Medline ® Abstracts for References 7,8,26,27
of 'Reactive airways dysfunction syndrome and irritant-induced asthma'
Long-term effects of exposure to sulfur dioxide. Lung function four years after a pyrite dust explosion.
Härkönen H, Nordman H, Korhonen O, Winblad I
Am Rev Respir Dis. 1983;128(5):890.
The lung function of 7 men accidentally exposed to sulfur dioxide (SO2) in a pyrite dust explosion was followed for 4 yr. The greatest decrease in forced vital capacity, forced expiratory volume in one second, and maximal midexpiratory flow was observed 1 wk after the accident. After about 3 months no further decrement occurred. The pattern of spirometric findings was obstructive in 6 and restrictive in 1 of the patients. Four years after the accident a reversible obstruction of the bronchi was still observable in 3. Four patients reacted positively to the histamine challenge test. Two patients either did not respond to bronchodilator or did not react to histamine. The results suggest that bronchial hyperreactivity is a frequent sequela after exposure to high concentrations of SO2. The hyperreactivity may persist for several years.
Cough and bronchial responsiveness in firefighters at the World Trade Center site.
Prezant DJ, Weiden M, Banauch GI, McGuinness G, Rom WN, Aldrich TK, Kelly KJ
N Engl J Med. 2002;347(11):806. Epub 2002 Sep 9.
BACKGROUND: Workers from the Fire Department of New York City were exposed to a variety of inhaled materials during and after the collapse of the World Trade Center. We evaluated clinical features in a series of 332 firefighters in whom severe cough developed after exposure and the prevalence and severity of bronchial hyperreactivity in firefighters without severe cough classified according to the level of exposure.
METHODS: "World Trade Center cough" was defined as a persistent cough that developed after exposure to the site and was accompanied by respiratory symptoms severe enough to require medical leave for at least four weeks. Evaluation of exposed firefighters included completion of a standard questionnaire, spirometry, airway-responsiveness testing, and chest imaging.
RESULTS: In the first six months after September 11, 2001, World Trade Center cough occurred in 128 of 1636 firefighters with a high level of exposure (8 percent), 187 of 6958 with a moderate level of exposure (3 percent), and 17 of 1320 with a low level of exposure (1 percent). In addition, 95 percent had symptoms of dyspnea, 87 percent had gastroesophageal reflux disease, and 54 percent had nasal congestion. Of those tested before treatment of World Trade Center cough, 63 percent of firefighters (149 of 237) had a response to a bronchodilator and 24 percent (9 of 37) had bronchial hyperreactivity. Chest radiographs were unchanged from precollapse findings in 319 of the 332 with World Trade Center cough. Among the cohort without severe cough, bronchial hyperreactivity was present in 77 firefighters with a high level of exposure (23 percent) and 26 with a moderate level of exposure (8 percent).
CONCLUSIONS: Intense, short-term exposure to materials generated during the collapse of the World Trade Center was associated with bronchial responsiveness and the development of cough. Clinical and physiological severity was related to the intensity of exposure.
Bureau of Health Services, Fire Department of New York City, New York, USA. firstname.lastname@example.org
Update on asthma and cleaning agents.
Folletti I, Siracusa A, Paolocci G
Curr Opin Allergy Clin Immunol. 2017;17(2):90.
PURPOSE OF REVIEW: Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016.
RECENT FINDINGS: Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances).
SUMMARY: The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.
aDepartment of Medicine, Section of Occupational Medicine, Respiratory Diseases, Occupational and Environmental Toxicology bDepartment of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
Work-related reactive airways dysfunction syndrome cases from surveillance in selected US states.
Henneberger PK, Derk SJ, Davis L, Tumpowsky C, Reilly MJ, Rosenman KD, Schill DP, Valiante D, Flattery J, Harrison R, Reinisch F, Filios MS, Tift B
J Occup Environ Med. 2003;45(4):360.
The objective was to elaborate the descriptive epidemiology of work-related cases of reactive airways dysfunction syndrome (RADS). Cases of work-related asthma (WRA) were identified in four states in the United States during 1993-1995 as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR). Information gathered by follow-back interview was used to describe 123 work-related RADS cases and to compare them to 301 other WRA cases whose onset of disease was associated with a known asthma inducer. RADS represented 14% of all new-onset WRA cases identified by the state SENSOR surveillance systems. RADS cases had significant adverse medical and occupational outcomes identified by follow-back interview. In particular, 89% still had breathing problems, 78% had ever sought emergency care and 39% had ever been hospitalized for work-related breathing problems, 54% had applied for worker compensation benefits, and 41% had left the company where they experienced onset of asthma. These values equaled or exceeded the comparable figures for those WRA cases whose onset was attributed to a known inducer. Work-related RADS represents a minority of all WRA cases, but the adverse impact of this condition appears toequal that of other WRA cases.
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road M/S H-2800, Morgantown, WV 26505, USA. email@example.com