The respiratory effects of occupational polypropylene flock exposure

Abstract

The present study evaluated the possible effects of exposure to polypropylene flock on respiratory health and serum cytokines in a cross-sectional study of workers from a plant in Turkey.A total of 50 polypropylene flocking workers were compared to a control group of 45 subjects. All subjects filled out a respiratory questionnaire and underwent a physical examination, a chest radiograph and pulmonary function testing, including single breath carbon monoxide diffusing capacity (DL,CO). Serum interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-a) were measured. Additionally, high resolution computed tomography (HRCT) of the chest was performed in 10 exposed workers with low DL,CO.Work-related respiratory symptoms were reported in 26% of the exposed subjects and in 13.3% of the controls. Logistic regression analysis showed that the risk of respiratory symptoms increased 3.6 fold in polypropylene flocking workers when compared to controls. Parameters of the study group, including per cent predicted: forced vital capacity, forced expiratory volume in one second, forced mid-expiratory flow 25-75% and DL,CO, were significantly lower than in controls. Multivariate analyses showed that being a polypropylene flocking worker was a predictive factor for impairment of pulmonary function. Serum IL-8 and TNF-a levels were increased in the study group compared with the controls. HRCT revealed peribronchial thickening and diffuse ground glass attenuation in some subjects.The present study suggests the presence of subtle or the beginning of interstitial lung disease in these polypropylene flocking workers.

Rayon Flock: A New Cause of Respiratory Morbidity in a Card Processing Plant

“…In a nylon flock plant, restriction was observed in 7% of production workers compared to 3% in office workers; the prevalences of low diffusing capacity were 13% and 5%, respectively [Washko et al, 2000]. Among polypropylene flock workers in Turkey, 20% had restriction and 26% had low DL CO , compared to 4.4% and 4.4%, respectively, of non-exposed controls [Atis et al, 2005]. The proportion of restriction among participants in this plant was 7.8%, and 3.9% had low DL CO .…”

“…The first clusters of flock workers' lung were identified in 1996, in association with nylon flock [Kern et al, 1997[Kern et al, , 1998]. Polyethylene flock has been implicated in a case of flock workers' lung in Spain [Barroso et al, 2002], and polypropylene flock was associated with increased respiratory symptoms in Turkey [Atis et al, 2005]. This article constitutes the first investigation of the health effects of rayon flock exposure.…”

Health hazard evaluation report: HETA-2004-0013-2990, Hallmark Cards, Inc., Lawrence, Kansas.

“…In a nylon flock plant, restriction was observed in 7% of production workers compared to 3% in office workers; the prevalences of low diffusing capacity were 13% and 5%, respectively [Washko 2000]. Among polypropylene flock workers in Turkey, 20% had restriction and 26% had low DL CO , compared to 4.4% and 4.4%, respectively, of non-exposed controls [Atis 2005]. The proportion of restriction among Hallmark participants was 7.8%, and 3.9% had low DL CO .…”

“…A case of flock workers' lung was described in a worker exposed to polyethylene flock in Spain [Barroso 2002]. In Turkey, a cross-sectional study in the polypropylene flock industry showed a 3.6-fold increase in respiratory symptoms in exposed workers compared to unexposed controls [Atis 2005]. …”

ERS position paper: work-related respiratory diseases in the EU

“…Thus, in the 1990s a very severe form of interstitial lung disease, called Ardystil syndrome, affected Spanish and Algerian textile workers who had been engaged in spraying paints that were reputedly non-toxic [22,23]. Another novel pulmonary disease, flock worker's lung, has recently been described in workers exposed to synthetic micro fibres (flock) of nylon [24], polyethylene [25] or polypropylene [26], although such polymeric materials are generally considered to be devoid of significant toxicity. Recently, serious airways disease affected workers from plants producing microwave popcorn ''popcorn worker's lung'' [27,28], probably as a result of their inhalatory exposure to artificial flavouring agents that are ''generally recognised as safe'' [28].…”