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Between January and March 2003 six patients were admitted to hospital in the Lausanne area of Switzerland with acute respiratory failure following use of a waterproofing spray for clothes and leather. Within hours of exposure all patients developed a dry cough and rapidly progressive dyspnoea. The clinical picture included severe hypoxaemia, increased white blood cell count, raised C-reactive protein, and reduced carbon monoxide transfer factor (Tlco). All patients had diffuse bilateral ground glass opacities on a high resolution CT scan, most often sparing the subpleural areas (fig 1). Every patient improved following treatment with oral prednisone (0.5–0.9 mg/kg) but residual dyspnoea and reduced Tlco (<80% of predicted value) could be seen for more than 2 weeks.
Acute respiratory failure was attributed to inhalation of the waterproofing spray in view of …
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