Why is the patients lung function below predicted, and can she return to work with either direct or indirect exposure to soldering fumes?
The Opinion of this website
The worker has asthma which is worse on workdays and is made worse (and probably caused) by colophony in the solder flux fumes. This is the most likely cause of her low FEV1 and airflow obstruction. The best solution would be to replace the flux with one without colophony. A less good solution would be to relocate her completely away from exposure. She should be followed up after remedial action with further measurements of peak expiratory flow and FEV1.
Show Opinions Left By Others
Hide Opinions Left By Others
| We are worried about her declining lung function. The first stage would be to replace the rosin with a non-colophony flux and resurvey. We think that the less than 15% change in PEF is clinically insignificant. The peak flows should be repeated after substitution of the rosin. We would like to visit the workplace. We have one dissenting view. It would be better to remove her from work to another department.Other exposed workers should be surveyed. |
| Old Forum User (Specialist), 3/13/2006 5:50:43 PM |
| For this case, are you sure she is not exposed also to isocyanates which are often used (at least in Québec) to cover the electronic circuits? I think that it is not as straight forward as we may wish! Her asthma is clearly unstable and she should probably be treated more agressively maybe by increasing Becloforte or by trying to add a long-acting theophylline (this is what I would have done). The specific challenge is probably positive but she varies quite a lot on her control challenge day (12%). I had a 19% fall in FEV1 if you use the baseline on that day (1.85). How did you get to 15% fall? |
| Old Forum User (Specialist), 3/13/2006 5:51:02 PM |
| I think that the case is probably colophony asthma but her asthma is quite unstable to be certain. I think that she should be treated more agressively to control her asthma first and then specific challenge done. Alternatively, you could take her off work for 2 or 3 weeks and see if she gets better and more stable. |
| Old Forum User (Specialist), 3/13/2006 5:51:22 PM |
| FEV1 significantly lower than FVC, with a low ratio. Mid flow rates are much lower than predicited. Methacholine reactivity is in moderate asthma range, and with specific bronchial challenge data and serial PEF data, the tests indicate this worker should be away from colophony solder. |
| Old Forum User (Specialist), 3/13/2006 5:51:43 PM |
Return to Questions