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Mwanga HH, Dumas O, Migueres N, Le Moual N, Jeebhay MF. Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1974-1986. [PMID: 38432401 DOI: 10.1016/j.jaip.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.
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Affiliation(s)
- Hussein H Mwanga
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Nicolas Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France; UMR 7357 Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie ICUBE, Strasbourg, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
| | - Mohamed F Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
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Alhadlaq HW, Ateeq A, Shayea AMF, Gasana J. Occupational Asthma Prevalence among Migrant Workers Attending Shuaiba Industrial Medical Center in Kuwait. Healthcare (Basel) 2023; 11:2021. [PMID: 37510462 PMCID: PMC10379107 DOI: 10.3390/healthcare11142021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Specific work environments, such as exposure to chemicals emitted during industrial processes, are related to occupational asthma. From 1985 to 2012, Kuwait was expected to have the highest asthma prevalence rate among Middle East nations, at 15%. This cross-sectional study was conducted using secondary data from occupational health physicians' records in the Shuaiba Industrial Medical Center (SIMC) extracted and analyzed using SPSS. Chi-square test and logistic regression were used to check the association between risk factors and bronchial asthma (BA). The data sample size was 3478 in 2018 and 3807 in 2019. In 2018, BA had a significant relationship with age categories, work year groups, and determinants of fitness. Migrant workers above 51 years of age had a high risk of developing BA (p-value = 0.012). There was a high risk of developing BA in workers who worked > 21 years (p-value < 0.001) and in workers who worked between 11 and 20 years (p-value = 0.042). Overweight workers had a risk of developing BA (p-value = 0.042). In 2019, BA had an associated relationship with age categories and determinants of fitness. Workers above 51 years of age had about a 39% risk of developing BA (p-value = 0.009). Otherwise, the BMI, working year groups, marital status, and smoking status had no association with BA. In conclusion, BA is prevalent among migrant workers at the SIMC. Long hours, low income, and a lack of PPE are just a few of the issues that migrant workers have been exposed to, raising their risk of poor health.
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Affiliation(s)
- Hussah Waleed Alhadlaq
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Safat 13110, Kuwait
| | - Alanoud Ateeq
- Shuaiba Medical Industrial Center, Occupational Health Department, Ministry of Health, Ahmadi 47005, Kuwait
| | - Abdulaziz M F Shayea
- Departments of Occupational Therapy, Faculty of Allied Health Science, Kuwait University, Kuwait City 12037, Kuwait
- Departments of Molecular Biology, Faculty of Graduate Studies, Kuwait University, Kuwait City 12037, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Safat 13110, Kuwait
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Lantto J, Suojalehto H, Karvala K, Remes J, Soini S, Suuronen K, Lindström I. Clinical Characteristics of Irritant-Induced Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1554-1561.e7. [PMID: 35259533 DOI: 10.1016/j.jaip.2022.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete. OBJECTIVES To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. METHODS This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. RESULTS Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting β-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). CONCLUSIONS Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
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Affiliation(s)
- Jussi Lantto
- Doctoral Program in Clinical Research, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland.
| | - Hille Suojalehto
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland; Varma Mutual Pension Insurance Company, Consultant Physicians, Helsinki, Finland
| | - Jouko Remes
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Satu Soini
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Katri Suuronen
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Irmeli Lindström
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
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Faria VS, da Silva SAEHC, Marchini JFM. Reactive airways dysfunction syndrome following inhalation of hydrogen chloride vapor. AUTOPSY AND CASE REPORTS 2021; 11:e2021266. [PMID: 33968833 PMCID: PMC8087388 DOI: 10.4322/acr.2021.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.
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Affiliation(s)
- Vanessa Simioni Faria
- Universidade de São Paulo (USP), Hospital das Clínicas, Disciplina de Emergências Clínicas do Departamento de Clínica Médica, São Paulo, SP, Brasil
| | | | - Julio Flávio Meirelles Marchini
- Universidade de São Paulo (USP), Hospital das Clínicas, Disciplina de Emergências Clínicas do Departamento de Clínica Médica, São Paulo, SP, Brasil
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Lindström I, Lantto J, Karvala K, Soini S, Ylinen K, Suojalehto H, Suuronen K. Occupations and exposure events in acute and subacute irritant-induced asthma. Occup Environ Med 2021; 78:793-800. [PMID: 33790028 PMCID: PMC8526874 DOI: 10.1136/oemed-2020-107323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
Background Exposures leading to irritant-induced asthma (IIA) are poorly documented. Methods We retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000–2018. We classified the cases into acute (onset after single exposure) and subacute (onset after multiple exposures) IIA. We analysed in detail, occupations, causative agents and their air levels in the workplace, exposure events and the root causes of high exposure. Results Altogether 69 patients were diagnosed with IIA, 30 with acute and 39 with subacute IIA. The most common occupational groups were industrial operators (n=23, 33%), metal and machinery workers (n=16, 11%) and construction workers (n=12, 8%). Among industrial operators significantly more cases had subacute IIA than acute IIA (p=0.002). Forty cases (57%) were attributable to some type of corrosive acidic or alkaline chemical. Acute IIA followed accidents at work in different types of occupation, while subacute IIA was typical among industrial operators performing their normal work tasks under poor work hygiene conditions. The most common root cause was lack of information or false guidance in acute IIA (n=11, 36%) and neglect of workplace hygiene measures in subacute IIA (n=29, 74%). Conclusions Accidents are the main causes of acute IIA, whereas subacute IIA can develop in normal work in risk trades with poor work hygiene. Airborne strong acids or bases seem to be the most important causative agents of acute and subacute IIA. The different risk profiles of acute and subacute IIA should be considered in the prevention and identification of the cases.
