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Occupational asthma – how to?

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Arbeidsrelatert astma

“Hensikt og omfang

  • Hensikten med veiledningen er å beskrive utredningen av mulig arbeidsrelatert astma, primært til bruk i de arbeidsmedisinsk sykehusavdelingene.
    • Arbeidsmedisinere utenfor slik avdeling kan basert på egen kompetanse, foreta deler av utredningen der dette synes hensiktsmessig.

Forekomst

  • Arbeidsrelatert astma representerer et vesentlig helseproblem i befolkningen og antas å være ansvarlig for 5-15 % av nyoppståtte tilfeller av astma hos voksne1.
  • De arbeidsmedisinske avdelingene i Norge utreder pr 2011 ca 250 saker årlig med spørsmål om arbeidsrelatert astma.
  • Arbeidstilsynets statistikk, som er basert på melding fra leger, har etter år 2000 vist i underkant av 100 tilfeller årlig. I perioden 1995- 99 var tallet det dobbelte. Med stor sannsynlighet er det en underrapportering av tilfellene da kun et fåtall av legene benytter seg av meldesystemet.

Inndeling av arbeidsrelatert astma

  • Arbeidsrelatert astma omfatter tilfeller som enten er forårsaket av (’arbeidsindusert (yrkesbetinget) astma’) eller
  • Forverres av eksponering i arbeidet (’arbeidsforverret astma’)
  • Ved alle tilfeller av nyoppstått astma er det viktig å avgjøre om eksponering i arbeidet har forårsaket sykdommen og spesielt om det er utviklet sensibilisering (’allergisk yrkesbetinget astma’) mot allergener eller lavmolekylære stoffer som forekommer i pasientens arbeidsmiljø
  • Irritanter kan forårsake astma ved kjemiske ulykker, såkalte ’reactive airways dysfunction syndrome’ (RADS). Og trolig også ved påvirkning i lavere nivå over tid, såkalt ’lavdose irritantindusert astma’2.

Utsatte yrkesgrupper

  • Det er hittil identifisert over 475 ulike agens som kan fremkalle arbeidsindusert astma gjennom sensibilisering3.
  • Eksempler på sensibiliserende agens som kan fremkalle arbeidsindusert astma:
Planter Yrke Referanse
Kornstøv (hvete, rug etc.)

Støv fra tørkede pulveriserte næringsmidler

Bomull, flax, hamp

KaffebønnestøvTobakksstøv

Trestøv (eksotiske trearter)

Bakere, møllearbeidere

Næringsmiddelindustri

Tekstilarbeidere

Kaffearbeidere

Tobakksarbeidere

Møbelsnekkere, treindustriarbeidere

45678
Dyr
Laboratoriedyr (rotter, mus etc.)

Fugl

Katt, hund etc.

Skalldyr (krabbe, reke etc.)Laks

Insektstøv

Midd

Dyrelaboratoriearbeidere

Fjærkreoppdrettere

Dyreforhandlere

Fiskeindustriarbeidere

Fiskeindustriarbeidere

Birøktere m.m.

Hønsefarmarbeidere

910111213
Enzymer og legemidler
EnzymerPenicillin, Cimetidin Produksjon av vaskemidler, Bakere

Legemiddelindustri, helsearbeidere

14151617
Lavmolekylære kjemiske forbindelser
DiisocyanaterSyre anhydrider Epoxy resiner

Varmespaltningsprodukter av plast (syre anhydrider m.m.)Kolofonium og andre flussmidler

Persulfater, oksidative hårfargemidler

Skumplastarbeidere

Bil- og flylakkerere

Bilopprettere, malere m.m.

