Acute Exposure Nitrogen dioxide is thought to damage lungs in three ways: (1) it is converted to nitric and nitrous acids in the distal airways, which
directly damages certain structural and functional lung cells; (2) it initiates free radical generation, which results in protein oxidation, lipid
peroxidation, and cell membrane damage; and (3) it reduces resistance to infection by altering macrophage and immune function. There may be an
immediate response to exposure to nitrogen oxide vapors that may include coughing, fatigue, nausea, choking, headache, abdominal pain, and difficulty
breathing. A symptom-free period of 3 to 30 hours may then be followed by the onset of pulmonary edema with anxiety, mental confusion, lethargy, and
loss of consciousness. If survived, this episode may be followed by bronchiolitis obliterans (fibrous obstruction of the bronchioles) several weeks
later. Any of these phases can be fatal.
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