Physician diagnosed asthma, respiratory symptoms, and associations with workplace tasks among radiographers in Ontario, Canada

Abstract

Background:Medical radiation technologists (MRTs) or radiographers have potential exposure to chemicals including sensitisers and irritants such as glutaraldehyde, formaldehyde, sulphur dioxide, and acetic acid.Aims:To determine the prevalence of asthma and work related respiratory symptoms among MRTs compared with physiotherapists, and to identify work related factors in the darkroom environment that are associated with these outcomes.Methods:As part of a two component study, we undertook a questionnaire mail survey of the members of the professional associations of MRTs and physiotherapists in Ontario, Canada, to ascertain the prevalence of physician diagnosed asthma, and the prevalence in the past 12 months of three or more of the nine respiratory symptoms (previously validated by Venableset alto be sensitive and specific for the presence of self reported asthma). Information on exposure factors during the past 12 months, such as ventilation conditions, processor leaks, cleanup activities, and use of personal protective equipment was also collected.Results:The survey response rate was 63.9% among MRTs and 63.1% among physiotherapists. Most analyses were confined to 1110 MRTs and 1523 physiotherapists who never smoked. The prevalence of new onset asthma (since starting in the profession) was greater among never smoking MRTs than physiotherapists (6.4%v3.95%), and this differed across gender: it was 30% greater among females but fivefold greater among males. Compared with physiotherapists, the prevalence of reporting three or more respiratory symptoms, two or more work related, and three or more work related respiratory symptoms in the past 12 months was more frequent among MRTs, with odds ratios (ORs) (and 95% confidence intervals) adjusted for age, gender, and childhood asthma, of 1.9 (1.5 to 2.3), 3.7 (2.6 to 5.3), and 3.2 (2.0 to 5.0), respectively. Analyses examining latex glove use indicated that this was not likely to account for these differences. Among MRTs, respiratory symptoms were associated with a number of workplace and exposure factors likely to generate aerosol or chemical exposures such as processors not having local ventilation, adjusted OR 2.0 (1.4 to 3.0); leaking processor in which clean up was delayed, 2.4 (1.6 to 3.5); floor drain clogged, 2.0 (1.2 to 3.2); freeing a film jam, 2.9 (1.8 to 4.8); unblocking a blocked processor drain, 2.4 (1.6 to 3.7); and cleaning up processor chemical spill, 2.8 (1.9 to 4.2). These outcomes were not associated with routine tasks unlikely to generate exposures, such as working outside primary workplace, loading film into processor, routine cleaning of processors, or removing processed film. Males reported that they carried out a number of tasks potentially associated with irritant exposures more frequently than females, consistent with the marked increase in risk for new onset asthma.Conclusions:These findings suggest an increase of work related asthma and respiratory symptoms shown to denote asthma among MRTs, which is consistent with previous surveys. The mechanism is not known but appears to be linked with workplace factors and may involve a role for irritant exposures.

EAACI position paper: irritant‐induced asthma

“…The frequent use of bleach (hypochlorite), ammonia, and degreasing sprays has been consistently associated with asthma among workers exposed to cleaning agents (42,44,48), although the precise chemical exposures and the mechanisms responsible for the increased incidence of asthma have not been clarified since cleaning materials typically contain a wide variety of ingredients, some of which are respiratory irritants, while others are potential airway sensitizers (Table 6). Other occupations associated with increased risk of asthma that cannot be readily or completely explained on the basis of a clear sensitizing exposure are presented in Table 6 (47,(49)(50)(51)(52)(53)(54)(55)(56).…”

Work‐attributed symptom clusters (darkroom disease) among radiographers versus physiotherapists: Associations between self‐reported exposures and psychosocial stressors

“…We included questions common for both professions regarding demographics, dates of training and starting work, shifts, hours, respiratory, and other symptoms, questions regarding chemical sensitivity, psychosocial factors, and smoking history. Results of the lower respiratory symptom analyses have been previously reported [Liss et al, 2003]. The questionnaire for MRTs included questions regarding ventilation conditions, X-ray processing tasks, leaking processors, clogged drains, cleanup activities, and personal protective equipment (PPE) (for the past 12 months).…”

“…The questionnaire included the following questions addressing 18 different symptoms in addition to the lower respiratory symptoms which were previously reported [Liss et al, 2003]. We asked, on how many days in the past 12 months (choices: none, 1-7, 8-14, 15þ), have you had the following symptoms (listed), and were they worse at work (no/yes)?…”

“…Subjects were recruited from members of the two professional associations, the Ontario Association of Medical Radiation Technologists (OAMRT) and the Ontario Physiotherapy Association (OPA) as previously reported [Liss et al, 2003]. Within the OAMRT, we included in our sampling frame only the 2,761 radiological technologists (excluding radiation therapists, nuclear medicine technologists, and magnetic resonance imaging technologists).…”

Effects of Glutaraldehyde Exposure on Human Health

“…Recently, not only irritation and sensitization but also darkroom disease (DRD) among radiographers, associated with various symptoms including indefinite complaints, has been reported to be related to GA exposure, though the relationship between DRD and GA exposure has not been clarified 9,10) . In addition, onset of multiple chemical sensitivity (MCS) has been reported among nurses using GA 11,12) , however, there was no description about work environmental conditions.…”