Occupational asthma with paroxysmal atrial fibrillation in a diamond polisher.

We present a case of a diamond polisher who developed occupational asthma as a result of prolonged exposure to various potent and well-recognized asthma-inducing agents, including cobalt dust. Although the patient was seen by various medical professionals during the initial course of his illness and given an early diagnosis of a respiratory condition, there were no attempts to evaluate the nature of his work, and therefore to establish a possible causal relationship with his exposures. This case clearly illustrates the importance of such an assessment. The ultimate fate of this patient (he had to retire from his job with a chronic and permanent illness) could have been avoided by early environmental intervention. In addition, this case illustrates a possible complication of asthma, that is, a severe cardiac arrhythmia. In this case, both the patient's symptoms and the prescribed medications contributed to worsening of the patient's underlying condition. Early diagnosis and intervention of this patient's work practices could have avoided this complication.

Occupational health problems of bridge and tunnel officers.

Bridge and tunnel officers (BTOs) sustain potential exposure to a number of physical, chemical, and work-organizational factors. They are at risk for both fatal and non-fatal occupational injuries due to moving vehicles, workplace violence, vehicular fires, and physical hazards, such as slippery walking surfaces due to oil or ice on roadways. This chapter describes the spectrum of occupational injuries and illnesses which may be seen in BTOs, focusing on: 1) vehicular exhaust and air pollution, 2) ergonomic hazards, 3) job strain, 4) noise, 5) blood-borne pathogens, 6) chemicals used in road work and maintenance (e.g., lead-based paint), and 7) with the recent advent of electronic traffic sensors, microwave radiation. Special emphasis is given to respiratory disease and cardiovascular disease. Finally, some recommendations for focused health surveillance and preventive efforts in this population are made.

Clinical evaluation, management, and prevention of work-related asthma.

Work-related asthma (WRA) is asthma that is attributable to, or is made worse by, environmental exposures in the workplace. WRA has become the most prevalent occupational lung disease in developed countries, is more common than is generally recognized, and can be severe and disabling. Identification of workplace exposures causing and/or aggravating the asthma, and appropriate control or cessation of these exposures can often lead to reduction or even complete elimination of symptoms and disability. This depends on timely recognition and diagnosis of WRA. In this review, the diagnostic evaluation has been organized in a stepwise fashion to make it more practical for primary care physicians as well as physicians specializing in occupational diseases and asthma. WRA merits more widespread attention among clinicians, labor and management health and safety specialists, researchers, health care organizations, public health policy makers, industrial hygienists, and others interested in disease prevention.

Medical evaluation for respirator use.

The purpose of a respirator is to prevent the inhalation of harmful airborne substances or to provide a source of respirable air when breathing in oxygen-deficient atmospheres. For a physician to recommend the use of respirator, general background information on respiratory-protective devices is required. The first part of this clinical practice review describes the general aspects of industrial hygiene, respirators and a respirator-certification program. The second part addresses matters related to medical certification for respirator use. Medical certification for respirators is an important part of the activities of the occupational physician. To determine whether a worker is able to tolerate the added strain of a respiratory protective device is a complex process in which factors such as fitness for work, health of the individual, characteristics of the work itself, and the properties, type, and requirements of the respiratory protective device, have to be considered. Medical certification is of utmost importance for respirator use, and it should be viewed as an element in a comprehensive respiratory protection program. A comprehensive program is the key element in affording the workers' effective respiratory protection once the initial steps of the hierarchy of methods of hazard control have proved insufficient or infeasible. As a result, the need for the industrial hygiene/safety officer, the worker, the employer and the medical professional to work as a team is much more than in any other field of occupational medicine--a necessary requirement for making the right decision.