Document Detail

Bronchial asthma and COPD due to irritants in the workplace - an evidence-based approach.
Jump to Full Text
MedLine Citation:
PMID:  23013890     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: Respiratory irritants represent a major cause of occupational obstructive airway diseases. We provide an overview of the evidence related to irritative agents causing occupational asthma or occupational COPD.
METHODS: We searched MEDLINE via PubMed. Reference lists of relevant reviews were also screened. The SIGN grading system was used to rate the quality of each study. The modified RCGP three-star system was used to grade the body of evidence for each irritant agent regarding its causative role in either occupational asthma or occupational COPD.
RESULTS: A total of 474 relevant papers were identified, covering 188 individual agents, professions or work-sites. The focus of most of the studies and the predominant diagnosis was occupational asthma, whereas occupational COPD arose only incidentally.The highest level assigned using the SIGN grading was 2+ (well-conducted systematic review, cohort or case-control study with a low risk of confounding or bias). According to the modified RCGP three-star grading, the strongest evidence of association with an individual agent, profession or work-site ("**") was found for 17 agents or work-sites, including benzene-1,2,4-tricarboxylicacid-1,2-anhydride, chlorine, platinum salt, isocyanates, cement dust, grain dust, animal farming, environmental tobacco smoke, welding fumes or construction work. Phthalic anhydride, glutaraldehyde, sulphur dioxide, cotton dust, cleaning agents, potrooms, farming (various), foundries were found to be moderately associated with occupational asthma or occupational COPD ("*[+]").
CONCLUSION: This study let us assume that irritant-induced occupational asthma and especially occupational COPD are considerably underreported. Defining the evidence of the many additional occupational irritants for causing airway disorders will be the subject of continued studies with implications for diagnostics and preventive measures.
Xaver Baur; Prudence Bakehe; Henning Vellguth
Publication Detail:
Type:  Journal Article     Date:  2012-09-26
Journal Detail:
Title:  Journal of occupational medicine and toxicology (London, England)     Volume:  7     ISSN:  1745-6673     ISO Abbreviation:  J Occup Med Toxicol     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-29     Completed Date:  2012-11-30     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  101245790     Medline TA:  J Occup Med Toxicol     Country:  England    
Other Details:
Languages:  eng     Pagination:  19     Citation Subset:  -    
Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstr, 10, 20459, Hamburg, Germany.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): J Occup Med Toxicol
Journal ID (iso-abbrev): J Occup Med Toxicol
ISSN: 1745-6673
Publisher: BioMed Central
Article Information
Download PDF
Copyright ©2012 Baur et al.; licensee BioMed Central Ltd.
Received Day: 20 Month: 4 Year: 2012
Accepted Day: 12 Month: 9 Year: 2012
collection publication date: Year: 2012
Electronic publication date: Day: 26 Month: 9 Year: 2012
Volume: 7First Page: 19 Last Page: 19
PubMed Id: 23013890
ID: 3508803
Publisher Id: 1745-6673-7-19
DOI: 10.1186/1745-6673-7-19

Bronchial asthma and COPD due to irritants in the workplace - an evidence-based approach
Xaver Baur1 Email:
Prudence Bakehe1 Email:
Henning Vellguth1 Email:
1Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstr. 10, 20459, Hamburg, Germany


Bronchial asthma and chronic obstructive pulmonary disease (COPD) are common conditions and are the dominating obstructive airway diseases in the general population.

Work-related asthma (WRA) including irritant-induced occupational asthma (OA)

Occupational asthma is defined as a chronic inflammatory disorder of the airways with recurrent episodes of coughing, wheezing, chest tightness, dyspnea, shortness of breath at rest, and reversible airflow limitations caused by a particular occupational environment [1-3].

The available epidemiological and comparative studies and reviews provide evidence that occupational agents cause 5 – 25% of all asthma cases [1,4-23]. Besides these evident occupational asthma (OA) cases, there is probably an even larger population of sufferers of work-aggravated asthma [24-26]. The latter population shows an objective worsening of pre-existing asthma or non-occupational asthma that develops in parallel with causative conditions encountered in the workplace (Figure 1).

Occupational agents eliciting bronchial asthma, i.e. OA, comprise occupational allergens, with their well-defined etiological role and IgE-mediated pathomechanism, as well as occupational agents with unknown pathomechanisms and occupational respiratory irritants, mainly representing low molecular weight chemicals (LMW; <5000 Daltons) causing irritant-induced OA (Figure 2). The latter agents may also elicit occupational COPD (see chapter 1.2) and include chlorine, acids, welding fumes, as well as isocyanates. The etiological role of such low molecular chemicals has not yet been completely clarified, primarily because of the lack of specific diagnostic tests.

There is sparse data available on causes and frequencies of irritant-induced COPD and work-aggravated asthma. Therefore, this work focuses on irritant-induced OA.

There is increasing evidence that irritant-induced OA can be further subdivided into three subcategories as outlined in Table 1[27-29].

Many case reports, case series and a few cross-sectional studies demonstrate that a single short-term accidental massive exposure or several short-term high-level exposures to a respiratory irritant can cause asthma within 24 hours without a latency period. Brooks et al. [30] defined this disorder as “reactive airways dysfunction syndrome” (RADS). This term was later extended to irritant-induced OA from multiple, somewhat lower, exposure incidents with a less sudden onset that were also shown to cause this disorder [27,31-36].

Furthermore, there is evidence that a susceptible subgroup of subjects mainly atopics with non-specific bronchial hyperresponsiveness (NSBHR) suffering from irritant-induced OA, is also affected by chronic exposures to relatively low concentrations of irritant gases, fumes or aerosols [27,37,38]. This disorder has been called “low-dose irritant asthma” (or “low-dose RADS”). Corresponding studies indicate respiratory effects including asthma from mainly chronic or repeated exposure to a single irritant or a mixture. Demonstrably causative concentrations of a particular irritant are often below their occupational exposure limits (OELs) or permissible exposure limits (PELs). Such irritant examples include swine confinement facilities [39,40], exposures to cleaning agents [12,41], solvents, ozone, endotoxin, formaldehyde, quaternary ammonium compounds, chlorine, bisulfite and SO2, or acid mist [36,37,42-44], diesel exhaust [10,45,46], fumigant residues [47], dusts in the textile paper, mineral fiber or construction industries or in mines [48-51], as well as a proportion of cases of potroom asthma [52] and meatwrappers' asthma [53]. Asthma in cold-air athletes may also be relevant [54,55]. A previous summary of the literature on respiratory effects from asthma due to irritants below their OELs/PELs is available [56]. Many of the earlier exposure limits have been lowered repeatedly in the light of subsequent clinical or epidemiological findings on their respiratory effects. Other limits remain obstinately high given their known irritative effects and/or that they are based on sparse data [56]. Accordingly, adherence to OELs/PELs does not preclude the onset of WRA in susceptible subjects.

The broader definition of these disorders (as used in the legal definition in Germany) includes all irritant-induced obstructive airway diseases irrespective of their causative concentrations and reversibility, i.e. irritant-induced occupational asthma as well as COPD.

Frequency of OA

OA has become the most prevalent occupational lung disease in developed countries [57,58] and it is one of the most frequent diagnosis among occupational diseases in general [59]. The annual incidence of OA is in the range of 50 per million with extremes up to 250 per million workers and more than 1,300 per million in specific workplaces [57,60]. As already mentioned there is evidence that occupational agents cause 5 - 25% of of all asthma cases. However, complete registries of OA do not exist and therefore the true frequency of the disease is unknown. Ameille et al. [61] and Fernández-Nieto et al. [59] stated that OA is underestimated among occupational diseases, because many OA cases are not subjected to appropriate diagnostic tests.

Irritant-induced OA is reported to occur in approximately 5 -18% of all OA cases, being the second most common form of OA after allergic OA [36,62].

Chronic obstructive pulmonary disease (COPD) due to occupational exposure

The diagnosis of COPD is based on chronic productive cough, airflow limitation that is usually not fully reversible, and a progressive, abnormal inflammative response of the lungs mostly caused by long-term smoking and by other noxious particles or gases [1].

During ongoing causative exposures (e.g. smoking particles, droplets and/or gases), airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs. Patients with COPD have greater number of neutrophils and alveolar macrophages in bronchoalveolar lavage fluid than healthy non-smokers [63]. Sites of emphysema, which are frequently found in COPD patients, contain large numbers of lymphocytes, and the extent of lymphocyte accumulation correlates with reduction of FEV1.

In their summaries of the literature, Hnizdo et al. [64], Trupin et al. [65] and Balmes et al. [1] found an occupational contribution in about 15% of COPD cases.

Occupational COPD is identified on epidemiological basis, by observing increased frequencies of COPD among certain working groups [66], e.g. in construction workers [2]. Some occupational exposures (e.g. welding fumes, aluminium, potroom fumes, and cadmium) may cause COPD associated with emphysema [67,68].

At later stages of OA, the condition of some subjects does not improve over weekends or during holidays and coincides with symptoms of COPD patients. This observation also applies to non-occupational obstructive airways diseases [69,70] and indicates that a group with changing diagnoses as well as with some overlap between OA and occupational COPD, does exist [66,71-73].

Background and objective

WRA and occupational COPD are serious and sometimes fatal diseases, which can lead to ill health, inability to work and lost productivity [1,25,74-76]. They represent a huge economic burden to the society. For details see Additional file 1: Online Supplement “Economic burden”.

The objective of this study is to summarize present knowledge on respiratory irritants causing obstructive airway diseases in humans in the occupational setting and to provide a rating of the strength of evidence for each irritant which has not been previously available.


A systematic review of the literature on occupational irritant-induced OA and occupational COPD due to occupational irritants was conducted. We considered asthma-inducing irritating agents as well as those reported to cause occupational COPD and related disorders, where obstructive ventilation patterns were demonstrated in clinical investigations, cross-sectional studies, cross-shift and/or in long-term exposure studies. Irritating gases mainly occurring in the general environment, such as ozone, and inorganic dusts, including silica, talcum, silicates and other fibers known to cause pneumoconioses, were not considered even though exposure to them is frequently associated with mixed ventilation patterns.

Definitions used

Occupational COPD: chronic bronchitis symptoms and non-reversible airflow limitation due to particular occupational environment (if lung function data was available; otherwise, clinical diagnosis as given by the authors is cited).

Occupational asthma: episodes of shorteness of breath due to particular occupational environment and reversible airflow limitation (if lung function data was available; otherwise, clinical diagnosis as given by the authors is cited).

Obstructive ventilation pattern: we applied reference values of FEV1/FVC from Brändli, Schindler et al. 2000 [77].

Information sources and selection criteria
Occupational respiratory irritants

To identify the evidence of irritants of the respiratory tract, all agents denoted as “may cause respiratory irritation” by the phrase H335 (previous code R37) and “may cause allergy or asthma symptoms or breathing difficulties if inhaled” H334 (previous code R42) [78] and/or as “irritants” by American Conference of Governmental Industrial Hygienists [79] were initially listed [80]; later this list was compared with results of our database search (see below).

Database search.

We searched for publications reporting investigations exclusively in humans (i.e. animal or in-vitro research was excluded). To be included, the publications had to deal with subjects occupationally exposed to airway irritants.

MEDLINE®-Database was searched with PubMed® from its inception up to December 2007 with the following medical subject headings (MeSH) combinations for each single agent:

Agent”[MeSH] AND “Humans”[MeSH] AND ((“Asthma”[MeSH] OR “Asthma/chemically induced”[MeSH] OR “Asthma/immunology”[MeSH]) OR “Pulmonary Disease, Chronic Obstructive”[MeSH] OR “Lung Diseases, Obstructive/*chemically induced”[MeSH] OR “Respiratory Function Tests”[MeSH]) AND (“Accidents, Occupational”[MeSH] OR “Occupational Exposure”[MeSH] OR “Occupational Diseases”[MeSH] OR “Occupational Diseases/chemically induced”[MeSH])).

If more than 20 publications per agent were found, the search was more specified:

Agent”[MeSH] AND “Humans”[MeSH] AND (“Cohort Studies”[MeSH] OR “Case–control Studies”[MeSH] OR “Case–control Studies”[All Fields] OR “Longitudinal Studies”[MeSH] OR “Longitudinal Studies”[All Fields] OR “Cross-Sectional Studies”[MeSH] OR “Cross-Sectional Studies”[All Fields] OR “Epidemiologic Studies”[MeSH] OR “Epidemiologic Studies”[All Fields] OR “Case Reports”[Publication Type] OR “Meta-Analysis”[MeSH] OR “Meta-Analysis”[All Fields]) AND “adverse effects”[Subheading] AND ((“Asthma”[MeSH] OR “Asthma/chemically induced”[MeSH] OR “Asthma/immunology”[MeSH]) OR “Pulmonary Disease, Chronic Obstructive”[MeSH] OR “Lung Diseases, Obstructive/*chemically induced”[MeSH] OR “Respiratory Function Tests”[MeSH]) AND (“Accidents, Occupational”[MeSH] OR “Occupational Exposure”[MeSH] OR “Occupational Diseases”[MeSH] OR “Occupational Diseases/chemically induced”[MeSH])).

Reference list screening

We also considered references in the identified already existing 13 systematic reviews or overviews of causes of work-related asthma or COPD and tried to combine results of both approaches.

Occupational diseases statistics

Further, we considered the following occupational diseases statistics based either on statutory surveillance or registration systems: SWORD 1994–1997 [81-83]; SHIELD 1993 [74]; SORDSA 2001 [84]; SENSOR 2003 [85]; Dokumentation der Berufskrankheiten 2007 (BK-DOK) [86].


Four different conditions were accepted for inclusion:

1. Irritant-induced OA including RADS. Asthma caused by single or multiple occupational exposures to airway irritants; de novo irritant-induced OA. Asthma within 24 hours without a latency period caused by short-term high-level exposures to a respiratory irritant known as acute irritant-induced asthma, or as RADS [30].

2. Work-aggravated (exacerbated) irritant-induced OA. Pre-existing or concurrent asthma worsened by work factors [24]. Subjects with work-related asthmatic symptoms, if not differentiated whether new-onset or work-aggravated.

3. Occupational COPD. On epidemiological basis, identified by observing increased frequencies of COPD among certain working groups [66].

4. Obstructive ventilation pattern. Studies about irritant agents, where obstructive ventilation patterns in occupational settings were reported.

Methodological selection criteria

Publications with one of the following study designs were included: Systematic reviews of cohorts, case–control or cross-sectional studies, cohort studies (prospective/retrospective), case–control studies, cross-sectional studies, surveys.

Non-analytic1a studies (i.e. case series, follow-up of cases or case reports) were only included when for an agent no studies with one of the above mentioned designs had been identified.

Publications were included when they met any of the following criteria: examining the frequency of irritant-induced OA or asthmatic work-related symptoms in occupationally exposed groups or individuals, reporting the causative role of the specific agent or mixture of agents for irritant-inducing WRA or COPD.

Studies were included when they applied any of the following diagnostic tools: description of work-related asthmatic symptoms (questionnaire), lung function test (LFT), testing for non-specific bronchial hyperresponsiveness (NSBHR) by means of methacholine, histamine or other pharmacological agents, serial spirometry or expiratory peak flow (PEF) monitoring or supervised exposure testing in the workplace, challenge with the help of lung function measurements (SFT), specific inhalation challenge testing (SIC), clinical diagnosis of OA by an expert (occupational or pulmonary physician), and exposure to an irritant agent.

Publication period: No restriction for publication dates were made, last updates were between 5th and 15th June 2012.

Language: English, German, Spanish, Italian or French.

Methodological studies, e.g. on effects of study design and subsequent procedures, and studies with non-occupational disorders were excluded. Publications about occupational agents which do not have an irritant effect on the respiratory tract (e.g. about IgE-sensitizing agents) or with unrelated issues (e.g. studies on immunological questions) were also excluded.

Assessment of study quality

The principal study characteristics and study results were systematically extracted using an extraction sheet (see Additional file 2: Table S1A of online supplement “Methodology”).

We assessed study quality with the help of a check list (see Additional file 2: Table S1B of online supplement “Methodology”). The evidence level of each study was graded according to the revised Scottish Intercollegiate Guidelines Network (SIGN) grading system [87]. Since population-based randomized assignment to different levels of irritant exposure are unethical, no randomised controlled trials (RCTs) could be expected on this topic and, thus, no level 1 evidence (as defined by the revised SIGN grading system) [87] would be available. In order to achieve more differentiation among lower evidence grades, we modified the SIGN grading system and added an additional grade (3+) (see Additional file 2: Table S1C of online supplement “Methodology”).

Details of the modified RCGP [88] grading system are given in the online supplement “Methodology”, Additional file 2: Table S1D.

Overview on publications retrieved

The database search (MEDLINE/ PubMed) yielded 383 potentially relevant publications. 480 additional potentially relevant publications were retrieved from the reference lists of 13 systematic reviews or overviews [2,30,36,80,89-97], from occupational diseases routine statistics (SWORD 1994–1997 [47,81-83]; SHIELD 1993 [74]; SORDSA 2001 [84]; SENSOR 2003 [85]; BK-DOK 2007 [86], and from the library of the Institute of Occupational Medicine, Hamburg. Alltogether, the different search approaches yielded a total of 474 relevant studies, including an extreme early study from the year 1932 [98]. (See selection flow diagram, Figure 3).

Most (n = 337) of the 474 relevant publications were identified through hand searching (i.e. reference list checking of systematic reviews and from our library database).

The 474 publications refer to 131 individual agents, 46 to “mixed” agents and 11 to work-sites or professions reported to cause OA and/ or occupational COPD.

Diagnostic aspects

Many different ways of confirming irritant-induced OA were used, with specific inhalation challenge (SIC) and lung function tests (LFT) being the most reliable diagnostic aids.

SIC was used as the “gold standard” in confirming OA mainly in non-analytical studies (n = 189 studies, i.e. 72% of non-analytical studies). Only few (n = 16, i.e. 7.5% of analytical studies) cohort or case–control reported diagnostic confirmation with SIC.

Another frequently used (n = 191) diagnostic method for OA or occupational COPD was lung function testing (LFT); showing an obstructive ventilation pattern and/or NSBHR related to occupational exposures, mostly in combination with WRA symptoms.

Exclusively self-reported asthma symptoms or physician reported asthma as documented in questionnaires as an alternative diagnosis for OA was used in 36 studies.

Other studies (n = 44) had not clear diagnosis of OA or occupational COPD but reported obstructive ventilation pattern. The number of subjects with asthma symptoms and frequencies of obstructive ventilation patterns and/or NSBHR are provided for each study (see Additional file 3: Table S2E of online supplement “Results”).

Irritant-induced OA as outcome

Irritant-induced OA was the focus of most studies and was the predominant diagnosis.

RADS, as a subgroup of irritant-induced OA, was reported to be due to 47 different agents, with the most prevalent being the World Trade Center disaster in 2001 (n = 7 studies), chlorine (n = 11), cleaning agents (n = 18) and isocyanates (n = 46). These were followed by disorders, caused by metam sodium (n = 17), ammonia (n = 11), diesel exhaust (n = 10), acids (n = 9), solvents (n = 8), sulfur dioxide (n = 7), dinitrogen tetraoxide (n = 6), hydrogen chloride (n = 4), smoke (fires, pyrolysis products) (n = 4), chlorofluorocarbons (n = 4), spray paint (n = 3), tear gas (n = 3), bromine (n = 2), dichlorvos (n = 2), sodium azide (n = 2), acrylates (n = 1), amprolium hydrochloride (n = 1), phthalic anhydride (n = 1), bromochlorodifluoromethane (n = 1), bromotrifluoromethane (n = 1), chloramine T (n = 1), chromate (n = 1), hydrazine (n = 1), hydrogen fluoride (n = 1), methylmercaptan (n = 1), phosgene (n = 1), uranium hexafluoride (n = 1), airbag content (n = 1), bleaching agent (n = 1), floor sealant (n = 1), fumigant (n = 1), metal coat remover (n = 1), metal oxide fume (n = 1), pesticides (n = 1), refractory ceramic fibers (n = 1), swine confinement (n = 1).

The majority of asthma-inducing agents elicited OA after prolonged exposure and rarely after a single exposure.

Work-aggravated asthma was of less importance in the literature and occurred in only a few studies [30,99-104].

Occupational COPD as outcome

Ten agents and five professions or work-sites were reported to cause occupational COPD, as shown in Table 2.

As already mentioned, occupational COPD was not specifically addressed in most of the studies. Some describe respiratory symptoms, such as chronic bronchitis (n = 21), which may be indicative of COPD. One of the few studies which specifically focused on COPD, was a large retrospective cohort study on diesel exhaust which caused a significantly increased COPD mortality in railroad workers after the introduction of diesel engines in 1945 [105,106]. Construction work was identified as a cause of occupational COPD in 2 publications [8,107].

