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Christensen BT, Calkins MM. Occupational exposure to per- and polyfluoroalkyl substances: a scope review of the literature from 1980-2021. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:673-686. [PMID: 36977833 PMCID: PMC10533727 DOI: 10.1038/s41370-023-00536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) comprise a large group of chemicals that have been integrated into a wide variety of industrial processes and consumer products since the 1950s. Due to their profuse usage and high persistence in human serum, understanding workplace exposures to PFAS is critical. OBJECTIVE We aimed to characterize the PFAS exposure profiles of relevant occupational populations, elucidate trends in the PFAS exposure characterization process, and identify major research gaps that remain within the occupational PFAS exposure literature. METHODS A systematic search of four literature databases for peer-reviewed articles published between 1980 and 2021 on PFAS exposure in occupational settings was conducted. RESULTS Of the 2574 articles identified, 92 met the inclusion criteria. Fluorochemical workers were the target population in most early exposure assessment research; however, studies conducted within the last 10 years have evaluated a wider range of occupational populations and settings. The highest exposures were reported in fluorochemical workers, but, in comparison to reference populations, one or more PFAS were elevated in most workers and in most workplaces that were assessed. PFAS was most frequently assessed in worker serum using a discrete analytical panel of PFAS, with earlier studies restricted to a few long-alkyl chain PFAS while more recent studies have included more expansive panels due to more robust methods. SIGNIFICANCE Characterization of occupational exposure to PFAS is limited but expanding. Current analytical methods are not robust enough to fully capture the potential range of PFAS present across different workers and workplaces. While exposures to PFAS for certain occupational groups have been studied in detail, exposure information for other occupational groups with high potential for exposure are limited. This review highlights substantial findings and major research gaps within the occupational literature.
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Affiliation(s)
- Brian T Christensen
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, 45213, USA.
| | - Miriam M Calkins
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, OH, 45213, USA
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Aoki A, Saito A, Shima K, Kimura Y, Asakawa K, Ohashi R, Umezu H, Sakagami T, Moriyama H, Kikuchi T. Occupational Lung Disease Caused by Exposure to Polytetrafluoroethylene. Intern Med 2022; 61:3713-3717. [PMID: 35598992 PMCID: PMC9841090 DOI: 10.2169/internalmedicine.9008-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We herein report a 45-year-old-man with multiple foreign body granulomas in the lungs caused by polytetrafluoroethylene (PTFE). A mass in the right lower lobe of the lung and bilateral centrilobular lung nodules were found unexpectedly during the patient's visit to a hospital for a respiratory infection. The patient's occupation for 26 years involved spraying PTFE. A lung biopsy using bronchoscopy revealed granulomatous lesions and giant cells. The presence of fluorine in the granulomatous lesions was confirmed using an electron probe microanalyzer with wavelength dispersive spectrometer. Fluorine is a component of PTFE and is not found in normal lung tissue.
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Affiliation(s)
- Ami Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Akira Saito
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Kenjiro Shima
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Yosuke Kimura
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Katsuaki Asakawa
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
- Department of Respiratory Medicine, Saiseikai Niigata Hospital, Japan
| | - Riuko Ohashi
- Histopathology Core Facility, Faculty of Medicine, Niigata University, Japan
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Hajime Umezu
- Division of Pathology, Niigata University Medical and Dental Hospital, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Japan
| | - Hiroshi Moriyama
- Department of Respiratory Medicine, National Hospital Organization Nishiniigata Chuo Hospital, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Pneumoconiosis in a polytetrafluoroethylene (PTFE) spray worker: a case report with an occupational hygiene study. Ann Occup Environ Med 2018; 30:37. [PMID: 29992029 PMCID: PMC5987387 DOI: 10.1186/s40557-018-0248-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/27/2018] [Indexed: 11/13/2022] Open
Abstract
Background Using analysis of air samples from the workplace, we report on one case of pneumoconiosis in an individual who has been working in a polytetrafluoroethylene (PTFE) spraying process for 28 years. Case presentation The patient was diagnosed with granulomatous lung disease caused by PTFE using computed tomography (CT), lung biopsy and electron microscopy. To assess the qualitative and quantitative exposure to PTFE in workplace, Fourier transform infrared spectroscopy (FT-IR), energy-dispersive X-ray spectroscopy (EDX) and thermogravimetric analysis (TGA) were performed on air samples from the workplace. The presence of PTFE particles was confirmed, and the airborne concentration of PTFE was estimated to be 0.75 mg/m3. Conclusions This case demonstrates that long-term exposure to PTFE spraying can cause granulomatous lung lesions such as pneumoconiosis; such lesions appear to be caused not by the degradation products of PTFE from high temperatures but by spraying the particles of PTFE. Along with air-sampling analysis, we suggest monitoring the concentration of airborne PTFE particles related to chronic lung disease.