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Affiliation(s)
- Irmeli Lindström
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Lantto
- Pulmonary Medicine, Helsinki University Hospital Heart and Lung Center, Helsinki, Finland.,University of Helsinki Faculty of Medicine, Helsinki, Finland
| | - Kirsi Karvala
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland.,Varma Mutual Pension Insurance Company, Helsinki, Finland
| | - Satu Soini
- Occupational Health, Finnish Institute of Occupational Health, Oulu, Finland
| | - Katriina Ylinen
- Work Environmental Laboratories, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Katri Suuronen
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
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Tiotiu AI, Novakova S, Labor M, Emelyanov A, Mihaicuta S, Novakova P, Nedeva D. Progress in Occupational Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4553. [PMID: 32599814 PMCID: PMC7345155 DOI: 10.3390/ijerph17124553] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023]
Abstract
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.
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Affiliation(s)
- Angelica I. Tiotiu
- Department of Pulmonology, University Hospital of Nancy, 54000 Nancy, France
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, 54000 Nancy, France
| | - Silviya Novakova
- Allergy Unit, Internal Consulting Department, University Hospital “St. George”, 4000 Plovdiv, Bulgaria;
| | - Marina Labor
- Department of Pulmonology, University Hospital Centre Osijek, 31000 Osijek, Croatia;
- Medical Faculty Osijek, J.J. Strossmayer University, 31000 Osijek, Croatia
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University, 191015 Saint-Petersburg, Russia;
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, 300120 Timisoara, Romania
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University, 1000 Sofia, Bulgaria;
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Elshaer NS, Foda NM, Kassem HS, Ayaad MW, Meleis DS. Bronchial asthma among workers in Alexandria and its association with occupation, eosinophil count, total serum immunoglobulin E antibodies, and glutathione S-transferase genes polymorphism. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Noha S. Elshaer
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Nermine M.T. Foda
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
| | - Heba S. Kassem
- Pathology Department, Clinical Genomics Center, Faculty of Medicine, Alexandria University, Egypt
| | - Mona W. Ayaad
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Dorreya S. Meleis
- Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt
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Abstract
Occupational exposures are a major cause of lung disease and disability worldwide. This article reviews the broad range of types of occupational lung diseases, including airways disease, pneumoconioses, and cancer. Common causes of occupational lung disease are reviewed with specific examples and clinical features. Emphasis on the importance of a detailed history to make an accurate diagnosis of an occupational lung disease is discussed.
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Affiliation(s)
- David M Perlman
- Division of Pulmonary and Critical Care Medicine, University of Minnesota, MMC # 276, 420 Delaware Street Southeast, Minneapolis, MN 55045, USA
| | - Lisa A Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, 1400 Jackson Street, G212, Denver, CO 80206, USA; Division of Pulmonary and Critical Care Sciences, Environmental Occupational Health Department, School of Medicine, Colorado School of Public Health, University of Colorado, Denver, CO, USA.
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10
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11
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Meggs WJ. History of the Rise and Fall of Environmental Medicine in the United States. ECOPSYCHOLOGY 2017. [DOI: 10.1089/eco.2016.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- William J. Meggs
- Division of Toxicology, Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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12
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Weinberg JL, Flattery J, Harrison R. Fragrances and work-related asthma-California surveillance data, 1993-2012. J Asthma 2017; 54:1041-1050. [PMID: 28332885 DOI: 10.1080/02770903.2017.1299755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Fragrance chemicals are used in a large array of products. Workers may be exposed to these chemicals in the workplace directly when used as air fresheners, or indirectly in personal care products used by coworkers or others. This study characterizes work-related asthma (WRA) cases associated with fragrance exposures in California workplaces from 1993 through 2012. METHODS We used the California Work-Related Asthma Prevention Program's surveillance database to identify individuals with physician-diagnosed WRA associated with the use of air fresheners and scented personal care products (perfumes, colognes, etc.). Cases were classified using previously published, standardized surveillance methods. RESULTS Perfume was the ninth most common exposure identified from 1993 through 2012. A total of 270 WRA cases associated with fragrance exposure were reported during this period, representing 3.8% of all confirmed cases. These 270 cases included 242 associated with perfume or cologne, 32 associated with air freshener, and 4 associated with both. Similar to non-fragrance cases, nearly a quarter of fragrance-associated cases were classified as new-onset asthma. Fragrance-associated cases were significantly more likely to be in office, health, and education jobs than non-fragrance-associated cases. When compared to non-fragrance cases, fragrance cases were significantly more likely to be female (94% vs 62%) and be classified as having work-aggravated asthma (38% vs 20%), yet had similar outcomes compared with cases associated with other exposures. CONCLUSIONS Our surveillance data show that fragrance use in the workplace is associated with WRA. Prevention methods include employee education, enforced fragrance-free policies, well-designed ventilation systems, and good building maintenance.
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Affiliation(s)
- Justine Lew Weinberg
- a Public Health Institute , Contractors to the California Department of Public Health , Richmond , CA , USA
| | | | - Robert Harrison
- b California Department of Public Health , Richmond , CA , USA
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Lee TK, Yoo HW, Bae SH, Kim MJ, Kim GH, Jang AS. Reactive airways dysfunction syndrome after hydrofluoric acid inhalation. Allergol Int 2016; 65:343-4. [PMID: 26944828 DOI: 10.1016/j.alit.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tae-Kyu Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Hae-Won Yoo
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Seong-Hwan Bae
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Min-Jung Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Gyu-Hyung Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - An-Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
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Vandenplas O, Wiszniewska M, Raulf M, de Blay F, Gerth van Wijk R, Moscato G, Nemery B, Pala G, Quirce S, Sastre J, Schlünssen V, Sigsgaard T, Siracusa A, Tarlo SM, van Kampen V, Zock JP, Walusiak-Skorupa J. EAACI position paper: irritant-induced asthma. Allergy 2014; 69:1141-53. [PMID: 24854136 DOI: 10.1111/all.12448] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 01/18/2023]
Abstract
The term irritant-induced (occupational) asthma (IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA.
