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• W4383270711 abstract "Sir, I take reference to the article mentioned in the title, which was published recently in your journal.[1] As the authors mention, no exposure measurements were available for the study. This introduced severe limitations into their study since critical information about accidental (acute) and background (chronic) exposure of the workers to phosgene as well as the presence of potentially interfering chemicals (e.g., chlorine, ammonia, potential other irritants, and asthmagens) was missing. Instead, the duration of employment was used as a surrogate measure for a presumed cumulative exposure to phosgene. It is standard safety practice in the industry to use area monitors and personal phosgene dosimeter badges (see recommendation by the Indian Phosgene Council) to assess both types of exposure.[2] Feedback from such monitoring indicates that background concentrations are typically below ppb levels, and that acute exposures in the form of positive badge readings are rare occurrences. It has been observed that acute exposure to phosgene may contribute to a reduction in the one-second forced expiratory volume (FEV1), which is closely related to the peak expiratory flow (PEFR).[3] Literature on chronic exposure to phosgene is limited but indicates that concentration rather than the cumulative dose (Cxt) is the determining metric.[4] Based on these considerations, it would seem very unlikely that “chronic low-dose exposure” would be the cause of the “effect on peak expiratory flow rate.” The analysis presented in the study was performed using a one-way analysis of variance (ANOVA) approach. This means that single parameters were evaluated against the measured PEFR. Since the investigated parameters (for instance, height and weight, but also age and duration of employment) are correlated to some extent, single parameter correlations do not allow for a differentiation between the contributions of the individual parameters to the measured outcome. The fact that only 6.6% of the participants showed a reduced PEFR compared to predicted values seems to indicate that age and other confounders were the main contributors to reduced PEFR. A two-way analysis should have been performed to assess the magnitude and significance of the contributions of the parameters “age” and “duration of employment.” In the absence thereof, a correlation or causal relationship with employment duration cannot be concluded based on the available data. In addition, PEFR can be indicative of both obstructive and restrictive effects in the airways. The differentiation requires the comparison with a lung volume parameter like the forced vital capacity (FVC). Phosgene being a lower-airway irritant, one would rather expect a restrictive effect.[5] Based on these considerations, there would seem to be inadequate proof of any “effect on peak expiratory flow rate” by “chronic low-dose exposure” to phosgene. In summary, in the absence of adequate dosimetry and methodology, the paper does not present any solid evidence that supports the conclusion stated in its title and abstract. Financial support and sponsorship This work was solely funded with regular dues of the institute. Conflicts of interest The author is employed by the International Isocyanate Institute, Inc. The institute is funded by producers of MDI and TDI." @default.
• W4383270711 created "2023-07-06" @default.
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• W4383270711 date "2023-01-01" @default.
• W4383270711 modified "2023-10-18" @default.
• W4383270711 title "Letter to the editor regarding tiwari and Raghavan, Indian J Occup Environ Med 2022;26:189-92" @default.
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• W4383270711 doi "https://doi.org/10.4103/ijoem.ijoem_22_23" @default.
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