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Scheepers PTJ, Masen-Poos L, van Rooy FGBGJ, Oerlemans A, van Daalen E, Cremers R, Lichtenbeld H, Biesma B, Sørli JB, Koponen IK, Larsen ST, Wolkoff P, Nørgaard AW. Pulmonary injury associated with spray of a water-based nano-sized waterproofing product: a case study. J Occup Med Toxicol 2017; 12:33. [PMID: 29234454 PMCID: PMC5721695 DOI: 10.1186/s12995-017-0180-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/23/2017] [Indexed: 12/24/2022] Open
Abstract
Background In most reported cases of lung trauma with water proofing products, volatile organic compounds (VOC) have a prominent role. Here we report on a case involving ten workers exposed to a sprayed product containing nanoparticles in a water solution with only a few percent VOC. Case presentation Ten workers suffered from respiratory symptoms following spray impregnation of hardwood furniture using a waterproofing product that contained positively charged fluorinated acrylate copolymer solid cores with a median diameter of 70 nm (1.3 w%) in aqueous suspension with 3.3 w% VOC and 0.3 w% quaternary ammonium. The worker who applied one liter of the product in a wood workshop, using an air mix spray gun, did not report any health complaints. Another worker, who entered the workshop 3 h later and had rolled and smoked two cigarettes, was hospitalized with severe chemical pneumonitis. A chest X-ray (CXR) showed bilateral infiltrative impairment in the lower lobe regions. On the next day a second CXR showed increased patchiness marking in all fields. A high-resolution Computer Tomography (CT)-scan demonstrated extensive bilateral areas of ground-glass opacities predominantly in the lower regions of the upper lobes, the right middle lobe and the apical regions of the lower lobes, compatible with severe chemical pneumonitis. On the following morning, nine workers in an adjacent workplace in the same building, experienced dry cough, chest tightness and substernal pain upon physical exercise. Reconstruction of the spray application in a climate chamber confirmed trimethyl silanol, glycol ethers and fluoroalkenes in the gas phase. Immediately after the spray application, aerosols were observed at a maximum concentration of 6.3 × 104 cm−3. Mass concentrations were 0.095 and 10 mg/m3 in the size ranges 5.6-560 nm and 0.22-30 μm, respectively, decreasing to less than 10 μg/m3 in both size ranges after 15 h. Conclusion The hospitalized worker had smoked cigarettes contaminated with fluoropolymers which is a plausible explanation for the lung trauma. Respiratory symptoms in the nine workers may be caused by inhalation of particles that became airborne by resuspension from surfaces when workers entered the adjacent workplace the next day. A contribution from VOC appears less likely because measurements and modelling showed that concentrations in the mg/m3 range could have occurred only if the building was assumed to be completely airtight. Electronic supplementary material The online version of this article (10.1186/s12995-017-0180-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul T J Scheepers
- Research Lab Molecular Epidemiology, Radboud Institute for Health Sciences, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Lucie Masen-Poos
- Department of Lung Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Arné Oerlemans
- Research Lab Molecular Epidemiology, Radboud Institute for Health Sciences, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eline van Daalen
- Research Lab Molecular Epidemiology, Radboud Institute for Health Sciences, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands.,Present address: Ministry of Social Affairs and Employment, The Hague, The Netherlands
| | - Robbert Cremers
- Research Lab Molecular Epidemiology, Radboud Institute for Health Sciences, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands.,Present address: Witteveen+Bos Consulting, The Hague, The Netherlands
| | | | - Bonne Biesma
- Department of Lung Diseases, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Jorid B Sørli
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Ismo K Koponen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Søren Thor Larsen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Peder Wolkoff
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Asger W Nørgaard
- The National Research Centre for the Working Environment, Copenhagen, Denmark
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Hamaya R, Ono Y, Chida Y, Inokuchi R, Kikuchi K, Tameda T, Tase C, Shinohara K. Polytetrafluoroethylene fume-induced pulmonary edema: a case report and review of the literature. J Med Case Rep 2015; 9:111. [PMID: 25971706 PMCID: PMC4436768 DOI: 10.1186/s13256-015-0593-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/08/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Polytetrafluoroethylene is ubiquitous in materials commonly used in cooking and industrial applications. Overheated polytetrafluoroethylene can generate toxic fumes, inducing acute pulmonary edema in some cases. However, neither the etiology nor the radiological features of this condition have been determined. For clarification, we report an illustrative case, together with the first comprehensive literature review. CASE PRESENTATION A previously healthy 35-year-old Japanese man who developed severe dyspnea presented to our hospital. He had left a polytetrafluoroethylene-coated pan on a gas-burning stove for 10 hours while unconscious. Upon admission, he was in severe respiratory distress. A chest computed tomographic scan showed massive bilateral patchy consolidations with ground-glass opacities and peripheral area sparing. A diagnosis of polytetrafluoroethylene fume-induced pulmonary edema was made. He was treated with non-invasive positive pressure ventilation and a neutrophil elastase inhibitor, which dramatically alleviated his symptoms and improved his oxygenation. He was discharged without sequelae on hospital day 11. A literature review was performed to survey all reported cases of polytetrafluoroethylene fume-induced pulmonary edema. We searched the PubMed, Embase, Web of Science and OvidSP databases for reports posted between the inception of the databases and 30 September 2014, as well as several Japanese databases (Ichushi Web, J-STAGE, Medical Online, and CiNii). Two radiologists independently interpreted all chest computed tomographic images. Eighteen relevant cases (including the presently reported case) were found. Our search revealed that (1) systemic inflammatory response syndrome was frequently accompanied by pulmonary edema, and (2) common computed tomography findings were bilateral ground-glass opacities, patchy consolidation and peripheral area sparing. Pathophysiological and radiological features were consistent with the exudative phase of acute respiratory distress syndrome. However, the contrast between the lesion and the spared peripheral area was striking and was distinguishable from the common radiological features of acute respiratory distress syndrome. CONCLUSION The essential etiology of polytetrafluoroethylene fume-induced pulmonary edema seems to be increased pulmonary vascular permeability caused by an inflammatory response to the toxic fumes. The radiological findings that distinguish polytetrafluoroethylene fume-induced pulmonary edema can be bilateral ground-glass opacity or a patchy consolidation with clear sparing of the peripheral area.
