This care study looks at occupational asthma and the impact that it can have on an individual.

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Chapter 1

Introduction

This care study looks at occupational asthma and the impact that it can have on an individual. Asthma and occupational asthma are very relevant today as the incidence is rising. In order to understand how occupational asthma occurs the process of becoming sensitised to an agent within the workplace will be discussed. The care study will look at what role pre-employment and post-placement health surveillance has with regards to the facilitation of employment. The allergy under discussion is the allergy to the complex platinum salts. Current literature surrounding this allergy is looked at to identify current thoughts on why individuals become sensitised and why some individuals develop the allergy and not others. Fitness to work is discussed and the role of occupational health in assessing fitness to work and the need for referral to specialists for diagnosis and prognosis so that the employee can plan his future

1.1         Background

Asthma is a common disorder with 5-10% of the general population affected, according to Venebles & Chan-Yeung (1997). Asthma can be defined as a narrowing of the airways that is reversible over short periods of time, either spontaneously, or with treatment. It is the clinical definition, which characterises asthma as reversible airway narrowing that distinguishes it from other irreversible causes of airway narrowing such as chronic obstructive bronchiolitis (Newman Taylor 1998). In the United Kingdom there has over the last 40 years been a shift away from manufacturing industries and along with the improved health and safety legislation there has been a decline in prevalence of silicosis and pneumoconiosis. However, the prevalence of occupational asthma has been seen to rise (Madan 1996), and is now the fastest growing occupational disease (Madden 1998). This is partly due to the introduction of highly reactive chemicals into manufacturing processes. Occupational asthma is estimated to account for five per cent of adult onset asthma, but Cross (1998), believes the incidence may be higher due to under reporting. Occupational asthma can be defined as asthma induced by specific substances encountered at work (HSE 1998). Occupational asthma is the most common occupationally acquired respiratory disease and accounts for a quarter of cases reported (Crawford 1999). This is backed up by Ross et al (1994), who state that out of a total of 3276 cases of work related respiratory disease reported in the UK in 1994, 941 were cases of occupational asthma .Cannon et al (1995) indicate that their research shows that 500 cases of occupational asthma are reported annually in the UK. The SWORD project (surveillance of work related and occupational respiratory disease), that was established in 1989 and sponsored by the Health and Safety Executive, was set up in an attempt to produce an informal national register of the incidence of respiratory disease. It has also increased our understanding of the epidemiology of occupational lung disease in Britain (Madan 1996).

There are many occupations in the UK within which employees are exposed to respiratory sensitisers. The more common of these are bakers who are exposed to flour, vehicle sprayers who work with isocyanates, and laboratory technicians and wood workers. One of the lesser known occupations is that of platinum refining. Platinum group metals consist of: platinum, palladium, rhodium, iridium, ruthenium and osmium. Platinum group metals are mined in South Africa, Canada, Australia and Russia. Platinum group metals usually occur in mixed ore bodies, especially copper, nickel and iron as sulphides. Platinum group metals are initially recovered using standard mining procedures, followed by crushing and concentration of the sulphide by flotation. The concentrate is then smelted to produce a copper nickel matte containing the six platinum group metals.

It is in this form that the platinum group metals are received in the UK to undergo refining. Primary refining of the platinum group metals consists of the copper nickel concentrate containing the platinum group metals being dissolved in hydrochloric acid and chlorine. Chloroplatinic acid is formed and other complex chlorides of the other platinum group metals. The stream is treated by pH change to precipitate rhodium and iridium salts. Ruthenium and osmium are distilled and condensed. In their crude forms palladium is precipitated as palladium diamine and finally platinum is precipitated as ammonium hexachloroplatinate (ACP). ACP as a yellow salt is calcined to produce a sponge and the refining process repeated to produce a high purity platinum 99.99%. The final precipitate of ACP may be reduced chemically with hydrazine before calcining to produce a sponge which is then melted to give a metal ingot which can be wrought into desired form. Platinum group metals are noble metals inert on body fluids. They are ductile, malleable alloys and catalysts. They therefore have uses as bullion, jewellery, catalysts, wire mesh or gauze, or precipitated on ceramic honeycomb for the glassware industry. In the medical field they are used in metal or alloy form as pacemaker contacts, or vascular stents. In the pharmaceutical industry they are used in the manufacture of Cisplatin and Carboplatin, both anti-neoplastic drugs.

The complex platinum salts are recognised as respiratory sensitisers. The first recognition that there was a problem with platinum salts was made by Hunter in 1945 (Newman Taylor 1994). Further studies were carried out by Cleare et al (1976) and Cromwell et al (1979) who looked at allergic responses to the platinum compounds in sensitized workers. Both studies agreed that sensitivity to the halide complexes of platinum manifests as rhinitis, conjunctivitis and asthma, with occasional urticaria and contact dermatitis. As discussed earlier occupational asthma is asthma, induced by an agent inhaled at work (Newman Taylor 1994). Madan (1996) clarifies this by explaining that occupational asthma is caused by specific sensitising agents inhaled within the workplace, and that occupational asthma does not include bronchoconstriction caused by irritants such as exercise or cold air that are encountered at work. Agents encountered at work may induce or incite asthma. Inducers initiate asthma, and when inhaled cause airway inflammation and airway hyper-responsiveness. Inciters provoke acute transient airway narrowing in individuals with pre-existing asthma. These individuals already have hyperesponsive airways, and Newman Taylor (1994) states that inciters do not therefore initiate asthma, cause airway inflammation or increase airway responsiveness.

1.2         Aims & Objectives

The aim of this care study is to demonstrate how respiratory sensitisers such as complex platinum salts can cause occupational asthma and the impact that this has on an individual.

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The objectives are to explore the impact of asthma and the ability to perform work. It will discuss the assessment of the fitness to work process, and look at the role of the occupational health nurse in carrying out the assessment.

1.3        Client presentation

Peter is currently 59 years old. He attended the occupational health department as part of his six monthly health surveillance. The health surveillance consists of skin prick tests for sensitivity to the complex platinum salts, spirometry and a questionnaire covering incidents of rhinitis, chest tightness or wheezing since last health surveillance. He discussed that in retrospect ...

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