Background -Glutaraldehyde is the best disinfectant for fibreoptic endoscopes. It is also used in the processing ofx ray films. A number of studies have reported eye, nose, and respiratory symptoms in exposed workers. Three individual case reports ofoccupational asthma in endoscopy workers and a radiographer have also been published. We describe a further seven cases ofoccupational asthma due to glutaraldehyde in endoscopy and x ray departments, together with exposure levels measured during the challenge tests and in 19 endoscopy and x ray departments in the region. Methods -Eight workers were referred for investigation ofsuspected occupational asthma following direct or indirect exposure to glutaraldehyde at work. They were investigated by serial measurements of peak expiratory flow (PEF) and specific bronchial provocation tests. Glutaraldehyde levels were measured using personal and static short and longer term air samples during the challenge tests and in 13 endoscopy units and six x ray darkrooms in the region where concern about glutaraldehyde exposure had been expressed. Three of the workers investigated with occupational asthma came from departments where glutaraldehyde air measurements had been made; the others came from other hospitals or departments. Results -The diagnosis of occupational asthma was confirmed in seven workers, all ofwhom had PEF records suggestive of occupational asthma and positive specific bronchial challenge tests to glutaraldehyde. Bronchial provocation testing was negative in one worker who was no longer exposed and who had a less clearcut history of occupational asthma. Three workers also had a positive specific bronchial challenge to formaldehyde. The mean level of glutaraldehyde in air during the challenge tests was 0-068 mg/m3, about one tenth of the short term occupational exposure standard of0 7 mg/m3. The levels obtained in the challenge chamber were similar to those measured in 13 endoscopy suites and six x ray darkrooms where median short term levels were 0-16 mg/m3 during decantation in endoscopy suites and <0_009 mg/m3 in darkrooms. Conclusions -Glutaraldehyde can cause occupational asthma. The exposure levels measured in the workplace suggest that sensitisation may occur at levels below the current occupational exposure standard. (Thorax 1995;50:156-159)

Abstractchromate solution is helpful in making the specific diagnosis where doubt exists. Background -Exposure to chromium dur- (Thorax 1997;52:28-32) ing electroplating is a recognised though poorly characterised cause of occupational Keywords: occupational asthma, electroplating, asthma. The first series of such patients chrome, nickel, bronchial provocation testing. referred to a specialist occupational lung disease clinic is reported. Methods -The diagnosis of occupationalChromium is the major industrial contact allerasthma was made from a history of asthma gen that causes dermatitis 1 and is widely used with rest day improvement and confirmed in electroplating, dyes, leather tanning, and by specific bronchial provocation testing cement works. Single cases of asthma caused with potassium dichromate and nickel by chrome have been described since the ninechloride.teenth century and in the 1930s both Smith 2 Results -Seven workers had been exposed and Joules 3 reported chromium induced to chrome and nickel fumes from electro-asthma due to exposure at work. Since then plating for eight months to six years before there have been very few reports of respiratory asthma developed. One subject, although symptoms in workers associated with electroexposed for 11 years without symptoms, plating. developed asthma after a single severeElectroplating is the application of a metallic exposure during a ventilation failure. coating to articles using inorganic salts of metals This was the only subject who had never such as chromium or nickel. In the electrosmoked. The diagnosis was confirmed by plating process the gases released at the elecspecific bronchial challenges. Two workers trodes rise to the surface of the bath and genhad isolated immediate reactions, one a erate a fine aerosol. Nickel electroplating is late asthmatic reaction, and four a dual 95% efficient and gas generation is minimal response following exposure to nebulised whereas chromium electroplating is inefficient potassium dichromate at 1-10 mg/ml. Two and 80-90% of the total energy used may of the four subjects were also challenged be directed to the generation of potentially with nebulised nickel chloride at respirable aerosols of chromic acid. Epi-0.1-10 mg/ml. Two showed isolated late demiological studies have suggested increased asthmatic reactions, in one at 0.1 mg/ml, respiratory morbidity in electroplaters comwhere nickel was probably the primary pared with galvanisers that is related to exsensitising agent. Four workers carried out posure to chromium. 4 We report here our two hourly measurements of peak ex-experience with chromium induced asthma in piratory flow over days at and away workers referred to a specialist occupational from work. All were scored as having lung disease clinic over 10 years. occupational asthma using OASYS-2. Breathing zone air monitoring was carried out in 60 workers from four decorative Methods The Occupational Lung Disease Unit, and two hard chrome plating shops from Subjects were identified at a specialist oc-

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Objectives-To assess the prevalence of respiratory symptoms and to measure spirometry in a sample of employees of Birmingham International Airport, United Kingdom, to examine whether occupational exposure to aircraft fuel or jet stream exhaust might be associated with respiratory symptoms or abnormalities of lung function. Methods-Cross sectional survey by questionnaire and on site measurement of lung function, skin prick tests, and exhaled carbon monoxide concentrations. Occupational exposure was assigned by job title, between group comparison were made by logistic regression analysis. Results-222/680 full time employees were studied (mean age 38.6 y, 63% male, 28% current smokers, 6% self reported asthma, 19% self reported hay fever). Upper and lower respiratory tract symptoms were common and 51% had one or more positive skin tests. There were no significant diVerences in lung function tests between exposure groups. Between group comparisons of respiratory symptoms were restricted to male members of the medium and high exposure groups. The adjusted odds ratio (OR) for cough with phlegm and runny nose were found to be significantly associated with high exposure (OR 3.5, 95% confidence interval (95% CI) 1.23 to 9.74 and 2.9, 1.32 to 6.40 respectively) when the measured confounding eVects of age and smoking, and in the case of runny nose, self reported hay fever had been taken into account. There was no obvious association between high exposure and the presence of shortness of breath or wheeze, or for the symptoms of watering eyes or stuVy nose. Conclusions-These findings support an association in male airport workers, between high occupational exposures to aviation fuel or jet stream exhaust and excess upper and lower respiratory tract symptoms, in keeping with a respiratory irritant. It is more likely that these eVects reflect exposure to exhaust rather than fuel, although the eVects of an unmeasured agent cannot be discounted. (Occup Environ Med 1999;56:118-123)

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