Occupational Asthma Reference

Hannu T, Piipari R, Tuppurainen M, Nordman H, Tuomi T, Occupational asthma caused by stainless steel welding fumes: a clinical study, Eur Respir J, 2007;29:85-90,

Keywords: Finland, stainless steel, welding, chrome, key, challenge

Known Authors

Henrik Nordman, Finnsh Institute of Occupational Health Henrik Nordman

Timo Hannu, Finnish Institute of Occupational Health Timo Hannu

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Abstract

The aim of the present study was to describe the cases of occupational asthma (OA) due to stainless steel welding fumes diagnosed at the Finnish Institute of Occupational Health during the period 1994–2003.

OA was diagnosed according to patient history, lung function examinations and welding challenge tests with measurements of the forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) values.

The present series comprised 34 patients, all male, with a mean age of 44.7 yrs (range 22–57), mainly working as welders. The mean duration of exposure was 22.4 yrs, and the mean duration of exposure before the onset of respiratory symptoms was 18 yrs. Dyspnoea was the most frequently reported work-related respiratory symptom. During the inhalation challenge tests, the mode of the asthmatic FEV1/PEF reaction was delayed in 16 (47%) patients, immediate in nine (26%) patients and dual (both immediate and delayed) in nine (26%) patients. In the follow-up assessment 6 months later, only six patients were considered able to continue performing welding tasks, whereas occupational injury pension was recommended for seven, and measures of vocational rehabilitation for 14 patients.

In most cases, after the diagnosis of occupational asthma, the continuation of welding work was not possible.


Plain text: The aim of the present study was to describe the cases of occupational asthma (OA) due to stainless steel welding fumes diagnosed at the Finnish Institute of Occupational Health during the period 1994-2003. OA was diagnosed according to patient history, lung function examinations and welding challenge tests with measurements of the forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) values. The present series comprised 34 patients, all male, with a mean age of 44.7 yrs (range 22-57), mainly working as welders. The mean duration of exposure was 22.4 yrs, and the mean duration of exposure before the onset of respiratory symptoms was 18 yrs. Dyspnoea was the most frequently reported work-related respiratory symptom. During the inhalation challenge tests, the mode of the asthmatic FEV1/PEF reaction was delayed in 16 (47%) patients, immediate in nine (26%) patients and dual (both immediate and delayed) in nine (26%) patients. In the follow-up assessment 6 months later, only six patients were considered able to continue performing welding tasks, whereas occupational injury pension was recommended for seven, and measures of vocational rehabilitation for 14 patients. In most cases, after the diagnosis of occupational asthma, the continuation of welding work was not possible.

Full Text

Associated Questions

Registered users of this website have associated this reference with the following questions. This association is not a part of the BOHRF occupational asthma guidelines.

Which agents cause occupational asthma and which workers are at risk?
burgeps stainless steelwelding fume with specific challenge tests
Is the incidence of occupational asthma reduced by respiratory protective equipment?
burgeps 6/9 initially assessed as suitable to continue work with powered RPE able to continue beyond 6 months (out of 34 cases)
What is the feasibility of obtaining serial measurements of peak flow in workers suspected of having occupational asthma?
burgeps Adequate in 6/9 in whom attempted
What are the sensitivity and the specificity of a normal measurement of non-specific reactivity while at work in the diagnosis of occupational asthma?
burgeps Sensitivity 71% against specific challenge

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Comments

34 workers with specific challenge tests to stainless steel welding are described. Only 6 were able to continue welding with powered respiratory protection. Non specific reactivity was normal in 38% at presentation. All had negative skin prick tests to potassium dichromate 1mg/ml

Agent
Stainless steel welding fume

Jobs
Welders (24), machine fitters 94), Plumbers (3), metalworker (1), teacher (1), inspector (1)

Proof
Specific IgE not tested

Skin prick test to potassium dichromate 1mg/ml negative 90/24)

Non specific bronchial reactivity normal pre challenge 38%

Serial peak flow records positive 5/6 plus 3 proper evaluation not possible

Specific Bronchial Challenge: immediate reaction to welding fume 27%, late (47%) dual 27%)

Follow up
Only 6/34 continued welding with powered RPE; vocation rehabilitation(14),relocation away from exposure (4); early retirement 97)
4/18/2008

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