Acute inhalation injuries
In the home
Acute inhalation accidents may occur at home during domestic work; for example, when mixing bleach with acids or ammonia or when using leather impregnation sprays. Respiratory complications are also a major cause of mortality in patients admitted for burn injuries, which affect 0.2–2.9 per 10 000 inhabitants annually in Europe.
In the workplace
The inhalation of certain agents can cause acute injury to the respiratory tract of varying severity. Occasional exposure to high levels of metal fumes or organic dusts contaminated with microorganisms and endotoxins may lead to metal fume fever and organic dust toxic syndrome, respectively. These inhalation fevers are the clinical expressions of a relatively benign and transient, though nonetheless unacceptable, condition of intense pulmonary inflammation. Such reactions occur commonly in agricultural work. Swedish and Finnish surveys indicate that about one in 10 farmers has experienced an acute febrile attack resulting from organic dust exposure. The possible long-term effects among affected subjects are poorly understood.
More severe injury to the tracheobronchial tree and lung parenchyma may result from the inhalation of toxic gases, vapours or complex mixtures of compounds released from explosions, fires, leaks or spills from industrial installations, transport accidents and military or terrorist operations. Such inhalation incidents can have massive dimensions and affect entire communities.
Toxic tracheobronchitis or pneumonitis with pulmonary oedema can be fatal; in survivors, these conditions may lead to long-term structural or functional effects, including irritantinduced asthma (reactive airways dysfunction syndrome (RADS)). Firefighters and emergency personnel are at particularly high risk, as are those working in confined areas.
The exact incidence of acute inhalational injuries at work is not known. The SWORD scheme registered an annual incidence rate of 5 per million in men and 1 per million in women. Although serious inhalation incidents are not very frequent compared to other injuries at work, they need to be prevented with appropriate administrative and technical measures. At a local level, there must be disaster plans and adequate facilities for the management of individual and collective inhalation injuries.