The spectrum of respiratory disease associated with exposure to metal working fluids

Occupational respiratory diseases have been reported following exposure to metal working fluids. We report a spectrum of respiratory illnesses occurring in an outbreak in 30 workers of an automobile parts engine manufacturing plant. Workers presented with respiratory complaints and, after clinical and laboratory evaluations, were classified as those having hypersensitivity pneumonitis, occupational asthma, or industrial bronchitis, or those without occupational lung disease. Hypersensitivity pneumonitis affected seven workers, with six exhibiting serum precipitins to Acinetobacter Iwoffii. Occupational asthma and industrial bronchitis affected 12 and six workers, respectively. Oil-mist exposures were below current recommendations. Gram-negative bacteria, but no fungi, Thermophiles, or Legionella, were identified. Although specific agents responsible for each individual case could not be identified, probably both specific sensitizing agents and non-specific irritants from metal working fluids, additives, or contaminants contributed to this spectrum of occupational respiratory illness.     

Intraoperative direct electrical stimulation of the lamina quadrigemina in a case of a deep tectal cavernoma

Occupational asthma is specifically induced by repeated exposure to substances in the work place. Diagnosis requires using the results of numerous tests, and a challenge test is the most appropriate to establish the diagnosis of occupational asthma due to chemical agents. Agents responsible for occupational asthma may be of animal or vegetable origin, or may be chemical agents. The pathophysiological mechanisms of occupational asthma are not well known. It is probable that immunologic mechanisms play an important role, in particular in occupational asthma due to glycoproteins. An important feature of occupational asthma is the relationship to chemical substances, for which the mechanisms are often still hypothetical. From the legal viewpoint, a recent law holds the promise of better compensation for those who are afflicted.     

Lung reduction surgery: a true advance?

Occupational asthma is one of the commonest occupational lung diseases. This is a case of asthma related to arc-welding in a shipyard. Serial peak expiratory flow rate readings were taken with and without exposure to the welding process. The results showed that the patient had occupational asthma from welding. This case report serves to remind us of the need to ask every adult with asthma for their occupational history. It emphasises the need for early diagnosis and removal from the cause of asthma. A delay in diagnosis may lead to non-specific bronchial reactivity and persistence of symptoms.     

Heparin, but not other proteoglycans potentiates the mitogenic effects of FGF-2 on mesencephalic precursor cells

Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12-32%) of cases giving an incidence of 71/100,000 (95% CI 43-111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma.     

Occupational asthma

The definition of occupational asthma is described. Causative agents which may be responsible for the development of occupational asthma are listed. Among factors responsible for the development of occupational asthma, immunological and nonimmunological mechanisms are specially described. The clinical characteristics of the disease, diagnostic methods, differential diagnosis, prognosis and prevention of occupational asthma are described. Procedures for determining exposure, occupations in which most frequently occupational asthma can develop, as well as preventive measures are reported.     

Nurse managed occupational health services without on-site clinical care delivery: a case example

1. In this program management/community network model of occupational health services, the occupational health nurse is responsible for managing program development and implementation, with vendors providing the clinical services. 2. Occupational health nurses' primary areas of responsibility are occupational health, disability case management, ergonomics, and health promotion. 3. Successful management of program outcomes requires the occupational health nurse to continually assess employee/business needs, maintain communication with employees and management, and partner with the environmental, health, and safety team, other functional work groups, and vendors. 4. Effective management of contracts becomes critical to the process beginning with clear service requirements through the delivery of quality services.     

Outpatient laparoscopic cholecystectomy: safe and cost effective?