Evidence level of the literature

Some publications investigated more than one irritant agent and thus have been considered several times in our study.

262 of the 474 publications were non-analytic studies and were rated according to SIGN as 4, 3 or 3+ and consisted of case reports (n = 228), case series (n = 63), and occupational diseases statistics (n = 33) and reviews of that kind of studies (n = 7). The other publications reported analytical studies and were rated according to SIGN as 2+ (n = 15), 2- (n = 103), or 3+ (n = 83).

The highest level was 2+, indicating a well conducted analytical study (case control or cohort studies) with a low risk of confounding or bias (n = 15 studies). Other studies with a similar design had a higher risk of confounding or bias and were individually rated lower by SIGN grading of 2- (n = 30 studies). Most of the other analytical studies were rated with a SIGN grade of 2-, because their design (cross-sectional or longitudinal study) was limiting (n = 82 studies). Cross-sectional studies or longitudinal studies, e.g. those with high risk of confounding or bias, were rated even lower with 3/ 3+ (n = 35 studies). A couple of study designs were difficult to classify epidemiologically, including those which were surveys, mostly with very low analytical evidence, rated 3/ 3+ (n = 53 studies), or larger surveys with a lower risk of confounding or bias, which were graded with 2- (n = 4 studies).

Investigations involving dose–response relationship as a form of scientific evidence were performed in 30 out of 474 studies analyzed [68,105,106,108-133].

Another assessment of the level of evidence found in individual studies is to consider their OR for irritant-induced OA or occupational COPD; this was done in 39 publications [15,23,44,48,105-108,113,117-120,122,126,128,134-156].

Strength of evidence per agent, work-site or profession

The outcome for each agent causing OA or occupational COPD was graded according to the modified RCGP three-star system to classify the strength of evidence of its causative role in irritant-induced OA/ occupational COPD. The strongest evidence achieved was two stars “**” (indicating a moderate strength of evidence provided by generally consistent findings in fewer, smaller or lower quality scientific studies) for 17 (mixed) agents, work-sites or professions. For six of them (chlorine, platinum salts, environmental tobacco smoke, welding fumes, construction work, World Trade Center disaster in 2001), this level was based on well- conducted studies with low risk of confounding and/or bias (SIGN 2+). For eleven of these 17 (mixed) agents, SIGN levels of individual studies were lower (benzene-1, 2, 4-tricarboxylic acid-1,2-anhydride [trimellitic anhydride], cobalt, isocyanates, cement dust, grain dust, animal farming (pig, beef/veal, dairy, poultry), or swine confinement.

Low to moderate scientific evidence – provided by generally consistent findings in fewer, smaller or lower quality analytical studies, based on questionnaires or other inadequacies, i.e. “*[*]” – was found for 12 agents (phthalic anhydride, glutaraldehyde [glutaral], sulfur dioxide, cotton (dust, raw) CNT 750, potroom aluminum smelting, farming (various) or foundry), smoke (fires, pyrolysis products), pesticides (not specified), cleaning agents (not specified), ceramic production (dust), health care workers.

Limited or contradictory evidence – provided by only one analytical study or inconsistent findings in multiple scientific studies, i.e.“*” – was identified for 39 agents, and after down-grading because of inadequate methodological aspects, i.e. “[*]” on three occasions. For the majority of agents, only non-analytical studies were reported for ≥ 5 cases, i.e. “(*)” or less than 5 cases, i.e. “-”. When only non-analytical studies were available, the strength of evidence for the agent was raised if at least 5 cases were identified by the case reports/ case series or occupational disease statistics for which proof of irritant-induced OA or occupational COPD existed. The strength of evidence reached when only non-analytical studies were available ranged from “very limited or contradictory evidence” in 29 studies, i.e. “(*)”, to “no scientific evidence” “-” 94 times. (see Tables 3 and 4 and Additional file 3: Table S2E of online supplement “Result”).

The compiled assessment of the individual studies, along with their relevant clinical data and strength of evidence for irritant agents, professions or workplaces causing asthma or COPD, is presented as a summary list (see Additional file 3: Table S2E “Results” for the full information).


The main objective of this study was to give a comprehensive and evidence-based overview of the literature on irritative agents, professions or work-sites causing irritant-induced work-related asthma and occupational COPD. To our knowledge this study is the first attempts to document these respiratory disorders, along with their causative irritant agents in an evidence-based manner.

The 474 publications retrieved (see Table 3 and Additional file 3: Table S2E of online supplement “Results”) in this work mainly refer to individual agents (n = 131), but also to mixed exposure(s) or multicomponent work-sites or professions (n = 57) where heterogeneous exposure to irritating substances is common, e.g. swine confinement, “construction work” or “farming”, giving 188 different causes of irritant-induced OA and/or occupational COPD in total.

Strength and limitations

This work covers a broad range of causative agents of irritant-induced occupational asthma or COPD. We included various study designs.

A strength of our work is that we not only assessed the quality of single investigations but the strength of the body of evidence for each irritant agent.

The paradigm of “evidenced-based medicine” has been criticized by leading scientists [547-550]. Bias in the selection of information may be a problem for generalization of findings in single studies [551,552]. In spite of these limitations, alternative approaches to evaluation of the literature have not been generally accepted. Evaluation of the evidence depends on the domain, which means the factors to be considered in assessing the extent to which the study results are reliable or valid.

Kunz et al. [553] stressed the approach of grading scientific studies on basis of additional qualified data, i.e. dose response relationships. This latter was seen in 30/474 individual studies in this current work. Other studies were based on evidence by OR >2 or < 0.5 for irritant-induced OA and occupational COPD which was applied as an approach in 40/474 individual studies (see Additional file 3: Table S2E of online supplement “Results”).

There are numerous procedural methods for rating the strength of scientific evidence. The AHRQ emphasized in 2002: “systems for grading the strength of a body of evidence are much less uniform than those for rating study quality” [554].

It is possible that not all relevant studies were found in our search of literature. Probably, some studies could not be found by the MeSH term raster applied. Relying solely on MeSH terms might be a problem in the identification of studies of irritant-induced OA or occupational COPD. We restricted the search to the MeSH fields in order to increase the specificity of the search. As for any electronic search strategy, an increase of specificity implies a decrease in sensitivity of the search.

For each single study, we took into consideration possible risks due to confounding, e.g. exposure to multiple agents and selection bias, e.g. healthy worker effect.

Basis and quality of data

Irritant-induced obstructive airways diseases cannot usually be diagnosed in one clinical visit and, instead, follow-up and/or detailed clinical investigations are necessary. The diagnostic “gold standard” for OA is SIC using a specific occupational agent in an exposure chamber. SIC is particularly indicated in the clinical setting where new causative substances with still unknown adverse respiratory sensitization potential are suspected. This “gold standard” is not applicable for large studies; so, it was used mainly in case series or reports.The evidence levels to confirm irritant-induced work-relaated asthma or occupational COPD for the listed irritant agents, professions or worksites (see Additional file 3: Table S2E of online supplement “Results”) are frequently low with the major reasons being that high quality studies were missing and the quality of the available studies was low. Nevertheless, this knowledge is the best available and may help physicians to identify a suspected irritant agent as causative in irritant-induced work-related asthma and / or occupational COPD [555]. As also recently stressed by Quint et al. [555], “implementing an evidence-based identification and regulatory process for OA will help to ensure primary prevention of OA”. In cases of low evidence level of an agent that does not exclude a causative role, caution should be exercised and a more detailed diagnostic testing of relevant exposure should be performed.

Occupational COPD, an underestimated category

We identified only 20 out of 474 publications that referred to occupational COPD, with most of them implicating inorganic or organic dust or fumes, such as cement dust, construction work and diesel exhaust, as the causative agents.

As an example, the mixed agent cement dust was investigated in 14 studies but only four studies documented cement dust as the causative agent in occupational COPD [111,418,419,422] (see Table 3 and Additional file 3: Table S2E “Results”). The remaining 10 studies described irritant-induced OA cases [235,423-426,530] or identified significant asthma symptoms/ obstructive ventilation patterns without a clear diagnosis (5 studies: [178,417,420,556]). It can be assumed that if it had been considered on the other 10 studies then occupational COPD caused by cement dust would have been frequently observed.

The population-attributable fraction for COPD associated with occupational exposure has been estimated between 9% and 31% [1,64,65]. However the true population-attributable risk due to occupational exposure is unclear [6,557] as occupational COPD is rarely clinically diagnosed. Blanc et al. [558] recently published an ecological analysis using data from three large studies, comprising the Burden of Obstructive Lung Disease study [169], the Latin American Project for Investigation of Obstructive Lung Disease (PLATINO) and the European Community Respiratory Health Survey follow-up (ECHRS II), where occupational COPD was also not a primary goal. The original publications are mainly concerned with OA or asthma symptoms, but a history of pre-existing OA or RADS cannot be allowed to exclude occupational COPD [559]. Blanc et al. [558] stressed that the contribution of occupational exposure cannot be ignored, because “the association between adverse working conditions and COPD (…) carries significance as a global finding (…), alongside the (…) critical contribution of cigarette smoking to disease prevalence”.

General acceptance of this statement does not exist [66,559], although evidence for an association between individual exposure levels and COPD is accumulating in the latest literature [1,6,106,506,557,560,561].

Irritant-induced WRA – a broader definition

Irritant-induced OA includes three subcategories that predominantly differ according to the concentration of irritants in the workplace atmosphere. It can occur without a latency period, such as RADS, as was shown for 46 causative agents in our study, with the highest prevalence after spills of acids or tear gas (see Additional file 3: Table S2E of online supplement“Results”). Other agents, e.g. isocyanates or welding fumes, usually induce a slower onset of low dose irritant-induced asthma with a latency period and mostly without evidence of an IgE-mediated pathomechanism.

The ACCP also stated in its last Consensus Statement in 2008 [24] that cases who do not meet the stringent criteria of RADS [30] (e.g. where there is a lag of several days before the onset of symptoms or where there is no single massive exposure but rather repeated exposure over days and weeks) should be subsumed into a broader category of irritant-induced OA. As outlined in the section “Introduction” Brooks et al. [31] and later also others, e.g. Burge [27] suggested using the term “not so sudden onset of irritant-induced asthma” for those developing the disorder after such exposure within a period of 2 days to 4 months. In an extended definition corresponding to ours, Burge [27] he used the term “low dose irritant-induced OA” for those developing the disorder after relatively low repeated exposure for more than 4 months.

Bardana [562] and Vandenplas and Malo [563] questioned whether such rather low concentrations could actually cause irritant-induced OA. These different opinions about the pathogenetic role of chronic or recurrent exposure(s) to low concentrations of respiratory irritants seem to be due to inadequate considering of the increased susceptibility of a small group of workers. Occupational disease statistics do mostly neither contain such cases nor work-aggravated asthma cases so far.

Another critical issue is the frequent disregarding of work-aggravated asthma due to occupational agents by physicians.

Comparison to occupational guidelines or consensus statements – what is new?

In the current analysis, the focus has been on irritant agents causing irritant-induced occupational asthma and COPD. Both entities have been underestimated or even overlooked in the past. Occupational COPD has not been considered as a subgroup of COPD thus so far [559,564]; and the definition of irritant-induced OA has been heterogenous at best [24,552,565,566]. Furthermore, the guidelines dealing with respiratory disorders have not even considered causation by individual irritant agents, so far.

The ACCP published a Consensus Statement in 2008 [24] which focuses on the diagnosis and management of WRA after a latency period, i.e. due allergens and “sensitizers” with unknown pathomechanisms, effectively sidelining irritant-induced OA to RADS.

The Agency for Healthcare Research and Quality (AHRQ) in its the Evidence Report “Diagnosis and Management of WRA” [552] addressed the key question of the best diagnostic approach for a patient with suspected WRA. In respect of irritant-induced OA, they only considered RADS as a non-allergic asthma due to mainly low molecular weight compounds of unknown pathomechanism.

The Canadian Thoracic Society “Guidelines for OA” [567] was the first evidence-based guideline, although irritant-induced OA was limited to RADS. If criteria were not fulfilled then irritant-induced OA was discussed as a controversial diagnosis. The three evidence levels in the “Guidelines for OA” were based on quality of scientific evidence within analyzed studies [568]. Compared with the modified RCGP three-star grading (see Additional file 2: Table S2D in online supplement “Methodology”), the different levels are defined in a more general way, i.e. not considering the quantitative aspect if only studies with lower scientific evidence exist.

The evidence review and recommendations for OA by the BOHRF [3,569] were designed to improve the prevention, identification and management of OA. This work mainly deals with asthma after a latency period and considers irritant-induced OA and RADS to be closely related entities. The difference in comparison with our analysis is obvious even though our evidence-based approach was closely related to the BOHRF guidelines and used the same grading systems.

In summary, the existing guidelines or statements mostly define irritant-induced OA as RADS. Work-aggravated asthma, and occupational COPD as a distinct entity, have not been considered in any guideline, although the latter is becoming recognized as such in more recent publications [557,559,564].

This evidence-based approach is the first which focuses on especially irritative agents within the broader definition of irritant-induced OA and occupational COPD. For clarification, the grading systems were modified in accordance with BOHRF [3] when considering the extent and quality of the clinical investigations, with the goal of creating evidence levels for causative irritative agents as precisely as possible.

Concluding remarks

OA is the most common chronic occupational lung disease in many industrialized countries [3]. COPD is the fourth leading cause of death worldwide with a significant portion of occupational cases [66]. The term occupational COPD does not officially exist. However, it has to be considered as a subcategory of COPD [559].

Our study shows that reliable, sensitive and specific methods are required in the diagnostic approach for confirming irritant-induced OA, work-aggravated asthma, or occupational COPD. The specific diagnostic work-up in a subject with such a suspected disorder depends on the individual clinical data and on the knowledge of asthma- or COPD-inducing agents in the workplace. On this basis, our review may help in diagnostics especially for agent exposures where we were able to relate irritant-induced work-related asthma or occupational COPD to a high evidence-based level (i.e. two stars according to the RCGP grading).

We have created a list representing the strength of evidence for irritating agents to be causative in irritant-induced work-related asthma or occupational COPD (see Additional file 3: Table S2E of online supplement “Results”).

A low level or absence of evidence for many agents in causing irritant-induced work-related asthma or occupational COPD is sometimes due to contradictory findings in literature, but is mostly due to the absence of rigorous scientific studies, with many gaps remaining in the knowledge of a causative role for individual agents and conditions. Therefore, and because of rarely applied diagnostic approach in the clinical setting, our literature search and evaluation lead us to assume that irritant-induced respiratory disorders are considerably underreported in cross-sectional studies and occupational disease statistics.

Our list needs updating in the light of recent literature, in order to provide a realistic overview of agents and evidence level in their causation of irritant-induced work-related or occupational COPD.

The estimated high population-attributable risk in the range of 5–25% for occupational asthma and COPD from occupational exposure, indicates that more detailed and intensive research, as well as strategies designed to prevent these disorders, should receive high priority in the global efforts to reduce the burden of these diseases. This implies extended evidence-based diagnostic procedures that help to optimize primary and secondary prevention by the physicians dealing with occupational diseases.

Reduction of the exposure to noxious agents by lowering the permissible exposure limits is the best and favoured way for intervention. If this is not possible then other effective primary preventive measures, such as wearing adequate respiratory devices, are required [28,570-574].

Finally, we would like to mention that the diagnosis of irritant-induced OA should be considered if:

there has been exposure to high concentration of an irritative agent identified in this study and the development of asthma without a latency period (original definition of RADS) or

there has been chronic or repeated exposures to moderate (in the TLV ranges) concentrations of an irritative agent identified in this review and the development of asthma with a latency period, but without evidence of an IgE-mediated pathomechanism and

there is evidence that a highly susceptible subject (e.g. with pre-existing NSBHR) develops new onset asthma upon occupational exposure to an identified irritative agent even at concentrations below the TLV.

Work-aggravated asthma should be considered if:

there have been any of the before-mentioned exposures and

there is a temporally related significant worsening of a pre-existing asthma or of a concomitant non-occupational asthma.

The diagnosis of occupational COPD should be considered if:

there has been exposure to an agent capable of causing occupational COPD, and

not reversible chronic airway disease is demonstrated and

there is a temporal relationship between the period of exposure (mostly cumulative exposures to identified irritants ) and the development of COPD (acute WRA symptoms are frequently missing).

Occupational COPD has to be taken into consideration especially in non-smokers, i.e. when dominating non-occupational causes for COPD are obviously not present.


aEpidemiologic study design which is generally applied to test one or more specific hypotheses, typically whether an exposure is a risk factor for a disease [575].


CAS: Chemical abstracts service; COPD: Chronic obstructive pulmonary disease; OA: Occupational asthma; RADS: Reactive airways dysfunction syndrome; RCGP: Royal college of general practitioners; SIGN: Scottish intercollegiate guideline network; WRA: Work-related asthma.

Competing interests

The authors declare that they have no conflict of interest.

Authors' contributions

All authors made substantial contributions to the study. XB made the design of the study and the final interpretation of data. HV and PB did the detailed literature search, data extraction and analyses, and statistical analyses. XB and HV wrote the manuscript with input from PB. All authors approved the final version for submission.

Supplementary Material Additional file 1

Economic burden.

Click here for additional data file (1745-6673-7-19-S1.docx)

Additional file 2

“Methodology” Selection criteria, information sources, strength of evidence. Table A: Data extraction and synthesis. Table B. Quality assessment of individual study. Table C - The revised Scottish Intercollegiate Guidelines Network (SIGN) grading system (modifications are given in italics) [87]. Table D The Royal College of General Practitioners (RCGP) three-star system [88] used by the British Occupational Health Research Foundation [3,574] (modifications are given in italics).

Click here for additional data file (1745-6673-7-19-S2.docx)

Additional file 3

“Results” Table E overview on publications and SIGN grading of reporting OA or occupational COPD due to irritants. X. Baur, P. Bakehe, H. Vellguth = > Knowledge Center.

Click here for additional data file (1745-6673-7-19-S3.xlsx)


We thank Marcial Velasco Garrido for critical review and support in drafting the manuscript.