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Affiliation(s)
- O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - M. Wiszniewska
- Department of Occupational Diseases and Clinical Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Fédération de Médecine Translationnelle de Strasbourg; Strasbourg University; Strasbourg France
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - B. Nemery
- Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ); CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - V. Schlünssen
- Section of Environment, Occupation and Health; Department of Public Health; University of Aarhus; Aarhus Denmark
| | - T. Sigsgaard
- Section of Environment, Occupation and Health; Department of Public Health; University of Aarhus; Aarhus Denmark
| | - A. Siracusa
- Formerly Department of Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - S. M. Tarlo
- Department of Medicine and Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
- Respiratory Division; Toronto Western Hospital; Toronto ON Canada
- Gage Occupational and Environmental Health Unit; St Michael's Hospital; Toronto ON Canada
| | - V. van Kampen
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - J.-P. Zock
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Universitat Pompeu Fabra (UPF); Barcelona Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP); Madrid Spain
- Netherlands Institute of Health Services Research (NIVEL); Utrecht the Netherlands
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases and Clinical Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
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15
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Exhaled Breath Condensate pH and FeNO as Biomarkers of Acute and Chronic Exposure to Hazards at Swine Farms. J Occup Environ Med 2014; 56:946-52. [DOI: 10.1097/jom.0000000000000151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Reactive airways dysfunction syndrome and considerations of irritant-induced Asthma. J Occup Environ Med 2014; 55:1118-20. [PMID: 23969509 DOI: 10.1097/jom.0b013e318229a679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.
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Abstract
Irritant-induced asthma in the workplace has been the focus of several articles in the past few years, and reviewed here. A clinical case definition is most readily associated with a single acute/accidental exposure to a presumed high concentration of an agent or agents expected to be irritant to the airways, as was initially reported with the subgroup Reactive Airways Dysfunction Syndrome (RADS). When most but not all criteria for RADS are met, then a diagnosis of irritant-induced asthma may also be considered to be "more probable than not". However, in addition, there is evolving understanding from epidemiological studies that chronic exposures may be associated with an increased risk of developing asthma. Despite this recognition, the mechanisms and clinical case definitions of work-related asthma that might be caused by chronic exposures to irritants (vs. new-onset asthma that begins coincidentally to work exposures), remain unclear at present.
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Affiliation(s)
- Susan M Tarlo
- Toronto Western Hospital, University Health Network, Toronto Western Hospital EW7-449, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada,
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18
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Abstract
Occupational asthma has been defined as asthma due to conditions attributable to work exposures, not to causes outside the workplace. This review focuses on current data on pathogenesis, evaluation, and management.
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Affiliation(s)
- Susan M Tarlo
- From the University Health Network, University of Toronto Department of Medicine and Dalla Lana School of Public Health, Toronto (S.M.T.); and Hôpital du Sacré Coeur de Montréal, Université de Montréal, Montreal (C.L.)
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Bernstein DI. Management of the individual worker with occupational asthma. Ann Allergy Asthma Immunol 2013; 111:167-9. [PMID: 23987189 DOI: 10.1016/j.anai.2013.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 11/16/2022]
Affiliation(s)
- David I Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
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Aasen TB, Burge PS, Henneberger PK, Schlünssen V, Baur X. Diagnostic approach in cases with suspected work-related asthma. J Occup Med Toxicol 2013; 8:17. [PMID: 23768266 PMCID: PMC3716794 DOI: 10.1186/1745-6673-8-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background Work-related asthma (WRA) is a major cause of respiratory disease in modern societies. The diagnosis and consequently an opportunity for prevention are often missed in practice. Methods Based on recent studies and systematic reviews of the literature methods for detection of WRA and identification of specific causes of allergic WRA are discussed. Results and Conclusions All workers should be asked whether symptoms improve on days away from work or on holidays. Positive answers should lead to further investigation. Spirometry and non-specific bronchial responsiveness should be measured, but carefully performed and validly analysed serial peak expiratory flow or forced expiratory volume in one second (FEV1) measurements are more specific and confirm occupational asthma in about 82% of those still exposed to the causative agent. Skin prick testing or specific immunoglobulin E assays are useful to document allergy to high molecular weight allergens. Specific inhalational challenge tests come closest to a gold standard test, but lack standardisation, availability and sensitivity. Supervised workplace challenges can be used when specific challenges are unavailable or the results non-diagnostic, but methodology lacks standardisation. Finally, if the diagnosis remains unclear a follow-up with serial measurements of FEV1 and non-specific bronchial hyperresponsiveness should detect those likely to develop permanent impairment from their occupational exposures.
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Affiliation(s)
- Tor B Aasen
- Department of Occupational Medicine, Haukeland University Hospital, NO-5021 Bergen, Norway.
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21
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Abstract
The study of occupational asthma (OA) provides insights into asthma in general, as the cause is known. The relationships between the cause and response can be measured and modifying factors can be identified and their influence quantified. Developing OA has much more serious consequences for the patient than new onset asthma unrelated to work exposures, as the patient's livelihood is nearly always affected. Many healthcare professionals are more ready to accept and act on asthmatic symptoms when they are unrelated to work than when work may be the cause; antagonism can also occur in the workplace. This article reviews some of the areas where development and controversy enrich the study of OA. It makes no attempt to be comprehensive.
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Affiliation(s)
- Sherwood Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK.
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22
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Jares EJ, Baena-Cagnani CE, Gómez RM. Diagnosis of occupational asthma: an update. Curr Allergy Asthma Rep 2013; 12:221-31. [PMID: 22467203 DOI: 10.1007/s11882-012-0259-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, "Does asthma improve away from work?" is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.
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Affiliation(s)
- Edgardo J Jares
- Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Pcia de Buenos Aires, Argentina.
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23
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Kenyon NJ, Morrissey BM, Schivo M, Albertson TE. Occupational asthma. Clin Rev Allergy Immunol 2013; 43:3-13. [PMID: 21573916 DOI: 10.1007/s12016-011-8272-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Occupational asthma is the most common occupational lung disease. Work-aggravated asthma and occupational asthma are two forms of asthma causally related to the workplace, while reactive airways dysfunction syndrome is a separate entity and a subtype of occupational asthma. The diagnosis of occupational asthma is most often made on clinical grounds. The gold standard test, specific inhalation challenge, is rarely used. Low molecular weight isocyanates are the most common compounds that cause occupational asthma. Workers with occupational asthma secondary to low molecular weight agents may not have elevated specific IgE levels. The mechanisms of occupational asthma associated with these compounds are partially described. Not all patients with occupational asthma will improve after removal from the workplace.
