Occupational respiratory diseases. Merchant JA, Bochlecke BA, Taylor G, eds. Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 86-102, 1986 Sep; :571-605
The acute and chronic effects of exposure to inhaled toxic agents are reviewed with respect to occupations and industries at risk, animal studies, and recommendations for prevention and further research. Agents discussed are ammonia (7664417) (NH3), cadmium (7440439), chlorine (7782505) (Cl), hydrogen-sulfide (7783064), mercury (7439976), osmium-tetroxide (20816120), oxides of nitrogen, ozone (10028156) (O3), phosgene (75445), sulfur-dioxide (7446095), and vanadium-pentoxide (1314621). Respiratory effects following acute or accidental exposure to any of the agents are dependent upon the concentration of the agent and the duration of the exposure. Factors modifying the individual's response to any particular exposure include preexisting heart or lung disease, prior exposure to the same agent, level of activity during exposure, and age at exposure. Symptoms of mild exposure to irritant gases relatively soluble in aqueous solution (NH3, Cl) are usually confined to the upper airways and include sneezing, throat irritation, unpleasant smell or taste, and tearing. Intensive exposure extends the airway involvement resulting in cough, sputum, chest constriction, and bronchospasm. The most intense exposures damage the alveolar capillary parenchyma resulting in pulmonary edema. The physiologic changes are not unique to the agent but reflect the respiratory involvement. Irritant gases mildly soluble in aqueous solution (O3, nitrous-oxide (10024972)) shift their primary effect to the periphery of the respiratory system. Detection of early abnormality requires a careful history, identification of cause, and periodic testing. Competing risks from nonoccupational sources are also discussed. Separate bibliographies were provided for each causative agent.