Quaternary ammonium compounds and occupational asthma

Purohit, A K; Kopferschmitt-Kubler, M.C.; Moreau, C; Popin, E; Blaumeiser, M; Pauli, Georg

doi:10.1007/s004200000162

Cited by 137 publications

(120 citation statements)

References 13 publications

(15 reference statements)

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“…Benzalkonium chloride has bronchoconstrictor properties, being only 7.4 times less potent as a bronchoconstrictor agonist than histamine [28][29][30]. Furthermore, exposure to benzalkonium chloride is a recognised cause of occupational asthma [31][32][33]. The administration of placebo Respimat solution containing benzalkonium chloride in a concentration of 100 mg?mL -1 causes bronchoconstriction with a fall in forced expiratory volume in 1 s (FEV1 ) of o15% from baseline in 4.3% of occasions in patients with COPD [34].…”

Section: Differential Risk With Tiotropium Productsmentioning

confidence: 99%

Tiotropium Respimat increases the risk of mortality: pro

Beasley

2013

Eur Respir J

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@ERSpublications Tiotropium Respimat increases mortality risk. First do no harm. Tiotropium Respimat should not be prescribed in COPD http://ow.ly/mzPGL Systematic reviews and meta-analyses of randomised controlled trials of medications provide a high standard of evidence to inform clinical practice, and can be considered the ''gold standard'' for assessing the risk/benefit profile of treatments [1,2]. Three systematic reviews and meta-analyses (including a Cochrane Review) of randomised placebo-controlled trials of tiotropium Respimat, each using different methods, have demonstrated a 50% increased risk of mortality, with its use in patients with chronic obstructive pulmonary disease (COPD) [3][4][5]. These analyses provide substantive evidence that tiotropium Respimat increases mortality in the treatment of COPD [6,7]. It is informative to review each of the systematic reviews and the issues that have been raised relevant to their interpretation.In 2011 the British Medical Journal (BMJ) published the first systematic review and meta-analysis, which included all parallel-group, randomised, placebo-controlled trials of tiotropium Respimat in the treatment of COPD that had reported data on mortality and were of a minimum 30-day duration [3] (table 1 [ [8][9][10]). Five trials were included in the analysis, two 12-week trials and three 12-month trials, studying 6522 participants. All five trials were judged to be at low risk of bias. Tiotropium Respimat significantly increased the risk of all-cause mortality, relative risk 1.52 (95% CI 1.06-2.16). There was an apparent dose-response effect on all-cause mortality, with RR 1.46 (95% CI 1.01-2.10) and 2.15 (95% CI 1.03-4.51), for the 5-mg and 10-mg preparations, respectively ( fig. 1). The overall estimates were not substantially changed by sensitivity analyses using the random effects model, limiting the analysis to three trials of 1-year duration period each, or the inclusion of additional preliminary data on tiotropium Respimat from an unpublished study. An accompanying editorial calculated, based on these figures, that one excess death is expected for every 121 (COPD) patients treated with a 5 mg dose of tiotropium by Respimat for 12 months [11].The 2012 Cochrane Review of tiotropium included the same five randomised placebo-controlled clinical trials of tiotropium Respimat, but used the Peto method for pooled estimation of odds ratio, which is arguably more appropriate for the combined analysis of rare events such as death [4]. Tiotropium Respimat significantly increased the risk of mortality, OR 1.47 (95% CI 1.04-2.08). In contrast there was no increased risk of mortality with tiotropium HandiHaler, OR 0.92 (95% CI 0.80-1.05).In 2012 Thorax published a systematic review with direct comparison and mixed treatment comparison meta-analyses of randomised controlled trials of medications used in the treatment of COPD that provided data about overall or cardiovascular death, and were a minimum 6 months in trial duration [5]. In the direct comparison meta-analysis, ti...

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Section: Differential Risk With Tiotropium Productsmentioning

confidence: 99%

Tiotropium Respimat increases the risk of mortality: pro

Beasley

2013

Eur Respir J

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“…In a recent registry study, the most commonly reported exposure linked to asthma among HCWs were cleaning products, which accounted for 24% of all cases, including 21% of the cases reported among nurses (6). Both general (e.g., bleach, ammonia) and more specific (e.g., quaternary ammonium compounds) cleaning products have been linked to occupational asthma (31). These and other commercial product ingredients, known to be potential respiratory sensitizers and/or irritants, were identified in the walk-throughs conducted for the development of our JEM (Table 4).…”

