Occupational Medicine 1994;44:95-98
© 1994 Society of Occupational Medicine
case-report |
Glutaraldehyde, asthma and work—a cautionary tale
*Chest Unit and Regional Unit for Occupational Lung Disease, Newcastle General Hospital, University of Newcastle upon Tyne Newcastle upon Tyne, UK
The Royal Infirmary Sunderland, UK
A 46-year-old endoscopy nurse developed symptoms suggestive of occupational asthma after seven years of exposure to glutaraldehyde. An initial inhalation challenge test at the endoscopy suite caused a very dramatic immediate fall in FEV1 from 3.6 to 1.5 litres. To further evaluate the case and establish a threshold for the response, a technique was devised to allow a series of double-blind inhalation challenges with activated glutaraldehyde vapour at exposure levels of 0.01–0.32 ppm. The results suggested marked dual asthmatic reactions following challenges with 0.032 ppm glutaraldehyde; however, similar ‘reactions’ were observed on control days. These were associated with an increase in airway responsiveness to methacholine, with the PD20FEV1 falling from >6400 µg to 135 µg. The interpretation of these results was potentially confounded by an intercurrent respiratory tract infection and by technically poor FEV1 recordings, so the challenge series was repeated three weeks later. The second series of double-blind inhalation challenges with carefully controlled exposures to glutaraldehyde (up to 0.32 ppm for 10 min) gave rise to no obvious asthmatic reactions, in marked contrast to the results of the unblinded workplace challenge. There was a slight increase in airway responsiveness, with the PD20FEV1 falling from >6400 µg to 1850 µg. These results illustrate the potential for misdiagnosis of occupational asthma when unblinded challenge tests are used and show that, even with sophisticated investigatory techniques, a clear-cut diagnostic result may be elusive.
Correspondence and reprint requests to: Dr S. C. Stenton, Chest Unit and Regional Unit for Occupational Lung Disease, Newcastle General Hospital, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 3PA, UK
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