Changes in airway function and bronchial responsiveness after acute occupational exposure to chlorine leading to treatment in a first aid unit

OBJECTIVES: To describe the baseline characteristics and the time course of changes in lung function in workers accidentally inhaling high concentrations of chlorine in a prospective study. METHODS: Baseline spirometry and methacholine challenge test were performed in a cohort of 278 workers at risk of accidental inhalation of chlorine. Workers in whom accidental inhalation led to intervention in a first aid unit were reassessed five to 25 days after the accident and serially thereafter when there where notable changes. RESULTS: During a four year follow up period, 13 workers were seen at the first aid unit after a symptomatic accidental inhalation. Three of them experienced notable functional changes: one worker experienced a 10% fall in forced expiratory volume in one second (FEV1), and the other two had a notable fall in the concentration of methacholine that caused a 20% fall in FEV1 (PC20). Two workers were smokers and one had a personal history of atopy. Baseline assessment was within the normal range in these three workers. Recovery was complete three months after the accidental inhalation. CONCLUSION: Transient but notable decreases in airway function or increases in bronchial responsiveness can occur after an accidental inhalation of high concentrations of chlorine in workers at risk.

 

     

First-aid reports of acute chlorine gassing among pulpmill workers as predictors of lung health consequences

Workers in pulpmills can be exposed to a multitude of gases hazardous to respiratory function, the most common of which is chlorine gas. First-aid reports of acute gas overexposure incidents ("gassings") over an 8 year period were used to generate exposure data on a group of pulpmill workers whose respiratory function had been studied cross-sectionally in 1981 and 1988. Three hundred forty-eight incidents representing 174 workers were identified, 78% of these being treated solely by the first-aid attendant with the administration of O2 and cough suppression medication. Among 316 workers tested during a 1988 respiratory health survey, 78 had at least one chlorine or chlorine dioxide "gassing" incident. There was a significant decrease in the FEV1/FVC ratio (p less than .05) as well as increased risk for workplace associated chest symptoms in this group with at least one "gassing" incident. In an age- and smoking-matched analysis, among workers tested both in 1981 and 1988, there was a greater decline in FEV2/FVC ratio and MMF (p less than .05) in the "gassed" group than in the nonexposed group over the 7 year period of observation. These results emphasize the need for worker protection against accidental chlorine gas exposures.     

Chronic rhinitis in workers at risk of reactive airways dysfunction syndrome due to exposure to chlorine

BACKGROUND: To assess the frequency of chronic upper airways symptoms and to relate the presence of these symptoms to accidental exposure to chlorine and changes in lower airways symptoms, airway function, and bronchial responsiveness in a cohort of workers at risk of sporadic occupational exposure to high concentrations of chlorine. METHODS: Data were collected on symptom assessment, spirometry, and methacholine challenge tests from 211 workers seen twice at a 2 year interval (1992- 4). RESULTS: The proportion of workers reporting chronic rhinitis was 46.9% in 1992 and 42.2% in 1994. Chronic rhinitis reported in 1994 was significantly associated with acute exposure to chlorine (self reports, p = 0.02; first aid reports, p = 0.001). In a multivariate logistic regression analysis the presence of reported accidents at the first aid unit (one accident, odds ratio (OR) 3.1, 95% confidence interval (95% CI) 1.3 to 7.5; two or more accidents, OR 6.2, 1.1 to 35.8) and of personal atopy (OR 5.5, 2.2 to 10.8) were significant predictors of chronic rhinitis in 1994. Chronic lower airways symptoms were more frequent in 1994 among workers reporting chronic rhinitis on both assessments than in others (p = 0.03) and changes in bronchial responsiveness were more pronounced in those with persistent rhinitis (p = 0.09). CONCLUSIONS: These results suggest that persistent nasal symptoms in workers at risk of reactive airways dysfunction syndrome could be a useful marker of lower respiratory tract abnormalities.     

Respiratory symptoms and ventilatory function in confectionery workers.

