prevalence and association of welding related systemic and respiratory symptoms in welders
Objective: to determine in the welder sample the prevalence of symptoms indicating coexistence welding-related systems of metal smoke heat (MFF)
Respiratory symptoms associated with welding indicate occupational asthma (OA)
, And the strength and significance of any association between the two groups of symptoms.
Methods: 351 of the 441 welders were subjected to a respiratory symptom questionnaire, a systematic symptom questionnaire and a career history questionnaire by telephone (79. 6%)
Two cities from Quebec, Canada. Results: Common
Possible MFF (
Defined as having at least two symptoms at the beginning of the working week: fever, flu, general discomfort, chills, dry cough, metallic flavor and shortness of breath, exposed to 3-10 hours after welding smoke)
Prompt OA with respiratory symptoms related to welding (
Defined as having at least two welding-related symptoms of cough, breathing and chest tightness)was 5. 8%.
The symptoms of these two groups were significantly related (χ2 = 18. 9, p < 0. 001).
Conclusion: there is a strong correlation between Weld-related MFF and weld-related respiratory symptoms, suggesting OA.
Therefore, MFF can be considered
Welding the mark of the associated OA is a hypothesis that needs further study.
Methods during the period 1994-96, occupational health team of the Montreal Public Health Bureau
Centre Canada and Laval have implemented medical and/or environmental monitoring interventions in primary metal, metal products, machinery and transport equipment manufacturing, with most welders in Canada working in the construction industry, except for the construction industry.
In each industry, welders are classified as representing homogeneous exposure groups from which the competent health personnel selected the number of subjects represented for intervention;
This was carried out by the Quebec Workers\' Compensation Commission in 15 industries considered as priority sectors (
Commission de la santédu Travail et de la sécurité du qébec).
As far as the current survey is concerned, we have used the available list of 441 Welders involved in the above intervention program.
This information includes the name, address, telephone number and Employment Company of the Welsh.
Select 68 companies that employ 1-5, 6-15, 16-50 or 51-100 employees.
Therefore, we believe that our study object represents a reasonable sample of the welder in Quebec, but not a random sample.
The Quebec Press Commission approved this information.
The investigation was approved by the Sacré ethics committee. Coeur Hospital.
Three different questionnaires
Respiratory Symptoms Questionnaire, general symptoms questionnaire and occupational history questionnaire)
Management by telephone from September 1997 to April 1998.
Respiratory Questionnaire standardized questionnaire from the International Alliance for tuberculosis and pulmonary diseases (IUATLD);
It also includes questions about smoking habits.
Followed by another original systematic symptom questionnaire adapted from a questionnaire developed by Menzies and colleagues to assess the work considered to be typical \"disease building syndrome\"
According to the clinical description of MFF, the main content of the system symptom questionnaire was selected.
3, 4 they include the following: History of specific flavors in the mouth (
Sweet taste like metal)Flu-like symptoms (
Such as fever, flu, general discomfort, Cold War)
Muscle pain, joint pain, throat symptoms (
Such as dry throat, itching or shrinking, dry cough, hoarse voice)
Digestive symptoms (
Such as loss of appetite, nausea, abdominal cramps, etc)Fatigue (
Weak, yawning, hard to focus on)
History of respiratory symptoms (
(Such as breathing, chest tightness, shortness of breath, cough).
For each of the above, information about the time of onset of symptoms and their duration was also collected.
The welding process and metal for welding in the event of symptoms were recorded.
This systemic symptom questionnaire was initially tested satisfactorily in 10 welders with clinical diagnosis of OA, some of whom reported MFF.
These questions are followed by a third questionnaire on career history with the aim of quantifying the number of experiences in the welding industry.
As mentioned earlier, there is no standard definition of an available MFF in the literature.
In the Encyclopedia of occupational health and safety, MFF is defined as flu
Like a disease that occurs after inhalation of metal smoke, symptoms begin to appear 3-10 hours after exposure.
