The use of volatile organic compounds (VOCs)

Implementing an evidence-based identification and regulatory process for occupational asthmagens will help to ensure primary prevention of occupational asthma in the US. This should include: establishing consistent identification criteria; publishing a list of occupational asthmagens; collecting use, exposure, and health effects information on asthma-causing substances; requiring medical surveillance and medical removal protection in addition to exposure limits; and stimulating development of safer alternatives.

Between 1981-1986 a state-based occupational health telephone hotline received more than 8,000 inquiries on over 3,000 hazardous agents. Major caller groups were employees (37%), employers (20%), health care providers, primarily physicians (19%), government agencies (12%), and labor unions (6%). Employees were the fastest growing caller group. Callers inquired about general health hazards of chemicals (65%), the relation of symptoms to work (22%), and risks to pregnancy (13%).

Exposure to glutaraldehyde is a recognized cause of work-related asthma. An investigation was undertaken to describe exposure to glutaraldehyde among workers making bioprosthetic heart valves and to make recommendations for prevention. At the two largest heart valve manufacturing facilities in California, the work process was observed; employer representatives and glutaraldehyde-exposed workers were interviewed; and employer written records, including company-generated industrial hygiene data, were analyzed. Approximately 600 female workers had continuous airborne exposure to glutaraldehyde over the course of every work shift and the routine potential for skin and eye contact with glutaraldehyde while making heart valves. Employee short-term (15-min) glutaraldehyde exposures were all well below the current regulatory ceiling level (0.20 ppm). Overall, approximately 40% of the glutaraldehyde-related job tasks involved exposures above the American Conference of Industrial Hygienists threshold limit value ceiling of 0.05 ppm; the majority (71.4% and 83.3%, depending on the company) involved exposures greater than 0.015 ppm. At one company, two cases of physician-diagnosed asthma were recorded by the employer in the previous 5-year period; these reports met the surveillance case definition for new-onset, work-related asthma associated with a known asthma inducer. Factors that contributed to worker exposure included large exposed surface areas of glutaraldehyde under agitation; working with glutaraldehyde-treated tissue in proximity to workers' breathing zones; manual pouring and disposal of glutaraldehyde solutions without local exhaust ventilation, eye protection, and waste neutralization; and prolonged use of latex gloves. Workers making bioprosthetic heart valves are at risk for occupationally acquired asthma. Employers should implement additional engineering controls to minimize workers' exposures to at least below a level of 0.015 ppm, an appropriate glove to prevent workers' skin exposure to glutaraldehyde, consistent and universal use of eye protection, and a medical surveillance program for glutaraldehyde-exposed workers.