Canadian Health and Care Mall: Case Reports of Reactive Airways Dysfunction Syndrome (RADS)

In: RADS

5 Sep 2015

respiratory protective deviceCase 1

A 53-year-old chemical worker had an accidental exposure to

uranium hexafluoride gas at work in a chemical plant on Nov 12, 1968. He was not wearing a respiratory protective device and breathed uranium hexafluoride vapors for about 15 minutes. He immediately developed shortness of breath and cough and was subsequently taken to an emergency room where because of severe respiratory distress, an emergency tracheotomy was performed. He was discharged from the hospital after four days, but noted persistent dyspnea and increased airway excitability after exposure to nonspecific irritants or stimuli such as marked temperature change, dusts, and a variety of fumes and vapors. He was evaluated at UC Medical Center approximately 140 months after his accident on July 8, 1980.

Case 2

This 19-year-old grocery clerk was previously in good health until Sept 22, 1978, when he was exposed to fumes from a concrete floor sealant used to coat a stockroom floor. The floor sealant was documented to contain several aromatic hydrocarbons, including Decane, ethylbenzene, toluene, xylol, and epichlorhydrin. It did not contain isocyanates or anhydrides. He had never performed this type of work before, and the room in which he worked was small and poorly ventilated. The work involved taking a 15-gallon drum of sealant, pouring it on the floor, and spreading the sealant with a mop. He noted the sealant smelled like “glue” or “varnish.” He worked in the enclosed space approximately 2Уг hours without respiratory protection. He developed dizziness, watery eyes, severe headache, and facial flushing and later, cough and dyspnea. The next day, he felt better but his symptoms did not completely abate. Three days later, he continued having symptoms but used the sealant again for ЗК2 hours in a similar operation working without respiratory protection. His dyspnea and cough worsened. A physical examination by a private physician a few days after the incident reported a mild conjunctivitis, inflamed throat, and runny eyes. Chest x-ray film was reported to be within normal limits. He was evaluated at the UC Medical Center 14 months later on Dec 4, 1979, describing exertional dyspnea, chest tightness, and wheezing after running a short distance. The information issued in the Internet becomes more qualified and our web site is not excluded – More info for read on – blogcanadianhealthmall.com.

Cases 3 and 4runny eyes

A 41-year-old painter and his partner, a 45-year-old man, both previously healthy and with no known respiratory illness, were working together, spray painting a new apartment. Because the weather was cold, the windows of the room were covered with heavy plastic material with duct tape placed around the edges to insure a seal, and the main entrance to the apartment was also covered to conserve heat. The ventilation in the work area was extremely poor. The painters did not wear appropriate respiratory protective devices but wore only paper masks over their nose and mouth while they spray painted. The paint used, a one-stage vinyl latex primer, was a rapid drying type, and contained 25 percent ammonia, 16.6 percent aluminum chlorohydrate, and a number of other additives. There were no isocyanates or anhydrides. Each individual worked only as a painter in the past, one for 20 years and the other 25 years. Each stated he never previously spray painted under the environmental conditions as in this instance.

After spray painting a total of 12 hours each, both simultaneously noted the onset of generalized weakness, nausea, cough, shortness of breath, paint taste in their mouths, chest tightness, and wheezing. Both subjects were subsequently hospitalized for about two weeks with provisional diagnoses of “acute chemical bronchitis.” Initial chest x-ray film in one subject was interpreted as showing increased bronchovascular markings consistent with “chemical pneumonitis.” The other x-ray film findings were normal. After discharge from hospital, each subject continued to note persistent wheezing, cough, exertional dyspnea, and each reported aggravation of symptoms after exposure to nonspecific stimuli such as cold air, dusts, aerosol sprays, smoke, and fumes. Each painter consulted different private physicians, and both were treated with prednisone, theophylline preparations, and aerosol bronchodilators. They were examined at the University of Cincinnati on March 4, 1982, four months after the incident.

Case 5

This 39-year-old power plant utility worker had a heavy exposure to a 35 percent hydrazine solution while at work on Dec 18, 1979, while transporting a 55-gallon drum containing hydrazine solution. The drum overturned and a large quantity of the solution spilled on him. He was pinned down by the drum for about five minutes and could not call for help because of pressure on his chest. The hydrazine solution flowed onto his face, mouth, neck, chest, arms, abdomen, and urogenital areas. He denied eye exposure, but he stated he reflexively swallowed some of the solution. Eventually, a co-worker noted his dilemma and assisted in his removal. Two hours later, he felt a “prickly,” pins and needles sensation over his face, neck, and anterior chest. A workmate noted he had a facial rash. He later became disoriented to time and place and was sent to a hospital emergency room. Within five hours from the time of the incident, he noted neck pain, respiratory symptoms, nausea, diarrhea, and abdominal cramping which persisted until the next day when he returned to the hospital and was told he had “the flu.” He described wheezing and chest tightness, paroxysmal nonproductive cough, and muscle aching which persisted. He received intermittent injections of corticosteroids over the next three weeks for these complaints. Over the next five to six months, he lost many days of work because of persistent respiratory symptoms, and musculoskeletal weakness which necessitated treatment with short courses of prednisone, albuterol inhaler, and a theophylline preparation. He developed severe episodes of bronchospasm at work after exposures to airborne irritants such as from a mixture of caustic soda and hydrochloric acid or sulfuric acid. He was examined at the University of Cincinnati on Oct 19, 1982, 34 months later.

