Results from the US industry-wide phosgene surveillance: the Diller Registry.

OBJECTIVE: In 2004, The American Chemistry Council Phosgene Panel established a phosgene exposure registry among US phosgene producers with the primary purpose of monitoring health outcome information for workers with acute exposure. METHODS: We examine symptoms among 338 workers with phosgene exposure. The phosgene exposures averaged 8.3 ppm-minutes ranging up to 159 ppm-minutes with most exposures below 10 ppm-minutes. RESULTS: We found that the level of phosgene exposure in ppm-minutes was related to workers reporting mostly irritation symptoms of the nose, throat and eyes within 48 hours of exposure. However, we found no relationship between phosgene exposure and the presence of symptoms 30 days after exposure. CONCLUSIONS: These findings lend credence to the theory that prolonged respiratory effects do not occur with doses less than 150 ppm-minutes.

Excessive longitudinal FEV1 decline and risks to future health: a case-control study.

BACKGROUND: Accelerated loss of forced expiratory volume in 1 s (FEV(1)) in an individual is considered an indicator of developing lung disease. METHODS: We investigated longitudinal FEV(1) slopes, calculated by simple linear regression, and adverse health outcomes after 10-30 years, among 1,428 chemical plant workers. Cases were defined by FEV(1) slopes below 5th percentile values for the cohort. Cases were matched with controls (107 pairs) for race, gender, smoking status, year of birth, age, height, and calendar year at first test. Matched pair statistics were used for comparisons. RESULTS: Cases had a higher proportion, compared to controls, of diagnosis of COPD or emphysema (17.8% vs. 1.9%, P = 0.0002), medication use for respiratory diseases (24.3% vs. 4.7%, P < 0.0001), dyspnea (15% vs. 3.7%, P = 0.0042), and wheezing or rhonchi on examination (10.3% vs. 1.9%, P = 0.0225). CONCLUSIONS: Chemical plant workers who experienced accelerated FEV(1) declines experienced four to nine times as many adverse health conditions over 10-30 years.

Interpreting longitudinal spirometry: weight gain and other factors affecting the recognition of excessive FEV1 decline.

BACKGROUND: Excessive FEV(1) loss in an individual or a group can reflect hazardous exposures and development of lung disease. However, multiple factors may affect FEV(1) measurements. METHODS: Using medical screening data collected in 1884 chemical plant workers between 1973 and 2003, the influence of multiple factors on repeated measurements of FEV(1) was examined. RESULTS: The FEV(1) level was associated with age, height, race, sex, cigarette smoking, changes in body weight, and spirometer model. After controlling for these factors, longitudinal FEV(1) decline averaged 23.8 ml/year for white males; an additional loss of 8.3 ml was associated with one pack-year smoking and 5.4 ml with a one pound weight gain. Depending on the spirometer model, FEV(1) differed by up to 95 ml. CONCLUSIONS: The study results provide quantitative estimates of the effect of specific factors on FEV(1), and should be useful to health professionals in the evaluation of accelerated lung function declines.

Interpreting periodic lung function tests in individuals: the relationship between 1- to 5-year and long-term FEV1 changes.

STUDY OBJECTIVE: Spirometry is performed to monitor lung health, but variability between tests can hinder recognition of excessive FEV(1) declines. We sought to describe the relationship between FEV(1) changes over 1 to 5 years and FEV(1) declines over longer terms, using 21,821 test results from 1,884 workers who participated in an annual health monitoring program at a chemical plant between 1973 and 2003. METHODS: Test results from workers with five or more valid results over > or = 10 years were included in our analysis (mean initial worker age, 35 years; range, 18 to 62 years; 91% male; 35% current smokers and 41% nonsmokers). For each worker, long-term FEV(1) slopes (milliliters per year) were calculated by simple linear regression using all available results and compared to changes in FEV(1) between two tests over 1 to 5 years, expressed in both milliliters and percentage of initial value. RESULTS: Long-term (mean, 18 years; range, 10 to 30 years) slopes averaged - 29.1 mL/yr (- 27, - 29, and - 37 mL/yr for male never-smokers, former smokers, and current smokers, and - 20, - 26, and - 27 mL/yr for female never-smokers, former smokers, and current smokers, respectively). Excessive short-term and long-term declines were defined by lower fifth percentile values. Individuals with abnormal short-term declines were found to be 3 to 18 times more likely to ultimately show excessive long-term declines; with the strength of the association increasing with the length of the short-term testing interval. Better test operating characteristics resulted if abnormal short-term FEV(1) change was based on percentage change (ie, percentage per year) rather than absolute change (ie, milliliters per year). CONCLUSIONS: Our findings provide guidance for interpreting periodic spirometry results from individuals exposed to respiratory hazards.