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Affiliation(s)
- Nicholas J Kenyon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of California, Davis, 4150 V. Street, Sacramento, CA 95817, USA.
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24
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Mayer A, Pacheco K. RADS and its variants: asthma by another name. Immunol Allergy Clin North Am 2012; 33:79-93. [PMID: 23337066 DOI: 10.1016/j.iac.2012.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article describes the different clinical variants of irritant-induced asthma, specifically focusing on high-dose irritant-induced asthma and irritant-induced work-exacerbated asthma, as well as reviews known causes, addresses the often adverse medical and socioeconomic outcomes of this complex condition, and considers issues of causation from an occupational and environmental medicine perspective.
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Affiliation(s)
- Annyce Mayer
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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25
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Abstract
This article summarizes the main new categories of occupational agents responsible for causing occupational asthma, with and without a latency period reported in the last 10 years. It also reports examples of occupational agents for which the fabrication processing or use have influenced the outcome of occupational asthma.
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26
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Abstract
PURPOSE OF REVIEW To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management. RECENT FINDINGS IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA. SUMMARY IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.
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27
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Brooks SM, Bernstein IL. Irritant-induced airway disorders. Immunol Allergy Clin North Am 2012; 31:747-68, vi. [PMID: 21978855 DOI: 10.1016/j.iac.2011.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Thousands of persons experience accidental high-level irritant exposures each year but most recover and few die. Irritants function differently than allergens because their actions proceed nonspecifically and by nonimmunologic mechanisms. For some individuals, the consequence of a single massive exposure to an irritant, gas, vapor or fume is persistent airway hyperresponsiveness and the clinical picture of asthma, referred to as reactive airways dysfunction syndrome (RADS). Repeated irritant exposures may lead to chronic cough and continual airway hyperresponsiveness. Cases of asthma attributed to repeated irritant-exposures may be the result of genetic and/or host factors.
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Affiliation(s)
- Stuart M Brooks
- Colleges of Public Health & Medicine, USF Health Science Center, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
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28
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Abstract
Much has been learned from epidemiologic studies conducted in the past 4 decades that can be directly applied to the management of workers affected with occupational asthma. Studies have provided information about host factors, environmental exposure, and occupational agents posing the highest risks for development of severe irreversible airway obstruction and asthma disability. Investigators have developed methods for screening workers at risk and novel interventions that may prevent new cases among exposed worker populations. Less is known about the natural history and chronic morbidity associated with work-aggravated asthma and irritant-induced asthma syndromes; more studies are needed in at-risk worker populations.
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Affiliation(s)
- Andrew M Smith
- Department of Internal Medicine, Division of Immunology, University of Cincinnati, 3255 Eden Avenue, ML 0563, Cincinnati, OH 45267-0563, USA.
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29
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Malo JL, Vandenplas O. Definitions and classification of work-related asthma. Immunol Allergy Clin North Am 2012; 31:645-62, v. [PMID: 21978849 DOI: 10.1016/j.iac.2011.07.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The workplace can trigger or induce asthma and cause the onset of different types of work-related asthma (WRA). Based on current knowledge of clinical features, pathophysiologic mechanisms, and evidence supporting a causal relationship, the following conditions should be distinguished in the spectrum of WRA: (1) immunologic occupational asthma (OA), (2) nonimmunologic OA, (3) work-exacerbated asthma, and (4) variant syndromes, including eosinophilic bronchitis, potroom asthma, and asthmalike disorders caused by organic dusts. The rationale, issues, and controversies relating to this approach are critically reviewed to stimulate the development of a consensus on operational definitions of the various phenotypes of WRA.
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Affiliation(s)
- Jean-Luc Malo
- Department of Chest Medicine, Hôpital du Sacré-Cœur, Université de Montréal, 5400 West Gouin Boulevard, Montreal H4J 1C5, Canada.
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Burge PS, Moore VC, Robertson AS. Sensitization and irritant-induced occupational asthma with latency are clinically indistinguishable. Occup Med (Lond) 2011; 62:129-33. [PMID: 22199365 DOI: 10.1093/occmed/kqr211] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute irritant exposures at work are well-recognized causes of asthma. In the occupational setting, low-dose exposure to the same agent does not provoke asthma. Occupational asthma (OA) with latency due to irritants is not widely accepted. AIMS To compare workers with OA with latency likely to be due to irritant exposures with workers with the more usual sensitization-induced OA. METHODS Following identification of a worker who fulfils all the criteria for irritant-induced OA with latency whose investigation documented lime dust as a cause for his OA, we searched the Shield reporting scheme database between 1989 and 2010 for entries where the OA was more likely to be due to irritant than allergic mechanisms and compared these with the remainder where allergic mechanisms were likely. Outcome measures were latent interval from first exposure to first work-related symptom, non-specific bronchial reactivity, smoking, atopy and the presence of pre-existing asthma. RESULTS A previously fit lecturer teaching bricklaying had irritant-induced OA with latency without unusual exposures with an immediate asthmatic reaction following exposure to a sand/lime mixture (pH 8). The Shield database identified 127 workers with likely irritant-induced asthma with latency and 1646 with hypersensitivity-induced OA. The two groups were indistinguishable in terms of pre-existing asthma, atopy, age, latent interval, non-specific reactivity and smoking. CONCLUSIONS Irritant exposure is a cause of OA with latency currently clinically indistinguishable from OA due to sensitization.
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Affiliation(s)
- P S Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK.
