Occupational Asthma Reference

Dawkins P, Robertson AS, Robertson W, Moore V, Reynolds J, Langman G, Robinson E, Harris-Roberts J, Crook B, Burge PS, An outbreak of extrinsic alveolitis at a car engine plant, Occup Med, 2006;56:559-565,

Keywords: Hypersensitivity pneumonitis, HP, EAA, UK, metal-working fluid

Known Authors

Joanne Harris-Roberts (nee Elms), HSL, Buxton, UK Joanne Harris-Roberts (nee Elms)

Sherwood Burge, Oasys Sherwood Burge

Vicky Moore, Oasys Vicky Moore

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Wendy Robertson, Public Health, Warwick University Wendy Robertson

Ed Robinson, Health and Safety Laboratories, Buxton, UK Ed Robinson

Paul Dawkins, University Hospital Birmingham Paul Dawkins

John Reynolds, Birmingham Heartlands Hospital John Reynolds

Gerald Langman, Birmingham Heartlands Hospital Gerald Langman

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Background Twelve workers from a car engine-manufacturing plant presented with extrinsic allergic alveolitis (EAA), with heterogeneous clinical, radiological and pathological findings. They were exposed to metalworking fluids (MWF) that cooled, lubricated and cleaned the machines.

Methods They were characterized by history, examination, lung function testing, radiology, bronchoscopic lavage, lung biopsy and serology. Sera were tested for precipitins to a crude extract of used MWF and to reference cultures of bacteria suspected to be implicated.

Results All were males and none were current smokers. All had dyspnoea, many had weight loss and cough, but only half had influenza-like symptoms. Only half had auscultatory crackles. Five had peak flow variability, four with an occupational component. There was overall restrictive spirometry, decreased lung volumes and reduced gas transfers. Ten had radiological evidence of interstitial lung disease. Seven (of eight) had lymphocytosis on bronchial lavage, including the two with inconclusive radiology. Seven (of 11) had lung biopsies showing inflammatory infiltrates, two with fibrosis and one with granulomas. Three (of 11) had strong positive precipitins to an extract of the used MWF from the plant. Molecular biological analysis of the MWF revealed Acinetobacter and Ochrobactrum. Precipitins to Acinetobacter were detected in seven of 11 workers tested (and four of 11 control workers). Precipitins to Ochrobactrum were detected in three of 11 workers tested (and three of 11 control workers).

Conclusion This is the largest series reported in Europe of EAA due to an aerosol of microbiologically contaminated MWF in heavy manufacturing industry.

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Associated Questions

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Which agents cause occupational asthma and which workers are at risk?
burgeps The paper is mostly about extrinsic allergic alveolitis, but 6/12 had symptomic wheeze in addition to evidence of EAA, 5 had peak flow diurnal variability >20% and 4 had an Oasys score >2.5. It is likely that some of the 12 had both occupational asthma and alveolitis. A subsequent (as yet ubpublished) epidemiological study showed a much larger number of workers with occupational asthma from the same plant. Aerosols from metal-working fluid were the most likely cause

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