Decreased lung function and exposure to diisocyanates (hdi and hdi‐bt) in car repair painters: Observations on re‐examination 6 years after initial study

Tornling, G; Alexandersson, R; Hedenstierna, Guran; Plato, Nils

doi:10.1002/ajim.4700170302

Cited by 52 publications

(38 citation statements)

References 17 publications

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“…A similarly sized cross-sectional study reported an association between estimated exposure levels and expiratory flow rates in aircraft painters [22]. A smaller longitudinal study that included exposure measurements found an association in smokers between FEV1, FVC and vital capacity and the frequency of peak exposures but not with mean levels [23]. Interestingly, the present authors only found significant associations with lung function in nonatopic workers.…”

Section: Lung Function and Isocyanate Exposurecontrasting

confidence: 55%

Different respiratory phenotypes are associated with isocyanate exposure in spray painters

Pronk¹,

Preller²,

Doekes³

et al. 2009

Eur Respir J

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Associations have been observed between exposure to isocyanates, consisting mainly of oligomers, and respiratory symptoms and isocyanate specific sensitisation in spray painters. The aim of the present study was to assess associations between isocyanate exposure and more objective respiratory effect measures such as bronchial hyperresponsiveness (BHR), baseline spirometry and exhaled nitric oxide (eNO) in a subset of spray painters.Methacholine challenge and eNO measurements were performed in 229 workers. Questionnaires and blood samples were obtained. Specific immunoglobulin (Ig)E and IgG to hexamethylene di-isocyanate were assessed in serum using various assays. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and timeactivity information.Workers with higher isocyanate exposure were more often hyperresponsive (prevalence ratio comparing the 75th versus 25th percentile of exposure 1.8). In addition, significant exposurerelated decreased forced expiratory volume in one second (FEV1), FEV1/forced vital capacity ratio and flow-volume parameters independent of BHR were found. BHR was more prevalent among sensitised workers. This was statistically significant for only IgG-ImmunoCAP (Phadia, Uppsala, Sweden) positive workers. eNO was not associated with exposure although slightly elevated eNO levels in specific IgG positive subjects were found.The current study provides evidence that exposure to isocyanate oligomers is related to asthma with bronchial hyperresponsiveness as a hallmark, but also shows independent chronic obstructive respiratory effects resulting from isocyanate exposure.KEYWORDS: Bronchial hyperresponsiveness, hexamethylene di-isocyanate, oligomer, sensitisation, spirometry, spray painter D i-isocyanates are among the most common causes of occupational asthma [1][2][3]. Although asthma is considered the major health effect, hypersensitivity pneumonitis and accelerated lung function decline have also been related to di-isocyanate exposure [4]. Di-isocyanate monomers are characterised by two highly reactive isocyanate (NCO) groups and are used as polymerising agents in polyurethane products [5]. Most of the evidence regarding health effects from di-isocyanates involves these monomers. Lately, isocyanate oligomers or poly-isocyanates, with lower vapour pressure, have been introduced to reduce inhalatory exposure. These are increasingly being used and currently many workers are exposed to complex mixtures of isocyanate oligomers. Exposure assessment for these agents is challenging [6] and few epidemiological studies incorporated an exposure assessment component. As a result, exposure-response information for isocyanate oligomers is extremely limited.The present authors recently demonstrated an association between exposure and (work-related) respiratory symptoms and isocyanate-specific sensitisation in a population of 581 spray painters exposed to mainly hexamethylene di-isocyanate (HDI) oligomers [7]. To further investigate the nature of respirato...

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Section: Lung Function and Isocyanate Exposurecontrasting

confidence: 55%

Different respiratory phenotypes are associated with isocyanate exposure in spray painters

Pronk¹,

Preller²,

Doekes³

et al. 2009

Eur Respir J

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“…Similar to our results, Shabani et al (24) also found a signifi cant difference between changes in peak flow among automobile paint shop workers on the day of painting and the day after that. A study by Torling et al (15) suggested that respiratory damage and complications in automobile paint shop workers was due to exposure to HDI.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have indicated that exposure to relatively low concentrations of isocyanides is related to impaired lung function (15).…”

mentioning

confidence: 99%

Effect of 1,6-Hexamethylene Diisocyanate Exposure on Peak Flowmetry in Automobile Paint Shop Workers in Iran

Pourabedian

Barkhordari

Habibi

et al. 2010

Archives of Industrial Hygiene and Toxicology

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The aim of this study was to investigate the effects of occupational exposure to 1,6-hexamethylene diisocyanate (HDI) on peak fl owmetry in automobile body paint shop workers in Iran. We studied a population of 43 car painters exposed to HDI at their workplaces. Peak expiratory fl ow was tested for one working week, from the start to the end of each shift. Air was sampled and HDI analysed in parallel, according to the OSHA 42 method. Daily and weekly HDI exposure averages were (0.42±0.1) mg m -3 and (0.13±0.05) mg m -3, respectively. On painting days, 72 % of workers showed more than a 10 % variation in peak expiratory fl ow. Inhalation exposure exceeded the threshold limit value (TLV) ten times over. This strongly suggests that HDI affected the peak fl owmetry in the studied workers.

