Persistent and Unusual Respiratory Findings after Prolonged Glutaraldehyde Exposure

Abstract

Glutaraldehyde is commonly used in endoscopy labs to clean and disinfect instruments. It can cause direct irritation of the skin and the upper and lower airways. Health care workers are also at risk for the development of irritant-induced or sensitizer-induced occupational asthma when exposed to this chemical. Herein, we report on a patient who had frequent exposures to glutaraldehyde over one year while working in an endoscopy lab and developed chronic upper and lower respiratory tract symptoms. Multiple spirometric tests during her evaluation revealed variable results including restrictive pattern with a response to bronchodilators, obstructive pattern with a paradoxic bronchoconstrictive response to bronchodilators, and obstructive pattern with a partial response to bronchodilators. These results indicate that the distribution of inflammation and bronchial responsiveness can vary in a single patient with glutaraldehyde-induced occupational asthma. Therefore, the evaluation may be more difficult than might be expected in patients with occupational asthma, and some patients will need multiple pulmonary function tests to characterize their airway disease.

Occupational Allergies: A Brief Review

“…), animal handlers, woodworkers, cleaners, healthcare workers (9% of cases), those working in food processing, and so on. 2,[10][11][12] Conversely, some studies showed no increase, or even decrease, in the prevalence of respiratory allergies in farming and textile industries, consistent with the so-called 'hygiene hypothesis'. 13,14 Well-recognised high WRA risk groups are females, smokers, those with history of upper airway symptoms and bronchial hyperresponsiveness, and those with certain hereditary factors, atopic histories, and frequent exposure to high amounts of causative factors.…”

Respiratory Health Problems Among Endoscopy Nurses Exposed to Glutaraldehyde in Zagazig University Hospitals, Egypt

“…This can be explained by McCarthy [19] study who noticed that the unbalanced reduction in the FEV1 as compared to the FVC is a sign of obstructive lung diseases such as asthma, acute and chronic bronchitis, emphysema, bronchiolitis, and bronchiectasis. Also, in a case study by Copeland and Nugent they reported multiple spirometric tests during evaluation which showed variable results glutaraldehyde-induced occupational asthma including restrictive pattern and obstructive pattern [20].…”

Reviewing the Use of Glutaraldehyde for High-level Disinfection by Sonographers

“…Copeland and Nugent studied respiratory effects after prolonged GA exposure. 29 The results found that GA can cause both irritant-induced or sensitization-induced asthma, along with irritation of the skin and airways, and an increased immune response. The symptoms of chest tightness and persistent cough were associated with GA-induced occupational asthma.…”

“…GA use has been associated with numerous health risks, both acute and chronic, for patients and health-care workers (see Figure 1). [18][19][20][22][23][24][25][26][27]29,30,32 The new occupational exposure limit set in Japan, of less than 0.03 ppm for GA, is even lower than the limit of 0.05 ppm previously set in the United States and the UK. 32 Several studies have also demonstrated the inefficacy of GA against HPV and mycobacterium, both of which can be found on ultrasound transducers.…”