Initially, there may be a sweet metallic flavor in the mouth, accompanied by a growing dry cough and shortness of breath.
There are frequent chills with fever and trembling, and the workers feel uncomfortable.
Workers react quickly
That is to say, symptoms only occur after a few days of exposure without exposure, rather than in the case of regular repeated exposure.
Two MFF indices are defined according to this definition: possible MFF is defined as having at least two symptoms: fever, flu sensation, general discomfort, chills, dry cough, metallic flavor, shortness of breath.
Possible MFF is defined as fever and at least two of the following symptoms: Flu, general discomfort, chills, dry cough, metallic flavor, shortness of breath.
For both indices, individual symptoms are considered only at the beginning of the work week, I . e. 3-10 hours after exposure to welding smoke reported by welders.
The weld-related respiratory symptom index for hint OA is defined as having at least two symptoms: cough, breathing and chest tightness when exposed to weld smoke.
For the welding-related respiratory and welding-related systemic symptoms and the index produced, the statistical analysis frequency distribution was generated.
The association between respiratory symptoms and MFF symptoms was examined with a X2 analysis.
Logistic regression analysis was performed to estimate odds and 95% confidence intervals, taking into account several potential risk factors, such as the number of years of employment, to examine the occurrence of respiratory symptoms associated with MFF, with a doctor diagnosed with asthma.
Data aggregation and statistical testing using SPSS statistical software package (SPSS, Inc. , Chicago, IL).
All statistical tests are double-sided; a p value of 0.
The statistical significance is less than 05.
Data were obtained from 351 participants (
As shown in Table 1)
Of the 441 welders invited to participate in the study.
This represents 79.
6% of those eligible for inclusion in the study.
Out of the existing list of 441 workers, 18 were unqualified because they were not welders, 15 dec were lined up for research, 57 were not reached, or because they could not be tracked, either because they have moved abroad.
These 90 non
Participants, 69 male subjects with an average age of 41, provided age and gender information (9. 06)years.
View this table: View inline View pop-up table 1 Social population and smoking features (n=351)
At the time of the interview, 46 welders had retired for 4 years or less.
Most welders are male (
Between the ages of 20 and 71, the average age is 43 years (10. 39)years.
In the study population, 27 people have non-
Welding related asthma 5.
1% reported a doctor\'s diagnosis of asthma (table 1).
About 1 welder per 3 (27. 9%)
Never smoked, 38.
At present, the number of smokers is 5% and 33. 6%, ex-smokers.
More than half of the population (60. 1%)
Considered a mild smoker (
Smoking less than 20 packs-years), whereas 39.
Heavy smokers accounted for 9% (
More than 20 packs-years). The majority (86. 9%)
Still working as a welder;
The average working time for welders is 20 days. 33 (10. 76)
Several years during the interview.
The age of welders starting welding career ranges from 12 to 45 years old, with an average of 22 years old (5. 5)years. Most (87. 7%)
As a welder, I work five days a week and 97% of people report 40 hours or more of welding per week.
More than 65% of welders reported welding of stainless steel, carbon steel, galvanized steel and aluminum, and nearly half reported welding of various other metals.
As shown in Table 2, 26.
6% of welders reported that they had experienced respiratory symptoms associated with welding at least once, such as cough, breathing, chest tightness, or other respiratory symptoms.
Only about 16% of people do not have any systemic symptoms associated with welding contact, such as flu
Symptoms like symptoms, pain, throat, digestion, taste and fatigue.
On the other hand, about half of the welders experienced at least three of the above system symptoms during welding. The majority (89–97%)
It is reported that the above systemic symptoms occurred within 3-10 hours after one day exposure to welding smoke, most (62–82%)
These symptoms were reported at the beginning of the work week.
In addition, it is reported that a high percentage of welders have at least one nose (40. 5%)or ocular (53. 3%)symptom.
