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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] [What about the content of this article? (0)] [Affiliation(s)] [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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van Rooy FGBGJ, Rooyackers JM, Prokop M, Houba R, Smit LAM, Heederik DJJ. Bronchiolitis Obliterans Syndrome in Chemical Workers Producing Diacetyl for Food Flavorings. Am J Respir Crit Care Med 2007; 176:498-504. [PMID: 17541015 DOI: 10.1164/rccm.200611-1620oc] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Workers in microwave popcorn plants are at risk of developing bronchiolitis obliterans associated with exposure to butter flavoring volatiles, including diacetyl. OBJECTIVES To investigate the risk of bronchiolitis obliterans for chemical workers producing diacetyl, with exposure to less complex mixtures of chemicals. METHODS We interviewed and conducted spirometry on 175 of 196 workers from a chemical production plant that produced diacetyl between 1960 and 2003. We used all available historical exposure data to classify all workers into three exposure groups with varying exposure profiles to diacetyl, based on frequency and level of exposure. MEASUREMENTS AND MAIN RESULTS Workers with fixed airway obstruction underwent further pulmonary function testing (including diffusing capacity and lung volumes) and paired inspiratory and expiratory high-resolution computed tomography studies. We identified three cases consistent with bronchiolitis obliterans syndrome with air trapping on high-resolution computed tomography of the lungs, in the highest exposure group of 102 process operators. Two of these cases were lifelong nonsmokers. Potential exposures included acetoin, diacetyl, acetaldehyde, and acetic acid, with diacetyl exposures in the range previously reported to be associated with fixed airway obstruction in the microwave popcorn industry. CONCLUSIONS Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome in chemical process operators, consistent with the suspected role of diacetyl in downstream food production.
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Affiliation(s)
- Frits G B G J van Rooy
- Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands.
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