Respiratory symptoms and ventilatory capacity were studied in a group of 288 workers (259 women and 29 men) employed in a confectionery plant. A group of workers (96 women and 31 men) not exposed to confectionery manufacture were also studied as controls. The prevalence of chronic respiratory symptoms was higher in exposed than in control workers, being greatest for confectionery workers exposed to the dust of flour, talc, and starch and the vapours of alcohol. Chronic bronchitis was reported by 7% of the women and 21% of the men, and chest tightness was reported by 27% of women and 66% of men. There was a high prevalence of acute irritative symptoms during the workshift in all groups of confectionery workers, especially for cough, dyspnoea, burning and dryness of the throat, and eye irritation. For all groups of confectionery workers there were statistically significant across shift reductions in ventilatory capacity, being most pronounced for maximum flow rate at 50% of the control vital capacity (FEF50; range 4.6-13.0%) and at 25% of the control vital capacity (FEF25; range 4.7-22.3%). Preshift values of FEF50 and FEF25 were significantly lower than predicted values. The data suggest that some workers employed in confectionery plants may develop acute and chronic respiratory symptoms associated with changes in lung function.     

Respiratory symptoms and ventilatory capacity in swine confinement workers.

A group of 59 workers (41 men and 18 women) employed in swine confinement areas was studied to assess the presence of acute and chronic respiratory symptoms and the prevalence of abnormalities in ventilatory function. A control group of 46 (31 men and 15 women) unexposed workers was studied for the prevalence of chronic respiratory symptoms. For both male and female swine confinement workers complaints of chronic cough, dyspnoea, and chest tightness were significantly more frequent than among control workers. Male workers also complained more of chronic phlegm. Male swine confinement workers who were smokers had significantly higher prevalences of chronic cough, chronic phlegm, and chronic bronchitis than male non-smoking swine confinement workers. The frequency of acute symptoms associated with the workshift was high among the swine confinement workers with more than half of the workers complaining of cough and dyspnoea associated with work. Significant acute across shift reductions in lung function occurred in swine confinement workers, being largest for FEF25. All Monday preshift ventilatory capacity measurements in male confinement workers were significantly lower than predicted values; FVC and FEV1 were found to be lower than predicted values for women. The data indicate that exposure in swine confinement buildings is associated with the development of acute and chronic respiratory symptoms and impairment of lung function. Smoking appears to aggravate these changes.     

Respiratory symptoms and ventilatory capacity in swine confinement workers.

A group of 59 workers (41 men and 18 women) employed in swine confinement areas was studied to assess the presence of acute and chronic respiratory symptoms and the prevalence of abnormalities in ventilatory function. A control group of 46 (31 men and 15 women) unexposed workers was studied for the prevalence of chronic respiratory symptoms. For both male and female swine confinement workers complaints of chronic cough, dyspnoea, and chest tightness were significantly more frequent than among control workers. Male workers also complained more of chronic phlegm. Male swine confinement workers who were smokers had significantly higher prevalences of chronic cough, chronic phlegm, and chronic bronchitis than male non-smoking swine confinement workers. The frequency of acute symptoms associated with the workshift was high among the swine confinement workers with more than half of the workers complaining of cough and dyspnoea associated with work. Significant acute across shift reductions in lung function occurred in swine confinement workers, being largest for FEF25. All Monday preshift ventilatory capacity measurements in male confinement workers were significantly lower than predicted values; FVC and FEV1 were found to be lower than predicted values for women. The data indicate that exposure in swine confinement buildings is associated with the development of acute and chronic respiratory symptoms and impairment of lung function. Smoking appears to aggravate these changes.     

Respiratory symptoms associated with low level sulphur dioxide exposure in silicon carbide production workers.

Relations between pulmonary symptoms and exposure to respirable dust and sulphur dioxide (SO2) were evaluated for 145 silicon carbide (SiC) production workers with an average of 13.9 (range 3-41) years of experience in this industry. Eight hour time weighted average exposures to SO2 were 1.5 ppm or less with momentary peaks up to 4 ppm. Cumulative SO2 exposure averaged 1.94 (range 0.02-19.5) ppm-years. Low level respirable dust exposures also occurred (0.63 +/- 0.26 mg/m3). After adjusting for age and current smoking status in multiple logistic regression models, highly significant, positive, dose dependent relations were found between cumulative and average exposure to SO2, and symptoms of usual and chronic phlegm, usual and chronic wheeze, and mild exertional dyspnoea. Mild and moderate dyspnoea were also associated with most recent exposure to SO2. Cough was not associated with SO2. No pulmonary symptoms were associated with exposure to respirable dust nor were any symptoms attributable to an interaction between dust and SO2. Cigarette smoking was strongly associated with cough, phlegm, and wheezing, but not dyspnoea. A greater than additive (synergistic) effect between smoking and exposure to SO2 was present for most symptoms. These findings suggest that long term, variable exposure to SO2 at 1.5 ppm or less was associated with significantly raised rates of phlegm, wheezing, and mild dyspnoea in SiC production workers, and that current threshold limits for SO2 may not adequately protect workers in this industry.     

