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Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players
Pages 538-541

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From page 538...
... Treatment with corticosteroids may diminish the severity of disease.67 Exposure to low levels of nitrogen dioxide also may produce adverse pulmonary effects. Human volunteers exposed to 5 ppm of nitrogen dioxide for 15 minutes and 2.5 ppm for 2 hours demonstrated increased pulmonary airway resistance.8 Also, recent studies suggest that long-term exposure to low levels of nitrogen dioxide, in the environment or in the home, may predispose residents to respiratory infections and chronic obstructive pulmonary disease.~'5 The National Institute for Occupational Safety and Health recommends 1 ppm of nitrogen dioxide as a work-site standard.' During February 1987, we investigated an outbreak of acute respiratory illness in participants and spectators of two high school hockey games played at an indoor ice arena located in a suburb of St Paul, Minn.
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From page 539...
... Survey of State Health Departments 1b evaluate air quality monitoring in indoor ice arenas nationally, and to obtain an estimate of the number of ice arenas located in each state, a telephone survey of all 50 state health departments was conducted. The Ice Skating Institute of America, the US Figure Skating Association, and the National Hockey Association also were contacted to obtain estimates of the number of indoor ice arenas located in the United States.
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From page 540...
... 21 COMMENT Nitrogen dioxide exposure was the most likely cause of this outbreak of respiratory illness for the following reasons. First, the acute onset of respiratory symptoms in persons attending the two hockey games supports a toxic environmental exposure.
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From page 541...
... The Chattanooga school children Printed and Published in the United States of America tions requiring routine exhaust emission checks of ice resurfacers may be necessary. When patients present with acute onset of pulmonary symptoms, particularly hemoptysis, with onset during or shortly after spending time in an indoor ice arena, physicians should consider the possibility of exposure to nitrogen dioxide.
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Key Terms

  • hockey players
  • ice arenas
  • indoor ice
  • ice resurfacer
  • respiratory illness

  • acute onset
  • ice arena
  • dioxide exposure
  • hockey games
  • respiratory symptoms

  • single exposure
  • lung function
  • pulmonary function
  • carbon monoxide
  • function testing

  • hockey game
  • multiple exposures
  • attack rates
  • ice skating
  • state health

  • treatment prescribed
  • ambient levels
  • players reported
  • elevated levels
  • school hockey

  • hockey teams
  • acute respiratory
  • chest roentgenogram
  • minnesota department
  • community exposure


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