Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant

Exposure to metalworking fluid aerosols and determinants of exposure

Metalworking fluid (MWF) aerosols are associated with respiratory disorders including asthma and hypersensitivity pneumonitis. The aims of this study were to describe exposure to inhalable MWF aerosols and volatile compounds in machine shops, to estimate the influence of important determinants of exposure and to compare different sampling techniques for MWF aerosols. Personal full-shift air samples of inhalable aerosol (PAS-6 sampler) and total aerosol (open-faced sampler) were collected on operators in five medium to big-sized machine shops in three companies. The filters were analysed gravimetrically and extracted by supercritical fluid extraction for MWF aerosol and triethanolamine content. In addition, personal measurements were taken for formaldehyde and volatile compounds on adsorbent samplers. Continuous dust measurements were performed with a real-time instrument (DataRAM) during 2 h periods, using 1-min average values. In total, 95 measurements of inhalable aerosol and extracted MWF aerosols on 51 operators were conducted. Within the companies, the average exposure to inhalable aerosol ranged from 0.19 to 0.25 mg m(-3) with geometric standard deviations from 1.56 to 1.79. On average, the extracted fraction of MWF aerosol was 67% of the inhalable aerosol concentration. The exposure levels of triethanolamine, formaldehyde and volatile compounds were generally low. About 45% of the between-worker variance could be explained by use of compressed air, lack of complete enclosure of machines or grinding as cutting task. In 21 workers with continuous aerosol measurements, short-term peak exposures during 6% of the work time contributed to approximately 25% of the average concentration of inhalable MWF aerosol. Inhalable MWF aerosol concentration measured with the PAS-6 sampler was a factor 2 higher than the concentrations derived from the open-faced sampler. These findings suggest that control measures, such as full enclosure of machines and the elimination of the use of compressed air as cleaning technique, are required to reduce the exposure to MWF aerosols to levels below the expected threshold for adverse respiratory health effects.

Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme

BACKGROUND

Trends of occupational asthma (OA) differ between regions depending on local industries, provisions for health and safety at the workplace and the availability of a reporting scheme to help in data collection and interpretation.

AIM

To assess trends in OA in an industrialized part of the UK over a 15-year period.

METHODS

Occupational and chest physicians in the West Midlands were invited to submit details of newly diagnosed cases with OA. Data were then transferred to the regional centre for occupational lung diseases for analysis.

RESULTS

A total of 1461 cases were reported to the scheme. Sixty-eight per cent were males with mean (standard deviation) age of 44 (12) years. The annual incidence of OA was 42 per million of working population (95% CI = 37-45). OA was most frequently reported in welders (9%) and health care-related professions (9%) while < 1% of cases were reported in farmers. Isocyanates were the commonest offending agents responsible for 21% of reports followed by metal working fluids (MWFs) (11%), adhesives (7%), chrome (7%), latex (6%) and glutaraldehyde (6%). Flour was suspected in 5% of cases while laboratory animals only in 1%.

CONCLUSIONS

Our data confirm a high annual incidence of OA in this part of the UK. MWFs are an emerging problem, while isocyanates remain the commonest cause. Incidence remained at a fairly stable background level with many small and a few large epidemics superimposed. Schemes like Midland Thoracic Society's Rare Respiratory Disease Registry Surveillance Scheme of Occupational Asthma could help in identifying outbreaks by linking cases at the workplace.