Respiratory Protection Behavior and Respiratory Indices among Poultry House Workers on Small,Family-Owned Farms in North Carolina: A Pilot Project

The aim of this pilot study was to evaluate respiratory behavior and respiratory indices of poultry workers on family-owned, poultry farms with 10 or less employees in North Carolina. A field study was conducted to collect data on participants (N = 24) using spirometry, fractional exhaled nitric oxide (Feno), and an interviewer-administered questionnaire. The majority of workers (76%) ranked respiratory protection as being important, yet 48% reported never or rarely wearing respiratory protection when working in dusty conditions. A large percent of workers reported eye (55%) and nasal (50%) irritation and dry cough (50%). On average, pulmonary lung function and Feno tests were normal among nonsmokers. In bivariate analysis, significant associations were identified between working 7 days on the farm (P = .01), with eye irritation, and working 5 or fewer years in poultry farming (P = .01). Poultry workers on family-owned farms spend a considerable amount of work time in poultry houses and report acute respiratory-related health symptoms. Administrative controls among small, family-owned poultry farms are necessary to improve and promote safety and health to its employees.     

Respiratory effects of chlorine gas

Beach, F. X. M., Sherwood Jones, E., and Scarrow, G. D. (1969).Brit. J. industr. Med.,26, 231-236. Respiratory effects of chlorine gas. Seven chemical workers who were accidentally exposed to chlorine gas in separate accidents were investigated. The usual symptoms were cough, dyspnoea, and chest pains, the symptoms starting within 10 minutes of exposure and lasting two to eight days. Chest radiographs showed congestion, consolidation, and nodules; lung oedema was also present in a severe case. These changes usually cleared within one week but in the severe case persisted for 10 weeks. Three patients had respiratory failure. Hypoxaemia was found in four patients and was quickly corrected by oxygen therapy in three of them, but in the severe case hypoxaemia persisted for four days despite continuous oxygen therapy. All the patients recovered completely.     

Toxicological Aspects of Increased Use of Surface and Hand Disinfectants in Croatia During the COVID-19 Pandemic: a Preliminary Report

All COVID-19 prevention strategies include regular use of surface disinfectants and hand sanitisers. As these measures took hold in Croatia, the Croatian Poison Control Centre started receiving phone calls from the general public and healthcare workers, which prompted us to investigate whether the risk of suspected/symptomatic poisonings with disinfectants and sanitisers really increased. To that end we compared their frequency and characteristics in the first half of 2019 and 2020. Cases of exposures to disinfectants doubled in the first half of 2020 (41 vs 21 cases in 2019), and exposure to sanitisers increased about nine times (46 vs 5 cases in 2019). In 2020, the most common ingredients of disinfectants and sanitisers involved in poisoning incidents were hypochlorite/glutaraldehyde, and ethanol/isopropyl alcohol, respectively. Exposures to disinfectants were recorded mostly in adults (56 %) as accidental (78 %) through ingestion or inhalation (86 %). Fortunately, most callers were asymptomatic (people called for advice because they were concerned), but nearly half reported mild gastrointestinal or respiratory irritation, and in one case severe symptoms were reported (gastrointestinal corrosive injury). Reports of exposure to hand sanitisers highlighted preschool children as the most vulnerable group. Accidental exposure through ingestion dominated, but, again, only mild symptoms (gastrointestinal or eye irritation) developed in one third of the cases. These preliminary findings, however limited, confirm that increased availability and use of disinfectants and sanitisers significantly increased the risk of poisoning, particularly in preschool children through accidental ingestion of hand sanitisers. We therefore believe that epidemiological recommendations for COVID-19 prevention should include warnings informing the general public of the risks of poisoning with surface and hand disinfectants in particular.     