Kjemisk industri

Plastarbeidere

Elektrikere, elektronikkarbeidere

Frisører

181920212223
Metaller og metallsalter
Nikkel

Krom

Kobolt

Vanadium

Metallarbeidere, sveisere

Gassturbinrensere

24252627
Andre
’Hallastma’(fluorforbindelser, støv)

Dyreavl, endotoksiner, soppsporer

Smelteverksarbeidere

Gårdbrukere

2829

Utredning av arbeidsrelatert astma

Arbeidsanamnese

  • Kronologisk registrering av alle arbeidsforhold med angivelse av bedrift og yrkestittel
  • Beskrive arbeidsprosesser, eksponeringer og verneforhold med spesiell vekt på eksponering for biologisk støv/partikler og kjemiske allergener/ haptener.
  • Om nødvendig skaffe tilveie ytterligere informasjon om eksponering
    • Informasjon fra bedriftshelsetjeneste
    • Historiske data om eksponering i aktuelle bransje
    • Yrkeshygieniske målinger og vurderinger
    • Bedriftsbesøk

Miljøanamnese

  • Beskrivelse av dyrehold, teppegulv, fuktskader og andre forhold i bolig
  • Annen fritidseksponering

Sykdommer i familien

  • Familiær forekomst av allergier og lungesykdom

Allergier

  • Pollenallergi, andre allergier

Tidligere sykdommer

  • Astma, atopi eller eksem som barn
  • Lungesykdommer og andre sykdommer
  • Eventuelt skaffe tilveie kopi av primærjournal fra bedriftslege, allmennlege og spesialist

Utredning av den aktuelle lidelsen

Har pasienten astma?

  • Sykehistorie og kliniske funn
  • Spirometri med reversibilitetstest
  • PEF-registrering i arbeid og fritid
    • Prøveperioden bør være i minimum 4 uker med 4 målinger pr døgn. Slike målinger bør fortrinnsvis gjøres med elektronisk PEF-måler som lagrer måleverdi og måletidspunkt30
  • Måling av bronkial reaktivitet: Metakolintest
  • Inflammometri
    • Ekshalert NO
    • Indusert sputum
    • ECP (eosinofilt kationisk protein)

Har pasienten arbeidsrelatert obstruksjon?

  • Beskrive symptomene og deres relasjon til eksponeringer og friperioder
    • Nye prosesser eller stoffer (umiddelbart) før symptomdebut
    • Eksponering for irritanter og sensibiliserende substanser
    • Obs senreaksjon (for eksempel nattlig hoste)
    • Bedring i friperioder mer sensitivt enn forverring i arbeidet

Skyldes pasientens astma en spesifikk sensibilisering mot et allergen eller et kjemisk stoff i pasientens arbeidsmiljø?

  • Prikktest
    • Kommersielle ekstrakter
    • Egenproduserte ekstrakter
  • In-vitro diagnose
    • Spesifikk IgE på relevante yrkesallergener
    • Histaminfrigjøringstest
  • Provokasjon og elimineringsforsøk
    • Ved hjelp av sykemelding eller friperioder
    • Spesifikk provokasjon

Medikamenter/stimulantia

  • Medisinering
  • Kartlegging av røykevaner og livsdose tobakk

Oppfølging

  • Personer med allergisk astma bør fjernes fra utløsende eksponering så fort det er praktisk mulig. Det finnes klare holdepunkter for at jo verre sykdommen er ved diagnosetidspunktet og jo lengre tid det tar før vedkommende fjernes fra eksponeringen, jo større er sannsynligheten for varige astmatiske plager
  • For personer med ikke-allergisk astma kan en forsøke yrkeshygienisk sanering av arbeidsmiljøet med samtidig tett oppfølging og vurdering av om tiltakene er tilstrekkelige til å reversere sykdomsutviklingen
  • Etter opphør av eksponering
    • Gradvis bedring av lungefunksjonen over 2 år eller mer2
    • Symptomfrihet oppnås hos 32 %2
    • Persisterende bronkial hyperreaktivitet hos 73 % 2
  • Melding til Arbeidstilsynet (skjema 154b), NAV og/eller arbeidsgiver ved mistanke om yrkesskade eller yrkessykdom

