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Heinzer et al. report cases of severe respiratory effects
following exposure to aerosol waterproofing sprays in Switzerland .
They report that while there are reports from elsewhere in Europe there
are no reports yet from the UK. We report the experience of the National
Poisons Information Service (London) [NPIS(L)] with these products in
The European Association of Poison...
The European Association of Poisons Centres and Clinical
Toxicologists (EAPCCT) issued a warning regarding the risk of respiratory
distress developing in people using aerosol waterproofing agents. Subsequently NPIS(L) received an enquiry concerning a patient who
had developed Adult Respiratory Distress Syndrome (ARDS) following the use of an
aerosol waterproofing product in a confined space. This patient developed
respiratory failure and despite supportive treatment died .
Since this date the NPIS(L) has undertaken enhanced surveillance of
enquiries regarding such products. There were 43 enquiries to the NPIS(L)
concerning 33 cases of inhalation of aerosol waterproofing agents in 2003.
Of these cases, 31 (94%) involved adults and 2 (6%) children. All cases
were accidental exposures, with 27 (82%) exposures occurring at home, 4
(12%) at work and 2 (6%) in cars. All patients were or had been
symptomatic (symptoms were scored using the IPCS/EAPCCT Poisoning Severity
Score  following their exposure; 22 (67%) with mild symptoms and 10
(30%) with moderate symptoms, mostly respiratory in nature. One patient
had severe symptoms leading to death .
Although the number of enquiries to NPIS(L), from 2000 to 2003,
regarding aerosol waterproofing agents was very small compared with total
enquiry load, the number of enquiries concerning these products has
increased each year from 18 in 2000 [0.011%] to 43 in 2003 [0.067%]. This
is despite a significant decrease in total call load and represents a
proportional increase of 5.6 fold from 2000 to 2003. 2003 saw the most
serious case reported to NPIS(L) .
The manufacturer of the product implicated in the death  informed
the NPIS of a recent change in formulation. A high-odour solvent had been
replaced by a low-odour solvent blend. This change may have allowed greater
exposure to the product than is recommended, as there would be less olfactory
warning compared with the original solvent (i.e. allowing heavier exposures to
be tolerated). This is despite the manufacturer’s instructions on the package
indicating that indoor use is not recommended. This low-odour variant has since
been withdrawn . 11
further cases in 2003, many in the early part of the year (1 case in
2002), involved this particular product. The high incidence may have been
related to the new low-odour variant, however, the variant involved in
these cases was either not known or not specified by the enquirer.
It seems likely that the fluorocarbon compounds in these products
cause the pulmonary problems [5,6,7] however the reason for this is not
clear. Nor is it clear why there has been an increase in cases in the UK
and elsewhere in Europe and unexpectedly severe effects. Some products
may generate smaller aerosol droplets, allowing the fluorocarbons to
penetrate deeper into the pulmonary tract [8,9,10] or that exposure is
prolonged because the products are less noxious due to different carrier
solvents. The cases reported to NPIS(L) involved at least 14 different
waterproofing brands and products and in some cases the exact product and
therefore ingredients are not known, the exact cause of the respiratory
problems is difficult to assess and is possibly due to a combination of
(1) Heinzer R, Fitting JW, Ribordy V, Kuzoe B, Lazor R. Recurrence of
acute respiratory failure following use of waterproofing sprays
[Correspondence]. Thorax 2004;59:541-542
(2) Malik M. Acute respiratory syndrome associated with extreme superpruf
aerosol [Correspondance]. Anaesthesia 2003;58:1037-8.
(3) The International Program on Chemical Safety/European Association of
Poison Centres and Clinical Toxicologists Poisoning Severity Score
(4) Communication from Grangers International Ltd to NPIS(UK)
(5) Jinn Y, Akizuki N, Ohkouchi M, Inase N, Ichioka M, Marumo F. Acute
lung injury after inhalation of water-proofing spray while smoking a
cigarette. Respiration 1998;65:486-8.
(6) Kupfershcmidt H. Epidemy of acute respiratory illness linked to use of
waterproofing textile and leather spray [Abstract No. 59]. Clinical
(7) Laliberte M, Sanfacon G, Blais R. Acute pulmonary toxicity linked to
use of a leather protector. Annals of Emergency Medicine 1995;25:841-4.
(8) Yamashita M, Tanaka J. Pulmonary collapse and pneumonia due to
inhalation of a waterproofing aerosol in Female CD-1 mice. Clinical
(9) Yamashita M, Tanaka J, Yamashita M, Hirai H, Suzuki M, Kajigaya H.
Mist particle diameters are related to the toxicity of waterproofing
sprays: Comparison between toxic and non-toxic products. Veterinary and
Human Toxicology 1997;39(2):71-4.
(10) Yamashita M, Yamashita M, Tanaka J, Hirai H, Suzuki M, Kajigaya H.
Toxicity of waterproofing spray is influenced by the mist particle size.
Veterinary and Human Toxicology 1997;39(6):332-4.