Rads

Astma

ASTMA

Normaleluchtweg

Matig/ernstig

astma

Blussen

RADS

• Brooks SM, Weiss MA, Bernstein IL. Reactive airways

dysfunction syndrome (RADS): persistent asthmasyndrome after high level irritant exposure. Chest, 1985, 8,376-84

• 10 clinical cases:

• no pre-existing respiratory complaints

• single exposure to high level chemical irritant with

respiratory symptoms within minutes or hours

• persistent (> 1 y) asthma: cough, wheezing,

dyspnoea, (FEV1↓), airway hyperreactivity

• 2 biopsies: chronic nonspecific airway inflammation

• ≠ typical occupational asthma (no reexposure)

Bron: prof dr B. Nemery

RADS

Brooks SM, Weiss MA, Bernstein IL. Reactive

airways dysfunction syndrome (RADS):

persistent asthma syndrome after high level

irritant exposure. Chest, 1985, 8, 376-84

= de novo asthma caused by an acute

inhalation injury

Bron: prof dr B. Nemery

RADS - criteria

1. Documented absence of preceding respiratory complaints

2. Onset of symptoms after a single specific exposureincident

3. Exposure to gas, smoke, fume or vapour present in very

high concentration and with irritant properties

4. Onset of symptoms within 24 h after exposure

5. Persistence of symptoms for at least 3 months

6. Symptoms simulate asthma (cough, wheezing, dyspnoea)

7. Pulmonary function tests may show airflow obstruction

8. Positive methacholine/histamine test

9. Other disease ruled out

Bron: prof dr B. Nemery

RADS

• Many case reports or case series of RADS

following a wide variety of inhaled agents

• chlorine

• inorganic gases & vapours (HCl, SO2, NO2,

NH3, H2S, …)

• organic chemicals (isocyanates, acids,

aldehydes, tear gas, pesticides, solvents, …)

• poorly defined mixtures (fire smoke, welding

fumes, diesel exhaust, irritant aerosols, ...)

Alberts WM, do Pico GA. Chest, 1996, 109, 1618-28

Bron: prof dr B. Nemery

Samenstelling rook

Goldfrank's Manual of Toxicologic Emergencies > Chapter 123. Smoke Inhalation > Pathophysiology >

Products Combustion Products

Acrylic Acrolein, hydrogen chloride, carbon monoxide

Fire-retardant materials Hydrogen chloride, hydrogen bromide

Fluorinated resins Hydrogen fluoride

Melamine resins Ammonia, cyanide

Nitrogen-containing material Cyanide, isocyanates, oxides of nitrogen

Nylon Ammonia, cyanide

Petroleum products Carbon monoxide, acrolein, acetic acid, formic acid

Plastics Cyanide, hydrogen chloride, aldehydes, ammonia, nitrogen oxides, phosgene, chlorine

Polystyrene Styrene

Polyurethane Cyanide, isocyanates

Polyvinyl chloride Carbon monoxide, hydrogen chloride, phosgene, chlorine

Rubber Hydrogen sulfide, sulfur dioxide

Silk Sulfur dioxide, hydrogen sulfide, ammonia, cyanide

Sulfur-containing material Sulfur dioxide

Wood, cotton, paper Carbon monoxide, acrolein, acetaldehyde, formaldehyde, acetic acid, formic acid, methane

Wool Carbon monoxide, hydrogen chloride, phosgene, chlorine, cyanide, ammonia

Datum Tijd Fase brand Stoffen Geschatte

(globaal) blootstelling

Woensdag 1 14.26 u Felle brand Verbrandingsproducten Bovenwinds lage

5 jan.2011 HCl, Cl2, COCl2, HF, blootstelling

NOx, HCN, SO2, H2S,

COS, HCN, NOx, NH3

2 23.15 u Schuimdeken Ook PAK, aldehyden, Mogelijk hoge

roet, PCDD, PCDF blootstelling

Donderdag 3 00.15 u Brandmeester Verbrandingsproducten Matige blootstelling

6 jan

4 17.30 u Technisch uit: Vluchtige organische Lage blootstelling

chemisch (gechloreerde) Blootstelling doorafval en koolwaterstoffen, direct contact enbluswater basisch inademen dampen

Chemiepack, Moerdijk

“Take home message”

in all workers at risk of inhalation injury:

at least baseline spirometry

yearly lung function testing

perhaps also test of nonspecific bronchial

hyperreactivity (histamine/methacholine)

Bron: prof dr B. Nemery