title: Cobalt asthma in metalworkers from an automotive engine valve manufacturer.
abstract: BACKGROUND
  Cobalt asthma has previously been described in cobalt production workers, diamond polishers and glassware manufacturers.
  
  
  OBJECTIVE
  To describe a case series of occupational asthma (OA) due to cobalt, identified at the Birmingham Heartlands Occupational Lung Disease Unit, West Midlands, UK.
  
  
  METHODS
  Cases of cobalt asthma from a West Midlands' manufacturer of automotive engine valves, diagnosed between 1996 and 2005, were identified from the SHIELD database of OA. Case note data on demographics, employment status, asthma symptoms and diagnostic tests, including spirometry, peak expiratory flow (PEF) measurements, skin prick testing (SPT) and specific inhalational challenge (SIC) tests to cobalt chloride, were gathered, and descriptive statistics used to illustrate the data.
  
  
  RESULTS
  The natural history of presentations has been described in detail, as well as a case study of one of the affected workers. Fourteen metalworkers (86% male; mean age 44.9 years) were diagnosed with cobalt asthma between 1996 and 2005. Workers were principally stellite grinders, stellite welders or machine setter-operators. All workers had positive Occupational Asthma SYStem analyses of serial PEF measurements, and sensitization to cobalt chloride was demonstrated in nine workers, by SPT or SIC.
  
  
  CONCLUSIONS
  We have described a series of 14 workers with cobalt asthma from the automotive manufacturing industry, with objective evidence for sensitization. Health care workers should remain vigilant for cobalt asthma in the automotive manufacturing industry.
authors.affiliation: Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. gaxwalters@hotmail.com.
authors.forename: G I
authors.initials: GI
authors.lastname: Walters
authors.affiliation: Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Robertson
authors.affiliation: Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: V C
authors.initials: VC
authors.lastname: Moore
authors.affiliation: Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
authors.forename: P S
authors.initials: PS
authors.lastname: Burge
mesh_terms: D000328:Adult; D059366:Asthma, Occupational / Q000209:etiology*; D001336:Automobiles; D003035:Cobalt / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D066192:Manufacturing Industry; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D009790:Occupations; D012129:Respiratory Function Tests; D012737:Sex Factors; D012882:Skin Tests; D006113:United Kingdom
chemical_list: D003035:Cobalt; C018021:cobaltous chloride
keywords: Cobalt; hard metal; metalworking fluid; occupational allergy; occupational asthma; occupational respiratory disease.