2. Scenario
33 yr
Nursing staff
Past h/o allergic rhinitis
Itching skin lesions, followed by cough, chest tightness
and breathlessness with wheeze in ward
Following handling Inj Piptaz.
4. Occupational allergies
Under recognized
Under diagnosed
Under treated
Under reported
Common Occupational allergies
Occupational asthma
Occupational dermatitis
Occupational rhinitis
Occupational conjunctivitis
5. Occupational asthma
Accounts for 5-10% of asthma in young adults
New‐onset asthma:
Hospital technicians (RR 4.63; 95% CI 1.87 to 11.5)
Those using ammonia and/or bleach at work (RR 2.16;
95% CI 1.03 to 4.53).
Kogevinas M et al.
Lancet. 1999
6. Occupational asthma
Of 182 cases of OA in HCWs over 10 years.
75% - nursing, operating theatre, endoscopy and
radiology staff.
70% - glutaraldehyde, latex and cleaning products
G. I. Walters et al. Occupational Medicine 2013;63:513–
516
7. Definition – occupational asthma
Occupational asthma (OA) refers to
de novo asthma or the recurrence of previously
quiescent asthma
induced by
sensitization to a specific substance, which is termed
sensitizer-induced OA, or
exposure to an inhaled irritant at work, which is termed
irritant-induced OA (reactive airways dysfunction syndrome).
Work related asthma
Work exacerbated asthma + OA
OA
10. Risk factors
Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
11. Irritant-induced OA
Exposure to airway irritants, in the absence of
sensitization
New-onset asthma after exposure to very high levels of
alkaline dust from the collapse of the World Trade
Center
16% of persons with high exposures at 1 year
At 9 years 36% of them recovered.
15. The Peak Flow Meter
like a thermometer for asthma
Inexpensive clinic
instrument
Monitoring
Builds confidence in
treatment
One ‘hard, fast blow’
16. Occupational asthma diagnosis
• Compatible history
• Detailed exposure history
• Spirometry with reversibility
• Bronchoprovocation test
• Establish the relationship
• Serial peak flow, BPT after exposure, Skin tests,
Immunoassay
18. An estimated prevalence of sensitization among the
general healthcare worker population - 12.1 %
4-7% : powder-free gloves
It can be assumed that rates have decreased even
further with the increased use of non-latex gloves.
Latex allergy
19. Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum
proteins
Sensitivity 65 -96 % and specificity – 88-94 %
Serology testing
Hevea latex-specific IgE antibody
Sensitivity – 70%, specificity - >95%
22. The odour threshold of glutaraldehyde has been
reported to be 0.04 parts per million (ppm),
Odour detection is a potential indicator that the
engineering controls are inadequate.
Odour detection - unreliable
23. Glutaraldemeter
United Kingdom Health and Safety Executive which
also has established a 0.05 ppm Workplace Exposure
Limit (WEL)
24. Prevention
Primary prevention
reducing workplace exposure to potential
causal agents
Substitution,
Process modification,
Respirator use,
Engineering control with monitoring of
airborne exposure levels.
25. Secondary prevention
identify early evidence of subclinical
disease
periodic medical surveillance by using tools such as
questionnaires, spirometry
26. Tertiary prevention
minimize effects of the workplace
environment on clinically manifest
disease
Control of specific factors responsible for
disease onset or exacerbation/aggravation
Change the person to another job.
28. Outcomes
Factors predicting a worse outcome
Smoking
Lower PC20 at baseline, longer duration of exposure, and
the interval since removal of the patient from exposure
Subjects with OA to HMW agents
Typical plateau for improvement in spirometry is
around 1 year, whereas the plateau for improvement in
BPT occurs around 2 years
29. Smoke inhalation
Three types of injuries:
Thermal injury to the upper airways,
Chemical injury to the tracheobronchial tree, and
Systemic poisoning due to carbon monoxide and/or
cyanide.
31. Thermal injury: airway compromise
Intubation is justified if any of the following signs are
present:
Stridor,
Use of accessory respiratory muscles,
Respiratory distress,
Hypoventilation,
Deep burns to the face or neck, or blistering or edema of
the oropharynx.
32. Oropharygeal examination -if erythema
Do Larygoscopy
Upper airway edema or blistering seen during
laryngoscopic exam should prompt intubation.
Bronchoscopy instead of laryngoscopy
if there is a history of inhalation
of superheated particles or steam,
34. Cyanide poisoning
Burning of certain compounds (eg, polyurethane,
acrylonitrile, nylon, wool, and cotton)
Clinical suspicion for cyanide poisoning should be
high
Unexplained lactic acidosis, low arterial carbon
dioxide tension
Treatment
high flow oxygen,
use of antidotes ( eg, sodium thiosulfate PLUS
hydroxocobalamin)