OBJECTIVE: Reports on the aetiology and risk of occupational rhinitis in different occupations are scarce. METHOD: The purpose of this study was to find the occupations with an increased risk of occupational rhinitis. Age and gender differences in occupational rhinitis and occupational asthma were also compared, and the most common causes of occupational rhinitis were analysed. DESIGN: This study covered the cases of occupational rhinitis and asthma reported to the Finnish Register of Occupational Diseases during the years 1986-1991. The cases on the Register were linked to the longitudinal census data file from the Finnish censuses. RESULTS: During 1986-1991, 1244 new cases of occupational rhinitis (474 women and 497 men) and 1867 new cases of occupational asthma (916 women and 951 men) were reported to the Register. Animal dander, flours, wood dusts, textiles, phthalic acid anhydrides and storage mites were important causes of occupational rhinitis. The highest relative risk of occupational rhinitis was among furriers, the age-standardized rate ratio (SRR) was 30.0. Bakers and livestock breeders had also a markedly elevated relative risk (SRR = 22.0). Men had the highest incidence of occupational rhinitis at the age of 25-29 years and among women the incidence gradually increased and reached the peak in the group 40-44 years of age. CONCLUSION: Furriers, bakers, and livestock breeders had the most elevated relative risk of occupational rhinitis. Occupational rhinitis cases reported at a younger age than asthma, suggesting that rhinitis often precedes asthma.     

Principles for assessment and diagnosis of work-related pulmonary and pleural diseases

Proposals for diagnostic methods and clinical evaluation of occupational lung and pleural diseases have been worked out by a Working Group appointed by the Norwegian Thoracic Society and the Norwegian Society of Occupational Medicine. The management of this group of diseases demands both an evaluation of occupational exposure and a specific pulmonary diagnosis. Recommendations were made especially for obstructive, interstitial, and malignant diseases.     

Occupational asthma. Practical points for diagnosis and management

Asthma is a common chronic illness characterized by episodes of reversible airflow obstruction. A cornerstone of asthma management is identifying and avoiding agents that cause bronchospasm. The workplace is an important potential source of respirable exposures that can cause or trigger asthma. Identification of an occupational factor in asthma is important: early diagnosis and removal of the worker from the exposure is associated with improved prognosis; the diagnosis of occupational asthma may lead to compensation for work-related impairment and disability; and the diagnosis of occupational asthma is a Sentinel Health Event with implications for public health and prevention. In this article, we review specific causes of occupational asthma and general settings in which an occupational factor should be suspected and explored as part of the management of the worker with asthma. We also review specific and simple elements of history and pulmonary function testing that can be easily assessed by most health care practitioners and may be sufficient to establish a diagnosis of occupational asthma. Finally, we review the medical-legal implications of occupational asthma.     

Occupational asthma in a latex doll manufacturing plant

BACKGROUND: Occupational asthma caused by latex has been reported in health care workers and workers in glove manufacturing plants. OBJECTIVE: We report occupational asthma from latex in a newly identified occupational setting, a latex doll manufacturing plant. METHODS: We evaluated an index case of asthma associated with work in a latex doll manufacturing plant by performing a workplace challenge and evaluating the work environment. We then performed an occupational survey and skin testing of 22 workers in the doll manufacturing plant. RESULTS: The patient, a 21-year-old woman, had severe immediate bronchospasm within minutes of beginning a workplace challenge where sanding of latex parts was performed. Two of 22 workers surveyed (including the patient) reported flushing, rhinoconjunctivitis, and wheezing on exposure to sanded doll parts. These two workers were the only subjects surveyed to have a history of atopy and positive immediate-type skin test responses to a raw latex extract and to common aeroallergens. CONCLUSIONS: Sanding or grinding of solid latex during the manufacturing process may result in a significant incidence of occupational asthma and rhinoconjunctivitis from latex sensitization. Atopic workers appear to be most susceptible to developing latex sensitivity in this setting.     

Occupational asthma: what have we learned?

Occupational asthma is one of the most frequent work-related diseases and may represent between 2% and 6% of all cases of asthma. It is defined as asthma causally and specifically related to exposure to airborne dusts, gases, vapors, or fumes in the working environment. Because it may cause long-lasting disability, it is important to properly identify affected workers and to withdraw them from exposure to the sensitizing agent as soon as possible. Although the history is the clue to the diagnosis, it is not sensitive or specific. The diagnosis should be confirmed by objective means, essentially by monitoring of peak expiratory flow and nonallergic bronchial responsiveness or by specific inhalation challenges. In this article the author reviews the investigation of occupational asthma.     