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31
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Schneider BC, Constant SL, Patierno SR, Jurjus RA, Ceryak SM. Exposure to particulate hexavalent chromium exacerbates allergic asthma pathology. Toxicol Appl Pharmacol 2011; 259:38-44. [PMID: 22178736 DOI: 10.1016/j.taap.2011.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/29/2011] [Accepted: 12/01/2011] [Indexed: 01/09/2023]
Abstract
Airborne hexavalent chromate, Cr(VI), has been identified by the Environmental Protection Agency as a possible health threat in urban areas, due to the carcinogenic potential of some of its forms. Particulate chromates are produced in many different industrial settings, with high levels of aerosolized forms historically documented. Along with an increased risk of lung cancer, a high incidence of allergic asthma has been reported in workers exposed to certain inhaled particulate Cr(VI) compounds. However, a direct causal association between Cr(VI) and allergic asthma has not been established. We recently showed that inhaled particulate Cr(VI) induces an innate neutrophilic inflammatory response in BALB/c mice. In the current studies we investigated how the inflammation induced by inhaled particulate Cr(VI) might alter the pathology of an allergic asthmatic response. We used a well-established mouse model of allergic asthma. Groups of ovalbumin protein (OVA)-primed mice were challenged either with OVA alone, or with a combination of OVA and particulate zinc chromate, and various parameters associated with asthmatic responses were measured. Co-exposure to particulate Cr(VI) and OVA mediated a mixed form of asthma in which both eosinophils and neutrophils are present in airways, tissue pathology is markedly exacerbated, and airway hyperresponsiveness is significantly increased. Taken together these findings suggest that inhalation of particulate forms of Cr(VI) may augment the severity of ongoing allergic asthma, as well as alter its phenotype. Such findings may have implications for asthmatics in settings in which airborne particulate Cr(VI) compounds are present at high levels.
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Affiliation(s)
- Brent C Schneider
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, DC 20037, USA
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32
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Kim KH, Jahan SA, Lee JT. Exposure to formaldehyde and its potential human health hazards. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2011; 29:277-299. [PMID: 22107164 DOI: 10.1080/10590501.2011.629972] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A widely used chemical, formaldehyde is normally present in both indoor and outdoor air. The rapid growth of formaldehyde-related industries in the past two decades reflects the result of its increased use in building materials and other commercial sectors. Consequently, formaldehyde is encountered almost every day from large segments of society due to its various sources. Many governments and agencies around the world have thus issued a series of standards to regulate its exposure in homes, office buildings, workshops, public places, and food. In light of the deleterious properties of formaldehyde, this article provides an overview of its market, regulation standards, and human health effects.
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Affiliation(s)
- Ki-Hyun Kim
- Department of Environment & Energy, Sejong University, Seoul, Korea.
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33
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Adewole F, Moore VC, Robertson AS, Burge PS. Diesel exhaust causing low-dose irritant asthma with latency? Occup Med (Lond) 2011; 59:424-7. [PMID: 19692525 DOI: 10.1093/occmed/kqp102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diesel exhaust exposure may cause acute irritant-induced asthma and potentiate allergen-induced asthma. There are no previous reports of occupational asthma due to diesel exhaust. AIMS To describe occupational asthma with latency in workers exposed to diesel exhaust in bus garages. METHODS The Shield database of occupational asthma notifications in the West Midlands, UK, was searched between 1990 and 2006 for workers where diesel exhaust exposure was thought to be the cause of the occupational asthma. Those without other confounding exposures whose occupational asthma was validated by serial peak expiratory flow (PEF) analysis using Oasys software were included. RESULTS Fifteen workers were identified with occupational asthma attributed to diesel exhaust. Three had validated new-onset asthma with latency. All worked in bus garages where diesel exhaust exposure was the only likely cause of their occupational asthma. Occupational asthma was confirmed by measures of non-specific reactivity and serial measurements of PEF with Oasys scores of 2.9, 3.73 and 4 (positive score > 2.5). CONCLUSIONS The known non-specific irritant effects of diesel exhaust suggest that this is an example of low-dose irritant-induced asthma and that exposures to diesel exhaust in at least some bus garages are at a sufficient level to cause this.
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Affiliation(s)
- Femi Adewole
- Department of Medicine, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Nigeria.
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34
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Greven FE, Rooyackers JM, Kerstjens HAM, Heederik DJ. Respiratory symptoms in firefighters. Am J Ind Med 2011; 54:350-5. [PMID: 21246589 DOI: 10.1002/ajim.20929] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to determine the prevalence and risk factors associated with respiratory symptoms in common firefighters in the Netherlands. METHODS A total of 1,330 firefighters from the municipal fire brigades of three provinces of the Netherlands were included in the study. All subjects were administered a Dutch web-based version of the European Community Respiratory Health Survey questionnaire. RESULTS General respiratory symptoms were associated with the number of fires fought in the last 12 months with odds ratios between 1.2 (95% CI 1.0-1.4) and 1.4 (95% CI 1.2-1.7) per 25 fires. A strong association was found between an inhalation incident and present respiratory symptoms with odds ratios between 1.7 (95% CI 1.1-2.7) and 3.0 (95% CI 1.9-4.7). Adjustments for smoking, sex, atopy, and age did not change any of the associations. After stratification, atopics showed elevated odds ratios. CONCLUSIONS It is recommended that firefighters are aware of these elevated healthcare risks associated with exposure to fire smoke and that they increase as much as possible the use of self-contained breathing apparatus.