Informasjon til den ansatte

  • Informasjon om hvilke allergener, evt. kjemiske eller fysiske irritanter som mest sannsynlig er årsak til plagene og må saneres fra arbeidsplass og privat
  • Tobakksrøyking kan være et fortsatt problem begge steder
  • Kombinasjon av arbeidseksponering og allergi utløst privat (katt, hund, støvmidd, muggsopp) må vurderes

Kildereferanser

  1. Toren K, Blanc PD. Asthma caused by occupational exposures is common – a systematic analysis of the  population-attributable fraction. BMC Pulm Med 2009;9:7 PubMed
  2. Tarlo SM, Balmes J, Balkisson R, et al. Diagnosis and management of work-related asthma: American College of Chets Physicians Consensus Statement. Chest 2008;134:1-41 PubMed
  3. Malo JL, Chan-Yeung M. Agents causing occupational asthma with key references.I: Bernstein IL, Chan-Yeung M, Malo JL et al. Asthma in the workplace. 3. utg. New York. NY: Taylor and Francis, 2006: 825-867 http://www.asthme.csst.qc.ca/document/Info_Me…
  4. Storaas T, Steinsvåg SK, Florvaag E, Irgens A, Aasen TB Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workersActa Otolaryngol. 2005;125:1211-1217
  5. Salvaggio JE, O’Neil CE, Butcher BT. Immunologic responses to inhaled cotton dust. Environ Health Perspect.1986;66:17-23. PubMed
  6. Larese F, Fiorito A, Casasola F, et al. Sensitization to green coffee beans and work-related allergic symptoms in coffee workers. Am J Ind Med 1998;34:623-627. PubMed
  7. Viegi G. Respiratory effects of occupational exposure to tobacco dust. Br J Ind Med 1986;43:802-808 PubMed
  8. Goldsmith DF, Shy CM. Respiratory health effects from occupational exposure to wood dusts. Scand J Work Environ Health 1988;14:1-15 PubMed
  9. Bush RK, Wood RA, Eggleston PA. Laboratory animal allergy. Allergy Clin Immunol. 1998;102:99-112 PubMed
  10. Hargreave FE, Pepys J. Allergy respiratory reaction in bird fancier provoked by allergen inhallation tests. J Allergy Clin Immunol 1972;50:157-173 PubMed
  11. Cartier A, Malo J-L, Forest F et al. Occupational asthma in snow crab processing workers. J Allergy Clin Immunol 1984;74:261-269 PubMed
  12. Douglas JDM, McSharry C et al. Occupational asthma caused by automated salmon processing. Lancet 1995;346:737-740 PubMed
  13. Lutsky I, Teichtahl H, Bar-Sela S. Occupational asthma due to poultry mites J Allergy Clin Immunol 1984;73:56-60 PubMed
  14. Flindt MLH. Pulmonary disease due to inhalation of derivates of Bacillus Subtilis containing enzyme. Lancet 1969;1:1407-1408 PubMed
  15. Baur X, Fruhman G, Haug B et al. Role of aspergillus amylase in bakers’ asthma. Lancet 1986;1,43
  16. Davies RJ, Hendrick DJ, Pepys J. Sthma due to inhaled chemical agents – ampicillin, benzyl penicillin, 6 amino penicillanic acid and related substances Clin Allergy 1974;4:227-247
  17. Coutts II, Losewicz S, Dalley MV et al. Respiratory symptoms in a factory manufacturing cimetidine tablets. Br J Ind Med 1984;228:14-18 PubMed
  18. Gandevia B Respiratory symptoms and ventilatory capacity in men exposed to isocyanate vapour. Australias Ann 1964;13:157-166 PubMed
  19. Pepys J, Pickering CAC, Breslin ABX et al. Asthma due to inhaled chemical agents – tolouene diisocyanate Clin Allergy 1972;2:189-196
  20. Fawcett IW, Newmann Taylor AJ, Pepys J. Asthma due to inhaled chemical agents-epoxy resin systems containing phtalate anhydride, trimellic anhydride and trietylene tetramine. Clin Allergy 1977;7:1-14 PubMed
  21. Pauli G, Bessot BC, Kopfersmitt MC, et al. Meat wrappers asthma: Identification of causal agent. Clin Allergy 1980;10:263-9 PubMed
  22. Fawcett IW, Newmann Taylor AJ, Pepys J. Asthma due to inhaled chemical agents, fumes from ’Multicore’ soldering flux and colophony resin. Clin Allergy 1976;6:577-585 PubMed
  23. Moscato, G, Galdi E. Asthma and hairdressers. Curr Opin Allergy Clin Immunol. 2006;6:91-95 PubMed
  24. Malo JL, Cartier A, Doepner M et al. Occupational asthma caused by nickel sulphate. J Allergy Clin Immunol 1982;69:55-59 PubMed
  25. Novey JS, Habib M, Wells ID. Asthma and IgE antibodies induced by chromium and nickel salts. J Allergy Clin Immunol 1983;72:407-411 PubMed
  26. Davison AG, Haslam PL, Corrin B et al. Interstitial lung disease and asthma in hard metal workers; brochoalveolar lavage, ultrastucture, and analytic findings and results of bronchial provocation tests. Thorax    1983;38:119-128. PubMed
  27. Browne RC. Vanadium poisoning from gas turbines. Br J Ind Med 1955;12:55-59 PubMed
  28. Kongerud J, Boe J, Søyseth V et al. Aluminium potroom asthma: the Norwegian experience. Eur Resp J 1994;7:165-172 PubMed
  29. Eduard W, Douwes J, Omenaas E, Heederik D. Do farming exposures cause or prevent asthma? Results from a study of adult Norwegian farmers. Thorax. 2004;59(5):381-6 PubMed
  30. Malo JL, Trudeau C, Ghezzo H, l’Archeveque J, Cartier A. Do subjects investigated for occupational asthma through serial peak exspiratory flow measurements falsify their results? J Allergy Clin Immunol 1995;96:601-7 PubMed