Prevention of occupational asthma including medical surveillance

The high figures of occupational asthma worldwide necessitate the intensification of appropriate primary, secondary, and tertiary preventive measures. Based on new scientific data on dose-response relationships as well as our own experience and ethical aspects, we focus on medical surveillance within the framework of secondary prevention. We propose that medical surveillance programs be mandatory for workplaces/occupations with an asthma incidence of > or = 200% than that of the general population. Medical surveillance programs are recommended if asthma frequency is elevated but below 200%. A stepwise approach of monitoring workers at risk for developing occupational asthma including a screening by questionnaire and a personal interview and diagnosis confirmation is presented. In addition, we briefly comment on the management of affected subjects.     

Surface tension of blood

Buckwheat flour, mainly used for pancakes, may induce asthma following inhalation and anaphylactic reactions following ingestion. These allergic reactions are mediated by specific IgE and may be confirmed by skin test and radio-allergo-sorbent test. The occupational asthma of a patient working in pancake restaurant was confirmed by specific challenge test with a computerised device to generate particles. A very small amount of buckwheat flour (10 micrograms) induced an immediate fall of the FEV1 to 56% of the initial value. No bronchial reaction was observed with lactose nor with wheat flour. Specific bronchial challenge identifies the allergen responsible for asthma, measures the level of sensitization and thus can prevent the occupational exposure.     

Identification and characterization of a constitutive HSP75 in sea urchin embryos

STUDY OBJECTIVE: To evaluate the influence of occupational exposure to carcinogens in explaining the association between socioeconomic status and lung cancer. DESIGN: A prospective cohort study. Data on diet, other lifestyle factors, sociodemographic characteristics and job history were collected by means of a self administered questionnaire. Follow up for incident cancer was established by record linkage with a national pathology register and with regional cancer registries. SETTING: Population originating from 204 municipalities in The Netherlands. PARTICIPANTS: These comprised 58 279 men aged 55-69 years in September 1986. After 4.3 years of follow up there were 470 microscopically confirmed incident lung cancer cases with complete data on dietary habits and job history. MEASUREMENTS AND MAIN RESULTS: Estimation of occupational exposure to asbestos, paint dust, polycyclic aromatic hydrocarbons, and welding fumes was carried out by two experts, using information on job history from the baseline questionnaire. Socioeconomic status was measured by means of highest attained level of education and two indicators based on occupation. In the initial multivariate analyses of socioeconomic status and lung cancer, adjustment was made for age, smoking habits, intake of vitamin C, beta-carotene and retinol, and history of chronic obstructive pulmonary disease or asthma. Additional adjustment for occupational exposure to the four carcinogens mentioned above did not change the inverse association between the level of education and lung cancer risk (initial model: RR highest/lowest level of education = 0.53; 95% CI 0.34, 0.82; additional model: RR highest/lowest level of education = 0.53; 95% CI 0.34, 0.84). Nor was the association between the two occupation based indicators of socioeconomic status and lung cancer risk influenced by occupational exposure to carcinogens. The effect of occupational exposure on the association between the level of education and lung cancer risk did not differ between ex-smokers and current smokers. CONCLUSIONS: Occupational exposure to asbestos, paint dust, polycyclic aromatic hydrocarbons, and welding fumes could not explain the inverse association between socioeconomic status and lung cancer risk. More research which explicitly addresses possible explanations for the association between socioeconomic status and lung cancer risk is needed.     

