1 occupational asthma causes and risk occupations r.piipari, ttl

1

Occupational asthma

Causes and risk occupations

R.Piipari, TTL

2

Asthma

• Airway inflammation, in which the amount of many kinds of inflammatory cells in the airways is increased.

• Susceptible persons get symptoms owing to the airway inflammation. Typical functional feature is variable airway obstruction.

Global strategy for Asthma Management

National Institute of Health and WHO 1995

3

Work-related diseases,

definitions in Estonia

• 1. An occupational disease:

– An illness brought about by risk factors present in the working environment or the nature of the work and which is included in the list of occupational diseases. (The list of occupational diseases shall be established by a regulation of the Minister of Social Affairs.)

• 2. A work-induced disease:– An illness brought about by the risk factors present in the

working environment, but which is not deemed an occupational disease.

4

• Occupational asthma obstructive airway disease, which is associated with exposure at the workplace to dusts, gases or fumes.– Includes

– Sensitizer induced cases

– non-allergic asthmatic diseases as

» reactive airways dysfunction syndrome (RADS)

» byssinosis

» irritant induced occupational asthma??

• Occupational asthma means asthma induced by getting sensitized to biological or chemical agents present in the workplace.

5

Occupational asthma, causes

• Organic agents recognized already at the 1700's (flour dust asthma in bakers and millers)– nowadays about 70-80% of cases

• Chemicals, first report in 1963 (asthma caused by phtalic acid anhydride in a chemist)– nowadays about 20-30% of cases

• More than 200 sensitizers recognized today

050

100150

200250

300350

400450

unknown

other chem.

diisocyanates

other biol.

moulds

flours

storage mites

animal epithelia

Occupational Asthma in Finland

N

The Finnish Register of Occupational Diseases

7

Occupational asthma Sensitization

– type I allergic, IgE mediated reaction• many biologic compounds • a few chemicals, which act as haptens

– other immunological mechanisms

– other possible mechanisms

8

Criteria for an allergic response

• Asthma occurs only in a proportion of those exposed to the particular agent

• Asthma develops only after an initial sympotomfree period fo exposure

• After sensitization asthmatic responses are provoked by very low exposure levels

9

Agents causing occupational asthma

• Organic agents

– Animal epithelia– Flour/grain/hay– Storage mites– Moulds– Wood dusts– Enzymes– Natural rubber– Colophony (pine resin)– Food, vegetables– Textiles, furs– Decorative flowers

• Chemicals

– Welding fumes– Metal salts– Di-isocyanates– Acrylates– Acid anhydrides– Formaldehyde– Persulphates– Diethanolamines– Glues/resins/varnishes– Drugs– Reactive dyes

10

Agents causing occupational asthma/rhinitis and related occupations

• Animal epithelia– farmers, cattle tenders, veterinarians, laboratory workers

• Flour, grain dust– bakers, millers, farmers, cattle tenders, food processing workers

• Storage mites– bakers, millers, farmers, food processing workers, stock room workers

• Some foodstuff– food processing workers, cooks, kitchen workers (eg. fruits, vegetables,

fish, crayfish, spices)

• Moulds– Farmers, bakers, greenhouse workers, sawmill workers

11


• Di-isocyanates– car sprayers, painters, laminators, insulators, plastic workers

• Metal fumes and salts– welders, metal workers, platers, refiners, grinders

• Formaldehyde– laboratory workers, foundry workers, resin and wood

processing workers, textile workers

• Persulphates– Hairdressers, persulphate processing workers

• Acrylates– dental workers, electronic workers, mechanicians

12


• Enzymes– Bakers, food processing workers, pharmaceutical and laboratory workers,

detergent manufactory workers, textile workers

• Decorative flowers– Florists, gardeners, botanists

• Wood dusts– Wood and sawmill workers, carpenters

• Natural rubber– Health care and laboratory workers, food processing workers

• Colophony– Soft soderers, electronic workers

13


• Acid anhydrides– Sprayers, painters, plastic workers, chemical workers

• Diethanolamines– Metal workers, cleaners, plastic workers, textile workers,

chemical workers

• Drugs– Pharmacoceutical workers, laboratory workers, chemists,

nurses

• Reactive dyes– Textile workers

14

Di-isocyanate exposure

• Spray painting, car painting

• Insulation work with polyurethane products

• Foam/plastics manufacture

15

Products that often contain di-isocyanates

– Two component paints– Two component glues– Insulation material– Plastics– Foams– Resins– Varnishes

