Occupational Asthma Reference

Moore VC, Burge PS, Robertson AS, Walters GI, What causes occupational asthma in cleaners?, Thorax, 2017;72:581–583.,org/10.1136/ thoraxjnl-2016-208827

Keywords: UK, chloramine, cleaner, nurse, healthcare, challenge, SIC, cr, PEF, chlorine, key

Known Authors

Sherwood Burge, Oasys Sherwood Burge

Vicky Moore, Oasys Vicky Moore

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Gareth Walters, Heartlands Gareth Walters

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Abstract

Lessons
SIC tests to the chlorine-releasing agent and urine individually produced negative results. However, the combination of urine with the chlorine-releasing agent, replicating the actual workplace exposure, produced a positive asthmatic reaction. It is likely that the chlorine and urine mixture produced chloramines. Chloramines are known sensitisers causing occupational asthma in swimming pool attendants and teachers, where SICs have shown chloramines to be the cause.3 We believe that this explains the previous negative tests to chlorine-releasing agents alone in healthcare workers, where chloramines produced in cleaning operations at work are the likely cause of much of their occupational asthma. Any SIC tests to chlorine tablets should be performed with a nitrogen source when exposures to the chlorine-releasing substance alone do not elicit an asthmatic reaction. The optimal management of a worker with occupational asthma requires identification of the specific cause, so that exposures can be reduced for others and eliminated for the sensitised worker. In this case, the cause was identified but unfortunately removal from direct exposure was insufficient to eliminate all work-related symptoms and small changes in peak flow (as shown by the positive timepoint analysis). With the help of her occupational health department, our patient decided to retire on medical grounds, which is sometimes the best solution.

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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 This is a key paper showing that chlorine-releasing cleaning agents may cause sensitising type occupational asthma by producing chloramines, and that a protein source as well as the chlorine is required

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