Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA.
Department of Medicine, New York University School of Medicine, New York, New York, USA.
Occup Environ Med. 2020 Jun;77(6):386-392. doi: 10.1136/oemed-2019-106296. Epub 2020 Mar 4.
Four machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers' respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid.
We offered a questionnaire and spirometry at baseline and 3.5 year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV) decline ≥10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV decline.
Among 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09-28.4 EU/m) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV decline (range: 403-2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3-7.5 EU/m) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy.
Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended.
4 名机器制造工厂工人患有一种新颖的职业性肺部疾病，病因不明，其特征为淋巴细胞性细支气管炎、肺泡小管炎和肺气肿（BADE）。我们旨在评估当前工人的呼吸健康与职业类别以及与内毒素暴露的关系，内毒素是从使用中的金属加工液中气溶胶化的。
我们在基线和 3.5 年随访时提供了一份问卷和肺活量测定。为 16 个生产和非生产作业组量化了内毒素暴露。用力呼气量（FEV）下降≥10%被认为是过度的。我们用美国成年人的标准死亡率（SMR）进行比较，根据内毒素暴露三分位数的健康结果调整患病率比（aPR），并预测 FEV 过度下降的因素。
在 388 名（89%）基线参与者中，气喘的 SMR 升高（2.5（95%CI 2.1 至 3.0）），但阻塞没有升高（0.5（95%CI 0.3 至 1.1））。车间工作的平均内毒素暴露量（范围：0.09-28.4 EU/m）最高。较高的暴露与运动性呼吸困难有关（aPR=2.8（95%CI 1.4 至 5.7）），但与肺功能无关。在 250 名（64%）随访参与者中，有 11 名（4%）出现 FEV 过度下降（范围：403-2074ml）；10 人从事生产工作。气喘（aPR=3.6（95%CI 1.1 至 12.1））和中等（1.3-7.5 EU/m）内毒素暴露（aPR=10.5（95%CI 1.3 至 83.1））与过度下降有关。一名生产工人的 FEV 过度下降，随后进行了肺活检，发现了 BADE。
肺功能下降和 BADE 与生产工作有关。与相对内毒素暴露的关系表明，除了哨兵疾病集群外，工作相关的不良呼吸健康结果，包括一个新发病例的 BADE。在确定 BADE 的病因和有效预防策略之前，建议减少暴露和对受影响劳动力进行医学监测。