Balmes J,Becklake M,Blanc P,Henneberger P,Kreiss K,Mapp C,Milton D,Schwartz D,Toren K,Viegi G,American Thoracic Society Statement: Occupational contribution to the burden of airway diseaseAm J Respir Crit Care MedYear: 2003167578779712598220
Bernstein IL,Chan-Yeung M,Malo JL,Bernstein DI,Asthma in the workplace and related conditionsYear: 20063Taylor & Francis, New York
Nicholson PJ,Cullinan P,Burge PS,Boyle C,Occupational asthma: Prevention, identification & management: Systematic review & recommendationsYear: 2010British Occupational Health Research Foundation, London
Arif AA,Whitehead LW,Delclos GL,Tortolero SR,Lee ES,Prevalence and risk factors of work related asthma by industry among United States workers: data from the third national health and nutrition examination survey (1988–94)Occup Environ MedYear: 200259850551112151605
Bakke PS,Baste V,Hanoa R,Gulsvik A,Prevalence of obstructive lung disease in a general population: relation to occupational title and exposure to some airborne agentsThoraxYear: 199146128638701792631
Becklake MR,Occupational exposures: evidence for a causal association with chronic obstructive pulmonary diseaseAm Rev Respir DisYear: 19891403 Pt 2S85S912675712
Becklake MR,Malo J-L,Chan-Yeung MY,Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DIEpidemiological approaches in occupational asthmaAsthma in the workplaceYear: 20063Taylor & Francis Group, New York, London3785
Bergdahl IA,Toren K,Eriksson K,Hedlund U,Nilsson T,Flodin R,Jarvholm B,Increased mortality in COPD among construction workers exposed to inorganic dustEur Respir JYear: 200423340240615065829
Blanc PD,Toren K,How much adult asthma can be attributed to occupational factors?Am J MedYear: 1999107658058710625027
Henneberger PK,Derk SJ,Davis L,Tumpowsky C,Reilly MJ,Rosenman KD,Schill DP,Valiante D,Flattery J,Harrison R,et al. Work-related reactive airways dysfunction syndrome cases from surveillance in selected US statesJ Occup Environ MedYear: 200345436036812708139
Karjalainen A,Kurppa K,Martikainen R,Klaukka T,Karjalainen J,Work is related to a substantial portion of adult-onset asthma incidence in the Finnish populationAm J Respir Crit Care MedYear: 2001164456556811520716
Kogevinas M,Anto JM,Sunyer J,Tobias A,Kromhout H,Burney P,Occupational asthma in Europe and other industrialised areas: a population-based study. European Community Respiratory Health Survey Study GroupLancetYear: 199935391661750175410347988
Leuenberger P,Schindler C,Schwartz J,Ackermann-Liebrich U,Tara D,Perruchoud AP,Wuthrich B,Zellweger JP,Blaser K,Bolognini G,et al. Occupational exposure to inhalative irritants and methacholine responsivenessScand J Work Environ HealthYear: 200026214615210817380
Le Moual N,Kennedy SM,Kauffmann F,Occupational exposures and asthma in 14,000 adults from the general populationAm J EpidemiolYear: 2004160111108111615561990
Medina-Ramon M,Zock JP,Kogevinas M,Sunyer J,Anto JM,Asthma symptoms in women employed in domestic cleaning: a community based studyThoraxYear: 2003581195095414586047
Meldrum M,Rawbone R,Curran AD,Fishwick D,The role of occupation in the development of chronic obstructive pulmonary disease (COPD)Occup Environ MedYear: 200562421221415778251
Taylor AJ,Respiratory irritants encountered at workThoraxYear: 19965155415458711687
Petsonk EL,Work-related asthma and implications for the general publicEnviron Health PerspectYear: 2002110Suppl 456957212194889
Viegi G,Di Pede C,Chronic obstructive lung diseases and occupational exposureCurr Opin Allergy Clin ImmunolYear: 20022211512111964759
WHOReducing Risks, Promoting Healthy LifeThe World Health Report 2002Year: 2002WHO, Geneva
Xu X,Christiani DC,Dockery DW,Wang L,Exposure-response relationships between occupational exposures and chronic respiratory illness: a community-based studyAm Rev Respir DisYear: 199214624134181489133
Toren K,Blanc PD,Asthma caused by occupational exposures is common - a systematic analysis of estimates of the population-attributable fractionBMC Pulm MedYear: 20099719178702
Kogevinas M,Zock JP,Jarvis D,Kromhout H,Lillienberg L,Plana E,Radon K,Toren K,Alliksoo A,Benke G,et al. Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)LancetYear: 2007370958433634117662882
Tarlo SM,Balmes J,Balkissoon R,Beach J,Beckett W,Bernstein D,Diagnosis and management of work-related asthma: American College of Chest Physicians Consensus StatementChestYear: 200813414118628211
Henneberger PK,Redlich CA,Callahan DB,Harber P,Lemiere C,Martin J,Tarlo SM,Vandenplas O,Toren K,An official american thoracic society statement: work-exacerbated asthmaAm J Respir Crit Care MedYear: 2011184336837821804122
Lemiere C,Forget A,Dufour MH,Boulet LP,Blais L,Characteristics and medical resource use of asthmatic subjects with and without work-related asthmaJ Allergy Clin ImmunolYear: 200712061354135917889289
Burge SP,Moore VC,Robertson AS,Sensitization and irritant-induced occupational asthma with latency are clinically indistinguishableOccup Med (Lond)Year: 201262212913322199365
Baur X,Sigsgaard T,Aasen TB,Burge PS,Heederik D,Henneberger P,Maestrelli P,Rooyackers J,Schlunssen V,Vandenplas O,et al. Guidelines for the management of work-related asthmaEur Respir JYear: 201239352954522379148
Baur X,Aasen TB,Burge PS,Heederik D,Henneberger PK,Maestrelli P,Schlunssen V,Vandenplas O,Wilken D,The management of work-related asthma guidelines: a broader perspectiveEur Respir RevYear: 20122112412513922654084
Brooks SM,Weiss MA,Bernstein IL,Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposuresChestYear: 19858833763844028848
Brooks SM,Hammad Y,Richards I,Giovinco-Barbas J,Jenkins K,The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of allergyChestYear: 1998113142499440566
Chan-Yeung M,Lam S,Kennedy SM,Frew AJ,Persistent asthma after repeated exposure to high concentrations of gases in pulpmillsAm J Respir Crit Care MedYear: 19941496167616808004329
Humerfelt S,Gulsvik A,Skjaerven R,Nilssen S,Kvale G,Sulheim O,Ramm E,Eilertsen E,Humerfelt SB,Decline in FEV1 and airflow limitation related to occupational exposures in men of an urban communityEur Respir JYear: 199368109511038224123
Krzyzanowski M,Jedrychowski W,Wysocki M,Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study. Risk of chronic obstructive pulmonary diseaseAm Rev Respir DisYear: 19861345101110193777663
Tarlo SM,Broder I,Irritant-induced occupational asthmaChestYear: 19899622973002666043
Gautrin D,Bernstein IL,Brooks SM,Henneberger PK,Bernstein IL, Chan-Yeung M, Malo JL, Bernstein DIReactive airways dysfunction syndrome and irritant-induced asthmaAsthma in the workplaceYear: 2006Taylor & Francis Group, New York, London581629
Kipen HM,Blume R,Hutt D,Asthma experience in an occupational and environmental medicine clinic. Low-dose reactive airways dysfunction syndromeJ Occup MedYear: 19943610113311377830173
Dykewicz MS,Occupational asthma: current concepts in pathogenesis, diagnosis, and managementJ Allergy Clin ImmunolYear: 20091233519528 quiz 529–530. 19281900
Cormier Y,Coll B,Laviolette M,Boulet LP,Reactive airways dysfunction syndrome (RADS) following exposure to toxic gases of a swine confinement buildingEur Respir JYear: 199695109010918793474
Dosman JA,Lawson JA,Kirychuk SP,Cornier Y,Biem J,Koehncke N,Occupational asthma in newly employed workers in intensive swine confinement facilitiesEur Respir JYear: 20042469870215459151
Reinisch F,Harrison RJ,Cussler S,Athanasoulis M,Balmes J,Blanc P,Cone J,Physician reports of work-related asthma in California, 1993–1996Am J Ind MedYear: 2001391728311148017
Liss GM,Tarlo SM,Doherty J,Purdham J,Greene J,McCaskell L,Kerr M,Physician diagnosed asthma, respiratory symptoms, and associations with workplace tasks among radiographers in Ontario, CanadaOccup Environ MedYear: 200360425426112660373
Smedley J,Coggon D,Health surveillance for hospital employees exposed to respiratory sensitizersOccup Med (Lond)Year: 199646133368672791
Toren K,Jarvholm B,Brisman J,Hagberg S,Hermansson BA,Lillienberg L,Adult-onset asthma and occupational exposuresScand J Work Environ HealthYear: 199925543043510569463
Makker HK,Ayres JG,Work-related asthma in an aircraft engine mechanicRespir MedYear: 1999931697010464853
Wade JF 3rd,Newman LS,Diesel asthma. Reactive airways disease following overexposure to locomotive exhaustJ Occup MedYear: 19933521491548433186
Baur X,Kay AB, Kaplan AP, Bousquet J, Holt PGAirborne allergens and irritants in the workplaceAllergy and allergic diseasesYear: 2008Blackwell Publishing, Boston10171122
Toren K,Balder B,Brisman J,Lindholm N,Lowhagen O,Palmqvist M,Tunsater A,The risk of asthma in relation to occupational exposures: a case–control study from a Swedish cityEur Respir JYear: 199913349650110232415
Hnizdo E,Sullivan PA,Bang KM,Wagner G,Association between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the Third National Health and Nutrition Examination SurveyAm J EpidemiolYear: 2002156873874612370162
Oxman AD,Muir DC,Shannon HS,Stock SR,Hnizdo E,Lange HJ,Occupational dust exposure and chronic obstructive pulmonary diseaseA systematic overview of the evidence. Am Rev Respir DisYear: 199314813848
Marine WM,Gurr D,Jacobsen M,Clinically important respiratory effects of dust exposure and smoking in British coal minersAm Rev Respir DisYear: 198813711061123337449
Kongerud J,Gronnesby JK,Magnus P,Respiratory symptoms and lung function of aluminum potroom workersScand J Work Environ HealthYear: 19901642702772389134
Andrasch RH,Bardana EJ Jr,Koster F,Pirofsky B,Clinical and bronchial provocation studies in patients with meatwrappers' asthmaJ Allergy Clin ImmunolYear: 1976582291298947981
Carlsen KH,Anderson SD,Bjermer L,Bonini S,Brusasco V,Canonica W,Cummiskey J,Delgado L,Del Giacco SR,Drobnic F,et al. Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: Part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LENAllergyYear: 20086338740318315727
Karjalainen A,Kurppa K,Virtanen S,Keskinen H,Nordman H,Incidence of occupational asthma by occupation and industry in FinlandAm J Ind MedYear: 200037545145810723039
Hansson SO,Critical effects and exposure limitsRisk AnalYear: 19971722272369202490
Latza U,Baur X,Occupational obstructive airway diseases in Germany: Frequency and causes in an international comparisonAm J Ind MedYear: 200548214415216032736
Chan-Yeung M,Malo JL,Aetiological agents in occupational asthmaEur Respir JYear: 1994723463718162990
Fernandez-Nieto M,Quirce S,Sastre J,Occupational asthma in industryAllergol Immunopathol (Madr)Year: 200634521222317064651
Baur X,Latza U,Non-malignant occupational respiratory diseases in Germany in comparison with those of other countriesInt Arch Occup Environ HealthYear: 200578759360216010575
Ameille J,Pauli G,Calastreng-Crinquand A,Vervloet D,Iwatsubo Y,Popin E,Bayeux-Dunglas MC,Kopferschmitt-Kubler MC,Reported incidence of occupational asthma in France, 1996–99: the ONAP programmeOccup Environ MedYear: 200360213614112554842
Tarlo SM,Liss GM,Occupational asthma: an approach to diagnosis and managementCMAJYear: 2003168786787112668547
Pesci A,Majori M,Cuomo A,Borciani N,Bertacco S,Cacciani G,Gabrielli M,Neutrophils infiltrating bronchial epithelium in chronic obstructive pulmonary diseaseRespir MedYear: 19989268638709850371
Hnizdo E,Glindmeyer HW,Petsonk EL,Enright P,Buist AS,Case definitions for chronic obstructive pulmonary diseaseCopdYear: 2006329510017175672
Trupin L,Earnest G,San Pedro M,Balmes JR,Eisner MD,Yelin E,Katz PP,Blanc PD,The occupational burden of chronic obstructive pulmonary diseaseEur Respir JYear: 200322346246914516136
Balmes JR,Occupational airways diseases from chronic low-level exposures to irritantsClin Chest MedYear: 2002234727735 vi. 12512162
Hendrick DJ,Smoking, cadmium, and emphysemaThoraxYear: 200459318418514985546
Davison AG,Fayers PM,Taylor AJ,Venables KM,Darbyshire J,Pickering CA,Chettle DR,Franklin D,Guthrie CJ,Scott MC,et al. Cadmium fume inhalation and emphysemaLancetYear: 1988185876636672895211
American Thoracic SocietyStandards for the diagnosis and care of patients with chronic obstructive pulmonary diseaseAm J Respir Crit Care MedYear: 199515277121
Postma DS,Boezen HM,Rationale for the Dutch hypothesis. Allergy and airway hyperresponsiveness as genetic factors and their interaction with environment in the development of asthma and COPDChestYear: 20041262 Suppl96S104S discussion 159S-161S. 15302769
Balmes JR,Work-related COPDEur Respir JYear: 199477687788005261
Bourdin A,Serre I,Flamme H,Vic P,Neveu D,Aubas P,Godard P,Chanez P,Can endobronchial biopsy analysis be recommended to discriminate between asthma and COPD in routine practice?ThoraxYear: 200459648849315170031
Hargreave FE,Parameswaran K,Asthma, COPD and bronchitis are just components of airway diseaseEur Respir JYear: 200628226426716880365
Gannon PF,Burge PS,The SHIELD scheme in the West Midlands Region, United Kingdom. Midland Thoracic Society Research GroupBr J Ind MedYear: 19935097917968398872
Eisner MD,Yelin EH,Katz PP,Lactao G,Iribarren C,Blanc PD,Risk factors for work disability in severe adult asthmaAm J MedYear: 20061191088489117000221
Toren K,Brisman J,Olin AC,Blanc PD,Asthma on the job: work-related factors in new-onset asthma and in exacerbations of pre-existing asthmaRespir MedYear: 200094652953510921755
Brändli O,Schindler C,Leuenberger PH,Baur X,Degens P,Kunzli N,Keller R,Perruchoud AP,Re-estimated equations for 5th percentiles of lung function variablesThoraxYear: 200055217317410702094
European Parliament, The Council of EURegulation (EC) No 1272/2008 of the European Parliament and on the Council of 16 December 2008 on classification, labelling and packing of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulations (EC) No 1907/2006Off J EUYear: 2008L 35311355
American Conference of Governmental Industrial HygienistsTLVs® and BEIs®. Threshold limit values for chemical substances and physical agents & biological exposure indicesYear: 2009ACGIH, Cincinnaty
Baur X,Occupational agents with respiratory effects according to ACGIH 2009 and / or classified with the R42 phrase* (may cause sensitization by inhalation) and / or with the R37 phrase* (irritating to respiratory system) according to the European Union directives 67/548/EEC (1), 2001/59/EC (2), 2004/73/EC (3) or 2009/2/EC (4) (identical to ILO/CIS 2002 Year: 2009 and => knowledge center.
Meyer JD,Holt DL,Chen Y,Cherry NM,McDonald JC,SWORD '99: surveillance of work-related and occupational respiratory disease in the UKOccup Med (Lond)Year: 200151320420811385125
Meyer JD,Holt DL,Cherry NM,McDonald JC,SWORD '98: surveillance of work-related and occupational respiratory disease in the UKOccup Med (Lond)Year: 199949848548910658300
Ross DJ,Keynes HL,McDonald JC,SWORD '96: surveillance of work-related and occupational respiratory disease in the UKOccup Med (Lond)Year: 19974763773819327643
Esterhuizen TM,Hnizdo E,Rees D,Occurrence and causes of occupational asthma in South Africa–results from SORDSA's Occupational Asthma Registry, 1997–1999S Afr Med JYear: 200191650951311455716
Buckley LA,Jiang XZ,James RA,Morgan KT,Barrow CS,Respiratory tract lesions induced by sensory irritants at the RD50 concentrationToxicol Appl PharmacolYear: 19847434174296740688
Haupt B,Drechsel-Schlund C,Guldner K,Rogosky E,Plinske W,Butz M,Dokumentation des Berufskrankheiten-Geschehens in Deutschland. BK-DOK 2005Year: 2007Deutsche Gesetzliche Unfallversicherung (DGUV), Sankt Augustin
Harbour R,Miller J,A new system for grading recommendations in evidence based guidelinesBMJYear: 2001323730833433611498496
The Royal College of General Practitioners RCGPThe development and implementation of clinical guidelinesReport of the Clinical Guidelines Working GroupYear: 1995RCGP, London
Alberts WM,do Pico GA,Reactive airways dysfunction syndromeChestYear: 19961096161816268769520
American Thoracic SocietyGuidelines for assessing and managing asthma risk at work, school, and recreationAm J Respir Crit Care MedYear: 2004169787388115044221
Baur X,Degens P,Weber K,Occupational obstructive airway diseases in GermanyAm J Ind MedYear: 19983354544629557168
van Kampen V,Merget R,Baur X,Occupational airway sensitizers: an overview on the respective literatureAm J Ind MedYear: 200038216421810893510
Malo JL,Irritant-induced asthma and reactive airways dysfunction syndromeCan Respir JYear: 19985166679556517
Malo JL,Chan-Yeung M,Asthma in the workplace: a Canadian contribution and perspectiveCan Respir JYear: 200714740741317948141
McDonald JC,Keynes HL,Meredith SK,Reported incidence of occupational asthma in the United Kingdom, 1989–97Occup Environ MedYear: 2000571282382911077011
Sastre J,Vandenplas O,Park HS,Pathogenesis of occupational asthmaEur Respir JYear: 200322236437312952275
Joules H,Asthma from sensitisation to chromiumLancetYear: 19322182183
Boulet LP,Increases in airway responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma?ChestYear: 19889434764812842114
Simonsson BG,Sjoberg A,Rolf C,Haeger-Aronsen B,Acute and long-term airway hyperreactivity in aluminium-salt exposed workers with nocturnal asthmaEur J Respir DisYear: 19856621051183882443
Matrat M,Laurence MF,Iwatsubo Y,Hubert C,Joly N,Legrand-Cattan K,L'Huillier JP,Villemain C,Pairon JC,Reactive airways dysfunction syndrome caused by bromochlorodifluoromethane from fire extinguishersOccup Environ MedYear: 200461871271415258280
Cone JE,Wugofski L,Balmes JR,Das R,Bowler R,Alexeeff G,Shusterman D,Persistent respiratory health effects after a metam sodium pesticide spillChestYear: 199410625005087774327
Valero AL,Bescos M,Amat P,Malet A,Bronchial asthma caused by occupational sulfite exposureAllergol Immunopathol (Madr)Year: 19932162212248160569
Cockcroft DW,Hoeppner VH,Dolovich J,Occupational asthma caused by cedar urea formaldehyde particle boardChestYear: 198282149537083936
Hart JE,Laden F,Schenker MB,Garshick E,Chronic obstructive pulmonary disease mortality in diesel-exposed railroad workersEnviron Health PerspectYear: 200611471013101716835052
Hart JE,Laden F,Eisen EA,Smith TJ,Garshick E,Chronic obstructive pulmonary disease mortality in railroad workersOccup Environ MedYear: 200966422122619039098
Ulvestad B,Lund MB,Increased risk of chronic obstructive pulmonary disease among tunnel construction workersTidsskr Nor LaegeforenYear: 2003123162292229514508559
Kern DG,Outbreak of the reactive airways dysfunction syndrome after a spill of glacial acetic acidAm Rev Respir DisYear: 19911445105810641952431
Gamble J,Jones W,Hancock J,Meckstroth RL,Epidemiological-environmental study of lead acid battery workers. III. Chronic effects of sulfuric acid on the respiratory system and teethEnviron ResYear: 198435130526386452
Bohadana AB,Massin N,Wild P,Berthiot G,Airflow obstruction in chalkpowder and sugar workersInt Arch Occup Environ HealthYear: 19966842432488738354
Mwaiselage J,Bratveit M,Moen BE,Mashalla Y,Respiratory symptoms and chronic obstructive pulmonary disease among cement factory workersScand J Work Environ HealthYear: 200531431632316161715
Massin N,Hecht G,Ambroise D,Hery M,Toamain JP,Hubert G,Dorotte M,Bianchi B,Respiratory symptoms and bronchial responsiveness among cleaning and disinfecting workers in the food industryOccup Environ MedYear: 2007642758116973735
Sprince NL,Oliver LC,Eisen EA,Greene RE,Chamberlin RI,Cobalt exposure and lung disease in tungsten carbide production. A cross-sectional study of current workersAm Rev Respir DisYear: 19881385122012263264482