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Affiliation(s)
- Frans E Greven
- Department of Environmental Health, Municipal Health Services Groningen, the Netherlands. f.greven.@hvd.groningen.nl
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35
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Bello A, Quinn MM, Perry MJ, Milton DK. Quantitative assessment of airborne exposures generated during common cleaning tasks: a pilot study. Environ Health 2010; 9:76. [PMID: 21118559 PMCID: PMC3002341 DOI: 10.1186/1476-069x-9-76] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 11/30/2010] [Indexed: 05/25/2023]
Abstract
BACKGROUND A growing body of epidemiologic evidence suggests an association between exposure to cleaning products with asthma and other respiratory disorders. Thus far, these studies have conducted only limited quantitative exposure assessments. Exposures from cleaning products are difficult to measure because they are complex mixtures of chemicals with a range of physicochemical properties, thus requiring multiple measurement techniques. We conducted a pilot exposure assessment study to identify methods for assessing short term, task-based airborne exposures and to quantitatively evaluate airborne exposures associated with cleaning tasks simulated under controlled work environment conditions. METHODS Sink, mirror, and toilet bowl cleaning tasks were simulated in a large ventilated bathroom and a small unventilated bathroom using a general purpose, a glass, and a bathroom cleaner. All tasks were performed for 10 minutes. Airborne total volatile organic compounds (TVOC) generated during the tasks were measured using a direct reading instrument (DRI) with a photo ionization detector. Volatile organic ingredients of the cleaning mixtures were assessed utilizing an integrated sampling and analytic method, EPA TO-17. Ammonia air concentrations were also measured with an electrochemical sensor embedded in the DRI. RESULTS Average TVOC concentrations calculated for 10 minute tasks ranged 0.02 - 6.49 ppm and the highest peak concentrations observed ranged 0.14-11 ppm. TVOC time concentration profiles indicated that exposures above background level remained present for about 20 minutes after cessation of the tasks. Among several targeted VOC compounds from cleaning mixtures, only 2-BE was detectable with the EPA method. The ten minute average 2- BE concentrations ranged 0.30 -21 ppm between tasks. The DRI underestimated 2-BE exposures compared to the results from the integrated method. The highest concentration of ammonia of 2.8 ppm occurred during mirror cleaning. CONCLUSIONS Our results indicate that airborne exposures from short-term cleaning tasks can remain in the air even after tasks' cessation, suggesting potential exposures to anyone entering the room shortly after cleaning. Additionally, 2-BE concentrations from cleaning could approach occupational exposure limits and warrant further investigation. Measurement methods applied in this study can be useful for workplace assessment of airborne exposures during cleaning, if the limitations identified here are addressed.
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Affiliation(s)
- Anila Bello
- Department of Environmental Health, Harvard School of Public Health, 410 Park Drive, Boston, MA- 02215, USA
- Department of Work Environment, University of Massachusetts Lowell, One University Avenue, Lowell, MA- 01854, USA
| | - Margaret M Quinn
- Department of Work Environment, University of Massachusetts Lowell, One University Avenue, Lowell, MA- 01854, USA
| | - Melissa J Perry
- Department of Environmental Health, Harvard School of Public Health, 410 Park Drive, Boston, MA- 02215, USA
| | - Donald K Milton
- Department of Environmental Health, Harvard School of Public Health, 410 Park Drive, Boston, MA- 02215, USA
- Department of Work Environment, University of Massachusetts Lowell, One University Avenue, Lowell, MA- 01854, USA
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD -20742, USA
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Ermis H, Gokirmak M, Yildirim Z, Yologlu S, Ankarali H. Exposure to SO2 does not have a chronic effect on pulmonary functions of apricot workers. Inhal Toxicol 2010; 22:219-23. [PMID: 20038208 DOI: 10.3109/08958370903176743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors have previously demonstrated that apricot sulfurization workers develop asthma-like syndrome during apricot sulfurization due to exposure to sulfur dioxide (SO(2)) gas. The aim of the current study was to demonstrate if exposure to SO(2) gas had any chronic effects on pulmonary functions and bronchial reactivity of the workers. Twenty-five apricot sulfurization workers and a control group were included in the study. Physical examination, skin prick tests, pulmonary function tests (PFTs), and bronchoprovocation tests (BPTs) were performed before and after the season of sulfurization in the worker group. Skin prick tests, PFTs, and BPTs were performed also in the control group without a history of exposure to SO(2) gas. There was no statistically significant difference between PFT and BPT results of the workers and the control group. Comparison of the PFT results of the workers before and after the season of apricot sulfurization neither reveal a significant difference. Four (16%) out of 25 workers were positive for BPTs before the period. Only one worker who had a negative BPT result before the sulfurization season was positive afterwards. The lack of a chronic effect on pulmonary functions is consistent with the diagnosis of asthma-like syndrome in apricot sulfurization workers.
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Affiliation(s)
- Hilal Ermis
- Department of Pulmonary Diseases, Baskent University Adana Research Hospital, Adana, Turkey
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37
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Brooks SM. Occupational, Environmental, and Irritant-Induced Cough. Otolaryngol Clin North Am 2010; 43:85-96, ix. [DOI: 10.1016/j.otc.2009.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Smith AM, Bernstein DI. Management of work-related asthma. J Allergy Clin Immunol 2009; 123:551-7. [PMID: 19281902 DOI: 10.1016/j.jaci.2008.12.1129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/12/2008] [Accepted: 12/17/2008] [Indexed: 01/15/2023]
Abstract
The physician managing work-related asthma (WRA) assumes many roles. The first is to confirm an accurate diagnosis, recognizing that WRA has multiple phenotypes, including sensitizer-induced occupational asthma (OA) caused by high-molecular-weight (HMW) proteins or low-molecular-weight (LMW) chemicals; irritant-induced asthma; and work-exacerbated asthma. Pharmacotherapy for WRA is identical to nonwork-related asthma and should be guided by current asthma guidelines emphasizing control of both asthma impairment and risk domains. It is well established that the majority of workers diagnosed with OA caused by sensitizers experience persistent asthma after leaving the workplace. However, the long-term risk of persistent unremitting asthma can be prevented in a minority of cases, particularly with OA caused by LMW sensitizers, by establishing an early diagnosis of OA and reducing or eliminating exposure. The physician consultant may advise employers on workplace interventions needed to minimize effectively an affected employee's exposure to a causative agent or condition, and what measures are required to prevent new cases of WRA (ie, primary prevention). Although allergen immunotherapy has a putative role in treating and preventing WRA caused by HMW sensitizers, further study is needed.
