Work-Related Adverse Respiratory Health Outcomes at a Machine Manufacturing Facility with a Cluster of Bronchiolitis, Alveolar Ductitis and Emphysema (BADE)

Details

• Personal Author:
  Blaser MJ ; Boylstein, Randy J. ; Cox-Ganser, Jean M. ; Cummings, Kristin J. ; Edwards, Nicole T. ; Kreiss, Kathleen ; Nett, Randall J. ; Park, Ju-Hyeong ; Segal LN ; Stanton, Marcia L. ; Virji, M. Abbas ; Weissman, David N.
• Description:
  Objectives: Four machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers' respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid. Methods: We offered a questionnaire and spirometry at baseline and 3.5 year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV1) decline >10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV1 decline. Results: Among 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09-28.4 EU/m3) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV1 decline (range: 403-2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3-7.5 EU/m3) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy. Conclusions: Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended. [Description provided by NIOSH]
• Subjects:
  Endotoxins Lung Manufacturing And Industrial Facilities Occupational Health Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety Surveys And Questionnaires
• Keywords:
  Bronchiolitis Lung Function Manufacturing Questionnaires Respiratory System Disorders Spirometry
• ISSN:
  1351-0711
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  California ; New York ; OSHA Region 2 ; OSHA Region 3 ; OSHA Region 9 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  386-392
• Volume:
  77
• Issue:
  6
• NIOSHTIC Number:
  nn:20058872
• Citation:
  Occup Environ Med 2020 Jun; 77(6):386-392
• Contact Point Address:
  Dr. Randall J Nett, California Department of Public Health Marina, Richmond, CA 94804
• Email:
  gge5@cdc.gov
• Federal Fiscal Year:
  2020
• Peer Reviewed:
  True
• Source Full Name:
  Occupational and Environmental Medicine
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5630f9b622f20e0a9750bcd2dfabc0591ed8381782f06e5ac33c047cc17f7784417ffb70cf056f24c838e8ea21c8d3aed0dd71c9eb7d66298228871451450cf1
• Download URL:
  https://stacks.cdc.gov/view/cdc/223247/cdc_223247_DS1.pdf
• File Type:
  [PDF - 358.49 KB ]