View this table: View inline View pop-up table 2 prevalence of welding-related symptoms 3 show prevalence of symptoms and signs used to describe MFF.
More than 10% people are reported to have been infected with various types of flu
Less than half, like symptoms (44. 4%)
About 30% of welders report dry cough, only 3.
7% describes the metallic taste in the mouth when exposed to welding smoke.
View this table: View inline View pop-up table 3 describe the prevalence of symptoms of metal smoke heat *(n=351)
Table 4 shows that about 15% of people reported respiratory symptoms suggesting OA, excluding subjects with non-OA symptoms, a decrease to 5%
Asthma related to welding
19 people reported possible MFF and possible MFF attacks.
7% and 12% respectively.
This table also shows 5. 8% and 4.
0% of welders state the case where possible MFF and possible MFF coexist with two welding-related respiratory symptoms, respectively.
View this table: view the prevalence of respiratory and systemic symptoms associated with welding (n=351)
There are at least two types of weld-related respiratory symptoms suggesting OA are significantly associated with possible MFF (χ2 = 18. 9, p < 0. 001)
, And possible MFF (χ2 = 16. 0, p < 0. 001).
In addition to metallic taste and respiratory symptoms, significant associations were found between various individual symptoms used when defining MFF (data not shown).
Table 5 shows that possible MFF and possible MFF appear to be primarily associated with respiratory symptoms associated with suggesting welding of OA (
Cough, breathing, chest tightness at least twice).
With the increase in the number of years of employment, there was no significant increase in the risk of welding-related respiratory symptoms.
Heavy smokers seem to be more prone to respiratory symptoms associated with welding.
As expected, the doctor reported by the welder diagnosed the presence of asthma as related to the presence of breathing (OR 4. 94, 95% CI 1. 85 to 13. 7)
Chest tightness (OR 2. 92, 95% CI 1. 04 to 8. 14).
View this table: View the association between Weld-related respiratory symptoms and metal smoke fever, working hours, smoking, inline View pop-up table 5, A physician diagnosed asthma estimated by a single-variable logistic regression analysis revealed by multivariate logistic regression analysis (table 6)
, Even after years of work adjustment, possible MFF and possible MFF are still significantly associated with respiratory symptoms associated with welding
The doctor diagnosed the presence of asthma.
View this table: View the association between the inline View pop-up table 6 MFF and weld-related respiratory symptoms in multivariate logistic regression analysis * second goal on the study, welding process GMAW and s welding metal galvanized and carbon steel are closely related to respiratory and systemic symptoms describing MFF (
See Tables 7 and 8).
Both welding processes are also closely related to symptoms of nose, eye, throat, digestion and fatigue.
Galvanized steel and carbon steel are also associated with the symptoms mentioned in the latter, as are stainless steel.
View this table: View prevalence of respiratory and systemic symptoms associated with various welding processes view this table: View prevalence of respiratory and systemic symptoms associated with various metal welding. This descriptive study shows that
Accompanied by the occurrence of at least two welding-related respiratory symptoms of possible MFF and possible MFF 5.
8% and 4% respectively.
Although people may think there is an overlap between flu
Just as symptoms and respiratory symptoms may confuse the outcome, because these symptoms and symptoms often occur in the same person during a flu attack, the welder specifically reported the occurrence of these symptoms during the welding operation, trying to rule out this possibility. The co-
Respiratory symptoms and the occurrence of MFF have been reported in some case reports.
Malo and co-reported an acute response to zinc inhalationworkers.
This response includes typical symptoms and signs of MFF (
Fever, discomfort, difficulty breathing, increased white blood cells)
In addition to the transient diffuse nodule infiltration seen in the chest X-ray examination (
This is not the case in the case of welder fever)
And evidence of temporary ventilation disorder after the challenge test.
This observation is supported by another report that describes what happens during the melting of copper, zinc and aluminum, which are mainly used to manufacture shape memory alloys.