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Affiliation(s)
- Andrew M Smith
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0563, USA
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Maestrelli P, Boschetto P, Fabbri LM, Mapp CE. Mechanisms of occupational asthma. J Allergy Clin Immunol 2009; 123:531-42; quiz 543-4. [DOI: 10.1016/j.jaci.2009.01.057] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 01/23/2009] [Accepted: 01/26/2009] [Indexed: 11/29/2022]
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41
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Gorguner M, Aslan S, Inandi T, Cakir Z. Reactive Airways Dysfunction Syndrome in Housewives Due to a Bleach–Hydrochloric Acid Mixture. Inhal Toxicol 2008; 16:87-91. [PMID: 15204781 DOI: 10.1080/08958370490265004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The sudden onset of asthmalike symptoms and persistence of airway reactivity following an acute exposure to an irritant gas or vapor has been termed reactive airways dysfunction syndrome (RADS). A mixture of sodium hypochlorite (bleach, 40%) and hydrochloric acid (18%) is commonly used as a household cleaning solution in our region. From this mixture, chlorine gas is produced, which can cause airway damage and ensuing RADS. Here we describe findings of patients with RADS due to this cleaning mixture, and determine factors associated with a favorable outcome. Data were collected retrospectively on 55 symptomatic patients presenting to our emergency department after inhalation exposure to a mixture of bleach and hydrochloric acid. Symptoms, past medical and smoking history, details of the exposure, initial peak expiratory flow rate (PEFR) and oxygenation, and acute reversibility of airways obstruction were documented. All patients met previously defined criteria for the diagnosis of RADS, but did not undergo methacholine challenge testing and bronchoalveolar lavage or histopathologic study. Fifty patients were followed over the course of 3 mo. The majority of exposures (64%) occurred in the bathroom or kitchen. Only 21 of 55 (38%) patients showed an improvement in PEFR of 15% or greater following two beta(2)-agonist inhalation treatments. In follow-up, 48 patients (87%) improved clinically and functionally (FEV(1)). Seven patients (13%) deteriorated, with ARDS developing in two, one of whom died from respiratory failure. Advanced age, initial low PEFR, exposure in a small enclosed area, use immediately after mixing, and prolonged short- and long-term exposures were associated with a poorer prognosis. This descriptive study is the largest case series in the literature of RADS developing after exposure to a bleach-hydrochloric acid mixture. The optimum acute treatment and long-term outcomes for patients with RADS due to this combination still need to be determined.
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Affiliation(s)
- Metin Gorguner
- Department of Chest Diseases, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
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Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F, Harber P, Lemiere C, Liss GM, Pacheco KA, Redlich CA, Rowe B, Heitzer J. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest 2008; 134:1S-41S. [PMID: 18779187 DOI: 10.1378/chest.08-0201] [Citation(s) in RCA: 306] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA). METHODS A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007. RESULTS The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed. CONCLUSIONS The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers.
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Affiliation(s)
| | - John Balmes
- University of California San Francisco, San Francisco, CA
| | | | | | - William Beckett
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Paul D Blanc
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Philip Harber
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | - Brian Rowe
- University of Alberta, Calgary, AB, Canada
| | - Julia Heitzer
- American College of Chest Physicians, Northbrook, IL
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Work-related asthma in automobile spray painters: two case reports. Arh Hig Rada Toksikol 2008; 59:117-25. [PMID: 18573749 DOI: 10.2478/10004-1254-59-2008-1858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This report describes two patients who had developed asthma after working as automobile painters with isocyanate-based aerosol paint for two years or over. In both patients asthma was confirmed using the standard diagnostic procedure. One of the subjects was atopic. One was ex-smoker and the other had never smoked. Neither had a family history of asthma. The symptoms occurred after workplace exposure lasting two years in one patient and three in the other. As both reported work-relatedness of the symptoms, they underwent serial peak expiratory flow rate (PEFR) measurement and bronchoprovocation testing. Significant work-related changes in PEFR diurnal variations and in non-specific bronchial hyperresponsiveness (NSBH) were observed in one patient, suggesting allergic occupational asthma (OA), while the other patient was diagnosed work-exacerbated asthma (WEA). Our data confirm that spray painting is an occupation with increased risk of respiratory impairment and asthma.
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Cell types involved in allergic asthma and their use in in vitro models to assess respiratory sensitization. Toxicol In Vitro 2008; 22:1419-31. [PMID: 18603401 DOI: 10.1016/j.tiv.2008.05.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/02/2008] [Accepted: 05/23/2008] [Indexed: 11/22/2022]
Abstract
This review first describes the mechanism and cell types involved in allergic asthma, which is a complex clinical disease characterized by airway obstruction, airway inflammation and airway hyperresponsiveness to a variety of stimuli. The development of allergic asthma exists of three phases, namely the induction phase, the early-phase asthmatic reaction (EAR) and the late-phase asthmatic reaction (LAR). In the induction phase, antigen-presenting cells play a major role. Most important cells in the EAR are mast cells, and during the LAR, various cell types, such as eosinophils, neutrophils, T cells, macrophages, dendritic cells (DCs), and cells that endow structure are involved. In occupational asthma, this immunological mechanism is involved in 90% of the cases. The second part of this review gives an overview of in vitro models to assess the hazardous potential of high- and low-molecular weight chemicals on the respiratory system. In order to develop a good in vitro model for respiratory allergy, the choice of appropriate cell types is important. Epithelial cells, macrophages and DCs are currently the most used models in this field of research.
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Abstract
This article presents our current understanding of the biological heterogeneity of asthma and reviews some of the key features of the latest proposed recommendations of the National Asthma Education and Prevention Program Guidelines. The diagnosis of asthma is based on such clinical features as variable airflow obstruction that is partially if not fully reversible and airway hyperresponsiveness that predisposes to episodic bronchospasm following exposure to a variety of triggers. The underlying inflammation and airway biology of asthma is heterogeneous and is part of the explanation for the variable response to therapy. New biologics that help to characterize patients according to their underlying biology will aid in making better choices for treatment. New asthma guidelines emphasize the importance of regular monitoring.
