Occupational asthma related to low levels of airborne methylene diphenyl diisocyanate (MDI) in orthopedic casting work

• Published in: American journal of industrial medicine Vol. 54; no. 12; pp. 906 - 910
• Main Authors: Suojalehto, Hille, Linström, Irmeli, Henriks‐Eckerman, Maj‐Len, Jungewelter, Soile, Suuronen, Katri
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2011; Wiley-Liss
• Subjects: Adult; Asthma, Occupational - chemically induced; Biological and medical sciences; Casts, Surgical - adverse effects; Chronic obstructive pulmonary disease, asthma; Environment. Living conditions; Female; Humans; Inhalation Exposure - adverse effects; isocyanates; Isocyanates - adverse effects; Male; MDI; Medical sciences; methylene diphenyl diisocyanate; occupational asthma; Occupational Diseases - epidemiology; Occupational Diseases - prevention & control; Occupational Exposure - adverse effects; Orthopedic Equipment - adverse effects; plaster casts; Pneumology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; specific bronchial provocation test; specific inhalation challenge test; Europe; Finland; occupational asthma; Toxicity; Occupational exposure; Respiratory system; Respiratory tract; specific inhalation challenge test; MDI; Organic diisocyanate; methylene diphenyl diisocyanate; Synthetic resin; Plastic material; Bronchus disease; Plaster; Cast molding; Obstructive pulmonary disease; Inhalation test; Human; Isocyanates; Lung disease; plaster casts; Respiratory disease; Health staff; Low dose; Bronchus; Asthma; Case study; Orthopedics; Aerosols; specific bronchial provocation test; Occupational medicine; Nurse; Provocation test
• ISSN: 0271-3586; 1097-0274; 1097-0274
• DOI: 10.1002/ajim.21010

Orthopedic plaster casts contain methylene diphenyl diisocyanate (MDI). A few case reports have suggested occupational asthma to MDI in casting work. However, the knowledge of the exposure levels related to the occupational asthma cases is lacking. We report on two occupational asthma cases due to MDI in nurses irregularly applying orthopedic plaster casts, verified with placebo controlled specific inhalation challenge. The levels of MDI in the air were measured in the exposure chamber during the specific inhalation challenges with a quantitative method including filter collection and subsequent liquid chromatography‐mass spectrometry (LC‐MS) analysis of the isocyanate groups. In order to estimate the level of airborne MDI in casting work, measurements were conducted also in two hospitals during the application and removal of synthetic plaster casts using the same method. The concentrations were well below the occupational exposure limit in both specific inhalation challenge and hospital measurements. Based on our findings, even minor exposure to airborne MDI in casting work can cause an asthmatic reaction in some patients. Am. J. Ind. Med. 54:906–910, 2011. © 2011 Wiley Periodicals, Inc.