Fagmedarbeidere

  • Norsk Arbeidsmedisinsk Forening – Kvalitetsutvalget for Arbeidsmedisinske Veiledninger
  • Karl Færden, overlege, Oslo universitetssykehus, Ullevål, Miljø og yrkesmedisin
  • Tor B Aasen, spesialist i lungemedisin, avdelingsdirektør, Yrkesmedisinsk avdeling, Haukeland universitetssykehus

Datoer

  • Sist endret: 02.11.2011″

Kilde: Informasjonen her er hentet fra Arbeidsmedisinsk Forening

In English

Work-related / Occupational asthma

“Purpose and scope

■ The purpose of this guidance is to describe the study of possible work-related asthma, primarily for use in the occupational medicine hospital departments.

■ Physicians working outside such department can based on their expertise, make parts of the report where this seems appropriate.

Occurrence

■ Work-related asthma represents a significant public health problem in the population and is believed to be responsible for 5-15% of new-onset cases of asthma in voksne1.
■ The occupational medicine departments in Norway studying at 2011 about 250 cases annually with questions about work-related asthma.
■ stats Labour Inspectorate, which is based on the message from doctors, has since 2000 shown in nearly 100 cases annually. In the period 1995 to 1999 the number was doubled. With high probability there is an under-reporting of cases when only a handful of doctors uses reporting system.

