Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant
Open Access
- 25 May 2007
- Vol. 62 (11), 981-990
- https://doi.org/10.1136/thx.2006.072199
Abstract
Background: Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed 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. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak. Methods: The outbreak was investigated in a three-phase cross-sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In 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 and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In 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. Results: 87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 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 MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, pConclusions: 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.This publication has 27 references indexed in Scilit:
- Metal-rich Ambient Particles (Particulate Matter2.5) Cause Airway Inflammation in Healthy SubjectsAmerican Journal of Respiratory and Critical Care Medicine, 2004
- Hypersensitivity pneumonitis: current concepts.2001
- Hypersensitivity pneumonitis in a metal‐working environmentAmerican Journal of Industrial Medicine, 2001
- Health, employment, and financial outcomes in workers with occupational asthma.Occupational and Environmental Medicine, 1993
- Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society.1993
- Occupational asthma: validity of monitoring of peak expiratory flow rates and non-allergic bronchial responsiveness as compared to specific inhalation challengeEuropean Respiratory Journal, 1992
- Acute pulmonary responses among automobile workers exposed to aerosols of machining fluidsAmerican Journal of Industrial Medicine, 1989
- Occupational asthma due to oil mists.Thorax, 1988
- Occupational asthma due to an emulsified oil mist.Occupational and Environmental Medicine, 1985
- Lipoid pneumonia caused by oil mist exposure from a steel rolling tandem millAmerican Journal of Industrial Medicine, 1981