Respiratory variables and exposure-effect relationships in isocyanate-exposed workers

The relationship between toluene diisocyanate exposure and respiratory health problems: A meta-analysis of epidemiological studies

Human epidemiological studies have shown inconclusive results over the effects of diisocyanates on respiratory health problems. A meta-analysis combined evidence on the association between occupational asthma (OA), respiratory function, and toluene diisocyanate (TDI) inhalation exposure. Sixty-one articles on occupational toluene diisocyanate exposure were identified via two databases. Fourteen studies were included in the meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies. Odds ratios (OR_asthma) for the association between TDI exposure compared to non-exposure and OA were calculated. The difference in mean differences (MD) of forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC), and the annual mean change differences-in milliliters per year (mL/yr)-in FEV₁ and FVC pulmonary function between TDI exposed and non-exposed, were calculated. When applicable, a random effects meta-analysis was performed. The overall summary OR_asthma for TDI exposed versus non-exposed was 1.18 (95% CI = 0.78-1.79). The summary of the predicted mean percentage difference (MD_%predicted) between exposed versus non-exposed was 2.96% for FEV₁ and 3.75% for FVC. A very small decrease of 5 mL/yr for FEV₁ and 10 mL/yr for FVC, respectively, was observed between the exposed and the non-exposed groups. There was moderate to low heterogeneity between study results, and most studies were evaluated as high-quality. This meta-analysis found no statistically significant adverse association between TDI occupational exposure and OA. No meaningful differences in lung function were detected between exposed and unexposed groups.

Risk Assessment for Toluene Diisocyanate and Respiratory Disease Human Studies

BACKGROUND

Toluene diisocyanate (TDI) is a highly reactive chemical that causes sensitization and has also been associated with increased lung cancer. A risk assessment was conducted based on occupational epidemiologic estimates for several health outcomes.

METHODS

Exposure and outcome details were extracted from published studies and a NIOSH Health Hazard Evaluation for new onset asthma, pulmonary function measurements, symptom prevalence, and mortality from lung cancer and respiratory disease. Summary exposure-response estimates were calculated taking into account relative precision and possible survivor selection effects. Attributable incidence of sensitization was estimated as were annual proportional losses of pulmonary function. Excess lifetime risks and benchmark doses were calculated.

RESULTS

Respiratory outcomes exhibited strong survivor bias. Asthma/sensitization exposure response decreased with increasing facility-average TDI air concentration as did TDI-associated pulmonary impairment. In a mortality cohort where mean employment duration was less than 1 year, survivor bias pre-empted estimation of lung cancer and respiratory disease exposure response.

CONCLUSION

Controlling for survivor bias and assuming a linear dose-response with facility-average TDI concentrations, excess lifetime risks exceeding one per thousand occurred at about 2 ppt TDI for sensitization and respiratory impairment. Under alternate assumptions regarding stationary and cumulative effects, one per thousand excess risks were estimated at TDI concentrations of 10 - 30 ppt. The unexplained reported excess mortality from lung cancer and other lung diseases, if attributable to TDI or associated emissions, could represent a lifetime risk comparable to that of sensitization.

Respiratory effects of toluene diisocyanate in the workplace: a discussion of exposure-response relationships

Toluene diisocyanate (TDI) is an important industrial intermediate used in manufacturing flexible polyurethane (PUR) foams, surface coatings, cast elastomers, sealants, and adhesives. In this review long-term trends in workplace exposures to TDI are assessed in both the producing and using industries, and respiratory health effects of TDI are evaluated in relation to workplace TDI concentrations. The key respiratory health effects associated with repeated or long-term TDI exposure are bronchial asthma and an accelerated rate of decline in lung function. In the early years of the industry, annual incidence rates of occupational asthma (OA) due to TDI ranged from 1% to as high as 5 to 6%, depending on the extent of engineering and work practice controls in the various workplaces. Since the mid-1970s, annual OA incidence rates have been <1%, where 8 h TDI concentrations have been maintained below 5 ppb as determined by personal monitoring, even where short-termTDI concentrations above 20 ppb and less frequently above 40 ppb were routinely detected. In these latter settings, there is evidence that the majority of OA cases may be attributable to TDI concentrations well above 20 ppb associated with overexposure incidents. Further study is needed regarding the role of such incidents in inducing respiratory sensitization. Cross-sectional and longitudinal studies of lung function have indicated that continued exposure after development of work-related respiratory symptoms can lead to transient or accelerated fixed declines in forced expiratory volume in 1 sec (FEV1). These findings are congruent with the FEV1 declines demonstrated in general population studies of persons with persistent bronchial hyperresponsiveness or nonoccupational asthma. More recent longitudinal studies in settings with ongoing medical surveillance have provided no consistent evidence of accelerated FEV1 loss among employees exposed up to 5 ppb TDI on an 8 h time-weighted average basis.

