Dr. BALAMUGESH.T Professor Dept. of Pulmonary Medicine CMC, Vellore
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Dr BALAMUGESHT
Professor
Dept of Pulmonary Medicine
CMC Vellore
Scenario
33 yr
Nursing staff
Past ho allergic rhinitis
Itching skin lesions followed by cough chest tightness and breathlessness with wheeze in ward
Following handling Inj Piptaz
Occupational respiratory diseases
Occupational allergies
At risk population
Diagnosis
Smoke inhalation
Infections
Tuberculosis
Influenza
Occupational allergies Under recognized
Under diagnosed
Under treated
Under reported
Common Occupational allergies
Occupational asthma
Occupational dermatitis
Occupational rhinitis
Occupational conjunctivitis
Occupational asthma
Accounts for 5-10 of asthma in young adults
New‐onset asthma
Hospital technicians (RR 463 95 CI 187 to 115)
Those using ammonia andor bleach at work (RR 216 95 CI 103 to 453)
Kogevinas M et al Lancet 1999
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 201363513ndash516
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Scenario
33 yr
Nursing staff
Past ho allergic rhinitis
Itching skin lesions followed by cough chest tightness and breathlessness with wheeze in ward
Following handling Inj Piptaz
Occupational respiratory diseases
Occupational allergies
At risk population
Diagnosis
Smoke inhalation
Infections
Tuberculosis
Influenza
Occupational allergies Under recognized
Under diagnosed
Under treated
Under reported
Common Occupational allergies
Occupational asthma
Occupational dermatitis
Occupational rhinitis
Occupational conjunctivitis
Occupational asthma
Accounts for 5-10 of asthma in young adults
New‐onset asthma
Hospital technicians (RR 463 95 CI 187 to 115)
Those using ammonia andor bleach at work (RR 216 95 CI 103 to 453)
Kogevinas M et al Lancet 1999
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 201363513ndash516
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Occupational respiratory diseases
Occupational allergies
At risk population
Diagnosis
Smoke inhalation
Infections
Tuberculosis
Influenza
Occupational allergies Under recognized
Under diagnosed
Under treated
Under reported
Common Occupational allergies
Occupational asthma
Occupational dermatitis
Occupational rhinitis
Occupational conjunctivitis
Occupational asthma
Accounts for 5-10 of asthma in young adults
New‐onset asthma
Hospital technicians (RR 463 95 CI 187 to 115)
Those using ammonia andor bleach at work (RR 216 95 CI 103 to 453)
Kogevinas M et al Lancet 1999
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 201363513ndash516
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Occupational allergies Under recognized
Under diagnosed
Under treated
Under reported
Common Occupational allergies
Occupational asthma
Occupational dermatitis
Occupational rhinitis
Occupational conjunctivitis
Occupational asthma
Accounts for 5-10 of asthma in young adults
New‐onset asthma
Hospital technicians (RR 463 95 CI 187 to 115)
Those using ammonia andor bleach at work (RR 216 95 CI 103 to 453)
Kogevinas M et al Lancet 1999
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 201363513ndash516
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Occupational asthma
Accounts for 5-10 of asthma in young adults
New‐onset asthma
Hospital technicians (RR 463 95 CI 187 to 115)
Those using ammonia andor bleach at work (RR 216 95 CI 103 to 453)
Kogevinas M et al Lancet 1999
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 201363513ndash516
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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 201363513ndash516
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Definition ndash 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
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Agents causing OA
NEJM July 1995
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Risk factors Level and duration of exposure
Smoking
Atopy
Occupational rhinitis and conjunctivitis
Genetic factors
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Lower airway disease symptoms -WTC dust exposure Irritant-induced asthma (of subacute onset)
Nonspecific chronic bronchitis
Chronic bronchiolitis or
Aggravated preexistent obstructive pulmonary disease
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Symptoms OA Cough
Breathlessness
Wheeze
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Diagnosis History
Examination
PEFR
Spirometry
Serum IgE
Skin prick test
Methacholine challenge test
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
The Peak Flow Meter like a thermometer for asthma
Inexpensive clinic instrument
Monitoring
Builds confidence in treatment
One lsquohard fast blowrsquo
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Occupational asthma diagnosis
bull Compatible history
bull Detailed exposure history
bull Spirometry with reversibility
bull Bronchoprovocation test
bull Establish the relationship
bull Serial peak flow BPT after exposure Skin tests Immunoassay
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Environmental Health Perspectives August 2000
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
An estimated prevalence of sensitization among the general healthcare worker population - 121
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
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Diagnostic tests for latex allergy
Skin testing
Extracts prepared with Hevea latex B and C serum proteins
Sensitivity 65 -96 and specificity ndash 88-94
Serology testing
Hevea latex-specific IgE antibody
Sensitivity ndash 70 specificity - gt95
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Glutaraldehyde induced asthma
Cidex
Agent used for disinfection
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
The odour threshold of glutaraldehyde has been reported to be 004 parts per million (ppm)
Odour detection is a potential indicator that the engineering controls are inadequate
Odour detection - unreliable
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Glutaraldemeter
United Kingdom Health and Safety Executive which also has established a 005 ppm Workplace Exposure Limit (WEL)
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Prevention Primary prevention
reducing workplace exposure to potential causal agents
Substitution
Process modification
Respirator use
Engineering control with monitoring of airborne exposure levels
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Secondary prevention identify early evidence of subclinical
disease periodic medical surveillance by using tools such as
questionnaires spirometry
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Tertiary prevention minimize effects of the workplace
environment on clinically manifest disease
Control of specific factors responsible for disease onset or exacerbationaggravation
Change the person to another job
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Treatment
Medical management of asthma
Controller inhalers
Rescue inhalers
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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 andor cyanide
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
95 people including members of the staff
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Carbon monoxide poisoning
Headache nausea malaise altered cognition dyspnea angina seizures coma cardiac dysrhythmias heart failure or bright cherry red lips
Detected by co-oximetry
Treatment
100 oxygen
Hyperbaric oxygen
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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)
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Prevention
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Influenza in HCW
Olga Anikeeva et al Am J Public Health 2009
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Additional benefits of vaccination Prevent sickness absenteeism
Protect transmission to patients
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
SUMMARY
High index of suspicion required for occupational respiratory diseases
Preparedness for smoke inhalation management
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
THANK YOU
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Cleveland clinic Nov 2013
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
Features of Irritant-Induced Occupational Asthma
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
ASSOCIATIONS BETWEEN OCCUPATIONAL EXPOSURES AND ASTHMA AMONG TEXAS HEALTH CARE WORKERS
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