Inhalation of the resulting smoke can also lead to significant transient respiratory disorders and MFF symptoms.
Another case related to MFF lung involvement was reported, and a patient with a clinical history of repeated zinc smoke fever was exposed to experimental welding.
Twelve lung function tests showed significant lung response, and a total cell count and a significant increase in the number of polynuclear white blood cells were shown in the trachea incision performed 24 hours after the challenge.
It is well known that, as reported in several case reports and reviews, welding can lead to asthma.
Contact metal (
Nickel, chromium, cobalt, etc)
The gas released during welding may be the cause of asthma.
In our study, a high prevalence of weld-related respiratory symptoms suggesting asthma was defined as having at least two symptoms of breathing, cough and/or chest tightness (14. 6%).
The exposure conditions of these workers can explain this in part.
In fact, nearly 43% of these welders do not use any respiratory protection equipment.
About 26% of subjects reported the use of appropriate breathing masks equipped with filters, and about 32% reported the use of ineffective respiratory protection devices such as regular paper masks.
However, there are only 17 people wearing enough masks.
6% of people use it for some time.
There is no data on other aspects of working conditions that can explain the high prevalence of symptoms.
Regarding the specific symptoms, about 15% of welders reported breathing and chest tightness associated with welding.
This is close to the results of an earlier cross-sectional survey of workers aged 19-27 who completed three to nine years of work as a shipyard welder;
16% and 14% reported breathing and chest tightness related to welding, respectively.
14 questionnaires are a good tool for early screening of OA;
Although the specificity of the questionnaire used as an OA diagnostic tool is low (14%)
High sensitivity (97%).
15. although most cross-sectional studies using respiratory questionnaires and/or respiratory function tests show an increased risk of developing respiratory symptoms and airway obstruction in welders compared to other workers, one of the few longitudinal studies has shown some contradictory findings.
One longitudinal study was unable to record the development of respiratory symptoms five years after exposure, while another study was conducted within seven years, showing worsening respiratory function associated with exposure to weld smoke.
The universality of possible MFF (19. 7%)
And possible MFF (12%)
In this study, Kilburn and colleagues found that the prevalence of MFF was lower than 35% in cross-sectional studies of 145 male shipyard welders.
This difference can be explained by the difference defined by MFF.
Our definition of MFF is a preliminary attempt to standardize the definition of a common disease such as welder.
The use of a possible MFF as a standardized definition is more specific but not sensitive as the welder may have symptoms of the MFF but may not necessarily have a fever (
Necessary conditions for defining possible MFF).
Therefore, it is recommended to use a possible MFF.
A large number of welder OA case reports have been published.
20-22 Malo and Cartier23 describe two cases of OA of welders exposed to galvanized metal smoke, and the specific inhalation challenge reveals this.
One of these two cases, in addition to the late airway spasm response, has developed fever, which may indicate that frequent onset of MFF may lead to respiratory problems such as airway hyperresponsiveness and OA.
The metals of some low molecular weight compounds have been shown to lead to OA, which is associated with the production of specific IgE antibodies against semi-antigens
Protein binding indicates the immune mechanism of OA development.
Immunity and non-immunity
Immune factors play an important role in the pathogenesis of metal-induced OA.
Nickel, chromium, cobalt, and platinum-induced asthma demonstrate an IgE-mediated mechanism.
Nevertheless, is it possible that MFF is a sign of respiratory symptoms that are exposed to weld smoke, prompting OA.
The study found no significant difference between smokers.
Smokers and non-smokers
Smokers were associated with welding-related respiratory symptoms, possible MFF, or possible MFF indices.
This finding is consistent with the results of a study conducted by Kilburn and his colleagues, 6 indicating that the frequency of respiratory and systemic symptoms in current smokers is no different from that in non-smokersWelder smoking
Experiments in human exposure to zinc metal smoke can lead to the release of cytokines, which can partially explain the heating composition of MFF.
