecules originate during expiration, VB should progressively increase as VP increases. However, absorption is very efficient in the small airways where a is exceedingly large, so that VB should level off once VP is larger than some critical value. This is exactly the type of VB-VP behavior that has been observed for Cl2 boluses in the present study (Fig. 7A) as well as for O3 boluses in a previous study (10). As was the case for O3, the VB for Cl2 tends to be greater during oral breathing than during nasal breathing and is not markedly affected by a change in Cmax. The value of sigma 2, which characterizes the volume of air in which the test gas becomes distributed by longitudinal mixing, will also tend to level off because boluses are truncated by the highly efficient absorption occurring in the small airways. As was previously observed for O3, sigma 2 for Cl2 is relatively independent of VP and Cmax and is greater during oral breathing than during nasal breathing.

To summarize, measurements of the Lambda -VP distribution of Cl2 during nasal as well as oral quiet breathing in five men and five women indicated that >95% of inspired Cl2 was absorbed in the upper airways of all subjects, whereas the dose delivered to the respiratory air spaces was negligible. Although there were no statistically significant gender differences in the results, individual values of (Ka)OR were inversely correlated with individual values of VOR. Representative overall mass transfer coefficients estimated in the nose were in good agreement with gas-phase mass transfer coefficients calculated from established correlations. This suggested that diffusional resistance in the nasal mucosa was negligible relative to diffusional resistance in the respired gas. Both the high absorptivity of Cl2 in the upper airways and the domination of the gas-phase diffusion resistance were attributable to the rapid hydrolysis of Cl2 in the mucosa.


    ACKNOWLEDGEMENTS

The authors are grateful to Janice Schneider of the Applied Research Laboratory and John Showalter for assistance with the chromatographic analyses of expired breaths and to Abdelaziz Ben-Jebria for insightful suggestions.


    FOOTNOTES

This work was funded by the Chlorine Institute through a subcontract with the Chemical Industry Institute of Toxicology. Clinical support was provided by the General Clinical Research Center through funding by National Heart, Lung, and Blood Institute Grant M01 RR-10732.

The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. §1734 solely to indicate this fact.

Address for reprint requests and other correspondence: J. Ultman, Dept. of Chemical Engineering, The Pennsylvania State Univ., 106 Fenske Lab, University Park, PA 16802 (E-mail: jsu{at}psu.edu).

Received 24 September 1998; accepted in final form 18 February 1999.


    REFERENCES
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ABSTRACT
INTRODUCTION
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RESULTS
DISCUSSION
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