A clinical and immunological study on 92 workers occupationally exposed to anhydrides

This study aimed at investigating sensitizing and hazardous effects of a new acid anhydride, pyromellitic dianhydride (PMDA), in addition to those of phthalic anhydride, maleic anhydride and trimellitic anhydride, in a group of 92 exposed workers in two German chemical plants. Of the 92 workers, 56 reported work-related complaints with a predominance of phlegm and dyspnoea in those exposed to anhydride dust for less than 1 year. Haemorrhagic rhinitis occurred only after a prolonged exposure of more than 15 years. Specific IgE antibodies to anhydride-HSA conjugates could be detected in 15 exposed subjects, 12 of whom had work-related symptoms. The IgE-positive group had significantly more impaired lung function parameters than the IgE-negative group. The proportion of IgE-positive subjects was highest in the groups with dyspnoea (5/18), cough (6/24) and rhinitis (11/44) whereas only 1 of 11 workers with haemorrhagic rhinitis had such antibodies. A follow-up study of 23 affected workers was performed after 10 months to assess clinical symptoms, lung function and IgE antibody levels. This follow-up study showed the absence of obstructive ventilation patterns in three out of six subjects in addition to cessation of symptoms in most initially affected workers who were no longer exposed. On the other hand, 14 workers under continuous exposure had comparable pathological findings on re-examination. Our results confirm that anhydrides including the lesser known PMDA, behave as respiratory irritants and as immediate-type sensitizers. They predominantly induced reversible symptoms in workers whose exposure stopped after a working period of about 0.7 years. Abnormal lung function parameters normalized in nearly 50% of these subjects.     

杭州市2004-2005年学校集聚性类流感疫情的流行特征

目的了解学校类流感疫情流行特征,为采取干预措施提供依据。方法对2004-2005年发生类流感疫情的在校学生和到当地医院就诊的学生进行调查。采集类流感病例鼻咽拭子标本,利用MDCK细胞传代技术分离流感病毒。结果2004-2005年杭州市学校共计报告类流感疫情150起,发病学生2853人,占全部类流感疫情的93.79%;2至4月及9至11月为2个高发期。每起类流感疫情发病人数均数为19.08例,平均报告时间为5.36d。65.85%的疫情检出流感病毒,29.41%的标本检出流感病毒。结论杭州市流感表现为散发和局部爆发的特征。     

Comparison of French and English versions of the American Thoracic Society respiratory questionnaire in a bilingual working population

Standardized French and English versions of the American Thoracic Society (ATS) respiratory disease questionnaire were administered to 204 English-speaking and 406 French-speaking male blue-collar aviation workers unexposed to occupational respiratory hazards. After adjusting for smoking status, age, years of education, foreign birth and maternal language other than French or English, no significant differences between the two questionnaires were found for response rates to usual cough, usual phlegm, mild or moderate dyspnoea, and chronic bronchitis. French-speaking workers reported significantly less wheeze with colds (OR = 0.60, p less than 0.02) and wheeze apart from colds (OR = 0.55, p less than 0.05) than the English-speaking group, but, the occurrence of wheeze on most days or nights was similar for both groups (OR = 1.02, NS). For 66 bilingual workers who completed both French and English questionnaires at a time interval of approximately two months, highly consistent results were found for sociodemographic data, smoking habits, cough, phlegm, breathlessness and chronic bronchitis, but not for wheeze with or apart from colds (agreement less than 90%; Kappa less than 0.50). These results reflect the difficulties in translating the concept of 'wheeze' from English to French. We conclude that most symptoms elicited by the French questionnaire may be generalized to English-speaking populations, but that questions pertaining to wheeze on most days or nights may be preferable to other questions concerning wheeze.     

