Quantity and Size Distribution of Cough-Generated Aerosol Particles Produced by Influenza Patients During and After Illness
Open accessAbstract
The question of whether influenza is transmitted to a significant degree by aerosols remains controversial, in part, because little is known about the quantity and size of potentially infectious airborne particles produced by people with influenza. In this study, the size and amount of aerosol particles produced by nine subjects during coughing were measured while they had influenza and after they had recovered, using a laser aerosol particle spectrometer with a size range of 0.35 to 10 μm. Individuals with influenza produce a significantly greater volume of aerosol when ill compared with afterward (p = 0.0143). When the patients had influenza, their average cough aerosol volume was 38.3 picoliters (pL) of particles per cough (SD 43.7); after patients recovered, the average volume was 26.4 pL per cough (SD 45.6). The number of particles produced per cough was also higher when subjects had influenza (average 75,400 particles/cough, SD 97,300) compared with afterward (average 52,200, SD 98,600), although the difference did not reach statistical significance (p = 0.1042). The average number of particles expelled per cough varied widely from patient to patient, ranging from 900 to 302,200 particles/cough while subjects had influenza and 1100 to 308,600 particles/cough after recovery. When the subjects had influenza, an average of 63% of each subject's cough aerosol particle volume in the detection range was in the respirable size fraction (SD 22%), indicating that these particles could reach the alveolar region of the lungs if inhaled by another person. This enhancement in aerosol generation during illness may play an important role in influenza transmission and suggests that a better understanding of this phenomenon is needed to predict the production and dissemination of influenza-laden aerosols by people infected with this virus. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a PDF file of demographic information, influenza test results, and volume and peak flow rate during each cough and a PDF file containing number and size of aerosol particles produced.].
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The size range of NaCl particles used is similar to the size of bioaerosols released by subjects under breathing conditions as reported previously.
“This size range of particles is similar to the size of bioaerosols released by subjects under breathing conditions as reported previously. (2-5)”
From A Quantitative Assessment of the Total Inward Leakage of NaCl Aerosol Representing Submicron-Size Bioaerosol Through N95 Filtering Facepiece Respirators and Surgical Masks (2014) · cites this paper as [3]
The Results report the size distribution of aerosols produced by coughing, and Methods > Calculations gives a measured range of 0.35–10 μm. The paper does not report a particle-size distribution measured under breathing conditions or compare it with the citing study’s NaCl particles, so it supports only the general aerosol-size context, not the stated similarity. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNormal human subjects and infected individuals release considerable numbers of submicron diameter particles in exhaled breath.
“Normal human subjects and infected individuals release considerable numbers of submicron diameter particles in the exhaled breath. (2-4)”
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Lindsley, W. G., Pearce, T. A., Hudnall, J. B., Davis, K. A., Davis, S. M., Fisher, M. A., Khakoo, R., Palmer, J. E., Clark, K. E., Celik, I., Coffey, C. C., Blachere, F. M., & Beezhold, D. H.
- Affiliations
- National Institute for Occupational Safety and Health (US)
- West Virginia University (US)
- Corresponding author
- Lindsley, William G.
- Venue
- Journal of Occupational and Environmental Hygiene
- Publisher
- Informa UK Limited
- Published
- 2012-07
- Volume
- 9
- Issue
- 7
- Pages
- 443-449
- ISSN
- 1545-9624 (ISSN-L)
- 1545-9632
- PMC
- PMC4676262
- OpenAlex
- W2154905738
- Cited by
- 300
- References
- 24
- Citations by year
- 2026: 8 · 2025: 23 · 2024: 16 · 2023: 31 · 2022: 36 · 2021: 76 · 2020: 67 · 2019: 6 · 2018: 7 · 2017: 2 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 9
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Occupational and Environmental Hygiene (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- National Institutes of Health (CC999999)
- National Institute for Occupational Safety and Health
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- influenza, cough aerosols, aerosol size distribution, airborne transmission, respiratory droplets, post-infection recovery
- MeSH terms
- Adolescent, Adult, Aerosols, Cough, Female, Humans, Influenza, Human, Male, Particle Size, Spectrum Analysis, Spirometry, Case-Control Studies, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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