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Different respiratory phenotypes are associated with isocyanate exposure in spray painters

¹ Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, ³ Netherlands Expertise Centre for Occupational Respiratory Disorders, Heart Lung Centre Utrecht, ⁴ Dept of Pulmonary Diseases, University Medical Centre Uterecht, ⁵ Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, and ² Business Unit Quality and Safety, TNO Quality of Life, Zeist, The Netherlands.

CORRESPONDENCE: D. Heederik, Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, PO Box 80176, 3508 TD Utrecht, The Netherlands. Fax: 31 302539499. E-mail: D.Heederik{at}iras.uu.nl

Keywords: Bronchial hyperresponsiveness, hexamethylene di-isocyanate, oligomer, sensitisation, spirometry, spray painter

Received: June 16, 2008
Accepted November 18, 2008

Associations have been observed between exposure to isocyanates, consisting mainly of oligomers, and respiratory symptoms and isocyanate specific sensitisation in spray painters. The aim of the present study was to assess associations between isocyanate exposure and more objective respiratory effect measures such as bronchial hyperresponsiveness (BHR), baseline spirometry and exhaled nitric oxide (eNO) in a subset of spray painters.

Methacholine challenge and eNO measurements were performed in 229 workers. Questionnaires and blood samples were obtained. Specific immunoglobulin (Ig)E and IgG to hexamethylene di-isocyanate were assessed in serum using various assays. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time-activity information.

Workers with higher isocyanate exposure were more often hyperresponsive (prevalence ratio comparing the 75th versus 25th percentile of exposure 1.8). In addition, significant exposure-related decreased forced expiratory volume in one second (FEV₁), FEV₁/forced vital capacity ratio and flow–volume parameters independent of BHR were found. BHR was more prevalent among sensitised workers. This was statistically significant for only IgG-ImmunoCAP (Phadia, Uppsala, Sweden) positive workers. eNO was not associated with exposure although slightly elevated eNO levels in specific IgG positive subjects were found.

The current study provides evidence that exposure to isocyanate oligomers is related to asthma with bronchial hyperresponsiveness as a hallmark, but also shows independent chronic obstructive respiratory effects resulting from isocyanate exposure.