Reactive Airways Dysfunction Syndrome in a Nurse Exposed to Pentamidine

Stanbury, Martha; Gatti, E; Sokolowski, Joseph W.

doi:10.1097/00043764-199604000-00004

Cited by 6 publications

(3 citation statements)

References 3 publications

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“…Later observations have made it clear that RADS can occur after exposure to a great variety of chemicals generated as gases or aerosols, such as sulphuric acid (22), as well as to smoke (7,14) or particles with an irritant nature (10,23,24). Inhalation accidents may occur at home (25), in the workplace (14,21,26,27), or in the general environment (28,29). There is common agreement that RADS is best described as non-immunological occupational asthma without a latency period, occurring after a single exposure to airway irritants and should be distinguished from the more commonly observed occupational asthma, which has in many cases an underlying immunologic mechanism characterized by sensitization (30).…”

Section: Discussionmentioning

confidence: 99%

Respiratory effects in the aftermath of a major fire in a chemical waste depot

Greven¹,

Kerstjens

Duijm³

et al. 2009

Scand J Work Environ Health

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Objective The aim of this study was to investigate respiratory effects among emergency services first responders and residents exposed to combustion products in the aftermath of a chemical waste depot fire.Methods The study population comprised 138 individuals who were present in the area downwind of an accidental fire. Identified by telephone interview six years later, subjects with persistent respiratory symptoms were suspected as having Reactive Airways Dysfunction Syndrome (RADS). Medical tests were performed. For bronchial responsiveness, a cut-off point of PD 20 <2.39 mg histamine was taken and a dose-response slope (DRS) was calculated. Suspected RADS cases were compared with healthy controls for exposure to combustion products, lung function, and bronchial responsiveness. ResultsThe 25 suspected RADS cases were more frequently exposed than the 99 controls; the crude odds ratio for high versus low exposure was 6.5 [95% confidence interval (95% CI) 2.4-18.0]. Suspected cases showed a lower ratio of forced expiratory volume in one second to forced vital capacity (FEV 1 /FVC; P=0.028). Overall, suspected cases had a higher DRS than controls. The difference was significant for males only (P=0.006), and non-smoking males (P=0.014). Highly exposed subjects had a higher DRS than low exposed subjects (P=0.056). These differences were significant when restricted to non-smokers (P=0.034) and males (P=0.019). Differences between cases and controls were stronger when the population was restricted to current non-smokers.Conclusions Persistent respiratory symptoms and bronchial responsiveness were associated with exposure to combustion products of a chemical waste depot fire which occurred more than six years earlier. Authorities and emergency services are recommended to take this into consideration when managing incidents in order to limit possible exposure to airway irritants.

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Section: Discussionmentioning

confidence: 99%

Respiratory effects in the aftermath of a major fire in a chemical waste depot

Greven¹,

Kerstjens

Duijm³

et al. 2009

Scand J Work Environ Health

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show abstract

“…113 In a more serious acute reaction, asthma-like symptoms in a health care worker required several months to resolve after exposure to aerosolized pentamidine. 114 The use of the Respirgard II nebulizer is recommended for administering aerosolized pentamidine and may help minimize ambient pentamidine concentrations because its design routes exhaled breaths through a 0.2-µm filter. 18 The drug may escape, however, when the patient removes the mouthpiece to talk or cough.…”

Section: Environmental Risks To Health Care Workersmentioning

confidence: 99%

Aerosolized Antimicrobial Therapy in Acutely Ill Patients

Wood

Boucher

2000

Pharmacotherapy

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Recent data are sparking renewed interest in therapy with aerosolized antimicrobials in critically ill patients as well as other populations such as those with neutropenia, human immunodeficiency virus infection, and cystic fibrosis. Pneumonia is a common complication in these patients and is associated with substantial morbidity and increased mortality. Clinical trials evaluated aerosolized antimicrobials for the prevention and treatment of pneumonia in hospitalized patients. In addition, factors that affect the pulmonary deposition of aerosolized drugs in mechanically ventilated patients were identified.

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“…8–10 Primary health effects associated with occupational exposure to pentamidine include dyspnea, chest tightness, cough, conjunctivitis, hematologic abnormalities, perinasal paresthesia and numbness. 11, 12 Aerosolized pentamidine also has been shown to be embryotoxic in animals. 13 Respiratory irritation, shortness of breath, ocular irritation, asthma, and skin rash have been reported by healthcare workers administering aerosolized ribavirin.…”

Section: Introductionmentioning

confidence: 99%

Precautionary Practices of Respiratory Therapists and Other Health-Care Practitioners Who Administer Aerosolized Medications

et al. 2015

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Introduction Respiratory therapists and other healthcare workers are potentially exposed to a variety of aerosolized medications. The NIOSH Health and Safety Practices Survey of Healthcare Workers describes current exposure control practices and barriers to using personal protective equipment during administration of selected aerosolized medications. Methods An anonymous, multi-module, web-based survey was conducted among members of healthcare professional practice organizations representing respiratory therapists, nurses and other healthcare practitioners. A module on aerosolized medications included submodules for antibiotics (amikacin, colistin, tobramycin), pentamidine and ribavirin. Results The submodules on antibiotics, pentamidine and ribavirin were completed by 321, 227 and 50 respondents, respectively, who were mostly respiratory therapists. The relatively low number of ribavirin respondents precluded meaningful interpretation of these data and may represent the rare use of this drug. Consequently, analysis focused on pentamidine, classified by NIOSH as a hazardous drug, and antibiotics amikacin, colistin, and tobramycin which currently lack authoritative safe handling guidelines. Respondents who administered pentamidine were more likely to adhere to good work practices compared to those who administered these antibiotics. Examples included: training received on safe handling procedures (75% vs 52%), availability of employer standard procedures (82% vs 55%), use of aerosol delivery devices equipped with an expiratory filter (96% vs 53%) or negative pressure rooms (61% vs 20%), and always using respiratory protection (51% vs 13%). Conclusions Despite the availability of safe handling guidelines for pentamidine, implementation was not universal, placing workers, co-workers, and even family members at risk of exposure. Although the antibiotics included in this study lack authoritative safe handling guidelines, prudence dictates that appropriate exposure controls are used to minimize exposure to the antibiotics as well as other aerosolized medications. Employers and employees share responsibility for ensuring that precautionary measures are taken to keep exposures to all aerosolized medications as low as practicable.

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Reactive Airways Dysfunction Syndrome in a Nurse Exposed to Pentamidine

Cited by 6 publications

References 3 publications

Respiratory effects in the aftermath of a major fire in a chemical waste depot

Respiratory effects in the aftermath of a major fire in a chemical waste depot

Aerosolized Antimicrobial Therapy in Acutely Ill Patients

Precautionary Practices of Respiratory Therapists and Other Health-Care Practitioners Who Administer Aerosolized Medications

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