Woldeyohannes M,Bergevin Y,Mgeni AY,Theriault G,Respiratory problems among cotton textile mill workers in EthiopiaBr J Ind MedYear: 19914821101151998605
Rylander R,Bergstrom R,Bronchial reactivity among cotton workers in relation to dust and endotoxin exposureAnn Occup HygYear: 199337157638460879
Rylander R,Haglind P,Lundholm M,Endotoxin in cotton dust and respiratory function decrement among cotton workers in an experimental cardroomAm Rev Respir DisYear: 198513122092133970452
Chen R,Tunstall-Pedoe H,Tavendale R,Environmental tobacco smoke and lung function in employees who never smoked: the Scottish MONICA studyOccup Environ MedYear: 200158956356811511742
Janson C,Chinn S,Jarvis D,Zock JP,Toren K,Burney P,Effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a cross-sectional studyLancetYear: 200135892992103210911784622
Hoppin JA,Umbach DM,London SJ,Alavanja MC,Sandler DP,Diesel exhaust, solvents, and other occupational exposures as risk factors for wheeze among farmersAm J Respir Crit Care MedYear: 2004169121308131315070818
Melenka LS,Hessel PA,Yoshida K,Enarson DA,Lung health in Alberta farmersInt J Tuberc Lung DisYear: 199931091391910524590
Ahman M,Alexandersson R,Ekholm U,Bergstrom B,Dahlqvist M,Ulfvarson U,Impeded lung function in moulders and coremakers handling furan resin sandInt Arch Occup Environ HealthYear: 19916331751801917067
Post W,Heederik D,Houba R,Decline in lung function related to exposure and selection processes among workers in the grain processing and animal feed industryOccup Environ MedYear: 19985553493559764113
Schwartz DA,Thorne PS,Yagla SJ,Burmeister LF,Olenchock SA,Watt JL,Quinn TJ,The role of endotoxin in grain dust-induced lung diseaseAm J Respir Crit Care MedYear: 199515226036087633714
Pahwa P,Senthilselvan A,McDuffie HH,Dosman JA,Longitudinal estimates of pulmonary function decline in grain workersAm J Respir Crit Care MedYear: 199415036566628087334
Wisnewski AV,Liu Q,Liu J,Redlich CA,Glutathione protects human airway proteins and epithelial cells from isocyanatesClin Exp AllergyYear: 200535335235715784115
Zock JP,Rodriguez-Trigo G,Pozo-Rodriguez F,Barbera JA,Bouso L,Torralba Y,Anto JM,Gomez FP,Fuster C,Verea H,Prolonged respiratory symptoms in clean-up workers of the prestige oil spillAm J Respir Crit Care MedYear: 2007176661061617556713
Wieslander G,Norback D,Edling C,Airway symptoms among house painters in relation to exposure to volatile organic compounds (VOCS)–a longitudinal studyAnn Occup HygYear: 19974121551669155237
Castro-Gutierrez N,McConnell R,Andersson K,Pacheco-Anton F,Hogstedt C,Respiratory symptoms, spirometry and chronic occupational paraquat exposureScand J Work Environ HealthYear: 19972364214279476805
Jones SM,Burks AW,Spencer HJ,Lensing S,Roberson PK,Gandy J,Helm RM,Occupational asthma symptoms and respiratory function among aerial pesticide applicatorsAm J Ind MedYear: 200343440741712645096
Hagmar L,Bellander T,Ranstam J,Skerfving S,Piperazine-induced airway symptoms: exposure-response relationships and selection in an occupational settingAm J Ind MedYear: 1984653473576517066
Calverley AE,Rees D,Dowdeswell RJ,Linnett PJ,Kielkowski D,Platinum salt sensitivity in refinery workers: incidence and effects of smoking and exposureOccup Environ MedYear: 199552106616667489056
Lorimer WV,Lilis R,Nicholson WJ,Anderson H,Fischbein A,Daum S,Rom W,Rice C,Selikoff IJ,Clinical studies of styrene workers: initial findingsEnviron Health PerspectYear: 1976171711811026403
Prezant DJ,Weiden M,Banauch GI,McGuinness G,Rom WN,Aldrich TK,Kelly KJ,Cough and bronchial responsiveness in firefighters at the World Trade Center siteN Engl J MedYear: 20023471180681512226151
Jaakkola MS,Leino T,Tammilehto L,Ylostalo P,Kuosma E,Alanko K,Respiratory effects of exposure to methacrylates among dental assistantsAllergyYear: 200762664865417508969
Medina-Ramon M,Zock JP,Kogevinas M,Sunyer J,Torralba Y,Borrell A,Burgos F,Anto JM,Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case–control studyOccup Environ MedYear: 200562959860616109815
Sauni R,Oksa P,Huikko S,Roto P,Uitti J,Increased risk of asthma among Finnish construction workersOccup Med (Lond)Year: 200353852753114673127
Jaakkola MS,Piipari R,Jaakkola N,Jaakkola JJ,Environmental tobacco smoke and adult-onset asthma: a population-based incident case–control studyAm J Public HealthYear: 200393122055206014652334
Greer JR,Abbey DE,Burchette RJ,Asthma related to occupational and ambient air pollutants in nonsmokersJ Occup MedYear: 19933599099158229343
Eisner MD,Balmes J,Katz PP,Trupin L,Yelin EH,Blanc PD,Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary diseaseEnviron HealthYear: 200541715890079
Fidan F,Cimrin AH,Ergor G,Sevinc C,Airway disease risk from environmental tobacco smoke among coffeehouse workers in TurkeyTob ControlYear: 200413216116615175534
Radon K,Busching K,Heinrich J,Wichmann HE,Jorres RA,Magnussen H,Nowak D,Passive smoking exposure: a risk factor for chronic bronchitis and asthma in adults?ChestYear: 200212231086109012226059
Blanc PD,Ellbjar S,Janson C,Norback D,Norrman E,Plaschke P,Toren K,Asthma-related work disability in Sweden. The impact of workplace exposuresAm J Respir Crit Care MedYear: 199916062028203310588624
Flodin U,Jonsson P,Ziegler J,Axelson O,An epidemiologic study of bronchial asthma and smokingEpidemiologyYear: 1995655035058562626
Eduard W,Douwes J,Omenaas E,Heederik D,Do farming exposures cause or prevent asthma? Results from a study of adult Norwegian farmersThoraxYear: 200459538138615115863
Hoppin JA,Umbach DM,London SJ,Alavanja MC,Sandler DP,Animal production and wheeze in the Agricultural Health Study: interactions with atopy, asthma, and smokingOccup Environ MedYear: 2003608e312883030
Melbostad E,Eduard W,Magnus P,Determinants of asthma in a farming populationScand J Work Environ HealthYear: 19982442622699754857
Mastrangelo G,Tartari M,Fedeli U,Fadda E,Saia B,Ascertaining the risk of chronic obstructive pulmonary disease in relation to occupation using a case–control designOccup Med (Lond)Year: 200353316517212724550
Mastrangelo G,Paruzzolo P,Mapp C,Asthma due to isocyanates: a mail survey in a 1% sample of furniture workers in the Veneto region, ItalyMed LavYear: 19958665035108815361
Meredith SK,Bugler J,Clark RL,Isocyanate exposure and occupational asthma: a case-referent studyOccup Environ MedYear: 2000571283083611077012
Jacobs JH,Spaan S,van Rooy GB,Meliefste C,Zaat VA,Rooyackers JM,Heederik D,Exposure to trichloramine and respiratory symptoms in indoor swimming pool workersEur Respir JYear: 200729469069817107995
Schenker MB,Stoecklin M,Lee K,Lupercio R,Zeballos RJ,Enright P,Hennessy T,Beckett LA,Pulmonary function and exercise-associated changes with chronic low-level paraquat exposureAm J Respir Crit Care MedYear: 2004170777377915229097
Senthilselvan A,McDuffie HH,Dosman JA,Association of asthma with use of pesticides. Results of a cross-sectional survey of farmersAm Rev Respir DisYear: 199214648848871416414
Danuser B,Weber C,Kunzli N,Schindler C,Nowak D,Respiratory symptoms in Swiss farmers: an epidemiological study of risk factorsAm J Ind MedYear: 200139441041811323791
Andersson E,Nilsson T,Persson B,Wingren G,Toren K,Mortality from asthma and cancer among sulfite mill workersScand J Work Environ HealthYear: 199824112179562396
Preller L,Heederik D,Boleij JS,Vogelzang PF,Tielen MJ,Lung function and chronic respiratory symptoms of pig farmers: focus on exposure to endotoxins and ammonia and use of disinfectantsOccup Environ MedYear: 199552106546607489055
Wheeler K,McKelvey W,Thorpe L,Perrin M,Cone J,Kass D,Farfel M,Thomas P,Brackbill R,Asthma diagnosed after 11 September 2001 among rescue and recovery workers: findings from the World Trade Center Health RegistryEnviron Health PerspectYear: 2007115111584159018007989
Rajan KG,Davies BH,Reversible airways obstruction and interstitial pneumonitis due to acetic acidBr J Ind MedYear: 198946167682920146
Kivity S,Fireman E,Lerman Y,Late asthmatic response to inhaled glacial acetic acidThoraxYear: 19944977277288066575
Moore VC,Manney S,Vellore AD,Burge PS,Occupational asthma to gel flux containing dodecanedioic acidAllergyYear: 20096471099110019222421
Musk AW,Peach S,Ryan G,Occupational asthma in a mineral analysis laboratoryBr J Ind MedYear: 19884563813863395574
Deschamps D,Soler P,Rosenberg N,Baud F,Gervais P,Persistent asthma after inhalation of a mixture of sodium hypochlorite and hydrochloric acidChestYear: 19941056189518968205904
Promisloff RA,Lenchner GS,Phan A,Cichelli AV,Reactive airway dysfunction syndrome in three police officers following a roadside chemical spillChestYear: 19909849289292209150
Franzblau A,Sahakian N,Asthma following household exposure to hydrofluoric acidAm J Ind MedYear: 200344332132412929153
el-Sadik YM,Osman HA,el-Gazzar RM,Exposure to sulfuric acid in manufacture of storage batteriesJ Occup MedYear: 19721432242264555202
Chatkin JM,Tarlo SM,Liss G,Banks D,Broder I,The outcome of asthma related to workplace irritant exposures: a comparison of irritant-induced asthma and irritant aggravation of asthmaChestYear: 199911661780178510593805
Savonius B,Keskinen H,Tuppurainen M,Kanerva L,Occupational respiratory disease caused by acrylatesClin Exp AllergyYear: 19932354164248334539
Yacoub MR,Lemiere C,Malo JL,Asthma caused by cyanoacrylate used in a leisure activityJ Allergy Clin ImmunolYear: 2005116246216083807
Nakazawa T,Occupational asthma due to alkyl cyanoacrylateJ Occup MedYear: 19903287097102401926
Lozewicz S,Davison AG,Hopkirk A,Burge PS,Boldy DA,Riordan JF,McGivern DV,Platts BW,Davies D,Newman Taylor AJ,Occupational asthma due to methyl methacrylate and cyanoacrylatesThoraxYear: 198540118368394071461
Chan CC,Cheong TH,Lee HS,Wang YT,Poh SC,Case of occupational asthma due to glue containing cyanoacrylateAnn Acad Med SingaporeYear: 19942357317337847755
Quirce S,Baeza ML,Tornero P,Blasco A,Barranco R,Sastre J,Occupational asthma caused by exposure to cyanoacrylateAllergyYear: 200156544644911350310
Kopp SK,McKay RT,Moller DR,Cassedy K,Brooks SM,Asthma and rhinitis due to ethylcyanoacrylate instant glueAnn Intern MedYear: 198510256136153885815
Weytjens K,Cartier A,Lemiere C,Malo JL,Occupational asthma to diacrylateAllergyYear: 199954328929010321570
Pickering CA,Bainbridge D,Birtwistle IH,Griffiths DL,Occupational asthma due to methyl methacrylate in an orthopaedic theatre sisterBr Med J (Clin Res Ed)Year: 1986292653213621363
Savonius B,Keskinen H,Tuppurainen M,Kanerva L,Occupational asthma caused by ethanolaminesAllergyYear: 199449108778817709998
Pepys J,Pickering CA,Asthma due to inhaled chemical fumes–amino-ethyl ethanolamine in aluminium soldering fluxClin AllergyYear: 1972221972044632184
Hnizdo E,Sylvain D,Lewis DM,Pechter E,Kreiss K,New-onset asthma associated with exposure to 3-amino-5-mercapto-1,2,4-triazoleJ Occup Environ MedYear: 200446121246125215591976
Ali BA,Ahmed HO,Ballal SG,Albar AA,Pulmonary function of workers exposed to ammonia: a study in the Eastern Province of Saudi ArabiaInt J Occup Environ HealthYear: 200171192211210008
Bernstein DI,Guidelines for the diagnosis and evaluation of occupational immunologic lung diseaseYear: 1989Mosby Co, St. Louis
de la Hoz RE,Schlueter DP,Rom WN,Chronic lung disease secondary to ammonia inhalation injury: a report on three casesAm J Ind MedYear: 19962922092148821365
Leduc D,Gris P,Lheureux P,Gevenois PA,De Vuyst P,Yernault JC,Acute and long term respiratory damage following inhalation of ammoniaThoraxYear: 19924797557571440475
Flury KE,Dines DE,Rodarte JR,Rodgers R,Airway obstruction due to inhalation of ammoniaMayo Clin ProcYear: 19835863893936855275
Weir DC,Robertson AS,Jones S,Burge PS,Occupational asthma due to soft corrosive soldering fluxes containing zinc chloride and ammonium chlorideThoraxYear: 19894432202232705153
Gelfand HH,Respiratory Allergy Due to Chemical Compounds Encountered in the Rubber, Lacquer, Shellac, and Beauty Culture IndustriesJ Allergy Clin ImmunolYear: 196334374381
Greene SA,Freedman S,Asthma due to inhaled chemical agents–amprolium hydrochlorideClin AllergyYear: 1976621051081277435
Baur X,Czuppon AB,Rauluk I,Zimmermann FB,Schmitt B,Egen-Korthaus M,Tenkhoff N,Degens PO,A clinical and immunological study on 92 workers occupationally exposed to anhydridesInt Arch Occup Environ HealthYear: 19956763954038567089
Drexler H,Weber A,Letzel S,Kraus G,Schaller KH,Lenhert G,Detection and clinical relevance of a type I allergy with occupational exposure to hexahydrophthalic anhydride and methyltetrahydrophthalic anhydrideInt Arch Occup Environ HealthYear: 19946552792838175180
Cipolla C,Belisario A,Sassi C,Auletti G,Nobile M,Raffi GB,Occupational asthma caused by dioctyl-phthalate in a bottle cap production workerMed LavYear: 199990351351810434532
Chee CB,Lee HS,Cheong TH,Wang YT,Poh SC,Occupational asthma due to hexahydrophthalic anhydride: a case reportBr J Ind MedYear: 19914896436451911408
Rosenman KD,Bernstein DI,O'Leary K,Gallagher JS,D'Souza L,Bernstein IL,Occupational asthma caused by himic anhydrideScand J Work Environ HealthYear: 19871321501543602969
Lee HS,Wang YT,Cheong TH,Tan KT,Chee BE,Narendran K,Occupational asthma due to maleic anhydrideBr J Ind MedYear: 19914842832852025597
Graneek BJ,Durham SR,Newman Taylor AJ,Late asthmatic reactions and changes in histamine responsiveness provoked by occupational agentsBull Eur Physiopathol RespirYear: 19872365775812840138
Nielsen J,Welinder H,Skerfving S,Allergic airway disease caused by methyl tetrahydrophthalic anhydride in epoxy resinScand J Work Environ HealthYear: 19891521541552772578
Nielsen J,Welinder H,Schutz A,Skerfving S,Specific serum antibodies against phthalic anhydride in occupationally exposed subjectsJ Allergy Clin ImmunolYear: 19888211261333392364
Wernfors M,Nielsen J,Schutz A,Skerfving S,Phthalic anhydride-induced occupational asthmaInt Arch Allergy Appl ImmunolYear: 198679177823941014
Frans A,Pahulycz C,Transient syndrome of acute irritation of the bronchi induced by single and massive inhalation of phthalic anhydrideRev Pneumol ClinYear: 19934952472518047786
Fawcett IW,Taylor AJ,Pepys J,Asthma due to inhaled chemical agents–epoxy resin systems containing phthalic acid anhydride, trimellitic acid anhydride and triethylene tetramineClin AllergyYear: 197771114872352
Maccia CA,Bernstein IL,Emmett EA,Brooks SM,In vitro demonstration of specific IgE in phthalic anhydride hypersensitivityAm Rev Respir DisYear: 197611357017041267268
Meadway J,Asthma and atopy in workers with an epoxy adhesiveBr J Dis ChestYear: 19807421491546448619
Venables KM,Topping MD,Howe W,Luczynska CM,Hawkins R,Taylor AJ,Interaction of smoking and atopy in producing specific IgE antibody against a hapten protein conjugateBr Med J (Clin Res Ed)Year: 19852906463201204
Venables KM,Topping MD,Nunn AJ,Howe W,Newman Taylor AJ,Immunologic and functional consequences of chemical (tetrachlorophthalic anhydride)-induced asthma after four years of avoidance of exposureJ Allergy Clin ImmunolYear: 19878022122183611542
Howe W,Venables KM,Topping MD,Dally MB,Hawkins R,Law JS,Taylor AJ,Tetrachlorophthalic anhydride asthma: evidence for specific IgE antibodyJ Allergy Clin ImmunolYear: 1983711 Pt 15116822691
Schlueter DP,Banaszak EF,Fink JN,Barboriak J,Occupational asthma due to tetrachlorophthalic anhydrideJ Occup MedYear: 1978203183188627936
Grammer LC,Shaughnessy MA,Kenamore BD,Clinical and immunologic outcome of 42 individuals with trimellitic anhydride-induced immunologic lung disease after transfer to low exposureAllergy Asthma ProcYear: 200021635535911191101
Grammer LC,Shaughnessy MA,Kenamore BD,Yarnold PR,A clinical and immunologic study to assess risk of TMA-induced lung disease as related to exposureJ Occup Environ MedYear: 199941121048105110609223
Grammer L,Shaughnessy M,Kenamore B,Utility of antibody in identifying individuals who have or will develop anhydride-induced respiratory diseaseChestYear: 19981144119912029792595
Zeiss CR,Patterson R,Pruzansky JJ,Miller MM,Rosenberg M,Levitz D,Trimellitic anhydride-induced airway syndromes: clinical and immunologic studiesJ Allergy Clin ImmunolYear: 19776029610368964
Kanerva L,Keskinen H,Autio P,Estlander T,Tuppurainen M,Jolanki R,Occupational respiratory and skin sensitization caused by polyfunctional aziridine hardenerClin Exp AllergyYear: 19952554324397553246
Leffler CT,Milton DK,Occupational asthma and contact dermatitis in a spray painter after introduction of an aziridine cross-linkerEnviron Health PerspectYear: 1999107759960110379008
Slovak AJ,Occupational asthma caused by a plastics blowing agent, azodicarbonamideThoraxYear: 198136129069097336369
Kim CW,Cho JH,Leem JH,Ryu JS,Lee HL,Hong YC,Occupational asthma due to azodicarbonamideYonsei Med JYear: 200445232532915119006
Normand JC,Grange F,Hernandez C,Ganay A,Davezies P,Bergeret A,Prost G,Occupational asthma after exposure to azodicarbonamide: report of four casesBr J Ind MedYear: 198946160622920144
Valentino M,Comai M,Occupational asthma caused by azodicarbonamide: clinical caseG Ital Med LavYear: 198572–397993939220
Malo JL,Pineau L,Cartier A,Occupational asthma due to azobisformamideClin AllergyYear: 19851532612644006176
Purohit A,Kopferschmitt-Kubler MC,Moreau C,Popin E,Blaumeiser M,Pauli G,Quaternary ammonium compounds and occupational asthmaInt Arch Occup Environ HealthYear: 200073642342711007347
Bernstein JA,Stauder T,Bernstein DI,Bernstein IL,A combined respiratory and cutaneous hypersensitivity syndrome induced by work exposure to quaternary aminesJ Allergy Clin ImmunolYear: 1994942 Pt 12572598064078
Moscato G,Omodeo P,Dellabianca A,Colli MC,Pugliese F,Locatelli C,Scibilia J,Occupational asthma and rhinitis caused by 1,2-benzisothiazolin-3-one in a chemical workerOccup Med (Lond)Year: 19974742492519231500
Burns MJ,Linden CH,Another hot tub hazard. Toxicity secondary to bromine and hydrobromic acid exposureChestYear: 199711138168199118727
de la Hoz RE,Reactive airways dysfunction syndrome following exposure to a fluorocarbonEur Respir JYear: 19991351192119410414425
Chan OY,Poh SC,Lee HS,Tan KT,Kwok SF,Respiratory function in cadmium battery workers–a follow-up studyAnn Acad Med SingaporeYear: 19881722832873408227
Leduc D,de Francquen P,Jacobovitz D,Vandeweyer R,Lauwerys R,De Vuyst P,Association of cadmium exposure with rapidly progressive emphysema in a smokerThoraxYear: 19934855705718322249
De Silva PE,Donnan MB,Chronic cadmium poisoning in a pigment manufacturing plantBr J Ind MedYear: 198138176867470406
Royce S,Wald P,Sheppard D,Balmes J,Occupational asthma in a pesticides manufacturing workerChestYear: 199310312952968417906
Neghab M,Mohraz MH,Hassanzadeh J,Symptoms of respiratory disease and lung functional impairment associated with occupational inhalation exposure to carbon black dustJ Occup HealthYear: 201153643243821996929
Bourne MS,Flindt ML,Walker JM,Asthma due to industrial use of chloramineBMJYear: 1979261811012466247
Feinberg SM,Watrons RM,Atopy to simple chemical compounds-sulfonechloramidesJ Allergy Clin ImmunolYear: 1945165209220
Kujala VM,Reijula KE,Ruotsalainen EM,Heikkinen K,Occupational asthma due to chloramine-T solutionRespir MedYear: 199589106936958570884
Jouannique V,Pillière F,Pouillard D,Gervais P,Rousselin X,Efthymiou ML,Asthme professionel à la chloramine TA propos de deux observationsYear: 1992Société De Médicine et d'Hygiène du Travail, Paris654657