16

Bakery work, sensitizers

• flours

• enzymes

• storage mites

• spices

• egg

• milk powder

• sesame seed

17

Cattle breeding, sensitizers

• animal epithelia

• storage mites

• feed flours

• feed additions (fish powder, enzymes, soya)

18

• Di-isocyanates • Epoxy resins, organic acid anhydride or amine

hardeners• Phtalates• Formaldehyde• Azodicarbonamide• Cyanoacrylates• Methacrylates• Polyfunctional aziridine hardener

Manufacturing/use of plastic products, sensitizers

19

• Di-isocyanate cured paints

• Epoxy paints, amine hardeners

• Epoxy powder paints

• Polyester powder paints

• Formaldehyde

• Paints with aziridine hardeners

Painting, sensitizers

20

• Soft soldering fumes (colophony)

• Di-isocyanate cured varnishes

• Epoxy resins, organic acid anhydrides

• Acrylate glues

• Formaldehyde

Electronics, sensitizers

21

• Persulphates

• Permanent wave chemicals

• Hair sprays

• Hair dyes

• Natural rubber

Hair dressers, sensitizers

22

• Formaldehyde (glues and shellacks)

• Wood dusts (exotic woods!)

• Di-isocyanate hardened paints

• Aziridine hardened paints

• Moulds (mouldy wood dusts)

Wood work, sensitizers

23

• Welding fumes and grinding dusts of stainless steel

• Hard metal dust

• Welding fumes of painted steel (2-component paints)

• Aerosols of cutting fluids

• Other welding fumes?

Metal work, sensitizers

24

Occupational asthma/ health care, sensitizers

• Clinics

– natural rubber

– chloramine T

– glutaraldehyde

– formaldehyde

• Dental care

– natural rubber

– methacrylates

– chloramine T

– formaldehyde

– ammonium persulphate

25

0 2 4 6 8 10 12 14 16

All industries 514

Furniture manufact. 3

Electrical products and optical equipment manufact. 11

Public, social and personal services 125

Rubber and plastic products manufact. 4

Wood and wood products manufact. 7

Transport equipment manufact. 5

Textiles, clothing, leather and footwear manufact. 5

Basic metals and fabricated metal products manufact. 17

Food, beverage and tobacco manufact. 42

Agriculture and forestry 201

ALLERGIC RESPIRATORY DISEASES (Cases/10 000 employed persons)

N

Lea AaltoFinnish Register of Occupational Diseases FIOH

Most common industries in 2001

26

0 5 10 15 20

All occupations 514

Chemical prosessing, pulp and paper making work 3

Health care and social work 40

Packing, warehousing and stevedoring work 7

Metal, foundry and engineering work 26

Service work 59

Textile, sewing, shoe and leather work 5

Wood work 9

Manufacturing work not elsewhere classified 16

Agricultural, forestry and fishing work 214

Food and beverage manufacturing work 33

ALLERGIC RESPIRATORY DISEASES (Cases/10 000 employed persons)

N

Lea Aalto

Most common occupations in 2001

Finnish Register of Occupational Diseases FIOH

27

Occupational asthma (OA) cases in Finland in 1995-2001

0

50

100

150

200

250

300

350

400

450

1995 1996 1997 1998 1999 2000 2001

New OA cases

OA cases diagnosed at FIOH

28

Occupational asthma (OA) cases caused by chemicals in Finland in 1995-2001

0

10

20

30

40

50

60

70

80

90

1995 1996 1997 1998 1999 2000 2001

Register of occupational diseases FIOH

29

Occupational asthma cases caused by the most common biological agents in Finland in 1995-2001

0

20

40

60

80

100

120

140

160

1995 1996 1997 1998 1999 2000 2001

Animal epithelia

Flours, grains

Moulds

Storage mites

1 occupational asthma causes and risk occupations r.piipari, ttl

Documents