CHAPTER 4: Toxicology and Treatment of Phosgene Induced Lung Injury

Phosgene gas was first synthesised in 1812, and is probably best known as the chemical warfare agent that caused the greatest number of chemical deaths during World War I. However, it remains an important global toxic industrial chemical, produced in megatonne quantities for use in numerous industrial synthetic processes. Although restrictions now exist on the supply and movement of phosgene, its widespread use as a chemical intermediate ensures its continued presence industrially. Due to its inherent high toxicity, it remains of concern, as the potential for accidental environmental or occupational exposure continues. Despite decades of research into its mechanisms of action in the development of acute lung injury, there are still no evidence based guidelines for the management of this injury, with supportive care in an intensive care unit the mainstay for treatment. Following large scale release of phosgene gas with large numbers of casualties, supportive care options may be quickly overwhelmed. There is therefore a continued need to further elucidate the initiating cellular events, which might identify new pathways for pharmacological intervention in order to reduce the requirement for intensive respiratory support.