The division of work-related asthma

■ Work-related asthma includes cases that are either caused by (‘work-(occupational) asthma’) or
■ aggravated by exposure at work (‘arbeidsforverret asthma’)
■ In all cases the onset of asthma it is important to determine whether occupational exposure has caused disease, and especially if they are developed sensitization (‘allergic occupational asthma’) against allergens or low molecular weight substances present in the patient’s work
■ Irritants can cause asthma in chemical accidents, so-called ‘reactive airways dysfunction syndrome’ (rads). And probably also by the influence of lower level over time, so-called ‘low-dose irritantindused astma’2.

Exposed occupational groups

■ So far identified over 475 different agents that can induce asthma through work-sensibilisering3.
■ Examples of sensitizing agent which can cause work-asthma:

Plants Profession / Occupation Reference
Dust Grains (wheat, rye, etc.)Dust from dried powdered foodstuffs

Cotton, flax, hemp

Coffee bean Dust

Tobacco dust

Wood dust (exotic tree species)

Baker, mill workers

FoodTextile Workers

Coffee Workers

Tobacco Workers

Cabinetmaker, timber workers

45678
Animals
Laboratory animals (rats, mice, etc.)

Bird

Cats, dogs etc.

Shellfish (crab, shrimp, etc.)

Salmon

Insect Dust

Mites

Animal Laboratory Workers

Poultry Breeders

Pet Retailers

Fish Manufacturing workers

Beekeepers and more

Chickens Farm Workers

910111213
Enzymes and drugs
Enzymes

Penicillin, Cimetidine

Production of detergents,

Baker

Pharmaceutical and health workers

14151617
Low molecular compounds
Diisocyanates

Acid anhydrides

Epoxy resins

Varmespaltningsprodukter (heat cleaving products) plastic (acid anhydrides mm)Rosin and other fluxes

Persulfate, oxidative hair dye products

Workers Foam

spray painters,

Panel beater,

painters etc.

Chemical Industry

Plastic Workers

Electricians, electrical workers

Hairdressers

181920212223
Metals and metal salts
Nickel

Chrome

Cobalt

Vanadium

Metal workers,  welders

Gas turbine cleaners

24252627
Other
‘Asthma’ (fluorine compounds, dust)Animal farming, endotoxin, fungal spores Smelters Workers

Farmers

2829

Investigation of work-related asthma

Arbeidsanamnese

■ Chronological record of all employment with an indication of the company and job title
■ Describe the work processes, exposures and protective factors, with special emphasis on exposure to organic dust / particulates and chemical allergens / haptens.
■ If necessary, obtain further information on exposure ■ Information from occupational
■ Historical data on exposure to current industry
■ Occupational Exposure measurements and assessments
■ Business Office

Emvironment

■ Description of husbandry, carpet flooring, moisture damage and other conditions in the housing
■ Other recreational exposure

Diseases of the family

■ Familial occurrence of allergies and lung disease

Allergies

■ Pollen allergy, other allergies

Earlier diseases

■ Asthma, atopy or eczema as a child
■ Pulmonary and other diseases
■ Alternatively, obtain a copy of the primary journal of company doctor, general practitioner and specialist

Study of the current disorder

Does the patient have asthma?
■ History and clinical findings
■ Spirometry with reversibility
■ PEC registration at work and play ■ The trial period should be a minimum of 4 weeks of 4 measurements per day. Such measurements should preferably be made with electronic PEF meter stores measuring and måletidspunkt30

■ Measurement of bronchial reactivity: Metakolintest
■ ■ Inflammometri exhaled NO
■ Induced sputum
■ ECP (Eosinophilic cationic protein)

Does the patient work-related obstruction?
■ Describe the symptoms and their relationship to exposures and free periods ■ New processes or substances (immediately) before the onset of symptoms
■ Exposure to irritants and sensitizing substances
■ Note senreaksjon (such as nocturnal cough)
■ Improvement in free periods more sensitive than deterioration in work

Due to the patient’s asthma a specific sensitization to an allergen or a chemical substance in the patient’s work environment?
■ ■ Sales Prick Test Extracts
■ Self-produced extracts

