[Reactive airway dysfunction syndrome: more flexible application of diagnostic criteria are important for occupational accident victims].
Reactive airway dysfunction syndrome (RADS), or Brooks syndrome, is a complication observed after inhalation of caustic or highly irritating substances. The diagnosis is based on a group of criteria which include the absence of prior respiratory disease. Strict application of these criteria could have a prejudicial effect for certain victims. Three serious cases of RADS were observed in workers who were exposed to massive inhalation of caustic substances. The products implicated (phosphoric oxychloride, titanium tetrachloride, and trichloroacetyl chloride) hydrolyze to hydrochloric acid when they come in contact with the airway mucosa. After an initial period of acute respiratory distress, the patients encountered serious difficulties in achieving an appropriate diagnosis, and in having their sequellae recognized as resulting from an occupational accident. The problem was that these patients had a history of cured allergic asthma or smoking-related COPD. The presence of prior respiratory disorders must not exclude the diagnosis of RADS. A prior respiratory disorder cannot be used as an argument to exclude such victims from indemnities for occupational accident sequelae.
Unité de Toxicovigilance, Centre Antipoison, Hôpital Edouard-Herriot, Hospices Civils de Lyon, 69424 Lyon Cedex 03. francois.testud@chu-lyon.fr
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D000328:Adult; D001249:Asthma / Q000150:complications; D002424:Caustics / Q000009:adverse effects; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D012130:Respiratory Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D013577:Syndrome
D002424:Caustics