How Should Patients Exposed to PAHs Be Treated and Managed?

Upon completion of this section, you will be able to

• identify strategies for managing patients with acute high dose PAH exposure, and
• identify strategies for managing patients with chronic low level PAH exposure.

The management and treatment focus of individuals exposed to PAHs differs for high dose acute and low dose chronic exposures. Decontamination and supportive measures are the primary objectives after acute high dose PAH exposure. Treatment of chronic PAH toxicity is symptomatic and supportive. Health education and risk communication are important aspects of patient care. Some clinicians recommend periodic pulmonary function tests and chest x-rays for PAH-exposed individuals (inhalation exposures).

Decontamination and supportive measures are the primary objectives after acute high dose PAH exposure. Acute symptoms are generally from co-exposures to other substances.

Contaminated clothing should be removed from the victim as soon as possible. The victim’s skin should be decontaminated by gently scrubbing with soap and water. Ocular contamination should be treated with irrigation and a complete eye examination. Supportive care should be administered as clinically necessary.

Effective risk communication and education for patients at risk for PAH-related disease is an important part of patient care. Persons exposed to potentially significant levels of PAHs should be aware of the increased risk for bronchogenic cancer and the additive effect of cigarette smoke and other toxic agents. Periodic evaluations of healthy patients who have been significantly exposed to PAHs, even in the absence of symptoms, may facilitate early diagnosis and intervention if a malignancy develops.

The OSHA coke oven emissions standard includes elements of medical surveillance for workers exposed to coke oven emissions. It should be noted that OSHA recommended surveillance (set at the time of the standard) may not necessarily be consistent with current evidenced based medical practice.

Because estimation of additional risk due to PAH exposure is often impossible, the challenge to the clinician is to maintain a balance between appropriate concern and undue alarm.

Predicting the carcinogenicity of a complex chemical mixture based on one or several of its components is difficult because of possible interactions among the components.

Effective risk communication takes this into account and can be important in prevention or management of disease.

• Decontamination and supportive measures are the primary objectives after acute high dose PAH exposure.
• Treatment of chronic PAH toxicity is generally symptomatic and supportive.
• Effective risk communication and health education are important aspects of patient care.
• Periodic evaluations of healthy patients who have been significantly exposed to PAHs, even in the absence of symptoms, is recommended by some clinicians to facilitate early diagnosis and intervention if a malignancy develops.