■ In-vitro diagnostics ■ Specific IgE to relevant occupational allergens
■ Histamine Release Test

■ Provocation and elimination trials ■ Using sick leave or leave periods
■ Specific provocation

Drugs / stimulants

■ Medication
■ Survey of smoking habits and life-dose tobacco

Follow-up

■ Persons with allergic asthma should be removed from the exposure as soon as practicable. There is clear evidence that the worse the disease is at diagnosis and the longer it takes before being removed from the exposure, the greater the likelihood of lasting Asthma
■ For people with non-allergic asthma, an attempt occupational redevelopment of the work environment with simultaneous close monitoring and assessment of whether the measures are sufficient to reverse the disease
■ After cessation of exposure ■ Gradual improvement in lung function over 2 years or mer2
■ Symptom Freedom achieved in 32% 2
■ Persistent bronchial hyperreactivity in 73% 2

■ Message to the Labour Inspection (Form 154b), NAV and / or employer suspected injury or occupational disease

Information to the employee

■ Information about the allergens, or chemical or physical irritants that are most likely to cause problems and must be decontaminated from the workplace and private
■ Tobacco smoking may be a continuing problem both places
■ Combination of work exposure and allergy triggered private (cat, dog, dust mites, molds) are considered

Source References

1.Toren K, Blanc PD. Asthma caused by occupational Exposures is common – a systematic analysis of the population-attributable fraction. BMC Pulm Med 2009; 9:7 PubMed
2.Tarlo SM, Balmes J Balkisson R, et al. Diagnosis and management of work-related asthma: American College of Physicians Consensus Statement Chet. Chest 2008; 134:1-41 PubMed
3.Malo JL, Chan-Yeung M. Agents Causing occupational asthma with key references.I: Bernstein IL, Chan-Yeung M, Malo JL et al. Asthma in the workplace. 3. Ed. New York. NY: Taylor and Francis, 2006: 825-867 http://www.asthme.csst.qc.ca/document/Info_Me
4.Storaas T, Steinsvåg SK, FLORVÅG E, Irgens A, Aasen TB Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers Acta Otolaryngol. 2005, 125:1211-1217
5.Salvaggio JE, O’Neil CE, Butcher BT. Immunologic responses two inhaled cotton dust. Environ Health Perspect.1986; 66:17-23. PubMed
6.Larese F, Fiorito A, Casasola F, et al. Sensitization to green coffee beans and work-related allergic Symptoms in coffee workers. Am J Ind Med 1998; 34:623-627. PubMed
7.Viegi G. Respiratory effects of occupational exposure two tobacco dust. Br J Ind Med 1986; 43:802-808 PubMed
8.Goldsmith DF, Shy CM. Respiratory health effects from occupational exposure two wood dusts. Scand J Work Environ Health 1988; 14:1-15 PubMed
9.Bush RC, Wood RA, Eggleston PA. Laboratory animal allergy. Allergy Clin Immunol. 1998, 102:99-112 PubMed
10.Hargreave FE, Pepys J. Allergy respiratory reaction in bird fancier provoked by allergen inhallation tests. J Allergy Clin Immunol 1972; 50:157-173 PubMed
11.Cartier A, Malo J-L, Forest F et al. Occupational asthma in snow crab processing workers. J Allergy Clin Immunol 1984; 74:261-269 PubMed
12.Douglas JDM, McSharry C et al. Occupational asthma caused by automated salmon processing. Lancet 1995; 346:737-740 PubMed
13.Lutsky I, Teichtahl H, Bar-Sela S. Occupational asthma due two poultry mites J Allergy Clin Immunol 1984; 73:56-60 PubMed
14.Flindt MLH. Pulmonary disease due two inhalation of derivates of Bacillus subtilis containing enzyme. Lancet 1969; 1:1407-1408 PubMed
