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1 Associate Professor of Medicine, University of Virginia School of Medicine, Charlottesville, Va.
There are few longitudinal studies of lung function following exposure of man to silage gas. Four episodes of silo filler's disease (nitrogen dioxide poisoning) in three patients are described, with serial pulmonary function studies. Obstructive, restrictive and diffusion defects were observedacutely, with almost complete clearing of detectable disease within the observation period (327, 10, 75, and 28 days). An analysis of the information concerning chronic pulmonary disease and nitrogen dioxide exposure leads the authors to conclude: 1) silo filler's disease may occasionally lead to chronic pulmonary disease by (a) the survival of the patient, despite severe bronchiolar injury by the nitrogen dioxide or more commonly, (b) less severe residual bronchiolar injury after exposure in patients with pre-existing "small airway disease" (chronic bronchitis and emphysema predominantly); 2) animal exposure studies and lung biopsies in human beings lead to the speculation that the chronic disease which is produced may be centrulogbar emphysema.
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