Respiratory symptoms associated with low level sulphur dioxide exposure in silicon carbide production workers

Relations between pulmonary symptoms and exposure to respirable dust and sulphur dioxide (SO2) were evaluated for 145 silicon carbide (SiC) production workers with an average of 13.9 (range 3-41) years of experience in this industry. Eight hour time weighted average exposures to SO2 were 1.5 ppm or less with momentary peaks up to 4 ppm. Cumulative SO2 exposure averaged 1.94 (range 0.02-19.5) ppm-years. Low level respirable dust exposures also occurred (0.63 +/- 0.26 mg/m3). After adjusting for age and current smoking status in multiple logistic regression models, highly significant, positive, dose dependent relations were found between cumulative and average exposure to SO2, and symptoms of usual and chronic phlegm, usual and chronic wheeze, and mild exertional dyspnoea. Mild and moderate dyspnoea were also associated with most recent exposure to SO2. Cough was not associated with SO2. No pulmonary symptoms were associated with exposure to respirable dust nor were any symptoms attributable to an interaction between dust and SO2. Cigarette smoking was strongly associated with cough, phlegm, and wheezing, but not dyspnoea. A greater than additive (synergistic) effect between smoking and exposure to SO2 was present for most symptoms. These findings suggest that long term, variable exposure to SO2 at 1.5 ppm or less was associated with significantly raised rates of phlegm, wheezing, and mild dyspnoea in SiC production workers, and that current threshold limits for SO2 may not adequately protect workers in this industry.     

接触对甲苯磺酸作业人员健康状况调查

目的了解3家企业接触对甲苯磺酸作业人员的健康状况,为保护职业接触者身体健康提供依据。方法采用自制的健康状况调查表对生产和使用对甲苯磺酸的3家企业194名作业人员（接触组）进行调查,并分别选取3家企业不接触对苯磺酸的166人的对照组,结合职业健康检查情况,综合分析其健康状况。结果接触对甲苯磺酸作业人员的急性刺激症状发生率（甲企业49．7％、乙丙企业51．0％）高于对照组（甲企业12．9％、乙丙企业23．8％）,差异有统计学意义（P〈0．01）;其职业健康检查异常情况构成与对照组的差异无统计学意义（P〉0．05）。结论接触对甲苯磺酸的作业人员健康损害主要表现为眼睛刺激、咳嗽、皮肤刺激等急性刺激症状,建议应加强工作场所通风及个人防护,尤其是皮肤防护。     

Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: II. Follow up of affected workers by questionnaire,spirometry, and assessment of bronchial responsiveness 18 to 24 months after exposure ended.

OBJECTIVE--The aim was to determine the prevalence of persistent respiratory symptoms and bronchial hyper-responsiveness due to reactive airways dysfunction syndrome in a population of construction workers at moderate to high risk of developing the syndrome, at an interval of 18 to 24 months after multiple exposures to chlorine gas during renovations to a pulp and paper mill. DESIGN AND PARTICIPANTS--71 of 289 exposed workers (25%) were identified on the basis of an exposure and the onset of respiratory symptoms shortly after this event (moderate to high risk). A standardised respiratory questionnaire was first presented, followed by spirometry and a methacholine inhalation test on those whose questionnaire suggested the persistence of respiratory symptoms. RESULTS--64 of 71 (90%) subjects completed the respiratory questionnaire at the time of the follow up. The questionnaire suggested a persistence of respiratory symptoms in 58 of the 64 workers (91%). Of the 58 subjects, 51 underwent spirometry and assessment of bronchial responsiveness. All of them used bronchodilators as required (not regularly) and four required inhaled anti-inflammatory preparations. Sixteen had bronchial obstruction (forced expiratory volume in one second) (FEV1 < 80% predicted) and 29 showed significant bronchial hyper-responsiveness. CONCLUSION--Of the subjects (n = 71) who were at moderate to high risk of developing reactive airways dysfunction syndrome after being exposed to chlorine and were seen 18 to 24 months after exposure ended, 58 (82%) still had respiratory symptoms, 16 (23%) had evidence of bronchial obstruction, and 29 (41%) had bronchial hyper-responsiveness.     

济南市某高校1起甲型H1N1流感暴发疫情调查

[目的]分析1起学校甲型H1N1流感暴发的特点和原因,为今后类似疾病的预防与控制提供经验。[方法]2009年10月14日至11月16日,到现场进行流行病学调查。[结果]本起疫情历时32d,全校发生甲型H1N1流感病例13例,罹患率为0.14%;无重症和死亡病例;男生罹患率为0.56%,女生罹患率为0.07%。13例病例分布在山东大学兴隆山校区7个学院10班级,采集20份患者咽拭子,13份甲型H1N1流感核酸阳性。[结论]确定为1起暴发甲型H1N1流感。     

Self reported respiratory symptoms and diseases among hairdressers.