15.Baur X, Fruhman G, B Haug et al. Role of Aspergillus amylase in bakers’ asthma. Lancet 1986; 1.43
16.Davies RJ, Hendrick DJ, Pepys J. Sthma due two inhaled chemical agents – ampicillin, benzyl penicillin, 6 amino penicillanic acid and related substances Clin Allergy 1974; 4:227-247
17.Coutts II Losewicz S, Dalley MV et al. Respiratory Symptoms in a factory manufacturing cimetidine tablets. Br J Ind Med 1984; 228:14-18 PubMed
18.Gandevia B Respiratory Symptoms and ventilatory capacity in exposed but two isocyanate vapor. Australia’s Ann 1964; 13:157-166 PubMed
19.Pepys J, Pickering CAC, Breslin ABX et al. Asthma Due to inhaled chemical agents – Tolou diisocyanate Clin Allergy 1972; 2:189-196
20.Fawcett IW, Newman Taylor AJ, Pepys J. Asthma due two inhaled chemical agents-epoxy resin systems containing phtalate anhydride, trimellic anhydride and triethylene tetra mine. Clin Allergy 1977; 7:1-14 PubMed
21.Pauli G Bessota BC, Kopfersmitt MC, et al. Meat wrappers asthma: Identification of causal agent. Clin Allergy 1980; 10:263-9 PubMed
22.Fawcett IW, Newman Taylor AJ, Pepys J. Asthma due two inhaled chemical agents, fumes from ‘Multicore’ soldering flux and colophony resin. Clin Allergy 1976; 6:577-585 PubMed
23.Moscato, G, Galdi E. Asthma and hairdressers. Curr Opin Allergy Clin Immunol. 2006: 6:91-95 PubMed
24.Malo JL, Cartier A, Doepner M et al. Occupational asthma caused by nickel sulphate. J Allergy Clin Immunol 1982; 69:55-59 PubMed
25.Novey JS, Habib M, Wells ID. Asthma and IgE antibodies induced by chromium and nickel salts. J Allergy Clin Immunol 1983; 72:407-411 PubMed
26.Davison AG, Haslam PL, Corrin B, et al. Interstitial lung disease and asthma in hard metal workers; brochoalveolar lavage, ultrastucture, and analytic Findings and results of bronchial provocation tests. Thorax 1983; 38:119-128. PubMed
27.Browne RC. Vanadium poisoning from gas turbines. Br J Ind Med 1955; 12:55-59 PubMed
28.Kongerud J, Boe J Søyseth V et al. Aluminium potroom asthma: the Norwegian experience. Eur Resp J 1994; 7:165-172 PubMed
29.Eduard W, Douwes J, Omenås E, Heederik D. Do farming Exposures or contraceptives cause asthma? Results from a study of adult Norwegian farmers. Thorax. 2004, 59 (5) :381-6 PubMed
30.Malo JL, Trudeau C, Ghezzo H, l’Archeveque J, Cartier A. Do subjects investigated for occupational asthma through serial peak flow measurements exspiratory falsify their results? J Allergy Clin Immunol 1995; 96:601-7 PubMed

Qualified staff

■ Working Norwegian Medical Association – Committee on Quality of Work Medical Guidelines
■ Karl Færden, consultant, Oslo University Hospital, Environmental and occupational medicine
■ Gate B Aasen, a specialist in pulmonary medicine, director, Occupational Medicine, Haukeland University Hospital

Dates

■ Last Modified: 02/11/2011 ”

Source: The information here is taken from the Occupational Medicine Society

Author: Annelie

I like canoeing, photographing, friends, movies, food, humor, and going on trips. I dislike rudeness, dishonesty, violence, nastyness, and people not caring for others. I do not drink much, I do not smoke and I do not do drugs. I love friends who are kind to me and stick with me. If you want to give me a gift, the best gift is to stop smoking and stop using fragranced products. Then you give me health and that dear friend, is the best gift a person can get. It is a gift of love. I got asthma and I am hearing disabled.

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