Obliterative bronchiolitis in fibreglass workers: a new occupational disease?
- Paul Cullinan1,2,
- Clive R McGavin3,
- Kathleen Kreiss4,
- Andrew G Nicholson1,2,
- Toby M Maher1,
- Tim Howell5,
- John Banks6,
- Anthony J Newman Taylor7,
- Chi-Hsien Chen8,
- Perng-Jy Tsai9,
- Tung-Sheng Shih10,
- P Sherwood Burge11
- 1Royal Brompton Hospital, London, UK
- 2Occupational and Environmental Medicine, National Heart & Lung Institute, Imperial College London, London, UK
- 3Nuffield Health Plymouth Hospital, Plymouth, UK
- 4National Institute for Occupational Safety and Health, Atlanta, Georgia, USA
- 5Derriford Hospital, Plymouth, UK
- 6Princess of Wales Hospital, Bridgend, UK
- 7Faculty of Medicine, Imperial College London, London, UK
- 8Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei City, Taiwan
- 9Department of Occupational Safety and Health, College of Public Health, China Medical University and Hospital, Taichung, Taiwan
- 10Department of Public Health, College of Public Health, China Medical University and Hospital, Taichung, Taiwan
- 11Birmingham Heartlands Hospital, Birmingham, UK
- Correspondence to Dr Paul Cullinan, Occupational and Environmental Medicine, National Heart & Lung Institute, Imperial College London, 1b Manresa Road, London SW3 6LR, UK;
- Received 11 July 2012
- Revised 12 November 2012
- Accepted 9 December 2012
- Published Online First 15 January 2013
Rationale and objectives Obliterative bronchiolitis (OB) is a rare disease with a small number of established occupational aetiologies. We describe a case series of severe OB in workers making glass-reinforced plastics.
Methods Workplace exposures were the likely cause after the independent diagnosis of OB in two workers laying up the fibreglass hulls of yachts; the second worker took over the job of the first after he left following a lung transplant. Presentation of these two cases at international meetings led to others identifying similar workers.
Main results We identified six workers with good evidence of OB. All were involved in preparing fibreglass with styrene resins, five as boat builders laying up fibreglass hulls and one during cooling-tower fabrication. The disease came on rapidly without unusual acute exposures. Two patients had lung transplants, while another died while waiting for one. Histology confirmed OB in the four with biopsies/post-mortem examinations or explanted lungs.
Conclusions A rare, potentially fatal disease occurring in six workers laying up fibreglass with styrene resins from five different worksites suggests that work exposures were the cause of their OB. The precise agent responsible awaits identification.