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“…It has been reported that intermittent peak exposures to airway irritants can cause airways hyperresponsiveness (AHR) [20], and that the number of peak exposures can be a better descriptor of lung function [21] than the average exposure. A recent study on AHR in 688 male workers exposed to low-level irritants [22] showed a lower prevalence of AHR in subjects with less than 5 yrs exposure to SO 2 and oil mist, probably due to pre-employment screening.…”

Section: Discussionmentioning

confidence: 99%

A five year follow-up of lung function among chemical workers using flow-volume and impedance measurements

Keman¹,

Willemse²,

Wesseling³

et al. 1996

Eur Respir J

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A A f fi iv ve e y ye ea ar r f fo ol ll lo ow w--u up p o of f l lu un ng g f fu un nc ct ti io on n a am mo on ng g c ch he em mi ic ca al l w wo or rk ke er rs s u us si in ng g f fl lo ow w--v vo ol lu um me e a an nd d i im mp pe ed da an nc ce e m me ea as su ur re em me en nt ts s S. Keman*, B. Willemse*, G.J. Wesseling**, E. Kusters + , P.J.A. Borm* A five year follow-up of lung function among chemical workers using flow-volume and impedance measurements. S. Keman, B. Willemse, G.J. Wesseling, E. Kusters, P.J.A. Borm. ERS Journals Ltd 1996. ABSTRACT: Impedance of the respiratory system, measured using the forced oscillation technique (FOT), has repeatedly been proposed as a tool for occupational health screening.The aim of this study was to compare the outcome of impedance measurements and flow-volume curves, and to study relationships between lung function decline and specific exposures and smoking. Both measurements were applied in 136 chemical workers from seven main production/personnel groups during a 5 year followup (1990)(1991)(1992)(1993)(1994)(1995).The prevalence of airway obstruction (forced expiratory volume in one second (FEV1) <80% of predicted) at both time-points was about 5% but did not necessarily include the same subjects. The average decline in FEV1 over 5 yrs was 200 mL (predicted decline 160 mL). Although most impedance parameters correlated to flow-volume parameters in both years, a rapid 5 year decline of FEV1 (>330 mL) was only accompanied by a significant decrease in the reactance at 8 Hz (X8) and an increase in the resonance frequency (f0). Interestingly, decline in FEV1 was significantly dependent on age, years of employment, pack-years, FEV1, and all impedance parameters at the start in 1990 (r=0.35; p=0.01). Similarly, the increase in f0 was significantly dependent on age, years of employment, pack-years, f0, FEV1, forced vital capacity (FVC), peak expiratory flow (PEF) and maximal mid-expiratory flow (MMEF) at the start (r=0.56; p<0.01). Those with a rapid decline in FEV1 were relatively more represented among acid workers (relative risk (RR)=2.14), maintenance workers (RR=2.1) and bulk/transport workers (RR=1.78), but none of these was significant. Lung function, however, was significantly lower in the bulk/transport workers (n=14) compared to the rest, based both on flow-volume (FEV1, FVC) and impedance (X8, f0) measurements. Smoking had a significant effect on most flow-volume parameters but only for frequency dependence among the impedance outcomes.It is concluded that alterations in impedance parameters do reflect changes in flow-volume curves induced by age, smoking and occupational exposure. Therefore, these data are a valuable extension to current cross-sectional data. Eur Respir J., 1996Respir J., , 9, 2109 Although a decline in forced expiratory volume in one second (FEV1) is generally considered as a gold standard to detect airflow limitation, different (mechanical) alterations of the respiratory system can influence this parameter. Impedance measurements of ...

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Decreased lung function and exposure to diisocyanates (hdi and hdi‐bt) in car repair painters: Observations on re‐examination 6 years after initial study

Cited by 52 publications

References 17 publications

Different respiratory phenotypes are associated with isocyanate exposure in spray painters

Different respiratory phenotypes are associated with isocyanate exposure in spray painters

Effect of 1,6-Hexamethylene Diisocyanate Exposure on Peak Flowmetry in Automobile Paint Shop Workers in Iran

A five year follow-up of lung function among chemical workers using flow-volume and impedance measurements

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