Dijkman JH,Vooren PH,Kramps JA,Occupational asthma due to inhalation of chloramine-T. I. Clinical observations and inhalation-provocation studiesInt Arch Allergy Appl ImmunolYear: 19816444224276782023
Waclawski ER,McAlpine LG,Thomson NC,Occupational asthma in nurses caused by chlorhexidine and alcohol aerosolsBmjYear: 198929866789299302497862
Glindmeyer HW,Lefante JJ,Freyder LM,Friedman M,Weill H,Jones RN,Relationship of asthma to irritant gas exposures in pulp and paper millsRespir MedYear: 200397554154812735673
Andersson E,Olin AC,Hagberg S,Nilsson R,Nilsson T,Toren K,Adult-onset asthma and wheeze among irritant-exposed bleachery workersAm J Ind MedYear: 200343553253812704626
Gautrin D,Leroyer C,L'Archeveque J,Dufour JG,Girard D,Malo JL,Cross-sectional assessment of workers with repeated exposure to chlorine over a three year periodEur Respir JYear: 1995812204620548666099
Bherer L,Cushman R,Courteau JP,Quevillon M,Cote G,Bourbeau J,L'Archeveque J,Cartier A,Malo JL,Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: II. Follow up of affected workers by questionnaire, spirometry, and assessment of bronchial responsiveness 18 to 24 months after exposure endedOccup Environ MedYear: 19945142252288199662
Leroyer C,Dewitte JD,Bassanets A,Boutoux M,Daniel C,Clavier J,Occupational asthma due to chromiumRespirationYear: 19986554034059782225
Chester EH,Gillespie DG,Krause FD,The prevalence of chronic obstructive pulmonary disease in chlorine gas workersAm Rev Respir DisYear: 19699933653735765628
Ferris BG Jr,Burgess WA,Worcester J,Prevalence of chronic respiratory disease in a pulp mill and a paper mill in the United StatesBr J Ind MedYear: 196724126376017136
Lemiere C,Malo JL,Boutet M,Reactive airways dysfunction syndrome due to chlorine: sequential bronchial biopsies and functional assessmentEur Respir JYear: 19971012412449032521
Schonhofer B,Voshaar T,Kohler D,Long-term lung sequelae following accidental chlorine gas exposureRespirationYear: 19966331551598739485
Olaguibel JM,Basomba A,Occupational asthma induced by chromium saltsAllergol Immunopathol (Madr)Year: 19891731331362816656
Onizuka R,Tanabe K,Nakayama Y,Fukuchi T,Nakata K,Hiki T,A case of chrome asthma induced by exposure to the stone cutter dustArerugiYear: 200655121556156117185917
Fernandez-Nieto M,Quirce S,Carnes J,Sastre J,Occupational asthma due to chromium and nickel saltsInt Arch Occup Environ HealthYear: 200679648348616402272
Sastre J,Fernandez-Nieto M,Maranon F,Fernandez-Caldas E,Pelta R,Quirce S,Allergenic cross-reactivity between nickel and chromium salts in electroplating-induced asthmaJ Allergy Clin ImmunolYear: 2001108465065111590397
Nagasaka Y,Nakano N,Tohda Y,Nakajima S,Persistent reactive airway dysfunction syndrome after exposure to chromate]Nihon Kyobu Shikkan Gakkai ZasshiYear: 19953377597647564004
Park HS,Yu HJ,Jung KS,Occupational asthma caused by chromiumClin Exp AllergyYear: 19942476766817953950
Novey HS,Habib M,Wells ID,Asthma and IgE antibodies induced by chromium and nickel saltsJ Allergy Clin ImmunolYear: 19837244074126413567
Bernstein IL,Merget R,Bernstein IL, Chan-Yeung M, Malo JL, Bernstein DIMetalsAsthma in the workplaceYear: 20063Taylor & Francis, New York525554
Linna A,Oksa P,Palmroos P,Roto P,Laippala P,Uitti J,Respiratory health of cobalt production workersAm J Ind MedYear: 200344212413212874844
Kusaka Y,Iki M,Kumagai S,Goto S,Epidemiological study of hard metal asthmaOccup Environ MedYear: 19965331881938704860
Kennedy SM,Chan-Yeung M,Marion S,Lea J,Teschke K,Maintenance of stellite and tungsten carbide saw tips: respiratory health and exposure-response evaluationsOccup Environ MedYear: 19955231851917735392
Roto P,Asthma, symptoms of chronic bronchitis and ventilatory capacity among cobalt and zinc production workersScand J Work Environ HealthYear: 19806Suppl 11496966823
Pisati G,Zedda S,Outcome of occupational asthma due to cobalt hypersensitivitySci Total EnvironYear: 19941501–31671717939592
Shirakawa T,Kusaka Y,Fujimura N,Goto S,Kato M,Heki S,Morimoto K,Occupational asthma from cobalt sensitivity in workers exposed to hard metal dustChestYear: 198995129372909353
Shirakawa T,Kusaka Y,Fujimura N,Goto S,Morimoto K,The existence of specific antibodies to cobalt in hard metal asthmaClin AllergyYear: 19881854514603233723
Shirakawa T,Kusaka Y,Fujimura N,Kato M,Heki S,Morimoto K,Hard metal asthma: cross immunological and respiratory reactivity between cobalt and nickel?ThoraxYear: 19904542672712356553
Gheysens B,Auwerx J,Van den Eeckhout A,Demedts M,Cobalt-induced bronchial asthma in diamond polishersChestYear: 19858857407442996839
Baik JJ,Yoon YB,Park HS,Cobalt-induced occupational asthma associated with systemic illnessJ Korean Med SciYear: 19951032002048527047
Wilk-Rivard E,Szeinuk J,Occupational asthma with paroxysmal atrial fibrillation in a diamond polisherEnviron Health PerspectYear: 2001109121303130611748040
Krakowiak A,Dudek W,Tarkowski M,Swiderska-Kielbik S,Niescierenko E,Palczynski C,Occupational asthma caused by cobalt chloride in a diamond polisher after cessation of occupational exposure: a case reportInt J Occup Med Environ HealthYear: 200518215115816201206
Sargent EV,Brubaker RE,Mitchell CA,Respiratory effects of occupational exposure to an epoxy resin systemArch Environ HealthYear: 1976315236240973736
Aleva RM,Aalbers R,Koeter GH,De Monchy JG,Occupational asthma caused by a hardener containing an aliphatic and a cycloaliphatic diamineAm Rev Respir DisYear: 19921455121712181586069
Luczynska CM,Hutchcroft BJ,Harrison MA,Dornan JD,Topping MD,Occupational asthma and specific IgE to a diazonium salt intermediate used in the polymer industryJ Allergy Clin ImmunolYear: 1990856107610822355154
Graham VA,Coe MJ,Davies RJ,Occupational asthma after exposure to a diazonium saltThoraxYear: 198136129509517336376
Emad A,Rezaian GR,The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure: analysis of 197 casesChestYear: 199711237347389315808
Deschamps D,Questel F,Baud FJ,Gervais P,Dally S,Persistent asthma after acute inhalation of organophosphate insecticideLancetYear: 1994344893817127996993
Barthel E,Irritative and allergic effects of pesticide aerosols on the respiratory tract and problems of their evaluationZ Gesamte HygYear: 198329116786816666172
Piipari R,Tuppurainen M,Tuomi T,Mantyla L,Henriks-Eckerman ML,Keskinen H,Nordman H,Diethanolamine-induced occupational asthma, a case reportClin Exp AllergyYear: 19982833583629543086
Gadon ME,Melius JM,McDonald GJ,Orgel D,New-onset asthma after exposure to the steam system additive 2-diethylaminoethanolA descriptive study. J Occup MedYear: 1994366623626
Vallieres M,Cockcroft DW,Taylor DM,Dolovich J,Hargreave FE,Dimethyl ethanolamine-induced asthmaAm Rev Respir DisYear: 19771155867871857720
Cockcroft DW,Cotton DJ,Mink JT,Nonspecific bronchial hyperreactivity after exposure to Western Red CedarAm Rev Respir DisYear: 19791193505510443623
Conrad E,Lo W,de Boisblanc BP,Shellito JE,Reactive airways dysfunction syndrome after exposure to dinitrogen tetroxideSouth Med JYear: 19989143383419563423
Aldrich FD,Stange AW,Geesaman RE,Smoking and ethylene diamine sensitization in an industrial populationJ Occup MedYear: 19872943113143585561
Casas X,Badorrey I,Monso E,Morera J,Occupational asthma due to amines]Arch BronconeumolYear: 2002382939411844442
Hagmar L,Bellander T,Bergoo B,Simonsson BG,Piperazine-induced occupational asthmaJ Occup MedYear: 19822431931977062155
Lam S,Chan-Yeung M,Ethylenediamine-induced asthmaAm Rev Respir DisYear: 198012111511556153256
Deschamps D,Rosenberg N,Soler P,Maillard G,Fournier E,Salson D,Gervais P,Persistent asthma after accidental exposure to ethylene oxideBr J Ind MedYear: 19924975235251637714
Dugue P,Faraut C,Figueredo M,Bettendorf A,Salvadori JM,Occupational asthma provoked by ethylene oxide in a nursePresse MedYear: 1991203014551835029
Nunn AJ,Craigen AA,Darbyshire JH,Venables KM,Newman Taylor AJ,Six year follow up of lung function in men occupationally exposed to formaldehydeBr J Ind MedYear: 199047117477522245186
Nordman H,Keskinen H,Tuppurainen M,Formaldehyde asthma–rare or overlooked?J Allergy Clin ImmunolYear: 1985751 Pt 191993968333
Burge PS,Harries MG,Lam WK,O'Brien IM,Patchett PA,Occupational asthma due to formaldehydeThoraxYear: 19854042552604023975
Piipari R,Keskinen H,Agents causing occupational asthma in Finland in 1986–2002: cow epithelium bypassed by moulds from moisture-damaged buildingsClin Exp AllergyYear: 200535121632163716393330
Kim CW,Song JS,Ahn YS,Park SH,Park JW,Noh JH,Hong CS,Occupational asthma due to formaldehydeYonsei Med JYear: 200142444044511519088
Lemiere C,Desjardins A,Cloutier Y,Drolet D,Perrault G,Cartier A,Malo JL,Occupational asthma due to formaldehyde resin dust with and without reaction to formaldehyde gasEur Respir JYear: 1995858618657656963
Porter JA,Letter: Acute respiratory distress following formalin inhalationLancetYear: 19752793560360451424
Hendrick DJ,Lane DJ,Formalin asthma in hospital staffBMJYear: 1975159586076081125625
Sjogren B,Gunnare S,Sandler H,Inhalation of decomposed chlorodifluoromethane (freon-22) and myocardial infarctionScand J Work Environ HealthYear: 200228320520712109561
Malo JL,Gagnon G,Cartier A,Occupational asthma due to heated freonThoraxYear: 19843986286296474392
Vyas A,Pickering CA,Oldham LA,Francis HC,Fletcher AM,Merrett T,Niven RM,Survey of symptoms, respiratory function, and immunology and their relation to glutaraldehyde and other occupational exposures among endoscopy nursing staffOccup Environ MedYear: 2000571175275911024199
Curran AD,Burge PS,Wiley K,Clinical and immunologic evaluation of workers exposed to glutaraldehydeAllergyYear: 199651118268328947341
Gannon PF,Bright P,Campbell M,O'Hickey SP,Burge PS,Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departmentsThoraxYear: 19955021561597701454
Jachuck SJ,Bound CL,Steel J,Blain PG,Occupational hazard in hospital staff exposed to 2 per cent glutaraldehyde in an endoscopy unitJ Soc Occup MedYear: 198939269712525652
Ong TH,Tan KL,Lee HS,Eng P,A case report of occupational asthma due to gluteraldehyde exposureAnn Acad Med SingaporeYear: 200433227527815098649
Cullinan P,Hayes J,Cannon J,Madan I,Heap D,Taylor AN,Occupational asthma in radiographersLancetYear: 1992340883314771360601
Corrado OJ,Osman J,Davies RJ,Asthma and rhinitis after exposure to glutaraldehyde in endoscopy unitsHum ToxicolYear: 1986553253283095219
Nagy L,Orosz M,Occupational asthma due to hexachloropheneThoraxYear: 19843986306316474393
Merget R,Topcu M,Friese K,Vormberg R,Fuchs T,Raulf-Heimsoth M,Breitstadt R,A cross-sectional study of workers in the chemical industry with occupational exposure to hexamethylenetetramineInt Arch Occup Environ HealthYear: 199972853353810592006
Gamble JF,McMichael AJ,Williams T,Battigelli M,Respiratory function and symptoms: an environmental-epidemiological study of rubber workers exposed to a phenolformaldehyde type resinAm Ind Hyg Assoc JYear: 19763794995131008033
Bergman A,Svedberg U,Nilsson E,Contact urticaria with anaphylactic reactions caused by occupational exposure to iridium saltContact DermatitisYear: 199532114177720364
Baur X,Dewair M,Fruhmann G,Detection of immunologically sensitized isocyanate workers by RAST and intracutaneous skin testsJ Allergy Clin ImmunolYear: 1984735 Pt 16106186609183
Piirila PL,Nordman H,Keskinen HM,Luukkonen R,Salo SP,Tuomi TO,Tuppurainen M,Long-term follow-up of hexamethylene diisocyanate-, diphenylmethane diisocyanate-, and toluene diisocyanate-induced asthmaAm J Respir Crit Care MedYear: 20001622 Pt 151652210934080
O'Brien IM,Harries MG,Burge PS,Pepys J,Toluene di-isocyanate-induced asthma. I. Reactions to TDI, MDI, HDI and histamineClin AllergyYear: 19799116217556
Cartier A,Grammer L,Malo JL,Lagier F,Ghezzo H,Harris K,Patterson R,Specific serum antibodies against isocyanates: association with occupational asthmaJ Allergy Clin ImmunolYear: 1989844 Pt 15075142794294
Tarlo SM,Liss GM,Yeung KS,Changes in rates and severity of compensation claims for asthma due to diisocyanates: a possible effect of medical surveillance measuresOccup Environ MedYear: 2002591586211836470
Bernstein DI,Korbee L,Stauder T,Bernstein JA,Scinto J,Herd ZL,Bernstein IL,The low prevalence of occupational asthma and antibody-dependent sensitization to diphenylmethane diisocyanate in a plant engineered for minimal exposure to diisocyanatesJ Allergy Clin ImmunolYear: 19939233873968360389
Liss GM,Bernstein DI,Moller DR,Gallagher JS,Stephenson RL,Bernstein IL,Pulmonary and immunologic evaluation of foundry workers exposed to methylene diphenyldiisocyanate (MDI)J Allergy Clin ImmunolYear: 198882155613392370
Woellner RC,Hall S,Greaves I,Schoenwetter WF,Epidemic of asthma in a wood products plant using methylene diphenyl diisocyanateAm J Ind MedYear: 199731156638986255
Mapp CE,Corona PC,De Marzo N,Fabbri L,Persistent asthma due to isocyanates. A follow-up study of subjects with occupational asthma due to toluene diisocyanate (TDI)Am Rev Respir DisYear: 19881376132613292849330
Zammit-Tabona M,Sherkin M,Kijek K,Chan H,Chan-Yeung M,Asthma caused by diphenylmethane diisocyanate in foundry workers. Clinical, bronchial provocation, and immunologic studiesAm Rev Respir DisYear: 198312822262306881681
Perfetti L,Brame B,Ferrari M,Moscato G,Occupational asthma (OA) with sensitization to diphenylmethane diisocyanate (MDI) presenting at the onset like a reactive airways dysfunction syndrome (RADS)Am J Ind MedYear: 200344332532812929154
Hur GY,Koh DH,Choi GS,Park HJ,Choi SJ,Ye YM,Kim KS,Park HS,Clinical and immunologic findings of methylene diphenyl diisocyanate-induced occupational asthma in a car upholstery factoryClin Exp AllergyYear: 200838458659318352975
Vandenplas O,Malo JL,Dugas M,Cartier A,Desjardins A,Levesque J,Shaughnessy MA,Grammer LC,Hypersensitivity pneumonitis-like reaction among workers exposed to diphenylmethane [correction to piphenylmethane] diisocyanate (MDI)Am Rev Respir DisYear: 199314723383468430956
Lemiere C,Malo JL,Boulet LP,Boutet M,Reactive airways dysfunction syndrome induced by exposure to a mixture containing isocyanate: functional and histopathologic behaviourAllergyYear: 19965142622658792924
Belin L,Hjortsberg U,Wass U,Life-threatening pulmonary reaction to car paint containing a prepolymerized isocyanateScand J Work Environ HealthYear: 1981743103117347916
Vandenplas O,Cartier A,Lesage J,Cloutier Y,Perreault G,Grammer LC,Shaughnessy MA,Malo JL,Prepolymers of hexamethylene diisocyanate as a cause of occupational asthmaJ Allergy Clin ImmunolYear: 19939148508618473673
Clarke CW,Aldons PM,Isophorone diisocyanate induced respiratory disease (IPDI)Aust N Z J MedYear: 19811132902926945844
Kamat SR,Patel MH,Pradhan PV,Taskar SP,Vaidya PR,Kolhatkar VP,Gopalani JP,Chandarana JP,Dalal N,Naik M,Sequential respiratory, psychologic, and immunologic studies in relation to methyl isocyanate exposure over two years with model developmentEnviron Health PerspectYear: 1992972412531396463
Baur X,Chen Z,Marczynski B,Respiratory diseases caused by occupational exposure to 1,5-naphthalene-diisocyanate (NDI): Results of workplace-related challenge tests and antibody analysesAm J Ind MedYear: 200139436937211323786
Vijayan VK,Sankaran K,Relationship between lung inflammation, changes in lung function and severity of exposure in victims of the Bhopal tragedyEur Respir JYear: 1996910197719828902453
Kamat SR,Mahashur AA,Tiwari AK,Potdar PV,Gaur M,Kolhatkar VP,Vaidya P,Parmar D,Rupwate R,Chatterjee TS,et al. Early observations on pulmonary changes and clinical morbidity due to the isocyanate gas leak at BhopalJ Postgrad MedYear: 198531263724057116
Harries MG,Burge PS,Samson M,Taylor AJ,Pepys J,Isocyanate asthma: respiratory symptoms due to 1,5-naphthylene di-isocyanateThoraxYear: 1979346762766542916
Mehta PS,Mehta AS,Mehta SJ,Makhijani AB,Bhopal tragedy's health effectsA review of methyl isocyanate toxicity. JAMAYear: 19902642127812787
Alexandersson R,Gustafsson P,Hedenstierna G,Rosen G,Exposure to naphthalene-diisocyanate in a rubber plant: symptoms and lung functionArch Environ HealthYear: 198641285893718007
Baur X,Wieners D,Marczynski B,Late asthmatic reaction caused by naphthylene-1,5 diisocyanateScand J Work Environ HealthYear: 2000261788010744182
Fuortes LJ,Kiken S,Makowsky M,An outbreak of naphthalene di-isocyanate-induced asthma in a plastics factoryArch Environ HealthYear: 19955053373407574886
Seguin P,Allard A,Cartier A,Malo JL,Prevalence of occupational asthma in spray painters exposed to several types of isocyanates, including polymethylene polyphenylisocyanateJ Occup MedYear: 19872943403443585565
Butcher BT,Jones RN,O'Neil CE,Glindmeyer HW,Diem JE,Dharmarajan V,Weill H,Salvaggio JE,Longitudinal study of workers employed in the manufacture of toluene-diisocyanateAm Rev Respir DisYear: 1977116341142171003
Ott MG,Klees JE,Poche SL,Respiratory health surveillance in a toluene di-isocyanate production unit, 1967–97: clinical observations and lung function analysesOccup Environ MedYear: 2000571435210711268
Omae K,Higashi T,Nakadate T,Tsugane S,Nakaza M,Sakurai H,Four-year follow-up of effects of toluene diisocyanate exposure on the respiratory system in polyurethane foam manufacturing workers. II. Four-year changes in the effects on the respiratory systemInt Arch Occup Environ HealthYear: 19926385655691316880
Marabini A,Brugnami G,Curradi F,Severini C,Siracusa A,The response to a specific bronchial provocation test and the evolution of occupational asthma. A longitudinal study in subjects with toluene diisocyanate-induced asthmaMed LavYear: 19948521341418072441
Karol MH,Tollerud DJ,Campbell TP,Fabbri L,Maestrelli P,Saetta M,Mapp CE,Predictive value of airways hyperresponsiveness and circulating IgE for identifying types of responses to toluene diisocyanate inhalation challengeAm J Respir Crit Care MedYear: 19941493 Pt 16116158118626
Paggiaro P,Bacci E,Paoletti P,Bernard P,Dente FL,Marchetti G,Talini D,Menconi GF,Giuntini C,Bronchoalveolar lavage and morphology of the airways after cessation of exposure in asthmatic subjects sensitized to toluene diisocyanateChestYear: 19909835365422168308
Axford AT,McKerrow CB,Jones AP,Le Quesne PM,Accidental exposure to isocyanate fumes in a group of firemenBr J Ind MedYear: 19763326571179561
Vandenplas O,Cartier A,Lesage J,Perrault G,Grammer LC,Malo JL,Occupational asthma caused by a prepolymer but not the monomer of toluene diisocyanate (TDI)J Allergy Clin ImmunolYear: 1992896118311881318888
Luo JC,Nelsen KG,Fischbein A,Persistent reactive airway dysfunction syndrome after exposure to toluene diisocyanateBr J Ind MedYear: 19904742392412159772
Piirila P,Estlander T,Hytonen M,Keskinen H,Tupasela O,Tuppurainen M,Rhinitis caused by ninhydrin develops into occupational asthmaEur Respir JYear: 1997108191819219272939
Buick JB,Todd GR,Concomitant alveolitis and asthma following exposure to triphenylmethane triisocyanateOccup Med (Lond)Year: 19974785045069604485
Bourke SJ,Convery RP,Stenton SC,Malcolm RM,Hendrick DJ,Occupational asthma in an isothiazolinone manufacturing plantThoraxYear: 19975287467489337839
Burge PS,Richardson MN,Occupational asthma due to indirect exposure to lauryl dimethyl benzyl ammonium chloride used in a floor cleanerThoraxYear: 19944988428438091336