Case 6

This 32-year-old paithe flunter, evaluated on May 13,1980, complained of “breathing problems” since Sept 3, 1975, when he was exposed to excessive paint fumes while working in an enclosed area. On this day, he was working in a spray painting operation for several hours without respiratory protection, and he inhaled “large amounts” of paint fumes of an oil-base enamel paint. At the end of the work day, he noted shortness of breath, cough, and a feeling of having to “force air into his lungs.” He described wheezing that night. Subsequently, he noted problems being around any type of paint fumes which necessitated his leaving the painting occupation and becoming a construction supervisor with limited exposure to irritants (Fig 1). A bronchial lung biopsy was performed in Feb 1981 because of persistent symptoms. He was examined 56 months later, on May 13,1980, at the University of Cincinnati.

Case 7

In mid-June 1974, this 32-year-old welder of 13 years, was welding a tank which previously contained acid. He used a stainless steel rod for this welding which consisted of 0.06 percent carbon, 20.5 percent chromium, 9.5 percent nickel, 0.6 percent manganese, and 0.5 percent silicon. The flux was lime and titanium coated. Significant fumes evolved from the welding process causing him to cough. Seven to eight hours later, he noted worsening cough, wheezing, and shortness of breath which persisted. A workup by an allergist was negative. In March 1977, bronchoscopy showed patent bronchi but hypertrophic mucosa and some bloody secretions in the lower lobes (Fig 2). A bronchial biopsy was performed. He was examined at the UC Medical Center 48 months after the incident on March 16,1978.

Case 8

This 24-year-old housewife was completely asymptomatic with no nasal or respiratory symptoms until Aug 16, 1974, when a firm was contacted to fumigate her apartment after a small kitchen fire. The patient remained in the apartment while the fumigating process was performed. She noted a thick brown fog which enveloped the apartment had a perfume-like odor as well as a background odor, like “insect exterminating solution.” Subsequent toxicologic report on the fumigating solution reported it contained polyoxyethylated vegetable oil, dipropylene glycol, a turpin hydrocarbon, sodium nitrate, a complex, unsaturated aldehyde, and isobomyl acetate. Within minutes after beginning the fumigation process and breathing in the fumes, she developed a gasping and choking sensation and ran out of the apartment in order to get fresh air. Within one half hour, she developed wheezing, cough, tremendous rhinorrhea, and a feeling of irritation in her sinuses. She was seen by a physician and treated with corticosteroids with some improvement but not disappearance of her symptoms. Allergy workup showed sensitization to dog and cat danders, house dusts, ragweed, and spores. Six months after the accident, she was evaluated the UC Medical Center on Oct 20, 1975.

Case 9tremendous rhinorrhea

This 34-year-old woman worked as a remover of coatings from metals and plastics. During the last week of May 1974 (she could not

remember the exact day), she accidentally breathed in a large concentration of a coating removing chemical, believed to contain chlorine. She immediately developed nausea, burning sensation on inspiration, and paroxysmal coughing. She was admitted to a hospital where chest x-ray film findings were normal but physical examination of the chest revealed fine rales. A diagnosis of “inhalation bronchitis” with possible “pulmonary edema” was made, and a corticosteroid and theophylline regimen was started. She became clinically improved. Her symptoms persisted and she was examined 39 months later at the UC Medical Center on May 6, 1976.

Case 10

This 46-year-old patient was inside a bookstore on Dec 16, 1982, when an airplane crashed into the building setting it on fire. She was knocked down because of the impact of the crash, and was inside the building for about 15 minutes. Books, papers, furniture, upholstery, and paint burst into flames, and she breathed in the smoke, fumes, combustion and pyrolysis products generated by the fire. When she got outside, she did not recall any specific symptoms, but was very frightened. She noted a cough and not “feeling well” the next day. Later, she developed worsening cough with paroxysms, shortness of breath, wheezing, and chest discomfort. She had a past history of allergic rhinitis and had received allergy injections for about two years but was well documented not to have asthma or respiratory symptoms before the incident. Her husband is a physician. She was evaluated at the UC Medical Center on Nov 17,1983,11 months after the accident.


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