1. 1 Occupational asthma Causes and risk occupations R.Piipari, TTL

2. 2 Asthma Airway inflammation, in which the amount of many kinds of inflammatory cells in the airways is increased. Susceptible persons get symptoms owing to the airway inflammation. Typical functional feature is variable airway obstruction. Global strategy for Asthma Management National Institute of Health and WHO 1995

3. 3 Work-related diseases, definitions in Estonia 1. An occupational disease: –An illness brought about by risk factors present in the working environment or the nature of the work and which is included in the list of occupational diseases. (The list of occupational diseases shall be established by a regulation of the Minister of Social Affairs.) 2. A work-induced disease: –An illness brought about by the risk factors present in the working environment, but which is not deemed an occupational disease.

4. 4 Occupational asthma obstructive airway disease, which is associated with exposure at the workplace to dusts, gases or fumes. –Includes –Sensitizer induced cases –non-allergic asthmatic diseases as »reactive airways dysfunction syndrome (RADS) »byssinosis »irritant induced occupational asthma?? Occupational asthma means asthma induced by getting sensitized to biological or chemical agents present in the workplace.

5. 5 Occupational asthma, causes Organic agents recognized already at the 1700's (flour dust asthma in bakers and millers) –nowadays about 70-80% of cases Chemicals, first report in 1963 (asthma caused by phtalic acid anhydride in a chemist) –nowadays about 20-30% of cases More than 200 sensitizers recognized today

6. Occupational Asthma in Finland N The Finnish Register of Occupational Diseases

7. 7 Occupational asthma Sensitization –type I allergic, IgE mediated reaction many biologic compounds a few chemicals, which act as haptens –other immunological mechanisms –other possible mechanisms

8. 8 Criteria for an allergic response Asthma occurs only in a proportion of those exposed to the particular agent Asthma develops only after an initial sympotomfree period fo exposure After sensitization asthmatic responses are provoked by very low exposure levels

9. 9 Agents causing occupational asthma Organic agents –Animal epithelia –Flour/grain/hay –Storage mites –Moulds –Wood dusts –Enzymes –Natural rubber –Colophony (pine resin) –Food, vegetables –Textiles, furs –Decorative flowers Chemicals –Welding fumes –Metal salts –Di-isocyanates –Acrylates –Acid anhydrides –Formaldehyde –Persulphates –Diethanolamines –Glues/resins/varnishes –Drugs –Reactive dyes

10. 10 Agents causing occupational asthma/rhinitis and related occupations Animal epithelia –farmers, cattle tenders, veterinarians, laboratory workers Flour, grain dust –bakers, millers, farmers, cattle tenders, food processing workers Storage mites –bakers, millers, farmers, food processing workers, stock room workers Some foodstuff –food processing workers, cooks, kitchen workers (eg. fruits, vegetables, fish, crayfish, spices) Moulds –Farmers, bakers, greenhouse workers, sawmill workers

11. 11 Agents causing occupational asthma/rhinitis and related occupations Di-isocyanates –car sprayers, painters, laminators, insulators, plastic workers Metal fumes and salts –welders, metal workers, platers, refiners, grinders Formaldehyde –laboratory workers, foundry workers, resin and wood processing workers, textile workers Persulphates –Hairdressers, persulphate processing workers Acrylates –dental workers, electronic workers, mechanicians

12. 12 Agents causing occupational asthma/rhinitis and related occupations Enzymes –Bakers, food processing workers, pharmaceutical and laboratory workers, detergent manufactory workers, textile workers Decorative flowers –Florists, gardeners, botanists Wood dusts –Wood and sawmill workers, carpenters Natural rubber –Health care and laboratory workers, food processing workers Colophony –Soft soderers, electronic workers

13. 13 Agents causing occupational asthma/rhinitis and related occupations Acid anhydrides –Sprayers, painters, plastic workers, chemical workers Diethanolamines –Metal workers, cleaners, plastic workers, textile workers, chemical workers Drugs –Pharmacoceutical workers, laboratory workers, chemists, nurses Reactive dyes –Textile workers

14. 14 Di-isocyanate exposure Spray painting, car painting Insulation work with polyurethane products Foam/plastics manufacture

15. 15 Products that often contain di-isocyanates –Two component paints –Two component glues –Insulation material –Plastics –Foams –Resins –Varnishes

16. 16 Bakery work, sensitizers flours enzymes storage mites spices egg milk powder sesame seed

17. 17 Cattle breeding, sensitizers animal epithelia storage mites feed flours feed additions (fish powder, enzymes, soya)

18. 18 Di-isocyanates Epoxy resins, organic acid anhydride or amine hardeners Phtalates Formaldehyde Azodicarbonamide Cyanoacrylates Methacrylates Polyfunctional aziridine hardener Manufacturing/use of plastic products, sensitizers

19. 19 Di-isocyanate cured paints Epoxy paints, amine hardeners Epoxy powder paints Polyester powder paints Formaldehyde Paints with aziridine hardeners Painting, sensitizers

20. 20 Soft soldering fumes (colophony) Di-isocyanate cured varnishes Epoxy resins, organic acid anhydrides Acrylate glues Formaldehyde Electronics, sensitizers

21. 21 Persulphates Permanent wave chemicals Hair sprays Hair dyes Natural rubber Hair dressers, sensitizers

22. 22 Formaldehyde (glues and shellacks) Wood dusts (exotic woods!) Di-isocyanate hardened paints Aziridine hardened paints Moulds (mouldy wood dusts) Wood work, sensitizers

23. 23 Welding fumes and grinding dusts of stainless steel Hard metal dust Welding fumes of painted steel (2-component paints) Aerosols of cutting fluids Other welding fumes? Metal work, sensitizers

24. 24 Occupational asthma/ health care, sensitizers Clinics –natural rubber –chloramine T –glutaraldehyde –formaldehyde Dental care –natural rubber –methacrylates –chloramine T –formaldehyde –ammonium persulphate

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27. 27 Occupational asthma (OA) cases in Finland in 1995-2001

28. 28 Occupational asthma (OA) cases caused by chemicals in Finland in 1995-2001

29. 29 Occupational asthma cases caused by the most common biological agents in Finland in 1995-2001