Belin L,Wass U,Audunsson G,Mathiasson L,Amines: possible causative agents in the development of bronchial hyperreactivity in workers manufacturing polyurethanes from isocyanatesBr J Ind MedYear: 19834032512576307337
Estlander T,Kanerva L,Tupasela O,Keskinen H,Jolanki R,Immediate and delayed allergy to nickel with contact urticaria, rhinitis, asthma and contact dermatitisClin Exp AllergyYear: 19932343063108319128
Block GT,Yeung M,Asthma induced by nickelJAMAYear: 198224711160016026460879
Malo JL,Cartier A,Doepner M,Nieboer E,Evans S,Dolovich J,Occupational asthma caused by nickel sulfateJ Allergy Clin ImmunolYear: 1982691 Pt 155597054253
McConnell LH,Fink JN,Schlueter DP,Schmidt MG Jr,Asthma caused by nickel sensitivityAnn Intern MedYear: 19737868888904197371
Thickett KM,McCoach JS,Gerber JM,Sadhra S,Burge PS,Occupational asthma caused by chloramines in indoor swimming-pool airEur Respir JYear: 200219582783212030720
Mehta AJ,Henneberger PK,Toren K,Olin AC,Airflow limitation and changes in pulmonary function among bleachery workersEur Respir JYear: 200526113313915994400
Daenen M,Rogiers P,Van de Walle C,Rochette F,Demedts M,Nemery B,Occupational asthma caused by palladiumEur Respir JYear: 199913121321610836351
Silberman DE,Sorrell AH,Allergy in fur workers with special reference to paraphenylenediamineJ AllergyYear: 1959301111813620440
Moscato G,Pignatti P,Yacoub MR,Romano C,Spezia S,Perfetti L,Occupational asthma and occupational rhinitis in hairdressersChestYear: 200512853590359816304318
Pankow W,Hein H,Bittner K,Wichert P,Persulfate asthma in hairdressersPneumologieYear: 19894331731752710769
Harth V,Raulf-Heimsoth M,Bruning T,Merget R,Isolated late asthmatic reaction after exposure to ammonium persulfate in a hairdresserContact DermatitisYear: 2006541626316426299
Wrbitzky R,Drexler H,Letzel S,Early reaction type allergies and diseases of the respiratory passages in employees from persulphate productionInt Arch Occup Environ HealthYear: 19956764134178567091
Therond M,Geraut C,Dupas D,Gayoux C,Pathology des persulfates alcalinsYear: 1989837838
Parra FM,Igea JM,Quirce S,Ferrando MC,Martin JA,Losada E,Occupational asthma in a hairdresser caused by persulphate saltsAllergyYear: 19924766566601285573
Munoz X,Cruz MJ,Orriols R,Bravo C,Espuga M,Morell F,Occupational asthma due to persulfate salts: diagnosis and follow-upChestYear: 200312362124212912796198
Blainey AD,Ollier S,Cundell D,Smith RE,Davies RJ,Occupational asthma in a hairdressing salonThoraxYear: 198641142503704965
Gamboa PM,de la Cuesta CG,Garcia BE,Castillo JG,Oehling A,Late asthmatic reaction in a hairdresser, due to the inhalation of ammonium persulphate saltsAllergol Immunopathol (Madr)Year: 19891721091112476013
Baur X,Fruhmann G,von Liebe V,Occupational asthma and dermatitis after exposure to dusts of persulfate salts in two industrial workers (author's transl)RespirationYear: 1979383144150515539
Kammermeyer JK,Mathews KP,Hypersensitivity to phenylglycine acid chlorideJ Allergy Clin ImmunolYear: 197352273844124984
Wyatt JP,Allister CA,Occupational phosgene poisoning: a case report and reviewJ Accid Emerg MedYear: 19951232122138581252
Merget R,Kulzer R,Dierkes-Globisch A,Breitstadt R,Gebler A,Kniffka A,Artelt S,Koenig HP,Alt F,Vormberg R,et al. Exposure-effect relationship of platinum salt allergy in a catalyst production plant: conclusions from a 5-year prospective cohort studyJ Allergy Clin ImmunolYear: 20001052 Pt 136437010669860
Hnizdo E,Esterhuizen TM,Rees D,Lalloo UG,Occupational asthma as identified by the Surveillance of Work-related and Occupational Respiratory Diseases programme in South AfricaClin Exp AllergyYear: 2001311323911167948
Merget R,Reineke M,Rueckmann A,Bergmann EM,Schultze-Werninghaus G,Nonspecific and specific bronchial responsiveness in occupational asthma caused by platinum salts after allergen avoidanceAm J Respir Crit Care MedYear: 19941504114611497921450
Baker DB,Gann PH,Brooks SM,Gallagher J,Bernstein IL,Cross-sectional study of platinum salts sensitization among precious metals refinery workersAm J Ind MedYear: 19901866536642264564
Venables KM,Dally MB,Nunn AJ,Stevens JF,Stephens R,Farrer N,Hunter JV,Stewart M,Hughes EG,Newman Taylor AJ,Smoking and occupational allergy in workers in a platinum refineryBmjYear: 198929967059399422508944
Pickering CA,Inhalation tests with chemical allergens: complex salts of platinumProc R Soc MedYear: 19726532722745083317
Stenton SC,Kelly CA,Walters EH,Hendrick DJ,Occupational asthma due to a repair process for polyethylene-coated electrical cablesJ Soc Occup MedYear: 198939133342716296
Gannon PF,Burge PS,Benfield GF,Occupational asthma due to polyethylene shrink wrapping (paper wrapper's asthma)ThoraxYear: 19924797591440477
Skerfving S,Akesson B,Simonsson BG,"Meat wrappers' asthma" caused by thermal degradation products of polyethyleneLancetYear: 1980181612116101670
Kennes B,Garcia-Herreros P,Dierckx P,Asthma from plexiglas powdersClin AllergyYear: 198111149547214684
Atis S,Tutluoglu B,Levent E,Ozturk C,Tunaci A,Sahin K,Saral A,Oktay I,Kanik A,Nemery B,The respiratory effects of occupational polypropylene flock exposureEur Respir JYear: 200525111011715640331
Malo JL,Cartier A,Boulet LP,L'Archeveque J,Saint-Denis F,Bherer L,Courteau JP,Bronchial hyperresponsiveness can improve while spirometry plateaus two to three years after repeated exposure to chlorine causing respiratory symptomsAm J Respir Crit Care MedYear: 19941504114211457921449
Tuomainen A,Stark H,Seuri M,Hirvonen MR,Linnainmaa M,Sieppi A,Tukiainen H,Experimental PVC material challenge in subjects with occupational PVC exposureEnviron Health PerspectYear: 200611491409141316966097
Lee HS,Ng TP,Ng YL,Phoon WH,Diurnal variation in peak expiratory flow rate among polyvinylchloride compounding workersBr J Ind MedYear: 19914842752782025595
Wegman DH,Smith TJ,Eisen EA,Greaves IA,Fine LJ,Chelton CS,Respiratory effects of work in retail food stores. I. Methodology and exposure assignmentsScand J Work Environ HealthYear: 19871332032083616547
Baser ME,Tockman MS,Kennedy TP,Pulmonary function and respiratory symptoms in polyvinylchloride fabrication workersAm Rev Respir DisYear: 198513122032083970451
Munoz X,Cruz MJ,Albanell M,Morell F,Occupational asthma in food packersArch BronconeumolYear: 200339732432612846963
Lee HS,Yap J,Wang YT,Lee CS,Tan KT,Poh SC,Occupational asthma due to unheated polyvinylchloride resin dustBr J Ind MedYear: 198946118208222590649
Sokol WN,Aelony Y,Beall GN,Meat-wrapper's asthma. A new syndrome?JamaYear: 197322666396414800606
Bright P,Burge PS,O'Hickey SP,Gannon PF,Robertson AS,Boran A,Occupational asthma due to chrome and nickel electroplatingThoraxYear: 199752128329039236
Hjortsberg U,Nise G,Orbaek P,Soes-Petersen U,Arborelius M Jr,Bronchial asthma due to exposure to potassium aluminumtetrafluorideScand J Work Environ HealthYear: 19861232233749838
Burge PS,Edge G,Hawkins R,White V,Taylor AJ,Occupational asthma in a factory making flux-cored solder containing colophonyThoraxYear: 198136118288347330804
Burge PS,Harries MG,O'Brien I,Pepys J,Bronchial provocation studies in workers exposed to the fumes of electronic soldering fluxesClin AllergyYear: 19801021371497389068
Maestrelli P,Alessandri MV,Dal Vecchio L,Bartolucci GB,Cocheo V,Occupational asthma due to colophonyMed LavYear: 19857653713784088120
Weiss JS,Reactive airway dysfunction syndrome due to sodium azide inhalationInt Arch Occup Environ HealthYear: 19966864694718891787
Stenton SC,Dennis JH,Walters EH,Hendrick DJ,Asthmagenic properties of a newly developed detergent ingredient: sodium iso-nonanoyl oxybenzene sulphonateBr J Ind MedYear: 19904764054102165800
Hendrick DJ,Connolly MJ,Stenton SC,Bird AG,Winterton IS,Walters EH,Occupational asthma due to sodium iso-nonanoyl oxybenzene sulphonate, a newly developed detergent ingredientThoraxYear: 19884365015023420567
Ferguson H,Thomas KE,Ollier S,Davies RJ,Bronchial provocation testing of sodium iso-nonanoyl oxybenzene sulphonateHum Exp ToxicolYear: 19909283892340196
Merget R,Korn M,Metabisulphite-induced occupational asthma in a radiographerEur Respir JYear: 200525238638815684307
Madsen J,Sherson D,Kjoller H,Hansen I,Rasmussen K,Occupational asthma caused by sodium disulphite in Norwegian lobster fishingOccup Environ MedYear: 2004611087387415377776
Malo JL,Cartier A,Desjardins A,Occupational asthma caused by dry metabisulphiteThoraxYear: 1995505585586 discussion 589. 7597678
Pougnet R,Lodde B,Lucas D,Jegaden D,Bell S,Dewitte JD,A case of occupational asthma from metabisulphite in a fishermanInt Marit HealthYear: 201062318018421154306
Steiner M,Scaife A,Semple S,Hulks G,Ayres JG,Sodium metabisulphite induced airways disease in the fishing and fish-processing industryOccup Med (Lond)Year: 200858854555018832347
Hayes JP,Lambourn L,Hopkirk JA,Durham SR,Taylor AJ,Occupational asthma due to styreneThoraxYear: 19914653963972068702
Moscato G,Biscaldi G,Cottica D,Pugliese F,Candura S,Candura F,Occupational asthma due to styrene: two case reportsJ Occup MedYear: 198729129579603430203
Andersson E,Knutsson A,Hagberg S,Nilsson T,Karlsson B,Alfredsson L,Toren K,Incidence of asthma among workers exposed to sulphur dioxide and other irritant gasesEur Respir JYear: 200627472072516585079
Koksal N,Hasanoglu HC,Gokirmak M,Yildirim Z,Gultek A,Apricot sulfurization: an occupation that induces an asthma-like syndrome in agricultural environmentsAm J Ind MedYear: 200343444745312645101
Harkonen H,Nordman H,Korhonen O,Winblad I,Long-term effects of exposure to sulfur dioxide. Lung function four years after a pyrite dust explosionAm Rev Respir DisYear: 198312858908936638677
Rosberg M,Asthma bronchiale caused by sulfthiazoleActa Medica ScandinavicaYear: 194612618519020249981
Eriksson KA,Levin JO,Sandstrom T,Lindstrom-Espeling K,Linden G,Stjernberg NL,Terpene exposure and respiratory effects among workers in Swedish joinery shopsScand J Work Environ HealthYear: 19972321141209167234
Seaton A,Cherrie B,Turnbull J,Rubber glove asthmaBr Med J (Clin Res Ed)Year: 19882966621531532
Honda I,Kohrogi H,Ando M,Araki S,Ueno T,Futatsuka M,Ueda A,Occupational asthma induced by the fungicide tetrachloroisophthalonitrileThoraxYear: 19924797607611440478
Baur X,Bittner C,Occupational obstructive airway diseases caused by the natural gas odorant tetrahydrothiophene–two case reportsAm J Ind MedYear: 2009521298298619852017
Vandenplas O,Delwiche JP,Auverdin J,Caroyer UM,Cangh FB,Asthma to tetramethrinAllergyYear: 200055441741810782541
Shelton D,Urch B,Tarlo SM,Occupational asthma induced by a carpet fungicide–tributyl tin oxideJ Allergy Clin ImmunolYear: 19929022742751500633
Bruckner HC,Extrinsic asthma in a tungsten carbide workerJ Occup MedYear: 19679105185196054048
Lee HS,Wang YT,Yeo CT,Tan KT,Ratnam KV,Occupational asthma due to tylosin tartrateBr J Ind MedYear: 19894674984992765423
Frigas E,Filley WV,Reed CE,Asthma induced by dust from urea-formaldehyde foam insulating materialChestYear: 19817967067077226963
Bertrand JP,Simon V,Chau N,Associations of symptoms related to isocyanate, ureaformol, and formophenolic exposures with respiratory symptoms and lung function in coal minersInt J Occup Environ HealthYear: 200713218118717718175
Irsigler GB,Visser PJ,Spangenberg PA,Asthma and chemical bronchitis in vanadium plant workersAm J Ind MedYear: 199935436637410086213
Pistelli R,Pupp N,Forastiere F,Agabiti N,Corbo GM,Tidei F,Perucci CA,Increase of nonspecific bronchial reactivity after occupational exposure to vanadiumMed LavYear: 19918232702751795672
Kielkowski D,Rees D,Report on exposure and health, assessment of vanadium workersYear: 1997
Musk AW,Tees JG,Asthma caused by occupational exposure to vanadium compoundsMed J AustYear: 1982141831846978990
Malo JL,Cartier A,Occupational asthma due to fumes of galvanized metalChestYear: 19879223753773608611
Malo JL,Cartier A,Dolovich J,Occupational asthma due to zincEur Respir JYear: 1993634474508472836
Kawane H,Soejima R,Umeki S,Niki Y,Metal fume fever and asthmaChestYear: 1988935111611173359839
Hambrook DW,Fink JN,Airbag asthma: a case report and review of the literatureAnn Allergy Asthma ImmunolYear: 200696236937216498862
Yang CY,Huang CC,Chiu HF,Chiu JF,Lan SJ,Ko YC,Effects of occupational dust exposure on the respiratory health of Portland cement workersJ Toxicol Environ HealthYear: 19964965815888977625
Abrons HL,Petersen MR,Sanderson WT,Engelberg AL,Harber P,Symptoms, ventilatory function, and environmental exposures in Portland cement workersBr J Ind MedYear: 19884563683753260798
Fell AK,Thomassen TR,Kristensen P,Egeland T,Kongerud J,Respiratory symptoms and ventilatory function in workers exposed to portland cement dustJ Occup Environ MedYear: 20034591008101414506344
Al-Neaimi YI,Gomes J,Lloyd OL,Respiratory illnesses and ventilatory function among workers at a cement factory in a rapidly developing countryOccup Med (Lond)Year: 200151636737311584114
Ali BA,Ballal SG,Albar AA,Ahmed HO,Post-shift changes in pulmonary function in a cement factory in eastern Saudi ArabiaOccup Med (Lond)Year: 199848851952210024727
Kalacic I,Chronic nonspecific lung disease in cement workersArch Environ HealthYear: 197326278834683536
Mengesha YA,Bekele A,Relative chronic effects of different occupational dusts on respiratory indices and health of workers in three Ethiopian factoriesAm J Ind MedYear: 19983443733809750944
Lockman LE,Case report: allergic contact dermatitis and new-onset asthma. Chromium exposure during leather tanningCan Fam PhysicianYear: 2002481907190912520790
De Raeve H,Vandecasteele C,Demedts M,Nemery B,Dermal and respiratory sensitization to chromate in a cement floorerAm J Ind MedYear: 19983421691769651627
Shirakawa T,Morimoto K,Brief reversible bronchospasm resulting from bichromate exposureArch Environ HealthYear: 19965132212268687243
Nordby KC,Fell AK,Noto H,Eduard W,Skogstad M,Thomassen Y,Bergamaschi A,Kongerud J,Kjuus H,Exposure to thoracic dust, airway symptoms and lung function in cement production workersEur Respir JYear: 20113861278128621659410
Piirila P,Espo T,Pfaffli P,Riihimaki V,Wolff H,Nordman H,Prolonged respiratory symptoms caused by thermal degradation products of freonsScand J Work Environ HealthYear: 2003291717712630439
Lee J,Lee C,Kim CH,Uncontrolled occupational exposure to 1,1-dichloro-1-Fluoroethane (HCFC-141b) is associated with acute pulmonary toxicityChestYear: 2009135114915518689598
Mirabelli MC,Zock JP,Plana E,Anto JM,Benke G,Blanc PD,Dahlman-Hoglund A,Jarvis DL,Kromhout H,Lillienberg L,et al. Occupational risk factors for asthma among nurses and related healthcare professionals in an international studyOccup Environ MedYear: 200764747447917332135
Rosenman KD,Reilly MJ,Schill DP,Valiante D,Flattery J,Harrison R,Reinisch F,Pechter E,Davis L,Tumpowsky CM,et al. Cleaning products and work-related asthmaJ Occup Environ MedYear: 200345555656312762081
Tabar AI,Alvarez MJ,Acero S,Olaguibel JM,Garcia BE,Quirce S,Reactive airways dysfunction syndrome: two case reportsJ Investig Allergol Clin ImmunolYear: 199882119122
Vizcaya D,Mirabelli MC,Anto JM,Orriols R,Burgos F,Arjona L,Zock JP,A workforce-based study of occupational exposures and asthma symptoms in cleaning workersOccup Environ MedYear: 2011681291491921558474
Murphy DM,Fairman RP,Lapp NL,Morgan WK,Severe airway disease due to inhalation of fumes from cleansing agentsChestYear: 1976693372376971606
Mapp CE,Beghe B,Balboni A,Zamorani G,Padoan M,Jovine L,Baricordi OR,Fabbri LM,Association between HLA genes and susceptibility to toluene diisocyanate-induced asthmaClin Exp AllergyYear: 200030565165610792356
Jones RN,Hughes JM,Lehrer SB,Butcher BT,Glindmeyer HW,Diem JE,Hammad YY,Salvaggio J,Weill H,Lung function consequences of exposure and hypersensitivity in workers who process green coffee beansAm Rev Respir DisYear: 198212521992027065523
Zuskin E,Kanceljak B,Skuric Z,Butkovic D,Bronchial reactivity in green coffee exposureBr J Ind MedYear: 19854264154204005196
Lemiere C,Malo JL,McCants M,Lehrer S,Occupational asthma caused by roasted coffee: immunologic evidence that roasted coffee contains the same antigens as green coffee, but at a lower concentrationJ Allergy Clin ImmunolYear: 19969824644668757226
Johansen JP,Viskum S,Asthma associated with the handling of green coffee beansUgeskr LaegerYear: 19871494228533433451
Oldenburg M,Bittner C,Baur X,Health risks due to coffee dustChestYear: 2009136253654419349381
Christiani DC,Wang XR,Pan LD,Zhang HX,Sun BX,Dai H,Eisen EA,Wegman DH,Olenchock SA,Longitudinal changes in pulmonary function and respiratory symptoms in cotton textile workers. A 15-yr follow-up studyAm J Respir Crit Care MedYear: 2001163484785311282755
Latza U,Oldenburg M,Baur X,Endotoxin exposure and respiratory symptoms in the cotton textile industryArch Environ HealthYear: 2004591051952516425662
Oldenburg M,Latza U,Baur X,Exposure-response relationship between endotoxin exposure and lung function impairment in cotton textile workersInt Arch Occup Environ HealthYear: 200780538839517051395
Hayes GB,Ye TT,Lu PL,Dai HL,Christiani DC,Respiratory disease in cotton textile workers: epidemiologic assessment of small airway functionEnviron ResYear: 199466131438013436
Wang XR,Pan LD,Zhang HX,Sun BX,Dai HL,Christiani DC,A longitudinal observation of early pulmonary responses to cotton dustOccup Environ MedYear: 200360211512112554839
Li D,Zhong YN,Rylander R,Ma QY,Zhou XY,Longitudinal study of the health of cotton workersOccup Environ MedYear: 19955253283317795755
Mberikunashe J,Banda S,Chadambuka A,Gombe NT,Shambira G,Tshimanga M,Matchaba-Hove R,Prevalence and risk factors for obstructive respiratory conditions among textile industry workers in Zimbabwe, 2006Pan Afr Med JYear: 20106121436944
Hendy MS,Beattie BE,Burge PS,Occupational asthma due to an emulsified oil mistBr J Ind MedYear: 198542151543965015
Keskinen H,Nordman H,Terho EO,ECG ink as a cause of asthmaAllergyYear: 19813642752767316102
Rodenstein D,Stanescu DC,Bronchial asthma following exposure to ECG inkAnn AllergyYear: 19824863513527091779
Milton DK,Wypij D,Kriebel D,Walters MD,Hammond SK,Evans JS,Endotoxin exposure-response in a fiberglass manufacturing facilityAm J Ind MedYear: 19962913138808037
Jaakkola JJ,Piipari R,Jaakkola MS,Occupation and asthma: a population-based incident case–control studyAm J EpidemiolYear: 20031581098198714607806
Lambourn EM,Hayes JP,McAllister WA,Taylor AJ,Occupational asthma due to EPO 60Br J Ind MedYear: 19924942942951571300
Cockcroft DW,Cartier A,Jones G,Tarlo SM,Dolovich J,Hargreave FE,Asthma caused by occupational exposure to a furan-based binder systemJ Allergy Clin ImmunolYear: 19806664584636159383
Chan-Yeung M,Schulzer M,MacLean L,Dorken E,Grzybowski S,Epidemiologic health survey of grain elevator workers in British ColumbiaAm Rev Respir DisYear: 198012123293387362139
Williams N,Skoulas A,Merriman JE,Exposure to Grain Dust. I. a Survey of the EffectsJ Occup MedYear: 1964631932914178791
Skoulas A,Williams N,Merriman JE,Exposure to Grain Dust. Ii. a Clinical Study of the EffectsJ Occup MedYear: 1964635937214205649
Baur X,Preisser A,Wegner R,Asthma due to grain dustPneumologieYear: 200357633533912813669
Chan-Yeung M,Dimich-Ward H,Enarson DA,Kennedy SM,Five cross-sectional studies of grain elevator workersAm J EpidemiolYear: 199213610126912791476149
Ye TT,Huang JX,Shen YE,Lu PL,Christiani DC,Respiratory symptoms and pulmonary function among Chinese rice-granary workersInt J Occup Environ HealthYear: 19984315515910026476
