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PostScript
Obliterative bronchiolitis in workers laying up fiberglass-reinforced plastics with polyester resin and methylethyl ketone peroxide catalyst Cullinan et al1 reported six obliterative bronchiolitis (OB) cases with plausible correlation with fiberglass-reinforced plastics (FRP) fabrication. Five of them were boat builders and one worked for a coolingtower manufacturer. Due to the complexity of the FRP-related boat building processes, the exact agent(s) and process causing OB were difficult to determine. The coolingtower manufacturing had a simpler manufacturing process, and may help narrow down the actual processes leading to OB. Both industries involved gel coating and manual lamination of FRP. Recently, we identified an additional two patients with OB and exposure to FRP lamination. The first is a 35-year-old man who has worked in a FRP yacht manufacturing factory for 4 years. He developed persistent dyspnoea 1 year after starting FRP lamination. Lung function shows severe airway obstruction with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) 2.72 and 1.28 litres, respectively. Work exposure included various resins, mainly polyester resin with methyl ethyl ketone peroxide (MEKPO) (as catalyst) and styrene (as active diluents). The second patient, a 28-year-old man, was a water storage tank repairer for 8 years. His work involved mainly leakage-proof FRP lamination. Dyspnoea developed 2 years after starting on the job; and progressed so badly that he had to quit this year. Chest CT scan revealed air trapping. Lung function showed severe irreversible obstructive ventilatory defect, with FVC 3.56 litres and FEV1 1.55 litres, respectively. Two points are noteworthy in our second patient. He has never been involved in gel coating processes, and he only used Occup Environ Med September 2013 Vol 70 No 9
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PostScript polyester resin (with MEKPO and styrene) as glue at work. These imply that the actual process causing OB was likely FRP lamination, not gel coating. Besides, polyester resin containing MEKPO and styrene could be the responsible agent. Nevertheless, these are indirect evidences. The conclusive identification of the actual causal agent(s) warrants further investigation. Chi-Hsien Chen,1 Perng-Jy Tsai,2 Wei-Chu Wang,1 Chih-Hong Pan,3 Jiune-Jye Ho,3 Yueliang Leon Guo1 1
Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
676
2
Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan 3 Division of Occupational Medicine, Institute of Occupational Safety and HealthCouncil of Labor Affairs, Executive Yuan, New Taipei City, Taiwan Correspondence to Professor Yueliang Leon Guo, Department of Environmental and Occupational Medicine, National Taiwan University (NTU), College of Medicine and NTU Hospital, Rm 339, 17 Syujhou Road, Taipei 100, Taiwan;
[email protected] Contributors C-HC and YLG had the idea for the letter, and wrote the manuscript for which they accept responsibility. PJT, CHP and JJH provided contribution in exposure assessment. WCW assisted in case evaluation. Competing interests None.
Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed. To cite Chen C-H, Tsai P-J, Wang W-C, et al. Occup Environ Med 2013;70:675–676. Received 6 May 2013 Accepted 8 May 2013 Published Online First 5 June 2013 Occup Environ Med 2013;70:675–676. doi:10.1136/oemed-2013-101594
REFERENCE 1
Cullinan P, McGavin CR, Kreiss K, et al. Obliterative bronchiolitis in fibreglass workers: a new occupational disease?. Occup Environ Med 2013;70:357–9.
Occup Environ Med September 2013 Vol 70 No 9
Downloaded from oem.bmj.com on August 9, 2013 - Published by group.bmj.com
Obliterative bronchiolitis in workers laying up fiberglass-reinforced plastics with polyester resin and methylethyl ketone peroxide catalyst Chi-Hsien Chen, Perng-Jy Tsai, Wei-Chu Wang, et al. Occup Environ Med 2013 70: 675-676 originally published online June 5, 2013
doi: 10.1136/oemed-2013-101594
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