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Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant

By Wendy Robertson, A. S. Robertson, C.B.S.G Burge, V.C. Moore, M.S. Jaakkola, P.A. Dawkins, M. Burd, R. Rawbone, I. Gardner, M. Kinoulty, B. Crook, G.S. Evans, J. Harris-Roberts, S. Rice and P.S. Burge

Abstract

Background Exposure to metal working fluid (MWF) has been associated with outbreaks of EAA in the US, with bacterial contamination of MWF being a possible cause, but was uncommon in the UK. Twelve workers developed extrinsic allergic alveolitis (EAA) in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. This had three aims:-\ud • To measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases.\ud • To provide case-detection so that those affected can be treated.\ud • To provide epidemiological data to identify the cause of the outbreak.\ud Methods The outbreak was investigated in a three-phase cross-sectional survey of the workforce.\ud Phase I A respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004.\ud Phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481(94.4%) responded along with 48/50(96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF).\ud Phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed.\ud Results 87 workers (10.4% of workforce) met case definitions for occupational lung disease, comprising EAA(19), occupational asthma(74) and humidifier fever(7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using metal working fluid (MWF) from a large sump(27.3%) compared with working all over the manufacturing area (7.9%) (OR=4.39,p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution.\ud Conclusions Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF, there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance

Topics: RA
Publisher: BMJ
Year: 2007
OAI identifier: oai:wrap.warwick.ac.uk:194

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Citations

  1. (1996). 15 Centers for Disease Control and Prevention. Biopsy-confirmed hypersensitivity pneumonitis in automobile production workers exposed to metalworking fluids—Michigan, 1994-1995. Morb Mortal Wkly Rep
  2. (1997). A field investigation of the acute respiratory effects of metal working fluids: I. Effects of aerosol exposures. doi
  3. Acute pulmonary response among automobile workers exposed to aerosols of machine fluids. doi
  4. Acute respiratory effects on workers exposed to metalworking fluid aerosols in an automotive transmission plant. doi
  5. (1996). Airway responsiveness, respiratory symptoms, and exposures to soluble oil mist in mechanical workers. Occup Environ Med doi
  6. (2006). An outbreak of extrinsic alveolitis at a car engine plant. Occup Med (Lond) doi
  7. Chronic lipoid pneumonia following occupational exposure. Ann Ind Hyg Occup Med 1950;1:105–11.
  8. (1996). Development of OASYS-2: a system for the analysis of serial measurements of peak expiratory flow in workers with suspected occupational asthma. Thorax doi
  9. Effect of peak expiratory flow data quality on diagnostic sensitivity and specificity in occupational asthma. doi
  10. (2007). employment and financial outcomes.
  11. Hypersensitivity pneumonitis in a metal-working environment. doi
  12. (2001). Hypersensitivity pneumonitis: current concepts. doi
  13. (1992). Industrial Injuries Advisory Council. Extrinsic allergic alveolitis. Report by the Industrial Injuries Council in accordance with Section 171 of the Social Security Administartion Act
  14. Lipid pneumonia following occupational exposure to oil spray. doi
  15. (1981). Lipoid pneumonia caused by oil mist exposure from a steel rolling tandem mill. doi
  16. (2003). Measurement of personal exposure of metalworking machine operators to airborne water-mix metalworking fluid. doi
  17. Metal working fluid-associated hypersensitivity pneumonitis: an outbreak investigation and case-control study. doi
  18. Occupational asthma due to an emulsified oil mist. doi
  19. (1988). Occupational asthma due to oil mists. Thorax doi
  20. (1992). Occupational asthma: validity of monitoring of peak expiratory flow rates and non-allergic bronchial responsiveness as compared to specific inhalation challenge. doi
  21. (2006). Outbreak of respiratory disease at Powertrain Ltd, Longbridge, Birmingham. Emerging Lessons.
  22. (2006). Powertrain occupational respiratory disease outbreak:: Report of immunological investigation. Health and Safety Laboratory
  23. Respiratory health of automobile workers and exposure to metal-working fluid aerosols: lung spirometry. doi
  24. (1997). Respiratory health of automobile workers exposed to metal-working fluid aerosols: respiratory symptoms. doi
  25. (1997). Respiratory symptoms and lung function abnormalities among machine operators in automobile production. doi
  26. (1993). Standardisation of lung function tests, European Community for Steel and Coal.
  27. (2005). Summary of results of large metalworking fluid user project
  28. (1999). Teschke K et al Change in airway responsiveness among apprentices exposed to metalworking fluids. doi
  29. (2008). thorax.bmj.com Downloaded from 21 14. Bernstein
  30. (2008). thorax.bmj.com Downloaded from 22 26. Zacharisen

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