Overview of nitrogen dioxide effects on the lung with emphasis on military relevance

Nitrogen dioxide exposure occurs in many civilian occupations as well as during military combat. Little interaction has occurred between the two communities in regards to the exchange of information about NO2 research. This presentation provides an overview of NO2 related epidemiology; available research models and issues of particular interest to both the civilian and military sectors; clinical presentations, prophylaxis and treatment; and pathophysiology and mechanisms of injury. Throughout the presentation civilian and military issues are contrasted when pertinent. The most significant difference between the civilian and military research requirements is the need for information on chronic (with and without intermittent peaks) for the former, and information on acute high-level NO2 research for the latter. Another military requirement is predicting not only injury but incapacitation. This requirement can be compared to the need of clinicians to measure impairment for patients seeking disability. Both communities are faced with the same challenges of selecting appropriate models, understanding dosimetry and its many variables, clarifying the fate of inhaled NO2, developing specific markers of injury, and elucidating the mechanisms of NO2 injury for the development of prophylactic and therapeutic agents. Further research is required in these areas and it is hoped that this symposium will be the first attempt to join civilian and military resources and expertise for future research cooperation and collaboration.