Prevention of dysbaric osteonecrosis in compressed-air workers.
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Approximately 400 indigenous divers live and work on Thailand's west coast. They dive with surface supplied air from primitive compressor units mounted on open boats which measure from seven to 11 meters in length. It was suspected that carbon monoxide was present in the breathing air of at least the gasoline-driven compressor units. To determine the presence of carbon monoxide gas in the breathing air, compressed air from the compressor was pumped through the diver air supply hose through a plenum (monitoring) chamber established on the boat. After a compressor warm-up of 15 minutes, the diving air was measured with the boat at eight different bearings to the wind, each 45 degrees apart at intervals of five minutes. Three of the four gasoline-driven compressor units tested showed presence of carbon monoxide in the breathing air. One diesel-driven unit showed a very low concentration of carbon monoxide (3-4 ppm) and six diesel-driven units showed no detectable carbon monoxide. Although not tested, diesel exhaust emissions could also enter the breathing air by the same route. A locally made modification to the compressor air intake was designed and successfully tested on one gasoline-driven compressor unit. An information sheet on the hazards of carbon monoxide as well as on the modification has been developed for distribution among the villages.
Oxygen supplementation is known to improve exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Although some COPD patients use oxygen after exercise to relieve dyspnea, the effect of oxygen during recovery from exercise is not clearly understood. Exercise duration and dyspnea recovery time were studied in 18 patients with stable COPD. Patients exercised at a constant submaximal work rate on a treadmill ergometer until they no longer wished to continue. Oxygen, room air and compressed air were randomly administered in three consecutive post-exercise recovery periods. Dyspnea was scored on a 100 mm visual analog scale at 30 s intervals until return to baseline. An additional 20 minute post-recovery resting period was allowed between each test. No significant differences were found in dyspnea recovery time breathing oxygen (271 s), room air (290 s) or compressed air (311 s) When the groups were sorted by sequence of testing, there was a highly significant increase in recovery time (208 s, 307 s and 358 s for the first, second and third tests; P < 0.005) and a non-statistically significant decrease in exercise duration (89 s, 79 s and 76 s). Post-exercise oxygen supplementation had no effect on dyspnea recovery time in these COPD patients. Repeated bouts of exercise increased dyspnea recovery time and tended to decrease exercise duration. These findings suggest that, despite recovery of symptoms, physiological recovery from prior exercise is incomplete.
Compressed breathing air, used in self-contained breathing apparatus (SCBA) by firefighters and other categories of workers as well as by recreational and commercial divers, is prepared with the aid of high-pressure compressors operating in the range of 5000 psig. There have been reports of unexplained deaths of SCUBA divers and anecdotal accounts of decreased time to exhaustion in firefighters using SCBAs. Compressed breathing air has been found to contain elevated levels of carbon monoxide (CO) and water vapor that are consistent with carboxyhemoglobin (COHb) poisoning and freezing of the user's regulator on the breathing apparatus. The Coburn-Forster-Kane equation (CFK equation) was used to estimate COHb levels at rest and at maximum exercise when exposed to different levels of CO in contaminated breathing air. The results demonstrated that, at maximum exercise, the COHb ranged from 6.0 to 17% with the use of 1 to 4 SCBA cylinders contaminated by 250 ppm CO. Standard operating procedures have been developed at the Montreal Fire Department to minimize the risk of compressed breathing air contamination. Results of the quality analysis/quality control program indicate that implementation of these procedures has improved the quality of the compressed breathing air. Recommendations are made for improvement of the air testing procedures mandated by the Canadian CAN3 180.1-M85 Standard on Compressed Breathing Air and Systems.