title: Non-malignant respiratory disease among workers in industries using styrene-A review of the evidence.
abstract: BACKGROUND
  Asthma and obliterative bronchiolitis (OB) cases have occurred among styrene-exposed workers. We aimed to investigate styrene as a risk factor for non-malignant respiratory disease (NMRD).
  
  
  METHODS
  From a literature review, we identified case reports and assessed cross-sectional and mortality studies for strength of evidence of positive association (i.e., strong, intermediate, suggestive, none) between styrene exposure and NMRD-related morbidity and mortality.
  
  
  RESULTS
  We analyzed 55 articles and two unpublished case reports. Ten OB cases and eight asthma cases were identified. Six (75%) asthma cases had abnormal styrene inhalation challenges. Thirteen (87%) of 15 cross-sectional studies and 12 (50%) of 24 mortality studies provided at least suggestive evidence that styrene was associated with NMRD-related morbidity or mortality. Six (66%) of nine mortality studies assessing chronic obstructive pulmonary disease-related mortality indicated excess mortality.
  
  
  CONCLUSIONS
  Available evidence suggests styrene exposure is a potential risk factor for NMRD. Additional studies of styrene-exposed workers are warranted. Am. J. Ind. Med. 60:163-180, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Respiratory Health Division, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Nett
authors.affiliation: Respiratory Health Division, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Cox-Ganser
authors.affiliation: Health Effects Laboratory Division, National Institute for Occupational Safety and Health (NIOSH), CDC, Morgantown, West Virginia.
authors.forename: Ann F
authors.initials: AF
authors.lastname: Hubbs
authors.affiliation: Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health (NIOSH), CDC, Cincinnati, Ohio.
authors.forename: Avima M
authors.initials: AM
authors.lastname: Ruder
authors.affiliation: Respiratory Health Division, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia.
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Cummings
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Yuh-Chin T
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Respiratory Health Division, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kreiss
mesh_terms: D001249:Asthma / Q000139:chemically induced*; D001989:Bronchiolitis Obliterans / Q000139:chemically induced*; D006801:Humans; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D020058:Styrene / Q000633:toxicity*
chemical_list: D020058:Styrene
keywords: asthma; bronchiolitis obliterans; non-malignant respiratory disease; obliterative bronchiolitis; occupational asthma; occupational lung disease; styrene; styrol; vinylbenzene