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Affiliation(s)
- Ronald Balkissoon
- National Jewish Medical and Research Center, The University of Colorado School of Medicine, 1400 Jackson Street, Room J215, Denver, CO 80206, USA.
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Noisel N, Bouchard M, Carrier G. Evaluation of the health impact of lowering the formaldehyde occupational exposure limit for Quebec workers. Regul Toxicol Pharmacol 2007; 48:118-27. [PMID: 17408825 DOI: 10.1016/j.yrtph.2007.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Indexed: 10/23/2022]
Abstract
This study aimed at assessing the impact on irritating effects of lowering the current occupational exposure limit (OEL) for formaldehyde in occupational settings in the Province of Quebec, Canada, from a 2 ppm ceiling value to 1, 0.75 or 0.3 ppm. This was achieved through (i) a re-assessment of the exposure-response relationship based on a pooled analysis of published controlled human studies on the incidence of the most sensitive effects related to acute formaldehyde exposure (irritation of the eyes, nose and throat) and (ii) application of this relationship to the data on current exposure to formaldehyde in industrial sectors of Quebec. Results show that the exposure-irritating effect relationship compiled by concentration ranges and by degree of severity was best described by quadratic regression. Considering the current distribution of formaldehyde exposure among the 143,491 Quebec workers concerned, eye irritation, the most sensitive effect, could affect 526 workers (0.367%) at a moderate degree and 50 workers (0.035%) at a severe degree. By reducing the OEL to 1, 0.75 and 0.3 ppm, the proportion of these effects estimated to be avoided would be 442/526 (84%), 526/526 (100%) and 526/526 (100%), respectively. Results for nose and throat irritation follow the same trend. The greatest gain would thus be obtained by respecting the current OEL; the additional gain was estimated to be negligible below 0.75 ppm. The level of 0.75 ppm can be considered as a safe level that allows protecting virtually all workers.
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Affiliation(s)
- Nolwenn Noisel
- Groupe de recherche interdisciplinaire en Santé, Faculté de Médecine, Université de Montréal, Main Station, Montreal, Que., Canada
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48
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Richards IS, DeHate RB. Formalin produces depolarizations in human airway smooth muscle in vitro. Toxicol Ind Health 2007; 22:59-63. [PMID: 16716036 DOI: 10.1191/0748233706th243oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Respiratory irritants may result in airway smooth muscle (ASM) depolarization and bronchoconstriction. We examined the effect of formalin on membrane potentials in human ASM in two types of in vitro preparations: strip preparations, which contain functional sensory and motor nerve endings and cultured cells, which lack these nerve endings due to the tissue dissociation process. Depolarizations occurred in atropine-treated strip preparations in response to formalin exposures, but not in similarly-treated cultured cells, suggesting a role for non-cholinergic mediators in formalin-induced depolarization. It is suggested that formalin may act as an irritant to produce bronchoconstriction that is mediated by the release of endogenous substance P (SP) from peripheral sensory nerve endings. This is supported by our observation that exogenous SP produced depolarizations of a magnitude similar to those produced by formalin in both strip preparations and cultured cells. In addition, capsaicin, which releases endogenous SP from nerve endings, produced depolarizations of a magnitude similar to formalin in strip preparations, but was without effect in cultured cells.
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Affiliation(s)
- Ira S Richards
- Department of Environmental and Occupational Health, College of Public Health, University of South Florida, Tampa, FL, USA.
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Francis HC, Prys-Picard CO, Fishwick D, Stenton C, Burge PS, Bradshaw LM, Ayres JG, Campbell SM, Niven RM. Defining and investigating occupational asthma: a consensus approach. Occup Environ Med 2006; 64:361-5. [PMID: 17130175 PMCID: PMC2078517 DOI: 10.1136/oem.2006.028902] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND At present there is no internationally agreed definition of occupational asthma and there is a lack of guidance regarding the resources that should be readily available to physicians running specialist occupational asthma services. AIMS To agree a working definition of occupational asthma and to develop a framework of resources necessary to run a specialist occupational asthma clinic. METHOD A modified RAND appropriateness method was used to gain a consensus of opinion from an expert panel of clinicians running specialist occupational asthma clinics in the UK. RESULTS Consensus was reached over 10 terms defining occupational asthma including: occupational asthma is defined as asthma induced by exposure in the working environment to airborne dusts vapours or fumes, with or without pre-existing asthma; occupational asthma encompasses the terms "sensitiser-induced asthma" and "acute irritant-induced asthma" (reactive airways dysfunction syndrome (RADS)); acute irritant-induced asthma is a type of occupational asthma where there is no latency and no immunological sensitisation and should only be used when a single high exposure has occurred; and the term "work-related asthma" can be used to include occupational asthma, acute irritant-induced asthma (RADS) and aggravation of pre-existing asthma. Disagreement arose on whether low dose irritant-induced asthma existed, but the panel agreed that if it did exist they would include it in the definition of "work-related asthma". The panel agreed on a set of 18 resources which should be available to a specialist occupational asthma service. These included pre-bronchodilator FEV1 and FVC (% predicted); peak flow monitoring (and plotting of results, OASYS II analysis); non-specific provocation challenge in the laboratory and specific IgE to a wide variety of occupational agents. CONCLUSION It is hoped that the outcome of this process will improve uniformity of definition and investigation of occupational asthma across the UK.
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Affiliation(s)
- H C Francis
- North West Lung Research Centre, Wythenshawe Hospital, Manchester, UK.
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Aslan S, Kandiş H, Akgun M, Cakir Z, Inandi T, Görgüner M. The effect of nebulized NaHCO3 treatment on "RADS" due to chlorine gas inhalation. Inhal Toxicol 2006; 18:895-900. [PMID: 16864407 DOI: 10.1080/08958370600822615] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17-56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd-even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting beta2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p < .05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p < .001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.
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Affiliation(s)
- Sahin Aslan
- Department of Emergency Medicine, School of Medicine, Atatürk University, Erzurum, Turkey
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