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Affiliation(s)
- Rikuta Hamaya
- Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Yuko Ono
- Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yasuyuki Chida
- Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of General and Emergency Medicine, JR General Hospital, Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.
| | - Ken Kikuchi
- Department of Radiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Tadanobu Tameda
- Department of Radiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Choichiro Tase
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Kazuaki Shinohara
- Department of Anesthesiology and Critical Care Medicine, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
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Abstract
A 29-year-old Japanese man presented with fever, dyspnoea and non-productive cough after massive inhalation of evaporant from a polytetrafluoroethylene-coated cooking pan. Chest CT scan showed diffuse interstitial infiltration in both lungs. Based on the patient history, images and the pan he brought to the hospital, polymer fume fever was strongly suspected. His symptoms dramatically improved over the following 2 days after admission.
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Lightfoot TL, Yeager JM. Pet bird toxicity and related environmental concerns. Vet Clin North Am Exot Anim Pract 2008; 11:229-59, vi. [PMID: 18406386 DOI: 10.1016/j.cvex.2008.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Birds may be exposed to toxins through various sources in their everyday environment. Toxicity may occur through inhalation or oral or dermal exposures. Clinicians diagnose and treat these toxicities in an effort to correct the disease of the individual patient. Recognition of toxicity in the avian patient has further significance as it relates to the patient's environment, including the health of other animals, humans, and the ecosystem. While some toxicities, such as lead and zinc toxicosis, are well-documented in avian species, others are limited to anecdotal reports and extrapolation from other species. Continued research is needed in this area of avian medicine to expand our knowledge and improve our ability to diagnose and treat toxic conditions in birds.
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Affiliation(s)
- Teresa L Lightfoot
- Department of Avian and Exotic Medicine, Florida Veterinary Specialists, Tampa, FL 33614, USA.
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Masaki Y, Sugiyama K, Tanaka H, Uwabe Y, Takayama M, Sakai M, Hayashi T, Otsuka M, Suzuki S. Effectiveness of CT for clinical stratification of occupational lung edema. INDUSTRIAL HEALTH 2007; 45:78-84. [PMID: 17284878 DOI: 10.2486/indhealth.45.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We treated two occupational lung diseases in different situations during military training. The purpose of this study is to investigate the availability of CT scanning for the evaluation of inhalation pulmonary edema. Two soldiers suffered severe lung edema after using a spray for the daily maintenance of their firearms. Four soldiers suffered severe dyspnea after undertaking drills in a narrow zone where numerous smoke bombs had been used. We evaluated these patients from several aspects. CT scans of the chest of spray-induced patients revealed bilateral infiltration predominantly in the upper lung fields. The patients received steroid pulse treatment and gradually recovered. CT scans of the chest of smoke-induced patients revealed bilateral ground-glass attenuation with peripheral lung sparing. The patients gradually recovered with steroid therapy. In accordance with previous studies, CT scans of the chest in our patients demonstrated that the periphery of the lungs remained normal, except in cases of serious injury. When differential diagnosis is required, we consider that CT scans of the chest are particularly useful; CT findings are useful in determining the severity of lung injury as well as the diagnosis of inhalation pulmonary edema.
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Affiliation(s)
- Yoshinori Masaki
- Division of Environmental Medicine, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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Abstract
Recent events have underscored the importance of proper diagnosis and management of patients with inhalation injury. Clinicians who care for individuals who have sustained inhalation damage to their respiratory tract need to take a careful exposure history and be alert to possibilities of delayed effects and clinical deterioration. Although supportive care and prevention remain the cornerstone of current approaches to this condition, better understanding of the mechanisms of cellular injury and repair may lead to improved treatments in the future.
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Affiliation(s)
- Peter M Rabinowitz
- Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, 135 College Street, Room 392, New Haven, CT 06510, USA.
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