title: Systematic review of respiratory case definitions in metalworking fluid outbreaks.
abstract: BACKGROUND
  Since the mid-1990s, outbreaks of asthma and extrinsic allergic alveolitis (EAA) have been identified in workers exposed to metalworking fluids (MWFs). The cause of these outbreaks remains to be determined.
  
  
  OBJECTIVE
  To identify and review all previously published occupational lung disease case definitions and diagnostic criteria that have been utilized during MWF outbreak investigations.
  
  
  METHODS
  Respiratory outbreaks due to MWFs were identified by a systematic literature search for articles published between 1990 and October 2011. Investigations reporting the usage of disease case definitions or diagnostic criteria for respiratory disease were reviewed and summarized.
  
  
  RESULTS
  The literature search identified 35 papers relating to 27 outbreaks of respiratory disease in MWF-exposed workers. Fourteen case definitions for MWF-related respiratory disease were identified: seven for EAA, five for occupational asthma and one each for humidifier fever and industrial bronchitis. A single paper was identified where any comparison of different disease case definitions (for EAA) had been performed.
  
  
  CONCLUSIONS
  A range of case definitions and diagnostic criteria for MWF respiratory disease have been utilized in outbreak investigations, but the majority have been produced for individual outbreak investigations without previous validation. It may be difficult to compare the findings of future workplace studies without a more standardized approach to case identification and diagnosis.
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK. chris.barber@hsl.gov.uk
authors.forename: C M
authors.initials: CM
authors.lastname: Barber
authors.forename: C M
authors.initials: CM
authors.lastname: Burton
authors.forename: H
authors.initials: H
authors.lastname: Scaife
authors.forename: B
authors.initials: B
authors.lastname: Crook
authors.forename: G S
authors.initials: GS
authors.lastname: Evans
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis* / Q000453:epidemiology; D059366:Asthma, Occupational / Q000175:diagnosis* / Q000453:epidemiology; D001991:Bronchitis / Q000175:diagnosis* / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008669:Metallurgy; D008670:Metals / Q000633:toxicity; D012129:Respiratory Function Tests / Q000379:methods
chemical_list: D008670:Metals