Hycones: a hybrid approach to designing decision support systems

Occupational respiratory disease statistics in Singapore from 1970 to 1993 were reviewed. Silicosis was the most common occupational respiratory disease in the 1970s and 1980s. About 78% of the cases were from granite quarries. With progressive reduction in dust levels and the closure of some quarries, there has been a decline in cases. From 1990 to 1993, occupational asthma was the most common occupational respiratory disease and more cases are expected with increasing awareness of the condition. The most common causative agent was isocyanates accounting for about 34% of cases. Of the asbestosis and malignant mesothelioma cases, about 70%-80% were from the one and only asbestos cement factory. With the closure of this factory and the increasing restrictions on the use of asbestos, cases of asbestosis are expected to decline in the long term. However, malignant mesothelioma cases may continue to surface because of the long latent period and the potential risk with low and brief exposures to asbestos. It is important to probe for possible occupational exposures (both present and past) in a patient with respiratory symptoms or disease.     

Telepathology: a powerful way to improve communication among pathologists]

Occupational sensitization to lactase is reported in workers formulating and packaging this consumer product, which is used for the relief of gastrointestinal symptoms caused by intolerance to lactose. Allergic rhinitis, conjunctivitis, and some cases of asthma were noted. There was suggestive evidence that atopic individuals may be at greater risk of sensitization. Lactase should be added to the list of potential occupational respiratory sensitizers.     

Open-lung biopsy in patients with acute respiratory distress syndrome

Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year. Family physicians can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed. This role can be maximized if physicians raise their level of suspicion for workplace disease, develop skills in taking occupational histories and establish routine access to occupational health resources.     

Occupational skin and respiratory diseases among hairdressers

OBJECTIVES: The occurrence and causes of hairdressers' occupational skin and respiratory diseases were studied. METHODS: Of a random sample of 500 female hairdressers aged 15-54 years, 355 were available for study. Of the 189 reporting work-related skin and respiratory symptoms in a computer-aided telephone interview on exposure and health, 130 underwent a physical examination, lung function tests, prick and patch testing, and nasal and lung provocation tests. An occupational disease was diagnosed when the causality between exposure and disease was probable and the clinical tests supported the diagnosis. RESULTS: The telephone interview revealed a life-time prevalence of 16.9% for hand dermatoses, 16.9% for allergic rhinitis, and 4.5% for asthma among the hairdressers. In the clinical investigations, the prevalence was 2.8% for occupational dermatoses, 1.7% for occupational rhinitis, and 0.8% for occupational asthma. Ammonium persulfate caused 90% of the respiratory diseases and 27% of the hand dermatoses. Paraphenylenediamine, natural rubber latex, and skin irritation were also causes of hand dermatitis. Allergy to human dandruff (8.6%) and Pityrosporum ovale (12.1%) was common. Previously diagnosed atopic diseases increased the risk for occupational skin or respiratory disease 3-fold (odds ratio 2.9, 95% confidence interval 1.1-7.9). Of the cases, 37.5% (6 of 16 persons) had to change occupations during a 3-year follow-up. CONCLUSIONS: Work-related skin and respiratory symptoms are common among hairdressers. Often a specific cause (eg, ammonium persulfate) can be found if occupational diseases are suspected and diagnosed. Hairdressers with atopic diseases are at risk of developing occupational skin and respiratory diseases.     

Protective effect of respiratory devices in farmers with occupational asthma

To the authors' knowledge there have been no previous reports on the protection afforded by powered filtering respirators in farmers with occupational asthma attributed to the inhalation of organic dust. In order to investigate this question, 26 farmers with occupational asthma were challenged with an exposure to work-related dusts for up to 60 min. This resulted in highly significant increases in airway resistance (Raw), thoracic gas volume (TGV) and specific airway resistance (sRaw) compared to baseline values. After a mean period of 21 weeks the farmers were subjected to a second challenge, this time wearing a protective respiratory device (RD) with a P2 filter. Significant increases in Raw, TGV and sRaw were again observed, but on average these were 50-80% smaller than the increases seen when RDs were not worn. These differences were found to be statistically significant. This shows that the use of a respiratory device in farmers suffering from occupational asthma reduces the development of bronchial obstruction but does not prevent it. The use of this kind of respiratory device cannot substitute for the proper management of asthma since the devices do not offer complete protection.