Airway hyper-responsiveness and the prevalence of work-related symptoms in workers exposed to irritants

The association between exposure to airway irritants and the presence of work-related symptoms and whether this association was modified by airway hyper-responsiveness, smoking, and allergy by history was studied in 668 workers of synthetic fiber plants. A Dutch version of the British Medical Research Council (BMRC) questionnaire with additional questions on allergy and work-related symptoms was used to assess symptoms, and a standardized histamine challenge test of airway hyper-responsiveness (AHR) was employed. Work-related symptoms were defined as having more than usual eye and respiratory symptoms during work. On the basis of job titles and working department, the exposure status of all workers was characterized into seven groups: (1) reference group; (2) white collars; (3) SO2, HCl, SO4(2-); (4) polyester vapor; (5) oil mist and oil vapor; (6) polyamide and polyester vapor; and (7) multiple exposure. The association between exposure groups and work-related symptom prevalence was estimated by means of multiple logistic regression. The overall prevalence of the work-related symptoms were: cough 9%; phlegm 6%; dyspnea 7%; wheeze 2%; eye symptoms 16%; nasal symptoms 15%. Exposure to airway irritants was significantly associated with work-related symptoms, independent of AHR, smoking, allergy by history, and chronic respiratory symptoms. The association of exposure group with work-related symptoms was stronger for subjects with AHR than for subjects with no AHR. The association with dyspnea and/or wheeze was also stronger for smokers than for nonsmokers and ex-smokers. In contrast, the association between exposure and a higher prevalence of work-related symptoms was stronger in subjects with no history of allergy than in subjects with history of allergy. This is most likely due to the relatively high prevalence of background symptoms in (nonexposed) allergic subjects. It is concluded that exposure to irritants in the working environment might lead to respiratory symptoms, even if exposure levels are relatively low.