Reactive Airways Dysfunction Syndrome in communities and first responders exposed to irritants due to chemical incidents and fires.

In this project the development of Reactive Airways Dysfunction Syndrome (RADS) as a possible long-term effect due to chemical incidents will be studied in the general population and in first responders. The term RADS has been applied to the persistence of airway responsiveness after acute exposure to respiratory irritants. In some occupational settings it has been recognized that a single high-dose exposure or repeated low exposures can cause RADS in personnel working with irritants. Studies show that police officers and firefighters during the performance of their tasks are potentially exposed to irritant substances during chemical incidents and fires and can develop Reactive Airways Dysfunction Syndrome. For communities surrounding specific industries, however, it is less clear if a RADS might develop after single exposure to irritants, for instance associated with accidental emissions or major accidents. Because there are no known studies on RADS in Public Health settings in the Netherlands the syndrome is not taken into account when the general population is exposed to irritants. A combination of factors impede the recognition of RADS in chemical incidents and fires. First there is the ignorance of RADS in Public Health, but often also in Occupational Health and in the clinical and general practice. Second in most incidents the number of exposed people is relatively small. Third, the connection between the persisting complaints and the exposure to irritants can be missed, because many people do not seek immediately medical attention, especially when the acute complaints only persist for a few days. Four, the health care given to exposed people is scattered over different organisations/physicians (hospitals, general practioners, different Occupational Health Services). Because these factors cause a 'dispersion' of typical complaints, and the percentage of exposed people developing a RADS is expected to be rather small, and protocols how should be dealt with patients who present them selves after accidental exposures are lacking, the overall picture of the problem is missing, and Reactive Airways Dysfunction Syndrome is likely to be missed or at least underestimated. Literature on the occurence of long-term pulmonary effects and deterioration of lung function after acute exposure to irritants and the development of Reactive Airways Dysfunction Syndrome following irritant exposure focused on Public Health settings will be reviewed . A retrospective study will be performed on a population exposed to combustion products of a large fire at a hazardous waste disposal site. This study includes spirometry, histamine challenge testing and blood tests. Further a cross-sectional study will be performed to assess the effects on firefighters of exposure during firefighting. Firefighters can also act as a model for the general population. Especially when the visual impression of the smoke concentration is considered low, a firefighter can be exposed to concentrations common to the general population. At last a prospective study can clearify the relation between exposure to smoke or irritant gases in chemical incidents and the development of RADS. First responders will be examined prospectively, because of the following reasons: * First, exposed first responders can be a model for exposed public. * Second, a higher percentage of first reponders is involved in incidents than the general population is. * Third, of the subjects exposed to irritants in performing their job medical records are known. * Fourth, first responders experience health hazards because the do not have disposal of personal protective equipment (ambulance personnel, police) or they do not use this equipment in time or long enough (Brandt-Rauf et al. noted that in many cases respiratory protective equipment was not used owing to the visual impression of low smoke intensity, and thus these levels represent actual direct exposure of the firefighters). * Fifth, the Health Advisor Hazmat (GAGS) has to take the public and the first responders into consideration. * Sixth, besides the professional fire brigade there is the volunteer fire brigade. Because incidents in which the public and/or first responders are exposed to irritants are not foreseeable just as the locations are, where these incidents occur, the area in which the study has to be performed will not be restricted to one region. The persons to be examined can be exposed throughout the Netherlands. The Environmental Accident Service (MOD) ensures that RIVM expertise is available 24 hours a day. In the prospective study health modified health questionnaires (ELON/MRC) will be used. Laboratory tests eosinophils, neutrophils and inhalatory allergens), spirometry with and without histamine challenge tests will be performed, as are reversibility tests and an induced sputum assessment. This study will be combined with a follow-up to get an impression on the persistence of RADS and to what degree the symptoms diminish in time.