Occupational Asthma Reference

Lindström I, Lantto J, Karvala K, Soini S, Ylinen K, Suojalehto H, Suuronen K, Occupations and exposure events in acute and subacute irritant-induced asthma, Occup Environ Med, 2021;78:793-800,http://orcid.org/0000-0002-6399-8846
(Plain text: Lindstrom I, Lantto J, Karvala K, Soini S, Ylinen K, Suojalehto H, Suuronen K, Occupations and exposure events in acute and subacute irritant-induced asthma, Occup Environ Med)

Keywords: Finland, irritant induced astma,causes

Known Authors

Hille Suojalehto, Finnish Institute of Occupational Health Hille Suojalehto

Irmeli Lindstrom, Finnish Institute of Occupational Health Irmeli Lindstrom

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Abstract

Background
Exposures leading to irritant-induced asthma (IIA) are poorly documented.

Methods
We retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000–2018. We classified the cases into acute (onset after single exposure) and subacute (onset after multiple exposures) IIA. We analysed in detail, occupations, causative agents and their air levels in the workplace, exposure events and the root causes of high exposure.

Results
Altogether 69 patients were diagnosed with IIA, 30 with acute and 39 with subacute IIA. The most common occupational groups were industrial operators (n=23, 33%), metal and machinery workers (n=16, 11%) and construction workers (n=12, 8%). Among industrial operators significantly more cases had subacute IIA than acute IIA (p=0.002). Forty cases (57%) were attributable to some type of corrosive acidic or alkaline chemical. Acute IIA followed accidents at work in different types of occupation, while subacute IIA was typical among industrial operators performing their normal work tasks under poor work hygiene conditions. The most common root cause was lack of information or false guidance in acute IIA (n=11, 36%) and neglect of workplace hygiene measures in subacute IIA (n=29, 74%).

Conclusions
Accidents are the main causes of acute IIA, whereas subacute IIA can develop in normal work in risk trades with poor work hygiene. Airborne strong acids or bases seem to be the most important causative agents of acute and subacute IIA. The different risk profiles of acute and subacute IIA should be considered in the prevention and identification of the cases.

Plain text: Background Exposures leading to irritant-induced asthma (IIA) are poorly documented. Methods We retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000-2018. We classified the cases into acute (onset after single exposure) and subacute (onset after multiple exposures) IIA. We analysed in detail, occupations, causative agents and their air levels in the workplace, exposure events and the root causes of high exposure. Results Altogether 69 patients were diagnosed with IIA, 30 with acute and 39 with subacute IIA. The most common occupational groups were industrial operators (n=23, 33%), metal and machinery workers (n=16, 11%) and construction workers (n=12, 8%). Among industrial operators significantly more cases had subacute IIA than acute IIA (p=0.002). Forty cases (57%) were attributable to some type of corrosive acidic or alkaline chemical. Acute IIA followed accidents at work in different types of occupation, while subacute IIA was typical among industrial operators performing their normal work tasks under poor work hygiene conditions. The most common root cause was lack of information or false guidance in acute IIA (n=11, 36%) and neglect of workplace hygiene measures in subacute IIA (n=29, 74%). Conclusions Accidents are the main causes of acute IIA, whereas subacute IIA can develop in normal work in risk trades with poor work hygiene. Airborne strong acids or bases seem to be the most important causative agents of acute and subacute IIA. The different risk profiles of acute and subacute IIA should be considered in the prevention and identification of the cases.

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Comments

Table 3
Causative agents of irritant-induced asthma

Main groups of causative agents Acute
N=30 Subacute
N=39 Total
N=69 (%)
Acid aerosols or fumes 6
Sulfuric acid
Hydrofluoric acid
Nitric acid
Hydrochloric acid
Hydrochloric acid and sulfur dioxide 7
Sulfuric acid* and ammonium fluoride
Sulfuric acid* and hydrogen sulfide
Sulfuric acid*, sulfur dioxide and sulfur trioxide
Hydrochloric acid
Nitric acid 13 (19)
Base aerosols or fumes 5
Ammonia
Sodium hydroxide
Black lye 4
Ammonia
Sodium hydroxide
Alkaline epoxy polyamine hardener and cleaning agent 9 (13)
Mixtures of acid and base aerosols or fumes 3
Ammonia, sulfuric acid, hydrochloric acid, hydrofluoric acid, nitric acid
Sodium hydroxide, potassium hydroxide, sulfuric acid, nitric acid 3 (4)
Inorganic gases 3
Chlorine dioxide 3
Chlorine dioxide
Chlorine dioxide and hydrogen sulfide
Sulfur dioxide 6 (9)
Oxidising agents 1
Ozone 1
Hydrogen peroxide 2 (3)
Other chemicals 5
Formaldehyde†
Glutaraldehyde†
Hexamethylene diisocyanate†
Naphthalene compounds
Pyrethrin 1
Hexamethylene diisocyanate† 6 (9)
Mixtures 6
Bitumen, solvents and their thermal degradation products
Sodium hydroxide, sodium hypochlorite
Combustion gas
Thermal degradation of polyester paint
Sulfuric acid, sodium hypochlorite, chlorine dioxide gas
Nitric oxides, diesel exhaust, mixture of oil and water 12
Ammonia and hydrogen sulfide
Ammonia, hydrogen sulfide and endotoxins
Hydrogen sulfide, sulfur compounds, sodium hydroxide, chlorine dioxide
Calcium oxide and hydrogen sulfide
Rubber chemicals and their thermal degradation products
Solvents and mine dust
Formic acid, acetic acid, formaldehyde
Thermal degradation of polyvinyl chloride-polyurethane fabrics
Trifluoroacetic acid and acetonitrile 18 (26)
Dusts 4
Calcium oxide
Cement 4
Ash
Calcium oxide and alkaline dusts
Cement
Sulfuric acid-containing titanium oxide powder 8 (12)
Endotoxins 0 4 4 (
4/15/2021

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