Section: Univariate Analysis Between Independent Variables As Assessmentioning

confidence: 99%

Occupational Risk Factors and Asthma among Health Care Professionals

Delclos

Gimeno

Arif

et al. 2007

Am J Respir Crit Care Med

132

172

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Rationale: Recent U.S. data suggest an increased risk of work-related asthma among health care workers, yet only a few specific determinants have been elucidated. Objectives: To evaluate associations of asthma prevalence with occupational exposures in a cross-sectional survey of health care professionals. Methods: A detailed questionnaire was mailed to a random sample (n ϭ 5,600) of all Texas physicians, nurses, respiratory therapists, and occupational therapists with active licenses in 2003. Information on asthma symptoms and nonoccupational asthma risk factors obtained from the questionnaire was linked to occupational exposures derived through an industry-specific job-exposure matrix. Measurements: There were two a priori defined outcomes: (1 ) physiciandiagnosed asthma with onset after entry into health care ("reported asthma") and (2 ) "bronchial hyperresponsiveness-related symptoms," defined through an 8-item symptom-based predictor. Conclusions:The contribution of occupational exposures to asthma in health care professionals is not trivial, meriting both implementation of appropriate controls and further study.

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“…Bezpośrednie toksyczne działanie QACs na nabło-nek oddechowy może więc wynikać z działania enzymów z grupy peptydaz trawiących wydzielone tachykininy, ale także ze zwiększenia ekspresji cząsteczek adhezyjnych na komórkach i nadprodukcji mediatorów zapalnych, takich jak pochodne kwasu arachidonowego (26). Działanie alergizujące QACs, podobnie jak w przypadku innych czynników o małej masie cząstecz-kowej, może wynikać z ich zachowywania się w ustroju jak hapteny, czyli cząstkowe antygeny zdolne do immunizacji po koniugacji z nośnikiem białkowym (27).…”

Section: Mechanizmy Działaniaunclassified

Quaternary ammonium compounds – new occupational hazards

Lipińska‐Ojrzanowska¹,

Walusiak‐Skorupa²

2014

Med Pr

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StreszczenieCzwartorzędowe związki amoniowe (quaternary ammonium compounds -QACs) należą do organicznych związków jonowych o unikalnych właściwościach surfaktantów i środków odkażających. Coraz szersze zastosowanie QACs w środowisku pracy, a także poza nim, niesie ze sobą nowe zagrożenia zdrowotne dla osób eksponowanych i służby medycyny pracy. W artykule przedstawiono wyniki przeglądu piśmiennictwa na temat wpływu amin czwartorzędowych na organizm człowieka. QACs mogą działać drażniąco na skórę i błony śluzowe, a także mieć potencjał uczulający. Podejrzewa się, że poszczególne QACs mogą wykazywać krzyżową reaktywność immunologiczną między sobą oraz z innymi związkami chemicznymi o podobnej budowie, np. z lekami anestetycznymi. QACs mogą promować rozwój alergii w obrębie dróg oddechowych, jakkolwiek mechanizmy leżące u podstawy tego działania wymagają dalszych badań. Dotychczas opisano kilka przypadków astmy zawodowej wywołanej ekspozycją na QACs oraz udokumentowano ich udział w rozwoju kontaktowego zapalenia skóry. Nie wyklucza się także możliwości wywołania wstrząsu anafilaktycznego przez QACs. Med. Pr. 2014;65(5):675-682 Słowa kluczowe: alergia zawodowa, czwartorzędowe związki amoniowe, QACs, chlorek benzalkonium, BAC, środki odkażające AbstractQuaternary ammonium compounds (QACs, quats) belong to organic ionic chemical agents which display unique properties of both surfactants and disinfectants. Their wide distribution in the work environment and also in private households brings about new occupational hazards. This paper reviews reports about the health effects of QACs. QACs could play a role of sensitizers and irritants to the skin and mucous membranes. It is suspected that particular QACs can display an immunologic crossreactivity between each other and with other chemical compounds containing ammonium ion, such as muscle relaxants widely used in anesthesia. They may promote the development of airway allergy, however, the background mechanisms are still unclear and need to be further investigated. Until now, a few cases of occupational asthma induced by QACs have been described and their involvement in contact dermatitis has been documented. The possibility of anaphylaxis due to QACs cannot be excluded as well. Med Pr 2014;65(5):675-682

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Quaternary ammonium compounds and occupational asthma

Abstract: These three cases, in addition to others reported in the literature, point out an as yet poorly known etiology of occupational asthma to quaternary ammonium compounds in hospital employees. The exact mechanism of the action remains unexplained.

Cited by 137 publications

References 13 publications

Tiotropium Respimat increases the risk of mortality: pro

Tiotropium Respimat increases the risk of mortality: pro

Occupational Risk Factors and Asthma among Health Care Professionals

Quaternary ammonium compounds – new occupational hazards

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