Acute respiratory effects in firefighters.

BACKGROUND: Associations between acute respiratory inflammatory responses, changes in bronchial hyperresponsiveness, serum pneumoprotein levels, and exposure to fire smoke were studied. METHODS: The study comprised 51 firefighters. Blood samples were taken within 24 hr following exposure to fire smoke, and after a week and 3 months. Sputum was induced within 5 days post-exposure and subjects underwent spirometry and methacholine provocation one week post-exposure. Exposure was registered by a questionnaire. RESULTS: No changes were observed following smoke exposure in bronchial hyperresponsiveness and serum pneumoprotein levels. Nevertheless, in a sizable proportion of the firefighters (44%) elevated sputum neutrophil levels (≥60%) were found. Serum IL-8 concentrations were higher 24 hr post-exposure compared to pre-exposure. Elevated neutrophil levels in sputum were associated with elevated serum IL-8 (ß = 0.010, P = 0.004) and TNFα (ß = 0.005, P = 0.034) levels within 24 hr post-exposure and IL-8 elevation lasted up to 3 months. CONCLUSIONS: Acute exposure to fire smoke induces acute neutrophilic airway and long-lasting systemic inflammation in healthy firefighters in the absence of bronchial hyperresponsiveness.

Respiratory symptoms in firefighters.

BACKGROUND: The aim of the present study was to determine the prevalence and risk factors associated with respiratory symptoms in common firefighters in the Netherlands. METHODS: A total of 1,330 firefighters from the municipal fire brigades of three provinces of the Netherlands were included in the study. All subjects were administered a Dutch web-based version of the European Community Respiratory Health Survey questionnaire. RESULTS: General respiratory symptoms were associated with the number of fires fought in the last 12 months with odds ratios between 1.2 (95% CI 1.0-1.4) and 1.4 (95% CI 1.2-1.7) per 25 fires. A strong association was found between an inhalation incident and present respiratory symptoms with odds ratios between 1.7 (95% CI 1.1-2.7) and 3.0 (95% CI 1.9-4.7). Adjustments for smoking, sex, atopy, and age did not change any of the associations. After stratification, atopics showed elevated odds ratios. CONCLUSIONS: It is recommended that firefighters are aware of these elevated healthcare risks associated with exposure to fire smoke and that they increase as much as possible the use of self-contained breathing apparatus.

[Sleep disorders and the ability to drive, revision of legislation]. / Slaapstoornissen en rijgeschiktheid: herziening van de regelgeving.

Professional truck drivers suffering from obstructive sleep apnoea syndrome (OSAS) are more often involved in traffic accidents. OSAS can be treated successfully and the effects of treatment are visible almost immediately. Treatment of OSAS has shown a significant reduction in the number of traffic accidents. Based on criteria for effective treatment, the requirements for the ability to drive have recently been modified by ministerial decree. The period during which persons with OSAS were not allowed to drive was formerly at least 1 year for a passenger car and 5 years for a truck or bus. The period has now been reduced to 2 and 3 months respectively. Legislation has also been adjusted for drivers with narcolepsy and idiopathic hypersomnia for whom the use of psychostimulant drugs is allowed. The modified legislation is intended to prevent underdiagnosis, may improve driving safety and is in the public interest.

Bronchiolitis obliterans syndrome in chemical workers producing diacetyl for food flavorings.

RATIONALE: Workers in microwave popcorn plants are at risk of developing bronchiolitis obliterans associated with exposure to butter flavoring volatiles, including diacetyl. OBJECTIVES: To investigate the risk of bronchiolitis obliterans for chemical workers producing diacetyl, with exposure to less complex mixtures of chemicals. METHODS: We interviewed and conducted spirometry on 175 of 196 workers from a chemical production plant that produced diacetyl between 1960 and 2003. We used all available historical exposure data to classify all workers into three exposure groups with varying exposure profiles to diacetyl, based on frequency and level of exposure. MEASUREMENTS AND MAIN RESULTS: Workers with fixed airway obstruction underwent further pulmonary function testing (including diffusing capacity and lung volumes) and paired inspiratory and expiratory high-resolution computed tomography studies. We identified three cases consistent with bronchiolitis obliterans syndrome with air trapping on high-resolution computed tomography of the lungs, in the highest exposure group of 102 process operators. Two of these cases were lifelong nonsmokers. Potential exposures included acetoin, diacetyl, acetaldehyde, and acetic acid, with diacetyl exposures in the range previously reported to be associated with fixed airway obstruction in the microwave popcorn industry. CONCLUSIONS: Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome in chemical process operators, consistent with the suspected role of diacetyl in downstream food production.