24 with regard to the toxicity of welding smoke, in vitro toxicity studies have shown that stainless steel welding produces the most toxic smoke and Shields particles generated during metal arc welding (SMAW)
The toxicity on stainless steel is far greater than that of gas metal arc welding (GMAW)
25, 26 both severe and cooperative
Staff 25 and hoofman and co-
Staff 26 reported that the observed toxic effects were mainly due to the soluble chromium content produced by SMAW on stainless steel.
On the other hand, Kilburn and his colleagues found that MFF symptoms of aluminum welders were significantly more common than stainless steel or carbon steel welders.
The explanation for this finding is that aluminum welders are most symptomatic because they use the GMAW process that produces less smoke than SMAW produces on steel, but Ozone
According to the literature, this survey shows that galvanized steel is mainly associated with the symptoms of MFF.
However, as indicated by this survey, exposure to mild steel welding smoke poses a breathing hazard that may have previously been underestimated.
Recently, an increased risk of asthma in welders was observed in some epidemiology studies, and 27, 28 support the relationship between stainless steel welding and OA, which also shows that, carbon steel welding may indeed be a potential cause of OA.
This has been documented in an interesting case report that is due to occupational asthma caused by light steel GMAW.
There are several limitations in the current cross-sectional study.
First of all, this is not a survey with a probability sampling and representation cannot be determined.
While the associations we report may be valid, they are uncertain about the general capabilities of all welders.
Second, the recall problem may affect the report.
The worker effect of Health also seems to be a problem: as shown in Table 5, 20-29 years of welder work has proved to be a protective factor in preventing the development of breathing.
As with other horizontal studies, temporary problems are always a limitation.
Here, examples of symptoms of both the system and the respiratory system illustrate this problem;
It is not certain which symptoms first occur, resulting in the performance of other symptoms.
Therefore, a more detailed longitudinal study is necessary, especially since this study shows that the prevalence of respiratory and systemic symptoms is quite high due to exposure to weld smoke, and baseline host factors can be examined.
In addition, the problem of no external comparison group in this survey may be considered to attribute the occurrence of symptoms to the limitation of exposure to weld smoke.
However, as revealed by earlier research, welders always show a higher prevalence of systemic symptoms than non-welders
Welders6: more than 35% of welders reported episodes of fever, chills, fatigue, muscle pain, thirst, and metallic taste, not
Experienced MFF for welders.
In the same study, welders who smoke (28. 6%), ex-
Welders (26. 3%), and non-
Welders (37. 0%)
It is reported that more symptoms of fatigue, muscle pain, or metallic taste were experienced compared to current smoking and non-smokingsmoking non-welders (17%).
6 In conclusion, this study shows a high prevalence of this co-infection
Occurrence of respiratory and systemic symptoms associated with welding.
It also shows the association between MFF and respiratory symptoms that suggest occupational asthma.
We assume that MFF might be an interesting pre-
Exposure to respiratory symptom markers of hint OA caused by welding smoke, as MFF occurs shortly after exposure, while respiratory symptoms associated with welding take longer.
A prospective study is needed to verify this hypothesis.
Confirming the author\'s appreciation for the coordinated efforts of Marcelle Petitclerc, Marcelle Petitclerc contacted the welders by sending a message describing their role in the investigation
They also thanked Danielle lecclere for the interview, Dr. Heberto Ghezzo\'s statistical opinion on the analysis of the data, and Dr. Margaret Baker Lake\'s opinion on the definition of MFF.
They also thanked the welders who participated in the investigation.
They thanked the people in Montreal for their \"direction of San plico\"
The center and Laval of the list of welders are provided.
Finally, the author thanks Laurie Schubert for revising the manuscript.
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Open football supported by the Québec Lung Association and the San de leche San du Québec Foundation in Québec (FRSQ). Mariam El-
Zein is a PhD student funded by Max.
Stern recruitment scholarship at McGill University.