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Welding of metals generates a complex mix of noxious gases and fumes,1 and has been linked with various respiratory diseases including metal fume fever,2 asthma,3 COPD4 and possibly bronchial carcinoma.1 ,2 In addition, there is now strong and consistent epidemiological evidence that welders are at increased risk of infectious, lobar pneumonia. Originally detected in national analyses of occupational mortality,5 the hazard was confirmed by a large case–control study of men admitted to hospitals in the English West Midlands with community-acquired pneumonia,6 and is supported by findings from more recent epidemiological investigations in the UK7 ,8 and other countries.9–11
The elevation of risk is associated specifically with recent exposure,6 and is not apparent in former welders after normal retirement age,5 ,7 suggesting that it reflects a reversible increase in susceptibility to infection. Moreover, it extends to other occupations such as furnacemen and moulders in foundries, who are exposed to metal fume but not to welding gases.5 ,12 It is demonstrable in men who work with ferrous metals,6 ,12 but the involvement of other metals cannot be ruled out. Resolution of this uncertainty with adequate statistical power is a challenge because lobar pneumonia is uncommon, and relatively few workers are exposed to fume exclusively from …
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