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Acute Respiratory Syndrome After Inhalation of Waterproofing Sprays: A Posteriori Exposure-Response Assessment in 102 Cases

2006; Taylor & Francis; Volume: 3; Issue: 5 Linguagem: Inglês

10.1080/15459620600628845

1545-9632

David Vernez, Raffaella Bruzzi, Hugo Kupferschmidt, Alice De-Batz, P. O. Droz, Romain Lazor,

Occupational exposure and asthma

Waterproofing agents are widely used to protect leather and textiles in both domestic and occupational activities. An outbreak of acute respiratory syndrome following exposure to waterproofing sprays occurred during the winter 2002–2003 in Switzerland. About 180 cases were reported by the Swiss Toxicological Information Centre between October 2002 and March 2003, whereas fewer than 10 cases per year had been recorded previously. The reported cases involved three brands of sprays containing a common waterproofing mixture, that had undergone a formulation change in the months preceding the outbreak. A retrospective analysis was undertaken in collaboration with the Swiss Toxicological Information Centre and the Swiss Registries for Interstitial and Orphan Lung Diseases to clarify the circumstances and possible causes of the observed health effects. Individual exposure data were generated with questionnaires and experimental emission measurements. The collected data was used to conduct numeric simulation for 102 cases of exposure. A classical two-zone model was used to assess the aerosol dispersion in the near- and far-field during spraying. The resulting assessed dose and exposure levels obtained were spread on large scales, of several orders of magnitude. No dose-response relationship was found between exposure indicators and health effects indicators (perceived severity and clinical indicators). Weak relationships were found between unspecific inflammatory response indicators (leukocytes, C-reactive protein) and the maximal exposure concentration. The results obtained disclose a high interindividual response variability and suggest that some indirect mechanism(s) predominates in the respiratory disease occurrence. Furthermore, no threshold could be found to define a safe level of exposure. These findings suggest that the improvement of environmental exposure conditions during spraying alone does not constitute a sufficient measure to prevent future outbreaks of waterproofing spray toxicity. More efficient preventive measures are needed prior to the marketing and distribution of new waterproofing agents. Keywords: airborne particlesexposure assessmentfluororesinsrespiratory diseaseswaterproofing spray ACKNOWLEDGMENTS The following physicians participating in the Swiss Registries for Interstitial and Orphan Lung Diseases contributed to this study by providing detailed clinical data on one or more cases: E. Achermann (Schlieren), C. Anderhalden (Münsingen), R.T. Anderhalden (Münsingen), M.C. Arigoni (Viganello), H.U. Bettschen (Spiez), T. Bieri (Altdorf), C. Blanchet (Lausanne), W. Bleisch (Aldelboden), H. Borrer (Solothurn), J.L. Bourban (Fully), P. Brändle (Cham), O. Brändli (Faltigberg-Wald), T. Bregenzer (Aarau), H. Bucher (Engelberg), T. Büsser (Gossau), N. Cottier (Sainte-Croix), M. Coutaz (St-Maurice), L. Christin (Nyon), C. Duc (Sion), T. Dünner (Herrliberg), D. Dürr (Heimberg), B. Durschei (Films), C. Ehrat (Engelberg), J. Fieber (Frutigen), J.-W. Fitting (Lausanne), M. Frei-Frischknecht (Schaffhausen), J.-G. Frey (Montana), S. Garrone (Monthey), W. Graf (Bern), S. Grandin (Geneva), A.-L. Gudinchet (Morges), O. Guinand (Geneva), S. Haase (Thun), J. Häggi (Schaffhausen), R. Heinzer (Lausanne), E. Iff (Solothurn), J. Inauen (Schlieren), S. Isaac (Lyon, France), D. Jacques (Lyon, France), P. Joder (St. Gallen), M. Katchaluba (Clarens), H. Kaufmann (Muttenz), M. Kaufmann (Lufingen), S. Keller (Wetzikon), C. Knoblauch (Stans), E. Koltai (Laufenburg), S. Kraljevic (Menziken), P. Krämer (Colombier), R. Krapf (Bruderholz), C. Kronauer (Zürich), J.-L. Magnenat (Geneva), C. Millard (Geneva), A. Martin-Achard (Geneva), H. Matti (Thun), T. Meier-Ruge (Fiesch), C. Meili (Wetzikon), J. Monegat (St. Gallen), H. Mottaz (Grolley), G. Müller-Esch (Konstanz, Germany), N. Nierhoff (St. Gallen), A. Paky (St. Gallen), B. Pfaaffi (Thun), R. Rakotoariminana (La Chaux-de-Fonds), M. Ramser (Basel), M. Riederer (Burgdorf), B. Riggenbach (Neuchâtel), C. Rindisbacher-Wyler (Uster), T. Ringli (Romanshorn), N. Roehrich (Lucens), A. Sauty (Lausanne), W. Schaub (Wetzikon), B. Schmid-Stöcklin (Dottikon), P. Schneller (Laax), O. Schoch (St. Gallen), R. Schück (Heerbrugg), M. Spiegel (Uster), U. Stampfli (Horgen), J. Stebler (Schaffhausen), J. Stierli (Vals), P. Strohmeier (Therwil), J.-M. Sulliger (Burgdorf), D. Tagan (Vevey), A. Terrier (Menznau), F. Testud (Lyon, France), Y. Trisconi (Morges), J.-M. Tschopp (Montana), C. Uldry (Rolle), A.-C. Vaney (Lausanne), C. Vauthey (Epalinges), B. Vermeulen (Geneva), J.-F. Vodez (Montreux), C. Voegeli (Genève), P. Vogt (Zürich), L. Vollenweider (Yverdon-les-Bains), J. Wacker (La Chaux-de-Fonds), C. Wicky (Monthey), A. Zorzi (Geroldswil), and K. Zürcher (Bern). The Swiss Registries for Interstitial and Orphan Lung Diseases are supported by the Swiss Academy of Medical Sciences, the Swiss Respiratory Society, the Swiss Pulmonary League, the Geneva Pulmonary League, the Geneva University Hospitals, the Bern University Hospital, GlaxoSmithKline, Aventis, and Actelion. The authors acknowledge Elodie Namer for data collection, data capture, and administrative tasks; Suzanne Meister for spraying measurements; and Dr. Bernhard Sandner for expert comments regarding fluororesin chemistry; as well as all patients who provided us with detailed information on their exposure conditions. The exposure assessment undertaken at the Institute of Occupational Health Sciences took place in the context of a doctoral study supported by the Swiss National Science Foundation (Grant 3200B0-100343). Notes A DELAY = delay before medical care. B DYSP = dyspnea score. C SCORE = symptom score. A Spearman's rank correlation coefficient. WBC = white blood cells, CRP = C-reactive protein. B Pearson product-moment correlation coefficient; PaO2 = arterial oxygen partial pressure