Occupational Asthma Reference

Robertson W, Robertson A, Burge CB, Moore V, Jaakkola MS, Dawkins PA, Burd M, Rawbone R, Gardner I, Kinoulty M, Crook B, Evans GS, Harris-Roberts J, Rice SB, Burge PS, Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant, Thorax, 2007;62:981-990,

Keywords: metal working fluid, challenge, epidemiology, air measurement, IgG, MWF, powertrain

Known Authors

Sherwood Burge, Oasys Sherwood Burge

Vicky Moore, Oasys Vicky Moore

Cedd Burge, Oasys Cedd Burge

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Arun Dev Vellore, Oasys Arun Dev Vellore

Roger Rawbone, Retired - ex Health and Safety Executive Roger Rawbone

Maritta Jaakkola, Oulu University Finland Maritta Jaakkola

Wendy Robertson, Public Health, Warwick University Wendy Robertson

Paul Dawkins, University Hospital Birmingham Paul Dawkins

Gareth Evans, HSL, Buxton Gareth Evans

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Abstract

Background
Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed EAA in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak.

Methods
The outbreak was investigated in a three-phase cross-sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481 (94.4%) responded and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed.

Results
87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution.

Conclusions
Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance.

Abbreviations
EAA, extrinsic allergic alveolitis; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; HF, humidifier fever; MWF, metal working fluid; OA, occupational asthma; PEF, peak expiratory flow

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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.

What is the frequency of occupational asthma?
Cedd Burge The prevalence was 74 out of 836 had peak flow documented occupational asthma in a cross sectional study. 10.4% of the workforce had some form of work related respiratory disease.
Which agents cause occupational asthma and which workers are at risk?
Cedd Burge Paper documents aerosols from metal working fluid as a cause of occupational asthma.
Is exposure to agents in the workplace a risk factor for developing occupational asthma?
Cedd Burge The prevalence of occupational asthma is significantly greater in work locations with greater exposure to aerosols of metal working fluid than in areas with lower levels of exposure to more contaminated fluids.

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Comments

Are you doing follow up studies to follow these cases and check on the occurrence of new cases? What role has HSE played in enforcing appropriate preventive measures?
4/18/2008

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