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Clinical Case Study 3

Clinical Case Study in Occupational and Environmental Medicine 

A nurse with persistent cough and wheeze


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    She had eczema as a child. Her six year old daughter has hay fever and her four year old son has asthma.  They keep cats and dogs. She stopped smoking two years ago having smoked 10 cigarettes per day. She used to work full time as a sister on a medical ward until she had children. She returned to work when her son was 6 months old as an endoscopy sister working '9 to 5' in an endoscopy suite. The suite has changed the type of sterilising fluid that they use. She moved house because of a change in her husband's job.

Her past history of eczema, and her children's history of hay fever and asthma respectively suggests that she is atopic, and at an increased risk of asthma (such as that caused by allergens from house dust mites, or cats or dogs) - but does not reduce the likelihood that the asthma is occupational. In some circumstances (e.g. with laboratory animal allergy) atopy increases the likelihood of developing occupational asthma though smoking probably increases the risk of occupational asthma even more than atopy in these circumstances.

What about other questions that you might wish to ask in this regard? You should ask her to bring in the 'MSDs' (Manufacturer Safety Data Sheets) of the chemical agents which she uses at work, as well as the 'COSHH asessments' (COSHH is an acronym for the 'Control of Substances Hazardous to Health' Regulations).  

A common sterilant that had been used in endoscopy that originally caused a great deal of concern as a causal agent of occupational asthma was glutaraldyde (or 'pentan-di-al' to use its approved chemical name). The following is its formula:

 

O:CH-CH2-CH2-CH2-HC:O

 

However glutaraldehyde's use was discontinued for this purpose (therefore unless  supplies were hoarded and still being used she should therefore not be exposed to it). 

What can you find out about sterilants currently used (instead of glutaraladheyde) to disinfect endoscopes?

There are a number.

For example one of them is orthophthalaldehyde  (OPA). Its chemical structure is such as to cause one to suspect that it might be an occupational hazard. Some cases of occupational asthma attributed to OPA have been described.

Substitution might help control the risk but does not necessarily abolish the hazard.

What other questions might you ask about the exposures at work, and other circumstances in her workplace? 

 

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Acknowledgement:

The case description on which this educational resource is based is (c) copyright of the University of Manchester. It is temporarily housed on this website for technical and other reasons.