A case of occupational asthma in a home pieceworker was described. A 67 year old white female was admitted to an emergency center with symptoms of severe shortness of breath, cough, and a feeling of choking to death. On physical examination, diffuse expiratory rhonchi were found to be present. Her respiratory rate was 40 breaths per minute. A chest X-ray showed evidence of emphysema. The patient was treated with intravenous aminophylline, aerosolized metaproterenol-sulfate, and steroids. Her bronchospasm abated promptly. She reported that she worked in her home dipping the ends of polyurethane coated wire into molten solder. The wires were used to produce components for the electronics industry. This process has been known to evolve isocyanate compounds. Pulmonary function studies performed when the patient was free of bronchospasm prior to discharge showed a forced vital capacity (FVC) of 68 percent of the predicted value, a 1 second forced expiratory volume (FEV1) of 72 percent of predicted, and a FEV1/FVC ratio of 76 percent. She was discharged on the third day. The patient's sister had also developed a cough and wheeze, and one episode of severe dyspnea, while doing similar home piecework. The patient's family refused a request to perform air sampling during subsequent dipping operations. The authors note that neither the manufacturer nor distributor of the wire provided a warning of the potential respiratory hazards. The case illustrates the hazards of piecework in the home or cottage industry. Home pieceworkers are not likely to have the benefit of advice from industrial hygienists or others skilled in recognizing potential hazards of the materials with which they work.
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