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A case of aluminium potroom asthma confirmed by functional evidence of reversible airway obstruction was described. A 35 year old male with recurrent episodes of dyspnea at work and progressive cough, wheezing, and dyspnea during exercise was evaluated at a chest clinic in May 1992. The patient did not have a history of respiratory illness, asthma, or atopy. He had worked in the potroom of an aluminum foundry since 1986. His job involved replacing 10 to 20 prebake type anodes which exposed him to hot fumes from the pots. Removal from work in January and December 1991 resulted in the disappearance of his symptoms. Albuterol was used when needed. Skin tests with common aeroallergens and metal salts showed a positive reaction only to D-farinae. Bronchoprovocation testing with histamine (51456) revealed mild to moderate bronchial hyperresponsiveness. Spirometry revealed significant deficits in one second forced expiratory volume (FEV1) and forced vital capacity, which improved after inhalation of salbutamol. In November and December 1992 at a time the patient still used inhaled albuterol, monitoring of peak expiratory flow rates (PEFRs) at work and away from work, evaluation of bronchial responsiveness to methacholine, and hourly monitoring of FEV1 were performed. These revealed a dual asthmatic response characterized by a decrease in methacholine concentration causing a 20% fall in FEV1 from 5.1 to 0.7 milligrams per milliliter when the patient was at work. Pulmonary function was normal when the patient was not at work. The PEFR data showed significantly more variation when the patient was at work than when not at work. The authors conclude that working in aluminium potrooms can cause a reversible type of airway obstruction with work related features that are consistent with occupational asthma.
American Journal of Respiratory and Critical Care Medicine 150(6):1714-1717, 1994. (18 references)
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