Occupational asthma

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

6. Occupational Asthma in Finland N The Finnish Register of Occupational Diseases

7. Occupational asthmaSensitization • 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. 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 Agents causing occupational asthma

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. Agents causing occupational asthma/rhinitis and related occupations • 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. Agents causing occupational asthma/rhinitis and related occupations • 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. Agents causing occupational asthma/rhinitis and related occupations • 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. Manufacturing/use of plastic products, sensitizers • Di-isocyanates • Epoxy resins, organic acid anhydride or amine hardeners • Phtalates • Formaldehyde • Azodicarbonamide • Cyanoacrylates • Methacrylates • Polyfunctional aziridine hardener

19. Painting, sensitizers • Di-isocyanate cured paints • Epoxy paints, amine hardeners • Epoxy powder paints • Polyester powder paints • Formaldehyde • Paints with aziridine hardeners

20. Electronics, sensitizers • Soft soldering fumes (colophony) • Di-isocyanate cured varnishes • Epoxy resins, organic acid anhydrides • Acrylate glues • Formaldehyde

21. Hair dressers, sensitizers • Persulphates • Permanent wave chemicals • Hair sprays • Hair dyes • Natural rubber

22. Wood work, sensitizers • Formaldehyde (glues and shellacks) • Wood dusts (exotic woods!) • Di-isocyanate hardened paints • Aziridine hardened paints • Moulds (mouldy wood dusts)

23. Metal work, sensitizers • 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?

24. Clinics natural rubber chloramine T glutaraldehyde formaldehyde Dental care natural rubber methacrylates chloramine T formaldehyde ammonium persulphate Occupational asthma/ health care, sensitizers

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

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

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