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.
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 hadgastroesophageal 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
Functional and biological characteristics of asthma in cleaning workers.
Vizcaya D, Mirabelli MC, Orriols R, AntóJM, Barreiro E, Burgos F, Arjona L, Gomez F, Zock JP
Respir Med. 2013 May;107(5):673-83. Epub 2013 Feb 20.
OBJECTIVES: Cleaning workers have an increased risk of asthma but the underlying mechanisms are largely unknown. We studied functional and biological characteristics in asthmatic cleaners and compared these to healthy cleaners.
METHODS: Forty-two cleaners with a history of asthma and/or recent respiratory symptoms and 53 symptom-free controls were identified. Fractional exhaled nitric oxide (FeNO) was measured and forced spirometry with reversibility testing was performed. Total IgE, pulmonary surfactant protein D and the 16 kDa Clara Cell secretory protein were measured in blood serum. Interleukins and other cytokines, growth factors, cys-leukotrienes and 8-isoprostane were measured in exhaled breath condensate. Information on occupational and domestic use of cleaning products was obtained in an interview. Associations between asthma status, specific characteristics and the use of cleaning products were evaluated using multivariable linear and logistic regression analyses.
RESULTS: Asthma was associated with an 8% (95% confidence interval (CI) 1-15%) lower postbronchodilator FEV1, a higher prevalence of atopy (42% vs. 10%) and a 2.9 (CI 1.5-5.6) times higher level of total IgE. Asthma status was not associated with the other respiratory biomarkers. Most irritant products and sprays were more often used by asthmatic cleaners. The use of multiuse products, glass cleaners and polishes at work was associated with higher FeNO, particularly in controls.
CONCLUSIONS: Asthma in cleaning workers is characterised by non-reversible lung function decrement and increased total IgE. Oxidative stress, altered lung permeability and eosinophilic inflammation are unlikely to play an important underlying role, although the latter may be affected by certain irritant cleaning exposures.
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. email@example.com
Asthma related to cleaning agents: a clinical insight.
Vandenplas O, D'Alpaos V, Evrard G, Jamart J, Thimpont J, Huaux F, Renauld JC
BMJ Open. 2013;3(9):e003568.
OBJECTIVE: To determine the agents causing asthmatic reactions during specific inhalation challenges (SICs) in workers with cleaning-related asthma symptoms and to assess the pattern of bronchial responses in order to identify the mechanisms involved in cleaning-related asthma.
DESIGN: A retrospective case series analysis.
SETTING: The study included all participants who completed an SIC procedure with the cleaning/disinfection products suspected of causing work-related asthma over the period 1992-2011 in a tertiary centre, which is the single specialised centre of the French-speaking part of Belgium where all participants with work-related asthma are referred to for SIC.
RESULTS: The review identified 44 participants who completed an SIC with cleaning/disinfection agents. Challenge exposure to the suspected cleaning agents elicited a≥20% fall in forced expiratory volume in 1 s (FEV1) in 17 (39%) participants. The cleaning products that induced a positive SIC contained quaternary ammonium compounds (n=10), glutaraldehyde (n=3), both of these agents (n=1) and ethanolamines (n=2). Positive SICs were associated with a significant decrease in the median (IQR) value of the provocative concentration of histamine causing a 20% fall in FEV1 (PC20) from 1.4 (0.2-4.2) mg/mL at baseline to 0.5 (0.4-3.0) mg/mL after the challenge and a significant increase in sputum eosinophils from 1.8 (0.8-7.2)% at baseline to 10.0 (4.1-15.9)% 7 h after the challenge exposure while these parameters did not significantly change in participants with a negative SIC. Overall, 11 of 17 participants with positive SICs showed greater than threefold decrease in postchallenge histamine PC20 value, a>2% increase in sputum eosinophils, or both of these outcomes.
CONCLUSIONS: These data indicate that a substantial proportion of workers who experience asthma symptoms related to cleaning materials show a pattern of bronchial reaction consistent with sensitiser-induced occupational asthma. The results also suggest that quaternary ammonium compounds are the principal cause of sensitiser-induced occupational asthma among cleaners.
Department of Chest Medicine, Centre Hospitalier Universitaire de Mont-Godinne, UniversitéCatholique de Louvain, Yvoir, Belgium.