Dube D,Puruckherr M,Byrd RP Jr,Roy TM,Reactive airways dysfunction syndrome following metal fume feverTenn MedYear: 200295623623812056129
Zacharisen MC,Kadambi AR,Schlueter DP,Kurup VP,Shack JB,Fox JL,Anderson HA,Fink JN,The spectrum of respiratory disease associated with exposure to metal working fluidsJ Occup Environ MedYear: 19984076406479675723
Wieslander G,Janson C,Norback D,Bjornsson E,Stalenheim G,Edling C,Occupational exposure to water-based paints and self-reported asthma, lower airway symptoms, bronchial hyperresponsiveness, and lung functionInt Arch Occup Environ HealthYear: 19946642612677843837
Temel O,Sakar Coskun A,Yaman N,Sarioglu N,Alkac C,Konyar I,Ozgen Alpaydin A,Celik P,Cengiz Ozyurt B,Keskin E,et al. Occupational asthma in welders and paintersTuberk ToraksYear: 2010581647020517731
Baur X,Schneider EM,Wieners D,Czuppon AB,Occupational asthma to perfumeAllergyYear: 199954121334133510688444
Lings S,Pesticide lung: a pilot investigation of fruit-growers and farmers during the spraying seasonBr J Ind MedYear: 19823943703767138795
Boers D,van Amelsvoort L,Colosio C,Corsini E,Fustinoni S,Campo L,Bosetti C,La Vecchia C,Vergieva T,Tarkowski M,et al. Asthmatic symptoms after exposure to ethylenebisdithiocarbamates and other pesticides in the Europit field studiesHum Exp ToxicolYear: 200827972172719042955
Ng TP,Lee HS,Malik MA,Chee CB,Cheong TH,Wang YT,Asthma in chemical workers exposed to aliphatic polyaminesOccup Med (Lond)Year: 199545145487703473
Cartier A,Vandenplas O,Grammer LC,Shaughnessy MA,Malo JL,Respiratory and systemic reaction following exposure to heated electrostatic polyester paintEur Respir JYear: 1994736086118013618
Zuskin E,Mustajbegovic J,Schachter EN,Kern J,Budak A,Godnic-Cvar J,Respiratory findings in synthetic textile workersAm J Ind MedYear: 19983332632739481425
Burge PS,Scott JA,McCoach J,Occupational asthma caused by aluminumAllergyYear: 200055877978010955707
Chan-Yeung M,Wong R,MacLean L,Tan F,Schulzer M,Enarson D,Martin A,Dennis R,Grzybowski S,Epidemiologic health study of workers in an aluminum smelter in British Columbia. Effects on the respiratory systemAm Rev Respir DisYear: 198312744654696838051
Desjardins A,Bergeron JP,Ghezzo H,Cartier A,Malo JL,Aluminium potroom asthma confirmed by monitoring of forced expiratory volume in one secondAm J Respir Crit Care MedYear: 19941506 Pt 1171417177952639
Musk AW,de Klerk NH,Beach JR,Fritschi L,Sim MR,Benke G,Abramson M,McNeil JJ,Respiratory symptoms and lung function in alumina refinery employeesOccup Environ MedYear: 200057427928310810116
O'Donnell TV,Welford B,Coleman ED,Potroom asthma: New Zealand experience and follow-upAm J Ind MedYear: 198915143492929607
Saric M,Godnic-Cvar J,Gomzi M,Stilinovic L,The role of atopy in potroom workers' asthmaAm J Ind MedYear: 1986932392423963006
Sorgdrager B,de Looff AJ,de Monchy JG,Pal TM,Dubois AE,Rijcken B,Occurrence of occupational asthma in aluminum potroom workers in relation to preventive measuresInt Arch Occup Environ HealthYear: 19987153599523250
Sorgdrager B,de Looff AJ,Pal TM,van Dijk FJ,de Monchy JG,Factors affecting FEV1 in workers with potroom asthma after their removal from exposureInt Arch Occup Environ HealthYear: 2001741555811196082
Blomqvist A,Duzakin-Nystedt M,Ohlson CG,Andersson L,Jonsson B,Nielsen J,Welinder H,Airways symptoms, immunological response and exposure in powder paintingInt Arch Occup Environ HealthYear: 200578212313115726393
Nakano Y,Tsuchiya T,Hirose K,Chida K,Occupational asthma caused by pyrazolone derivative used in silver halide photographic paperChestYear: 2000118124624810893388
Alanko K,Keskinen H,Bjorksten F,Ojanen S,Immediate-type hypersensitivity to reactive dyesClin AllergyYear: 1978812531627041
Nilsson R,Nordlinder R,Wass U,Meding B,Belin L,Asthma, rhinitis, and dermatitis in workers exposed to reactive dyesBr J Ind MedYear: 199350165708431393
Park HS,Lee MK,Hong CS,Reactive dye induced occupational asthma without nonspecific bronchial hyperreactivityYonsei Med JYear: 1990312981022219979
Park HS,Lee MK,Kim BO,Lee KJ,Roh JH,Moon YH,Hong CS,Clinical and immunologic evaluations of reactive dye-exposed workersJ Allergy Clin ImmunolYear: 19918736396492005316
Romano C,Sulotto F,Pavan I,Chiesa A,Scansetti G,A new case of occupational asthma from reactive dyes with severe anaphylactic response to the specific challengeAm J Ind MedYear: 19922122092161536155
Forrester BG,Reactive airways dysfunction syndrome: occurrence after exposure to a refractory ceramic fiber-phosphoric acid binder mixtureSouth Med JYear: 19979044474509114842
Lemasters GK,Lockey JE,Levin LS,McKay RT,Rice CH,Horvath EP,Papes DM,Lu JW,Feldman DJ,An industry-wide pulmonary study of men and women manufacturing refractory ceramic fibersAm J EpidemiolYear: 199814899109199801022
Almeida AG,Duarte R,Mieiro L,Paiva AC,Rodrigues AM,Almeida MH,Barbara C,Pulmonary function in Portuguese firefightersRev Port PneumolYear: 200713334936417632674
Moisan TC,Prolonged asthma after smoke inhalation: a report of three cases and a review of previous reportsJ Occup MedYear: 19913344584612037900
Greven F,Krop E,Spithoven J,Rooyackers J,Kerstjens H,Heederik D,Lung function, bronchial hyperresponsiveness, and atopy among firefightersScand J Work Environ HealthYear: 201137432533121340442
Kelsall HL,Sim MR,Forbes AB,Glass DC,McKenzie DP,Ikin JF,Abramson MJ,Blizzard L,Ittak P,Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposuresOccup Environ MedYear: 200461121006101315550607
Ekici A,Ekici M,Kurtipek E,Akin A,Arslan M,Kara T,Apaydin Z,Demir S,Obstructive airway diseases in women exposed to biomass smokeEnviron ResYear: 2005991939816053933
Burge PS,Perks W,O'Brien IM,Hawkins R,Green M,Occupational asthma in an electronics factoryThoraxYear: 19793411318441994
Lee HS,Koh D,Chia HP,Phoon WH,Symptoms, lung function, and diurnal variation in peak expiratory flow rate among female solderers in the electronics industryAm J Ind MedYear: 19942656136197832209
Stevens JJ,Asthma due to soldering flux: a polyether alcohol-polypropylene glycol mixtureAnn AllergyYear: 19763664194221275329
Cakmak A,Ekici A,Ekici M,Arslan M,Iteginli A,Kurtipek E,Kara T,Respiratory findings in gun factory workers exposed to solventsRespir MedYear: 2004981525614959814
Ebbehoj NE,Hein HO,Suadicani P,Gyntelberg F,Occupational organic solvent exposure, smoking, and prevalence of chronic bronchitis-an epidemiological study of 3387 menJ Occup Environ MedYear: 200850773073518617828
Tarlo SM,Occupational asthma induced by tall oil in the rubber tyre industryClin Exp AllergyYear: 1992221991011551039
Bayeux-Dunglas MC,Deparis P,Touati MA,Ameille J,Occupational asthma in a teacher after repeated exposure to tear gasRev Mal RespirYear: 199916455855910549067
Hill AR,Silverberg NB,Mayorga D,Baldwin HE,Medical hazards of the tear gas CS. A case of persistent, multisystem, hypersensitivity reaction and review of the literatureMedicine (Baltimore)Year: 200079423424010941352
Hu H,Christiani D,Reactive airways dysfunction after exposure to teargasLancetYear: 1992339880815351351200
Roth VS,Franzblau A,RADS after exposure to a riot-control agent: a case reportJ Occup Environ MedYear: 19963898638658877834
El-Zein M,Malo JL,Infante-Rivard C,Gautrin D,Incidence of probable occupational asthma and changes in airway calibre and responsiveness in apprentice weldersEur Respir JYear: 200322351351814516144
Jafari AJ,Assari MJ,Respiratory effects from work-related exposure to welding fumes in Hamadan, IranArch Environ HealthYear: 200459311612016121900
Nakadate T,Aizawa Y,Yagami T,Zheg YQ,Kotani M,Ishiwata K,Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by magnetopneumography in Japanese arc weldersOccup Environ MedYear: 199855106736779930088
Beach JR,Dennis JH,Avery AJ,Bromly CL,Ward RJ,Walters EH,Stenton SC,Hendrick DJ,An epidemiologic investigation of asthma in weldersAm J Respir Crit Care MedYear: 19961545139414008912754
Hannu T,Piipari R,Toskala E,Immediate hypersensitivity type of occupational laryngitis in a welder exposed to welding fumes of stainless steelAm J Ind MedYear: 200649540240516570256
Karjalainen A,Martikainen R,Oksa P,Saarinen K,Uitti J,Incidence of asthma among Finnish construction workersJ Occup Environ MedYear: 200244875275712185796
Contreras GR,Chan-Yeung M,Bronchial reactions to exposure to welding fumesOccup Environ MedYear: 199754118368399538358
Hannu T,Piipari R,Kasurinen H,Keskinen H,Tuppurainen M,Tuomi T,Occupational asthma due to manual metal-arc welding of special stainless steelsEur Respir JYear: 200526473673916204606
Vandenplas O,Delwiche JP,Vanbilsen ML,Joly J,Roosels D,Occupational asthma caused by aluminium weldingEur Respir JYear: 1998115118211849648975
Vandenplas O,Dargent F,Auverdin JJ,Boulanger J,Bossiroy JM,Roosels D,Van de Weyer R,Occupational asthma due to gas metal arc welding on mild steelThoraxYear: 1995505587588 discussion 589. 7597679
Keskinen H,Kalliomaki PL,Alanko K,Occupational asthma due to stainless steel welding fumesClin AllergyYear: 19801021511597389069
Halvani GH,Zare M,Halvani A,Barkhordari A,Evaluation and comparison of respiratory symptoms and lung capacities in tile and ceramic factory workers of YazdArh Hig Rada ToksikolYear: 200859319720418796387
Neghab M,Zadeh JH,Fakoorziba MR,Respiratory toxicity of raw materials used in ceramic productionInd HealthYear: 2009471646919218759
Oliver LC,Miracle-McMahill H,Littman AB,Oakes JM,Gaita RR Jr,Respiratory symptoms and lung function in workers in heavy and highway construction: a cross-sectional studyAm J Ind MedYear: 2001401738611439399
Kaukiainen A,Martikainen R,Riala R,Reijula K,Tammilehto L,Work tasks, chemical exposure and respiratory health in construction paintingAm J Ind MedYear: 20085111818033694
Walusiak J,Krawczyk-Adamus P,Hanke W,Wittczak T,Palczynski C,Small nonspecialized farming as a protective factor against immediate-type occupational respiratory allergy?AllergyYear: 200459121294130015507098
Gomez MI,Hwang SA,Lin S,Stark AD,May JJ,Hallman EM,Prevalence and predictors of respiratory symptoms among New York farmers and farm residentsAm J Ind MedYear: 2004461425415202124
Dosman JA,Graham BL,Hall D,Van Loon P,Bhasin P,Froh F,Respiratory symptoms and pulmonary function in farmersJ Occup MedYear: 198729138433819883
Rask-Andersen A,Asthma increase among farmers: a 12-year follow-upUps J Med SciYear: 20111161607120812893
Portengen L,Preller L,Tielen M,Doekes G,Heederik D,Endotoxin exposure and atopic sensitization in adult pig farmersJ Allergy Clin ImmunolYear: 2005115479780215806001
Monso E,Riu E,Radon K,Magarolas R,Danuser B,Iversen M,Morera J,Nowak D,Chronic obstructive pulmonary disease in never-smoking animal farmers working inside confinement buildingsAm J Ind MedYear: 200446435736215376214
Radon K,Weber C,Iversen M,Danuser B,Pedersen S,Nowak D,Exposure assessment and lung function in pig and poultry farmersOccup Environ MedYear: 200158640541011351057
Hansen ES,A cohort mortality study of foundry workersAm J Ind MedYear: 19973232232339219651
Hahn R,Beck B,Incidence of chronic bronchitis in foundry workersZ Erkr AtmungsorganeYear: 198616632672733489327
Pechter E,Davis LK,Tumpowsky C,Flattery J,Harrison R,Reinisch F,Reilly MJ,Rosenman KD,Schill DP,Valiante D,et al. Work-related asthma among health care workers: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993–1997Am J Ind MedYear: 200547326527515712261
Arif AA,Delclos GL,Association between cleaning-related chemicals and work-related asthma and asthma symptoms among healthcare professionalsOccup Environ MedYear: 2012691354021602538
Arif AA,Delclos GL,Serra C,Occupational exposures and asthma among nursing professionalsOccup Environ MedYear: 200966427427819164328
Bala S,Tabaku A,Chronic obstructive pulmonary disease in iron-steel and ferrochrome industry workersCent Eur J Public HealthYear: 2010182939820939259
Rylander R,Carvalheiro MF,Airways inflammation among workers in poultry housesInt Arch Occup Environ HealthYear: 200679648749016395591
Hagmar L,Schutz A,Hallberg T,Sjoholm A,Health effects of exposure to endotoxins and organic dust in poultry slaughter-house workersInt Arch Occup Environ HealthYear: 19906221591642323833
Danuser B,Wyss C,Hauser R,von Planta U,Folsch D,Lung function and symptoms in employees of poultry farmsSoz PraventivmedYear: 19883362862913213243
King BS,Page EH,Mueller CA,Dollberg DD,Gomez KE,Warren AM,Eye and respiratory symptoms in poultry processing workers exposed to chlorine by-productsAm J Ind MedYear: 200649211912616419092
Borghetti C,Magarolas R,Badorrey I,Radon K,Morera J,Monso E,Sensitization and occupational asthma in poultry workersMed Clin (Barc)Year: 2002118725125511882277
Perfetti L,Cartier A,Malo JL,Occupational asthma in poultry-slaughterhouse workersAllergyYear: 19975255945959201376
Vogelzang PF,van der Gulden JW,Folgering H,Heederik D,Tielen MJ,van Schayck CP,Longitudinal changes in bronchial responsiveness associated with swine confinement dust exposureChestYear: 200011751488149510807840
Reynolds SJ,Donham KJ,Whitten P,Merchant JA,Burmeister LF,Popendorf WJ,Longitudinal evaluation of dose–response relationships for environmental exposures and pulmonary function in swine production workersAm J Ind MedYear: 199629133408808040
Schwartz DA,Donham KJ,Olenchock SA,Popendorf WJ,Van Fossen DS,Burmeister LF,Merchant JA,Determinants of longitudinal changes in spirometric function among swine confinement operators and farmersAm J Respir Crit Care MedYear: 1995151147537812571
Vogelzang PF,van der Gulden JW,Folgering H,Kolk JJ,Heederik D,Preller L,Tielen MJ,van Schayck CP,Endotoxin exposure as a major determinant of lung function decline in pig farmersAm J Respir Crit Care MedYear: 1998157115189445272
Banauch GI,Alleyne D,Sanchez R,Olender K,Cohen HW,Weiden M,Kelly KJ,Prezant DJ,Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade CenterAm J Respir Crit Care MedYear: 20031681546212615613
Banauch GI,Dhala A,Prezant DJ,Pulmonary disease in rescue workers at the World Trade Center siteCurr Opin Pulm MedYear: 200511216016815699790
Banauch GI,Hall C,Weiden M,Cohen HW,Aldrich TK,Christodoulou V,Arcentales N,Kelly KJ,Prezant DJ,Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire DepartmentAm J Respir Crit Care MedYear: 2006174331231916645172
Herbstman JB,Frank R,Schwab M,Williams DL,Samet JM,Breysse PN,Geyh AS,Respiratory effects of inhalation exposure among workers during the clean-up effort at the World Trade Center disaster siteEnviron ResYear: 2005991859216053932
Salzman SH,Moosavy FM,Miskoff JA,Friedmann P,Fried G,Rosen MJ,Early respiratory abnormalities in emergency services police officers at the World Trade Center siteJ Occup Environ MedYear: 200446211312214767214
Mauer MP,Cummings KR,Hoen R,Long-term respiratory symptoms in World Trade Center respondersOccup Med (Lond)Year: 201060214515120035001
Feinstein AR,Horwitz RI,Problems in the "evidence" of "evidence-based medicine"Am J MedYear: 199710365295359428837
Miettinen OS,Evidence in medicine: invited commentaryCmajYear: 199815822152219469145
Miettinen OS,Evidence-based medicine, case-based medicine; scientific medicine, quasi-scientific medicine. Commentary on Tonelli (2006), Integrating evidence into clinical practice: an alternative to evidence-based approaches. Journal of Evaluation in Clinical Practice 12, 248–256J Eval Clin PractYear: 200612326026416722904
Tobin MJ,Counterpoint: evidence-based medicine lacks a sound scientific baseChestYear: 2008133510711074 discussion 1074–1077. 18460514
Lijmer JG,Mol BW,Heisterkamp S,Bonsel GJ,Prins MH,van der Meulen JH,Bossuyt PM,Empirical evidence of design-related bias in studies of diagnostic testsJamaYear: 1999282111061106610493205
Beach J,Rowe BH,Blitz S,Crumley E,Hooton N,Russell K,Spooner C,Klassen T,Diagnosis and management of work-related asthma. Evidence Report/Technology Assessment No 129Year: 2005U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville
Kunz R,Burnand B,Schunemann HJ,The GRADE System. An international approach to standardize the graduation of evidence and recommendations in guidelinesInternist (Berl)Year: 200849667368018461295
West S,King V,CT S,Lohr KN,McKoy N,Sutton SF,Lux L,Systems to rate the strength of scientific evidence, vol. 47Year: 2002Agency for Healthcare, Research and Quality, Rockville
Quint J,Beckett WS,Campleman SL,Sutton P,Prudhomme J,Flattery J,Harrison R,Cowan B,Kreutzer R,Primary prevention of occupational asthma: identifying and controlling exposures to asthma-causing agentsAm J Ind MedYear: 200851747749118459148
AbuDhaise BA,Rabi AZ,Al Zwairy MA,El Hader AF,El Qaderi S,Pulmonary manifestations in cement workers in JordanInt J Occup Med Environ HealthYear: 19971044174289575667
Salvi SS,Barnes PJ,Chronic obstructive pulmonary disease in non-smokersLancetYear: 2009374969173374319716966
Blanc FX,Coirault C,Oliviero P,Lecarpentier Y,Relaxation of tracheal smooth muscle is impaired in innate airway hyperresponsivenessEur Respir JYear: 200934241742419648519
Balmes JR,Nowak D,Donner CF, Carone MCOPD caused by occupational exposureCOPDYear: 2007Clinical publishing, Oxford8595
Blanc PD,Toren K,Occupation in chronic obstructive pulmonary disease and chronic bronchitis: an updateInt J Tuberc Lung DisYear: 200711325125717352088
Toren K,Balmes J,Chronic obstructive pulmonary disease: does occupation matter?Am J Respir Crit Care MedYear: 20071761095195217984309
Bardana EJ Jr,Reactive airways dysfunction syndrome (RADS): guidelines for diagnosis and treatment and insight into likely prognosisAnn Allergy Asthma ImmunolYear: 1999836 Pt 258358610619325
Vandenplas O,Malo JL,Definitions and types of work-related asthma: a nosological approachEur Respir JYear: 200321470671212762361
Blanc PD,Menezes AM,Plana E,Mannino DM,Hallal PC,Toren K,Eisner MD,Zock JP,Occupational exposures and COPD: an ecological analysis of international dataEur Respir JYear: 200933229830419010980
Malo JL,Chan-Yeung M,Agents causing occupational asthmaJ Allergy Clin ImmunolYear: 2009123354555018951622
Cullinan P,Irritant-induced asthma from work. What happens next?Am J Respir Crit Care MedYear: 20091791085785819434803
Tarlo SM,Boulet LP,Cartier A,Cockcroft D,Cote J,Hargreave FE,Holness L,Liss G,Malo JL,Chan-Yeung M,Canadian Thoracic Society guidelines for occupational asthmaCan Respir JYear: 1998542893009753529
Ernst P,Fitzgerald JM,Spier S,Canadian Asthma Consensus Conference Summary of recommendationsCan Respir JYear: 19963289101
Newman Taylor AJ,Cullinan P,Burge PS,Nicholson P,Boyle C,BOHRF guidelines for occupational asthmaThoraxYear: 200560536436615860710
Heederik D,van Rooy F,Exposure assessment should be integrated in studies on the prevention and management of occupational asthmaOccup Environ MedYear: 200865314915018283124
Venables KM,Prevention of occupational asthmaEur Respir JYear: 1994747687788005261
Vineis P,Evidence-based primary prevention?Scand J Work Environ HealthYear: 200026544344811103844
Drummond MF,Stoddart GL,Torrance GW,Method of economic evaluation of health care programesYear: 1987Oxford Medical Publications, Oxford
Heederik D,Henneberger PK,Redlich CA,Primary prevention: exposure reduction, skin exposure and respiratory protectionEur Respir RevYear: 20122112411212422654083
Schoenbach V,Wayne D,Understanding the fundamentals of epidemiology: an evolving text. Chapter 8: Analytic study designsYear:, Chapel Hill