OBJECTIVES: Hairdressers are exposed to many irritative and allergenic substances capable of causing occupational respiratory symptoms and diseases. The self reported prevalence of respiratory symptoms and diseases was studied, and the risks among hairdressers compared with saleswomen was estimated. METHODS: A cross sectional prevalence study of respiratory symptoms and diseases was carried out among hairdressers and supermarket saleswomen, with a computer assisted telephone interview method (CATI). The study population comprised all the female hairdressers and supermarket saleswomen aged 15-54 years in the Helsinki metropolitan area, Finland. Disproportionate random samples of female hairdressers and sales-women were drawn from the trade union membership registers. The interviews were carried out between February and April 1994. A response rate of 80.5% (355/440) was obtained for hairdressers and 82.2% (583/709) for saleswomen. Atopy, smoking, chronic illnesses, type of work, working hours, working conditions, personal and professional use of hair products, and the use of personal protective devices were assessed. The outcome variables were self reported symptoms of the upper and lower respiratory tract. These were used to define chronic bronchitis, and asthma, laryngitis, and allergic rhinitis diagnosed by a physician. RESULTS: There was a considerable difference in the prevalence of chronic bronchitis; 6.8% in hairdressers versus 1.9% in saleswomen. The odds ratio (OR) adjusted for age, smoking, and atopy for chronic bronchitis indicated an increased risk of chronic bronchitis (OR 4.8, 95% confidence interval (95% CI) 2.2 to 10.1). No association was found between work as a hairdresser and asthma, laryngitis, and allergic rhinitis. Also the prevalence of rhinitis, rhinitis with eye symptoms, cough with phlegm, dyspnoea, and dyspnoea accompanied by cough was increased among hairdressers. The corresponding adjusted risk ORs were 1.7 (95% CI 1.3 to 2.3) for rhinitis, 1.9 (95% CI 1.4 to 2.6) for rhinitis with eye symptoms, 1.4 (CI 1.1 to 1.9) for cough with phlegm, 1.5 (95% CI 1.0 to 2.2) for dyspnoea, and 1.6 (95% CI 1.0 to 2.7) for dyspnoea with cough. CONCLUSIONS: Our results indicate an increased prevalence of upper and lower respiratory symptoms among hairdressers. Allergenic and irritative chemicals in hairdressing are likely candidates explaining the difference found between the hairdressers and controls. Work related reasons should be considered when a hairdresser presents with airway symptoms. Preventive actions are needed to improve the working conditions and personal protection.     

Short term respiratory effects of acute exposure to chlorine due to a swimming pool accident

OBJECTIVE—Acute exposure to chlorine causes lung damage, and recovery may proceed slowly for several weeks. The short term respiratory effects of acute chlorine inhalation during a swimming pool accident were examined.
METHODS—A total of 282 subjects (134 children, aged <14 years) inhaled hydrogen chloride and sodium hypochlorite during an accident caused by a malfunction of the water chlorinating system in a community pool in Rome in 1998. Most people received bronchodilators and cortisone at the emergency room; five children were admitted to hospital. A total of 260 subjects (92.2%) were interviewed about duration of exposure (<3, 3-5, >5 minutes), intensity of exposure (not at all or a little, a moderate amount, a lot), and respiratory symptoms. Lung function was measured in 184 people (82 children) after 15-30 days. The effects of exposure to chlorine were analysed through multiple linear regression, separately in adults and in children.
RESULTS—Acute respiratory symptoms occurred among 66.7% of adults and 71.6% of children. The incidences were highest among those who had chronic respiratory disease and had a longer duration of exposure. In about 30% of the subjects, respiratory symptoms persisted for 15-30 days after the accident. Lung function levels were lower in those who reported a high intensity of exposure than in those who reported low exposure, both in children and in adults (mean (95% confidence interval (95% CI)) differences in forced expiratory volume in 1 second (FEV_1,) were −109 (−310 to 93) ml, and −275 (−510 to −40) ml, respectively).
CONCLUSION—Persistent symptoms and lung function impairment were found up to 1 month after the incident. Although community pool accidents happen rarely, the medical community needs to be alerted to the possible clinical and physiological sequelae, especially among susceptible people.


Keywords: accidental exposure; chlorine gas; lung function