The overall reaction results in the release of fluid that causes pulmonary edema.Nitrogen dioxide poisoning may alter macrophage activity and immune function leading to susceptibility of the body to a wide range of infections, and overexposure to the gas may also lead to methemoglobinemia, a disorder characterized by a higher than normal level of methemoglobin (metHb, i.e., ferric [Fe3+] rather than ferrous [Fe2+] haemoglobin) in the blood. Methemoglobinemia prevents the binding of oxygen to haemoglobin causing oxygen depletion that could lead to severe hypoxia.If nitrogen dioxide poisoning is untreated,  fibrous granulation tissue is likely to develop within the alveolar ducts, tiny ducts that connect the respiratory bronchioles to alveolar sacs, each of which contains a collection of alveoli (small mucus-lined pouches made of flattened epithelial cells). The overall reaction may cause an obstructive lung disease. Meanwhile, proliferative bronchiolitis is a secondary effect of nitrogen dioxide poisoning. Epidemiology
The EPA have some regulations and guidelines for monitoring nitrogen dioxide levels. Historically, some states in the U.S including Chicago, Northeast corridor and L.A have had high levels of nitrogen dioxide. In 2006, the WHO estimated that over 2 million deaths result annually from air pollution in which nitrogen dioxide constitute one of the pollutants. While over 50% of the disease that results from these pollutants are common in developing countries and the effects in developed countries is also significant.
It also causes a decrease in glucose-6-phosphate dehydrogenase which may results in glucose-6-phosphate dehydrogenase deficiency known as favism, a condition that predisposes to hemolysis (spontaneous destruction of red blood cells). Acute and chronic exposure also reduces glutathione reductase, an enzyme that catalyzes the reduction of glutathione disulfide (GSSG) to the sulfhydryl form glutathione (GSH), which is a critical molecule in resisting oxidative stress and maintaining the reducing environment of the cell. Reproductive effects
Exposure to nitrogen dioxide has a significant effect on the male reproductive system by inhibiting the production of Sertoli cells, the "nurse" cells of the testicles that are part of a seminiferous tubule and help in the process of spermatogenesis. These effects consequently retard the production of sperm cells. The effects of nitrogen dioxide poisoning on female reproduction may be linked with the effects of oxidative stress on female reproduction. Nitrogen dioxide poisoning disrupts the balance of reactive oxygen species (ROS), which results in oxidative stress, leading to significant effects on the female reproductive lifespan. ROS play a significant role in body physiology, from oocyte production, development and maturation to fertilization, development of the embryo and gestation. Exposure to nitrogen dioxide causes ovulation-induced oxidative damage to the DNA of ovarian epithelium. There is a growing body of literature on the pathological effects of ROS on female reproduction as evidenced by free-radical-induced birth defects, abortions, hydatidiform moles and pre-eclampsia. ROS also play a significant role in the etiopathogenesis of endometriosis, a disease in which tissue that normally grows inside the uterus grows outside of it.