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Occupational Medicine Advance Access originally published online on March 16, 2009
Occupational Medicine 2009 59(4):277-279; doi:10.1093/occmed/kqp024
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© The Author 2009. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Case Report

Occupational asthma and the paper recycling industry

Steven Tran1,2, Helen Francis2, Jennifer Hoyle3 and Robert Niven2

1 Royal Bolton Hospital, Bolton, UK
2 South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK
3 North Manchester General Hospital, Delaunays Road, Manchester M8 6RB, UK

Background Occupational disease linked to the paper recycling industry has not been well documented. No previously confirmed formal diagnosis of occupational asthma (OA) caused by hydroxylamine has been made.

Methods We have assessed and performed occupational assessment of eight workers involved in this industry. Two of these were later diagnosed with OA and are reported here.

Results Both workers developed their respiratory symptoms within 2 years of the first use of the chemical hydroxylamine as part of the ‘de-inking’ process. Hydroxylamine was used as a substitute for glutaraldehyde on risk grounds, although no prior cases of OA had been found. The two workers had worked at the same plant for 11 and 20 years, respectively. Both gave histories of work-related wheeze, shortness of breath and cough. Both cases performed OASYS peak flow records over a 3-week period and had OASYS II index of 2.85 and 2.67, respectively. Both were redeployed on site to non-exposed areas and subsequently demonstrated improvement in bronchial reactivity. Case 2 subsequently consented to and underwent a blinded, placebo-controlled occupational challenge using hydroxylamine demonstrating a significant isolated late asthmatic response.

Conclusions We believe that these are the first two confirmed cases of OA caused by hydroxylamine in the paper recycling industry.

Keywords      Asthma; glutaraldehyde; hydroxylamine; occupational asthma; paper recycling

Correspondence to: Steven Tran, North West Lung Center, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, UK. Tel: +44 (0)161 998 7070; e-mail: steven.tran{at}doctors.org.uk


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