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Katrina Hedberg, MD; Craig W. Hedberg, MS; Conrad Iber, MD; Karen E. White, MPH; Michael T. Osterholm, PhD, MPH; David B. W. Jones; James R. Flink, MD; Kristine L. MacDonald, MD

JAMA. 1989;262(21):3014-3017.

Abstract
During February 1987 an outbreak of nitrogen dioxide—induced respiratory illness occurred among players and spectators of two high school hockey games played at an indoor ice arena in Minnesota. The source of the nitrogen dioxide was the malfunctioning engine of the ice resurfacer. Case patients experienced acute onset of cough, hemoptysis, and/or dyspnea during, or within 48 hours of attending, a hockey game. One hundred sixteen cases were identified among hockey players, cheerleaders, and band members who attended the two games. Members of two hockey teams had spirometry performed at 10 days and 2 months after exposure; no significant compromise in lung function was documented. Nitrogen dioxide exposure in indoor ice arenas may be more common than currently is recognized; only three states require routine monitoring of air quality in ice arenas, and the respiratory symptoms caused by exposure to nitrogen dioxide are nonspecific and easily misdiagnosed.

(JAMA. 1989;262:3014-3017)

Author Affiliations
From the Division of Field Services, Centers for Disease Control, Atlanta, Ga (Dr K. Hedberg); the Acute Disease Epidemiology Section, Minnesota Department of Health, Minneapolis (Drs K. Hedberg, Osterholm, and MacDonald and Ms White and Messrs C. W. Hedberg and Jones); the Department of Internal Medicine, Hennepin County Medical Center, Minneapolis (Dr lber); and Pulmonary Health Associates, St Paul, Minn (Dr Flink).

Footnotes
Reprint requests to Acute Disease Epidemiology Section, Minnesota Department of Health, 717 Delaware St SE, Minneapolis, MN 55440 (Dr MacDonald).

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