Occupational asthma, lung function decrement, and toluene diisocyanate (TDI) exposure: a critical review of exposure-response relationships

An extensive amount of clinical/epidemiological literature exists regarding the effects of toluene diisocyanate (TDI) exposure on respiratory health. This review presents an evaluation and synthesis of that literature with an emphasis on assessing exposure-response relationships in the workplace. The key respiratory disorders examined are bronchial asthma and an accelerated decline in lung function. In the early years of the industry, annual incidence rates of TDI-induced occupational asthma (OA) were as high as 5-6 percent. In settings where mean TDI concentrations have been maintained below 5 ppb based on 8-hr personal samples, OA incidence rates have declined to < 1 percent annually. Recent data also suggest that overexposure incidents may play an important role in inducing OA, particularly in work environments engineered to minimize routine ambient air concentrations. Fourteen studies were reviewed that examined lung function decrement. Early studies from the 1960s and 1970s provided evidence of transient or fixed lung function loss (measured as a decline in forced expiratory volume in one second [FEV1]) during periods of ongoing exposure among employees experiencing high rates of work-related symptoms of OA. Such findings would not be unexpected in that modest FEV1 declines have been demonstrated in general population studies of persons with bronchial hyperresponsiveness or persistent non-occupational asthma. More recent workplace studies have provided no consistent evidence of accelerated FEV1 loss among employees exposed up to 5 ppb TDI (8-hr TWA) even with documented routine short-term TDI concentrations exceeding 20 ppb TDI.

Biological monitoring of occupational exposure to toluene diisocyanate

The study validated the use of urinary toluene diamine (TDA) in postshift samples as an indicator of preceding 8-h exposure to toluene diisocyanate (TDI). Nine workers exposed in TDI-based polyurethane foam production were studied. Their exposure levels varied in 8-h time-averaged samples from 9.5 to 94 micrograms/m3. The urinary TDA concentrations varied from 6.5 to 31.7 micrograms/g creatinine and they were linearly related to the atmospheric TDI levels. Approximately 20% of TDI is metabolized to diamines but their specificity is remarkable to the extent that by analysis for the 2,4- and 2,6-diamino isomers an idea of the percutaneous absorption may be had.

Four-year follow-up of effects of toluene diisocyanate exposure on the respiratory system in polyurethane foam manufacturing workers. I. Study design and results of the first cross-sectional observation

A 4-year cohort study was designed to assess the exposure-effect relationship of working in polyurethane foam (PF) manufacturing factories with exposure to toluene diisocyanate (TDI) and its effects on the respiratory system. This paper describes the results of the first cross-sectional observations. The study population included 90 male workers who had been working in PF factories for 0.5-25 years (mean 13.3 years) (PF workers) and 44 reference workers in the same factories. The mean exposure concentration of TDI calculated from 129 personal samples was 3.2 ppb. Peak exposure excursions above 20 ppb occurred in 16 of 129 samples. Pulmonary function and its change during the working day as assessed by examining the forced expiratory flow-volume curve, respiratory impedance, and airway resistance and specific airway conductance were not different in the PF workers from those in the reference workers. Chest X-radiographs did not show any noteworthy radiological changes. Prevalences of "phlegm in winter," "nasal stuffiness or discharge in winter," and "irritation of eye and throat mucous membranes" were significantly higher in the PF workers. The findings indicate that TDI exposure at levels around 3 ppb may not adversely affect the pulmonary function over many years of exposure of those who are not hypersensitive to TDI. The causal chemicals inducing some respiratory and irritative symptoms could not be specifically identified since the PF workers were exposed not only to TDI but also to other irritative agents in the PF manufacturing processes.

Short-term respiratory changes in polyurethane foam workers exposed to low MDI concentration

Our study included 27 polyurethane foam workers exposed to MDI only at low concentrations (ranging from 0.0005 to 0.001 ppm) and 27 clerks from the same factory matched by age. Respiratory function tests were performed on a Monday and Friday of the same week at shift onset, 4 h later and at shift end. The subjects under study were asymptomatic for asthma. The two groups had quite similar spirometric values with minimal functional impairment. A statistical analysis was carried out by Student's t-test for matched pairs and two-way analysis of variance (ANOVA), in order to take into account both occupational exposure and smoking habits. No significant differences between the two groups were observed with paired t-tests in the respiratory parameter trend during both the Monday and Friday work shift. Nor were differences observed within the two groups when Friday's and Monday's results were compared. No significant differences between the two groups were found in paired comparisons between Friday and Monday for respiratory parameters. ANOVA demonstrated that the FEV1 and FEF25-75 reduction present on Friday, when compared to Monday, was related to smoking and not to occupational exposure. In conclusion our findings showed no short-term respiratory changes in subjects exposed to low MDI concentration.

Health status of copper refinery workers with specific reference to selenium exposure

Copper refinery workers exposed to selenium were studied before, during, and after a shutdown period. Urine selenium levels were 83 +/- 30 mumol/mol creatinine and 69 +/- 27 mumol/mol creatinine when measured on two occasions during exposure compared with 56 +/- 17 mumol/mol creatinine when the workers had been free of exposure for 10 wk during a shutdown. The refinery workers reported more nose and eye irritation, indigestion, stomach pain, and fatigue than controls. "Garlic-like" breath odor was reported to be personally and socially offensive by many of the workers. Reporting of symptoms, pulmonary function indices, and laboratory test results did not change with exposure except for hemoglobin level, which rose during the shutdown. Hemoglobin levels were found to be inversely correlated with the urine selenium level, and there was a positive correlation noted for the interactive effect of urine selenium and urine arsenic levels on hemoglobin.

Isocyanates and respiratory disease: current status

This paper reviews the known respiratory effects of isocyanates. There is good evidence to indicate that isocyanates: cause chemical bronchitis/pneumonitis; are potent pulmonary sensitizers capable of causing "isocyanate asthma"; cause nonspecific airways disease, including chronic bronchitis; can induce a general asthmatic state; and can cause hypersensitivity pneumonitis. Similar dose-response relationships are seen for both acute and chronic effects. There are plants operating in which exposures are well controlled and in which no respiratory effects can be detected. Suggestions are provided for preplacement assessment and periodic surveillance for workers exposed to these compounds.