Whats up Occ' Doc

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Whats up Occ. Doc?

• Carole Davison
• Workers Compensation Board

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SCOPE

• Common claims in ODS
• Allergies Lung disease skin disease
• Effects of exposures common to many industries

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NATURE OF DISEASEvs TRAUMA

• Insidious onset
• Latency
• Difficult to recognise
• Difficult to distinguish from non-occupational
  disease (important for disease management)

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ASTHMA

• Airways reversible obstructive
• Chest tightness SOB wheeze cough (nighttime)
• Constitutional vs occupational
• Same symptoms temporal relationship (immediate,
  delayed, dual)

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ASTHMA

• Allergen/sensitiser
• Sensitised vs sensitive/susceptible
• Latency for sensitisation process
• Inhalation skin contact
• Prompt diagnosis and early removal from
  exposure twitchy airways death

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ASTHMA

• Over 250 known workplace asthmagens
• Isocyanates epoxies red cedar colophony
  glutaraldehyde
• Paints, glues, foams, coatings, soft solder flux,
  plaster casts

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ASTHMA

• Serial peak flow measurements
• Pulmonary function tests/bronchodilator response
• Methacholine challenge
• Specific challenge

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Peak flow/instructions

• Ideally start while on vacation, etc and continue
  on return to work. Otherwise, carry out for
  several weeks, spanning periods at and away from
  work ie include weekends
• perform every 2 hours (waking)
• record, on every occasion
• the time of the test
• the result of the best of 3 blows
• where you are and what you were doing prior to
  the test
• any other relevant details such as the use of
  inhalers, smoking, exercise, wearing a
  respiratory, etc
• perform the test while either standing or sitting
  (it should always be done in the same position)
• there may be special instructions for an
  individual e.g., testing when a particular
  product is being used, etc.
• Visit the doctor for instructions on how to use
  the peak flow meter.

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RED CEDAR

• Number of claims per year 40-50
• Plicatic acid vs red cedar pollen
• Importance of early removal
• Airstream (Racal) efficiency vs practicality

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ISOCYANATES

• Two part vs cured one part vs prepolymer
• Probably peak exposure no RPE, spill, torch
  drums
• TDI vs MDI
• Exothermic reaction
• Paint, glues, foams, mould binders
• Machining or burning cured items
• Inhalation skin contact

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ASTHMA

• Once sensitised Only one molecule!
• Allergic rhinitis may be presenting feature
• Importance of pre-existing non-occupational
  asthma (Atmospheric irritants cold exercise
  RPE)

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RADS

• RADS (reactive airways dysfunction syndrome)
• No latency irritant-induced asthma rather than
  allergen-induced
• Single inhalation exposure to a high
  concentration of an irritant gas, fume, vapour or
  dust resulting in significant acute airway injury

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RADS

• Onset of symptoms occurs within 24 h of
  inhalation
• Asthmatic symptoms continue to occur for at least
  3 months, accompanied by persistent or
  intermittent airflow obstruction and increased
  NSBR
• Work-related patterns absent as one time
  accidental exposure

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No work-related pattern
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RADS

• Common irritants
• Chlorine, ammonia, hydrogen chloride,
  formaldehyde, oxides of nitrogen, ozone, sulphur
  dioxide, diesel fumes, fire smoke, acid mists,
  others
• Not to be confused with hyper-reactive airways
• Role of infection

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RESTRICTIVE LUNG DISEASE

• Lung tissue rather than airways
• Scarring
• Asbestosis silicosis

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SILICOSIS

• Foundries
• Concrete (sand rock/aggregate cement)
• Quartz/crystalline silica
• Grinding, drilling, cutting, roughening, abrasive
  blasting (with sand) (concrete surfaces using
  non-sand abrasives)

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SILICOSIS

• Latency can be short
• High exposures shorter latency outcome worse
• Does not improve when exposure stops
• No medical treatment
• Lungs scarred and stiff
• Can cause cancer

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ASBESTOSIS

• Asbestosis lung cancer mesothelioma
• 20-40 year latency
• Stiff scarred lungs
• No treatment
• Smoking increases number of cases of lung cancer
  associated with asbestosis

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ALLERGIES

• Type I type IV (rubber vs latex)
• Patch vs skin prick
• Allergist vs dermatologist

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ALLERGIES

• Type I 10 min -1 hour
• Asthma, angioedema, anaphylaxis, urticaria/hives
• Bee stings, NRL (latex protein) allergy
• Potentially life-threatening

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ALLERGIES

• Type IV 48-72 hours
• Eczematous skin reactions
• Additives in rubber products

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DERMATITIS

• Common not life-threatening/quality of life
• Irritant / allergic / chemical burn
• Similar appearance
• Differentiation in history distribution

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DERMATITIS

• Sensitisers (Cr, Ni, epoxies, u/f resin),
• Irritants (water, solvents, alkalis, acids)
• Contributing factors (friction, pH, wet, cold,
  sweat, gloves)
• Home dont take skin off after work

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DERMATITIS

• Distribution
• Pre-existing conditions (eczema, psoriasis,
  atopy)
• Barrier creams reconditioning creams gloves
• Patch testing
• Early removal to avoid chronicity
• Mid life occurrence

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DERMATITIS

• Cleaners/Solvents (remove grease marks, clean
  paint brushes, strip paint) dissolve oils
  protective fats from skin
• Additives scents (citrus), biocides,
  preservatives

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GLOVES

• Type appropriate/life
• Barrier creams
• Sweating
• Rinsing
• Leather/cotton

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Cement

• Dermatitis - irritant allergic
• Irritant friction, alkalinity
• Allergic - Cr, Co, epoxies
• (Addition of ferrous sulphate ? Cr allergy)
• Burns 3rd degree requiring skin graft
• pH 13 (pH of water 7)
• Wet/pressure boots, kneeling, hands
• Delayed reaction not everyone

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CEMENT

• Wet cement trapped in boots

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FIBREGLASS/RESINS/EYES

• Claims data show eye protection seldom worn
• Eye damage can be serious and permanent,
  especially if catalyst involved
• Many individuals have good correctible vision in
  only one eye to start with
• Severe damage to one eye can cause disease in
  other eye

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SOLVENTS

• Styrene, varsol, white spirit, trichloroethylene
  methylene chloride, methanol, water

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SOLVENTS

• Alcohol anaesthetics (trilene)
• Each person affected differently and by different
  amounts
• Feel OK and doing great - work accidents/going
  home
• Young persons more susceptible to serious effects
  fatalities (reason unknown) given simple
  cleaning jobs in confined areas