Delayed cognitive impairment and pilot incapacitation following contaminated air inhalation

Coxon, Leonie

doi:10.4024/13co14m.jbpc.14.04

Cited by 5 publications

(1 citation statement)

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“…In patient A onset of complaints was gradual over a prolonged period of 14 years of flying, which may seem unusual, but is not uncommon in neurotoxicological disorders (e.g. painter's disease) and has been reported in a previous study of aircrew exposed to contaminated air [4]. Delayed onset of symptoms may reflect the cumulative effects of low level exposure or infrequent exposure to contaminated air.…”

Section: Discussionsupporting

confidence: 49%

Three patients with probable aerotoxic syndrome

Hageman

Pal

Nihom

et al. 2019

Clinical Toxicology

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Introduction: "Aerotoxic syndrome" is a debated entity. Regulatory authorities consider long-term health effects to be an unlikely consequence of exposure to contaminated air because several air quality monitoring studies report low concentrations of toxic chemicals in cabin air. We describe two pilots and one flight attendant, who developed ill health during their flying career which improved after cessation of flying. Case details: The most frequently reported symptoms were headache, balance problems, fatigue, gastro-intestinal complaints and cognitive impairment. One of these patients had reduced levels of butyrylcholinesterase after a flight suggesting exposure to organophosphate compounds had occurred. All three were found to have elevated neuronal and glial auto-antibodies, biomarkers of central nervous system injury, and all three had genetic polymorphisms of paraoxonase (PON-1) and two of cytochrome P450, leading to a reduced ability to metabolize organophosphate compound (OPs). Discussion: A similar constellation of symptoms has been described in other studies of aircrew, although objective evidence of exposure is lacking in most of these studies. Reduced levels of butyrylcholinesterases in one of our cases is suggestive of causation and elevated neuronal and glial autoantibodies provide objective evidence of damage to the central nervous system. We consider further research is warranted.

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Section: Discussionsupporting

confidence: 49%

Three patients with probable aerotoxic syndrome

Hageman

Pal

Nihom

et al. 2019

Clinical Toxicology

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Aerotoxic syndrome: A new occupational disease caused by contaminated cabin air?

Hageman

Ross

Nihom

et al. 2022

Advances in Neurotoxicology

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Ultrafine particle levels measured on board short-haul commercial passenger jet aircraft

Michaelis

Loraine²,

Howard

2021

Environ Health

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Background Airline crew members report adverse health effects during and after inhalation exposure to engine oil fumes sourced to the air supply system onboard commercial and military aircraft. Most investigations into the causal factors of their reported symptoms focus on specific chemical contaminants in the fumes. The adverse health effects reported in aircrew exposed to the aircraft air supply, bled unfiltered off the engine or Auxiliary Power Unit (APU) may be related to particulate exposures, which are widely known to effect health. While oil contaminates the aircraft air supply, some suggest that this will only occur when there is a bearing seal failure, others document that there is low level oil contamination of the air supply during normal engine operation. This brief pilot study explores whether particulate exposure may be associated with the normal engine/APU and air supply operation and to therefore increase the understanding that UFP exposures may have on crew and passengers. Methods An ultrafine particle counter was utilised by an experienced airline captain in the passenger cabin of four short-haul commercial passenger aircraft. All flights were under 90 min on aircraft from two different carriers ranging from 7 months to 14 years old. Results UFP concentrations showed maximum concentrations ranging from 31,300 to 97,800 particles/cm3 when APU was selected on as a source of air on the ground and with engine bleed air and the air conditioning packs selected on during the climb. In 2 of the 4 flights the peaks were associated with an engine oil smell. Increases in UFP particle concentrations occurred with changes in engine/APU power and air supply configuration changes. Conclusions This study identified increases in UFP concentrations associated with engine and APU power changes and changes in air supply configuration. These results correlated with times when engine and APU oil seals are known to be less effective, enabling oil leakage to occur. The concentrations reached in the passenger cabins exceeded those taken in other ground-based environments. UFP exposures in aircraft cabins during normal flight indicates there will be health consequences for long serving aircrew and some passengers.

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Delayed cognitive impairment and pilot incapacitation following contaminated air inhalation

Cited by 5 publications

References 0 publications

Three patients with probable aerotoxic syndrome

Three patients with probable aerotoxic syndrome

Aerotoxic syndrome: A new occupational disease caused by contaminated cabin air?

Ultrafine particle levels measured on board short-haul commercial passenger jet aircraft

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