[Figure ID: F1]
Figure 1 

Work-related asthma is dividedinto occupational asthma andwork-aggravated asthma.

[Figure ID: F2]
Figure 2 

Subgroups of OA.

[Figure ID: F3]
Figure 3 

Flow diagram demonstrating thesource of references.

[TableWrap ID: T1] Table 1 

Subcategories of irritant-induced OA

Subcategories of irritant-induced OA Exposure concentration Duration of exposure
Reactive airways dysfunction syndrome (RADS)
Extremely high, > OEL
≤1 day
Not so sudden onset of irritant-induced OA
Moderate, around OEL
>1 day <4 months
Low dose irritant-induced OA Low, below OEL >4 months

OA = Occupational asthma, OEL = Occupational Exposure Limit.

[TableWrap ID: T2] Table 2 

Agents and professions showingevidence of occupational COPD

Agents, number of studies (n) Work-sites or professions, number of studies (n)
○ ammonia (1)
○ cement dust (4)
○ chlorine (1)
○ cleaning agent (1)
○ mustard gas (1)
○ diesel exhaust (2)
○ environmental tobacco smoke(1)
○ isocyanate (1)
○ smoke (1)
○ sulphur dioxide (1)
○ construction work (3)
○ swine confinement (1)
○ farming (1)
○ foundry (1)
○ metallurgical industry workers (1)

COPD = Chronic obstructive pulmonary disease.

[TableWrap ID: T3] Table 3 

Overview of individual agentscausing irritant-induced OA oroccupational COPD

Agent CAS Strength of evidence (modifiedRCGP three star grading) Number of studies peragent References
", acetic
", not specified
", dodecanedioic
", various
", " (hydrochloric, hydrofluoric, nitric, perchloric, sulfuric)
", hydrochloric
", hydrofluoric
", sulfuric
", not specified
", alkyl cyanoacrylates
", cyanoacrylate glue
", " [loctite]
", methacrylates
", methyl 2-cyanoacrylate
", methylmethacrylate
Aluminum salts
aluminum fluoride: 7724-18-1
aluminum sulfate: 10043-01-3
2-Aminoethanol [2-ethanolamine]
Ammonium chloride (triple salt)
Ammonium thioglycolate
Amprolium hydrochloride
", various
", dioctyl phthalate
", hexahydrophthalic
", himic
", maleic
", methyltetrahydrophthalic
", phthalic anhydride
", pyromellitic dianhydride
", tetrachlorophthalic anhydride
[200], [201], [202], [203]
", benzene-1, 2, 4- tricarboxylic acid 1,2-anhydride [trimellitic anhydride]
Aziridine, polyfunctional
Azobisformamide [azodicarbonamide]
Benzalkonium chloride (fumes)
1, 2-Benzisothiazoline-3-one (fumes)
Bisulfite, SO2
SO2: 7446-09-5
Bromine, hydrobromic acid
Bromochlorodifluoromethane (Halon 1211)
Bromotrifluoromethane (Halon 1301)
Cadmium (fumes)
Calcium carbonate [chalk powder]
Calcium oxide
Captafol (chlorinated thiocarboximide fungicide)
Carbon black dust
Chloramine T (powder dust)
Chromate (not specified)
[see also cement]
3-(Diamino-amino)propylamine 3-(dimethylamino)propylamine]
Diamine, aliphatic + cycloaliphatic (hardener) 2855-13-2 (isophorone diamine)
Diazonium tetrafluoroborate 14239-22-6
Dichlorodiethyl sulfide [mustard gas] +505-60-2
Dichlorvos (organophosphate)
2-Diethylaminoethanol [diethyl aminoethanol]
2-Dimethylaminoethanol [dimethyl ethanolamine]
Diinitrogen tetraoxide [dinitrogentetroxide]
Ethylenediamine [ethylene diamine]
Ethylene oxide
Formaldehyde (gas, dust)
[278-283], [284,285]
Freon, (freon-22)
Glutaraldehyde [glutaral]
Iridium salt
Isocyanates, isocyanurate
", various (HDI, MDI, TDI)
", Diphenylmethane diisocyanate [MDI]
", " prepolymers
", Hexamethylene diisocyanate [HDI]; plus isodurane Diisocyanate
", HDI biuret plus
", 3-Isocyanatomethyl-3,5,5-trimethylcyclohexyl isocyanate [isophorone diisocyanate, IPDI]
", Methyl isocyanate [MIC]
", 1,5-Naphthylene diisocyanate [NDI]
", Polymethylene polyphenyl isocyanate
", Toluene diisocyanate, TDI 2,4: 584-84-9;
", Triglycidil isocyanurate
", Triphenylmethane triisocyanate
Lauryl dimethyl benzyl ammoniumchloride
Metam sodium [methyldithiocarbamate]
Nickel sulphate
→anhydrous 7786-81-4
→hexahydrate 10101-97-0
Ninhydrin 485-47-2
Nitrogen chloride [nitrogen trichloride, trichloramine]
Ozone (gassings)
", not specified
", ammonium
", potassium (7727-21-1) and ammonium peroxydisufate
", alcalic
", Sodium persulfate
", Dipotassium peroxo-peroxodisulfate [potassium persulfate] 7727-21-1
", Diammonium peroxodisulfate [ammonium persulfate]
Phenylglycine acid chloride
Piperazine dihydrochloride
Platinum salts
Polymethyl-methacrylate [plexiglas powder]
Polypropylene, heated to 250 °C
Polyvinyl chloride (fume)
Potassium dichromate
7778-50-9 ( see also chromium;cement)
Potassium aluminum tetrafluoride
Rosin core solder, thermal decomposition [colophony]
Sodium azide (powder dust)
Sodium iso-nonanoyl oxybenzene sulphonate [SINOS] 123354-92-7
Sodium metabisulfite [metabisulfite sodium]
Styrene monomer
Sulfur dioxide
Terpene (3-carene)
Tetrachloroisophthalonitrile (fungicide)
Tetramethrin [1-(5-tretrazoly)- 4-guanyl-tetrazene hydrate] 7696-12-0
Tributyl tin oxide [carpet fungicide]
Tungsten carbide
Tylosin tartrate
Uranium hexafluoride
Urea (fume)
Urea formaldehyde foam
Phenol-formaldehyde resin
Vanadium 7440-62-2 + divanadium pentoxide
Zinc (fume)
Zinc chloride (fume)
Mixed agent
Evidence level
Number of studies peragent
Acid fluxes
Acrylic acid
Airbag content
Bleaching agent (fumes)
(degradation products)
Cleaning agents (not specified)
", detergents
Coffee, green
Cotton (dust, raw)
CNT 750
Cutting oil
Diesel exhaust
ECG ink
Endotoxin (see also cotton dust, swine confinement, poultry confinement, house dust)
Environmental tobacco smoke
Floor sealant (aromatic hydrocarbons)
Fumigating agent
Furan-based binder
", rice
Hairdressing chemicals
Lubricants (not specified)
Metal coat remover (coating removing chemical)
Metal oxide (fume)
Metal working fluids [MWF]
Oil (spill)
Paint (fumes)
Paper dust A111
Perfume agents (research lab)
Pesticides (not specified)
Polyamines, aliphatic
Potroom aluminum smelting
Powder paints
Pyrazolone (see reactive dye)
Reactive dyes
Refractory ceramic fibers [RCF]
Smoke (fires, pyrolysis products)
", (oil fire and duststorm)
", (biomass, indoor)
Soldering flux (fumes)
Solvents (not specified)
Spray paint
Tall oil
Tear gas
Welding fumes
Work-site or profession
Evidence level
Number of studies perwork-site or profession
Ceramic production
Construction work (dust, agent not specified)
", (various)
", animals (pig, beef/veal, dairy, poultry)
[see also isocyanates (MDI)]
Health care workers
Metallurgical industry workers
Poultry confinement
Poultry confinement, slaughtery house
Swine confinement
World Trade Center disaster2001 ** 8 [133,156,541-546]

[ ] down-grading due to lower quality of clinical investigations relative to the scale of the scientific level of the study.

(*) up-grading due to at least 5 cases without contradictory findings.

[TableWrap ID: T4] Table 4 

Strength of evidence foragents, professions and work-siteaccording to the modifiedRCGP three-star system[88]

Evidence level (modified RCGPthree-star grading) Number of agents/work-sites orprofessions Agents, work-site or profession [Synonym] (CAS)
Benzene-1, 2, 4-tricarboxylic acid-1,2-anhydride [trimellitic anhydride] (552-30-7); chlorine (7782-50-5); cobalt (7440-48-4); various isocyanates, isocyanurate (HDI, MDI, TDI), diphenylmethane diisocyanate [MDI] (5873-54-1), toluene diisocyanate, TDI 2,4 (584-84-9), TDI 2,6: (91-08-7); platinum salts (7440-06-4); cement ; environmental tobacco smoke; grain ; welding fumes; construction work (dust, agent not specified); farming, animals (pig, beef/veal, dairy, poultry); swine confinement; World Trade Center disaster 2001
Ceramic production; Phthalic anhydride (85-44-9); glutaraldehyde [glutaral] (11-30-8); sulfur dioxide (7446-09-5); cotton (dust, raw) CNT 750; potroom aluminum smelting; farming (various); foundry; smoke (fires, pyrolysis products); pesticides (not specified); cleaning agents (not specified); health care workers
Acetic acid (64-19-7); sulfuric acid (7664-93-9); metacrylates, loctide® (53858-53-0); aluminum salts [aluminum fluoride] (7724-18-1); aluminum sulfate: (10043-01-3); ammonia (7664-41-7); various anhydrides; tetrachlorophthalic anhydride (117-08-8); azobisformamide (123-77-3); cadmium (fumes) (7440-43-9); carbon black dust (1333-86-4); ethylenediamine (107-15-3); formaldehyde (gas, dust) (50-00-0); hexamethylenetetramine (100-97-0); methyl isocyanate [MIC] (624-83-9); naphthylene diisocyanate (3173-72-6); polymethylene polyphenyl isocyanate (9016-87-9); N-methylmorpholine (09-02-4); ozone (gassings) (10028-15-6); paraquat (4685-14-7); diammonium peroxodisulfate (7727-54-0); phenylglycine acid chloride (39478-47-2); piperazine dihydrochloride (142-64-3); polyvinyl chloride (fume) (9002-86-2); rosin core solder; thermal decomposition (8050-09-7); vanadium (7440-62-2) + divanadium pentoxide (1314-62-1); cleaning agents (not specified); green coffee ; diesel exhaust; endotoxin; oil (spill); paint (fumes); pesticides (not specified); reactive dyes; refractory ceramic fibers [RCF]; smoke (fires, pyrolysis products; oil fire and dust storm); soldering flux; solvents (not specified); health care workers; poultry confinement; slaughtery house; metallurgical industry workers
Nitrogen chloride (10025-85-1); polyamines, aliphatic; potassium persulfate (7727-21-1) and ammonium peroxydisufate (7727-54-0); grain rice
Acids not specified; hydrochloric acids (7647-01-0); alkyl cyanoacrylates; 3-amino-5-mercapto-1,2,4-triazole l(16691-43-3); aziridine, polyfunctional (64265-57-2); chloramine T (powder dust) (7080-50-4); chromate (not specified); 3-(diamino-amino)propylamine (109-55-7); dichlorodiethyl sulfide (505-60-2); 2-diethylaminoethanol (100-37-8); diinitrogen tetraoxide (10544-72-6); hexamethylene diisocyanate [HDI], plus isodurane diisocyanate (822-06-0); HDI biuret plus (4035-89-6); nickel sulphate anhydrous (7786-81-4); hexahydrate (10101-97-0); paraphenylenediamine (106-50-3); persulfate (not specified); polypropylene, heated to 250 °C (9003-07-0); potassium dichromate (7778-50-9); potassium aluminum tetrafluoride (14484-69-6); sodium iso-nonanoyl oxybenzene sulphonate [SINOS] (123354-92-7); sodium metabisulfite (7681-57-4); styrene monomer (100-42-5); chlorofluorocarbons (degradation products); hairdressing chemicals; lubricants (not specified); paper dust A111; aliphatic polyamines; polyester; powder paints; smoke (biomass, indoor)
- 93 Acids various; dodecanedioic (693-23-2-1); hydrofluoric acids (7664-39-3); cyanoacrylate glue; methyl 2-cyanoacrylate (137-05-3); methylmethacrylate (80-62-6); 2-aminoethanol (141-43-5); amino-ethyl-ethanolamine (111-41-1); ammonium chloride (triple salt) (12125-02-9); ammonium thioglycolate (5421-46-5); amprolium hydrochloride (137-88-2); dioctyl phthalate (117-81-7); hexahydrophthalic anhydrides (37226-48-5); himic anhydrides (2746-19-2); maleic anhydrides (108-31-6); methyltetrahydrophthalic anhydrides (26590-20-9); pyromellitic dianhydride (89-32-7); benzalkonium chloride (fumes) (8001-54-5); 1, 2-benzisothiazoline-3-one (fumes) (2634-33-5); bisulfite, SO2:(7446-09-5); hydrobromic acid bromine; bromochlorodifluoromethane [halon 1211] (353-59-3); bromotrifluoromethane [halon 1301](75-63-8); calcium carbonate [chalk powder]; calcium oxide (1305-78-8); captafol (2425-06-1); chlorhexidine (55-56-1); aliphatic + cycloaliphatic diamine, (hardener) (2855-13-2) [isophorone diamine]; diazonium tetrafluoroborate (14239-22-6); dichlorvos [organophosphate] (62-73-7); diethanolamine (111-42-2); 2-dimethylaminoethanol [dimethyl ethanolamine] (108-01-0); ethylene oxide (75-21-8); freon-22; hexachlorophene (70-30-4); hydrazine (302-01-2); iridium salt; isocyanate prepolymers; 3-isocyanatomethyl-3,5,5-trimethylcyclohexyl isocyanate (4098-71-9); triglycidil isocyanurate (2451-62-1); triphenylmethane triisocyanate; isothiazolinone (55965-84-9); lauryl dimethyl benzyl ammonium chloride (139-07-1); metam sodium (144-54-7); methylmercaptan (74-93-1); monoethanolamine (141-43-5); ninhydrin (485-47-2); palladium (7440-05-3); ammonium persulfate; alcalic persulfate; sodium persulfate (7775-27-1); dipotassium peroxo-peroxodisulfate (7727-21-1); phosgene (75-44-5); polyethylene (9002-88-4); polymethyl-methacrylate (9011-14-7); sodium azide (powder dust) (26628-22-8); sulfathiazole (2-14-0); terpene (3-carene) (3466-78-9); tetrahydrothiophene (110-01-0); tetrachloroisophthalonitrile (fungicide); tetramethrin (7696-12-0); tributyl tin oxide; triethanolamine (102-71-6); tungsten carbide (11130-73-7); turpentine (8006-64-2); tylosin tartrate; uranium hexafluoride (7783-81-5); urea (fume) (57-13-6); urea formaldehyde foam (64869-57-4); phenol-formaldehyde resin (9003-35-4); zinc (fume) (7440-66-6); zinc chloride (fume) (7646-85-7); acid fluxes; acrylic acid; airbag content; bleaching agent (fumes); chlorofluorocarbons (degradation products); detergents; cutting oil; ECG ink; floor sealant (aromatic hydrocarbons); fumigating agent; furan-based binder; metal coating remover (coating removing chemical); metal oxide (fume); metal working fluids; perfume agents (research lab); pyrazolone; spray paint; tall oil; tear gas

CAS = Chemical abstracts service.

RCGP = Royal College of General Practitioners.

Article Categories:
  • Research

Keywords: Work-related asthma, Occupational asthma, Occupational COPD, RADS, Irritant-induced asthma.

Previous Document:  Comparison of effects of angiotensin II receptor blocker on morning home blood pressure and cardiore...
Next Document:  Determination of Seven Phenolic Compounds in Rhizoma Sparganii by RP-HPLC.