Asthma work-related

Petsonk, E.L., Work-related asthma and implications for the general public, Environ. Health Perspect., 110 Suppl 4, 569, 2002. 

Gautrin, D., Ghezzo, H., and Malo, J.L., Rhinoconjunctivitis, bronchial responsiveness, and atopy as determinants for incident non-work-related asthma symptoms in apprentices exposed to high-molecular-weight allergens, Allergy, 58, 608, 2003. 

In work-aggravated asthma, a worker with preexisting asthma has worsening of asthma symptoms due to exposures in the workplace. These exposures may be irritant chemicals, cold air, or allergens to which the worker was sensitized prior to hire. The diagnosis is made if the asthma was not active within 2 years before the hire date and there is (1) worsening of asthma symptoms on workdays and (2) serial spirometry tests and /or repeat PEER measurements suggesting a work-related pattern. 

Important commercial isocyanates include the diisocyanate monomers toluene diisocyanate (TDI), methylene diphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI), and MDI-, TDI-, and HDI-based isocyanates (e.g., prepolymers and polyisocyanates). World-wide production volume is estimated at over 12 billion lb. Isocyanates (diisocyanates, polyisocyanates, and prepolymers) all cause similar health effects, most commonly asthma [32]. Isocyanates are reported to be the leading attributable cause of work-related asthma [16]. Isocyanates are potent sensitizers that can trigger a severe and potentially fatal asthma attack in sensitized persons at very low isocyanate exposure levels [16]. Toluene diisocyanate is reasonably anticipated to be a human carcinogen by National Toxicology Program. 

NIOSH scientists work in multidisciplinary teams and carry out a focused program of intramural and extramural research to prevent or reduce work-related injury and illness. In 1996, NIOSH and over 500 partners established the National Occupational Research Agenda (NORA), a framework to guide the efforts of the occupational safety and health community in 21 priority research areas. NORA encompasses research areas such as traumatic injury, asthma and chronic obstructive pulmonary disease, hearing loss, and control technologies. These priority areas were identified through extensive input from NIOSH s federal and nonfederal partners. Since 1996, NIOSH has aligned its intramural and extramural research to increase its investment in NORA priority areas. 

Rosenman KD, Reilly MJ, Schill MS, et al. Cleaning products and work-related asthma. J Occup Environ Med 2003 45(5) 556-63. 

The first element in risk assessment is knowledge of the chemical exposures of a workforce to see if a known sensitizer is present. A chemical becomes accepted as a cause of occupational asthma if there are at least two convincing clinical case reports from independent centres. Specialist clinicians are likely to be aware of the published literature at an early stage and may be a useful source of informal information. There is currently much interest in publishing lists of sensitizers. One is available in a recent textbook (Chan-Yeung and Malo, 1993). The Health and Safety Executive in the UK, the National Institute for Occupational Safety and Health in the USA and other agencies may publish lists with updates. Other sources of information on causes are reporting schemes such as SWORD (Surveillance of Work-related and Occupational Respiratory Disease) in the UK (Ross el al., 1995) and SENSOR (Sentinel Event Notification System for Occupational Risks) in some states in the USA (Matte et al., 1990). 

Work-related asthma is a frequent occupational problem. Classic occupational asthma typically occurs after sensitization to either high-molecu-lar-weight chemicals (eg, inhaled foreign proteins) or to small chemicals that appear to act as haptens (the most common of which are the urethane isocyanates such as toluene diisocyanate [TDI]). After acute, high-level irritant inhalations, for example of chlorine, a chronic irritant-induced... 

Occupational or work-related ill-health - is concerned with those illnesses or physical and mental disorders that are either caused or triggered by workplace activities. Such conditions may be induced by the particular work activity of the individual or by activities of others in the workplace. The time interval between exposure and the onset of the illness may be short (e.g. asthma attacks) or long (e.g. deafness or cancer). 

Of 28 patients presenting with work-related rhinitis (alone or with asthma) 10 gave a positive response when undergoing a nasal provocation test with tetrasodium EDTA (1-4%) [85 ]. The patients were health care workers frequently exposed to cleaning sprays containing EDTA. 

Considering all disinfectants, aldehydes have a special status as they are able to pose occupational hazards even at very low concentrations in air. A survey in Germany shows that the use of aldehydes for disinfechon of surfaces and instruments did considerably decline in 2009/2010 compared to 2005, specifically because the use of formaldehyde has been reduced [1 ]. Between 2001 and 2009, a significant decrease in work-related asthma cases due to aldehyde exposure was reported in France [2 ]. 

Respiratory In a study of health care professionals using a validated questionnaire (n=3650), the prevalence of work-related asthma symptoms was elevated in professionals who reported the use of ethylene oxide in instrument cleaning/sterilisation (Adjusted OR 2.97, 95% Cl 1.21-7.33) [59 ]. 

Paris C, Ngatchou-Wandji J, Luc A, McNamee R, Bensefa-Colas L, Larabi L, et al. Work-related asthma in France recent trends for the period 2001-2009. Occup Environ Med 2012 69(6) 391-7. 

Arif AA, Delclos GL. Association between deaning-related chemicals and work-related asthma and asthma symptoms among healthcare professionals. Occup Environ Med 2012 69(l) 35-4O. 

Death from severe asthma in some sensitized subjects has been reported. Workers potentially exposed to isocyanates who experience persistent or recurring eye irritation, nasal congestion, dry or sore throat, cold-like S5rmptoms, cough, shortness of breath, wheezing, or chest tightness should see a physician knowledgeable in work-related health problems. 

SICK BUILDING SYNDROME A group of symptoms more common in workers in certain buildings and which are temporarily related to working in them. Symptoms include lethargy, tiredness, headache also sore/dry eyes, dry throat, dry skin, symptoms suggestive of asthma, blocked or runny nose. Cause is multifunctional but does include agents encountered in the workplace. 

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