Bright P, Burge P S, O'Hickey S P, Gannon P F, Robertson A S, Boran A
Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK.
Thorax. 1997 Jan;52(1):28-32. doi: 10.1136/thx.52.1.28.
Exposure to chromium during electroplating is a recognised though poorly characterised cause of occupational asthma. The first series of such patients referred to a specialist occupational lung disease clinic is reported.
The diagnosis of occupational asthma was made from a history of asthma with rest day improvement and confirmed by specific bronchial provocation testing with potassium dichromate and nickel chloride.
Seven workers had been exposed to chrome and nickel fumes from electroplating for eight months to six years before asthma developed. One subject, although exposed for 11 years without symptoms, developed asthma after a single severe exposure during a ventilation failure. This was the only subject who had never smoked. The diagnosis was confirmed by specific bronchial challenges. Two workers had isolated immediate reactions, one a late asthmatic reaction, and four a dual response following exposure to nebulised potassium dichromate at 1-10 mg/ml. Two of the four subjects were also challenged with nebulised nickel chloride at 0.1-10 mg/ml. Two showed isolated late asthmatic reactions, in one at 0.1 mg/ml, where nickel was probably the primary sensitising agent. Four workers carried out two hourly measurements of peak expiratory flow over days at and away from work. All were scored as having occupational asthma using OASYS-2. Breathing zone air monitoring was carried out in 60 workers from four decorative and two hard chrome plating shops from workers with similar jobs to those sensitised. No measurement exceeded the current occupational exposure standard for chromate or nickel, the mean levels of chromate exposure for jobs similar to those of the affected workers were 9-15 micrograms/m3.
Chrome used in electroplating is a potential cause of occupational asthma. Sensitivity to chrome in electroplaters may occur in situations where exposure levels are likely to be within the current exposure standards. There may be cross reactivity with nickel. Inhalation challenge with nebulised potassium dichromate solution is helpful in making the specific diagnosis where doubt exists.
电镀过程中接触铬是一种公认的职业性哮喘病因，但其特征描述尚不充分。本文报告了首批转诊至专业职业性肺病诊所的此类患者。
根据哮喘病史及休息日症状改善情况诊断职业性哮喘，并通过重铬酸钾和氯化镍特异性支气管激发试验进行确诊。
7名工人在患哮喘前已接触电镀产生的铬和镍烟雾8个月至6年。1名工人虽接触11年无症状，但在一次通风故障期间严重暴露一次后患上哮喘。该工人是唯一从不吸烟的。诊断通过特异性支气管激发试验得以证实。2名工人出现单纯速发反应，1名出现迟发性哮喘反应，4名在吸入1 - 10毫克/毫升雾化重铬酸钾后出现双相反应。4名受试者中的2名还接受了0.1 - 10毫克/毫升雾化氯化镍激发试验。2名出现单纯迟发性哮喘反应，其中1名在0.1毫克/毫升时出现，镍可能是主要致敏原。4名工人在工作日和非工作日每天进行两次每小时呼气峰值流速测量。使用OASYS - 2评分，所有工人均被诊断为职业性哮喘。对来自4家装饰性镀铬车间和2家硬镀铬车间的60名从事与致敏工人类似工作的工人进行了呼吸带空气监测。没有测量值超过铬酸盐或镍的现行职业接触标准，与受影响工人类似工作的铬酸盐平均接触水平为9 - 15微克/立方米。
电镀中使用的铬是职业性哮喘的潜在病因。在接触水平可能在现行接触标准范围内的情况下，电镀工人可能对铬敏感。可能存在与镍的交叉反应。在存在疑问的情况下，雾化重铬酸钾溶液吸入激发试验有助于做出特异性诊断。
