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Assessing the chronic respiratory health risk associated with inhalation exposure to powdered toner for printing in actual working conditions: a cohort study on occupationally exposed workers over 10 years
  1. Toshio Nakadate,
  2. Yuko Yamano,
  3. Takenori Yamauchi,
  4. Shigeko Okubo,
  5. Daichi Nagashima
  1. Department of Hygiene, Public Health, and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan
  1. Correspondence to Professor Toshio Nakadate; nakadate{at}


Background Little epidemiological evidence exists regarding the chronic respiratory effects of inhaled powdered toner exposure in humans, although several case reports have suggested the existence of lung disorders that might be related to exposure to toner dust.

Objective We aimed to estimate the chronic health risk to humans associated with routine toner dust exposure in copier industry workers under current actual work conditions.

Design A prospective observational cohort study of occupational population.

Methods Changes in chest radiogram, spirometry measurements and serum and urine biomarkers of biomedical responses to extrinsic stress, as well as subjective symptoms were longitudinally observed for up to 10 years in Japanese copier industry workers responsible for the manufacturing, maintenance or recycling of powdered toner or toner-using machines. A total of 694 subjects who did not change their work category during the follow-up and were free from chronic respiratory diseases at the baseline survey provided reliable results on at least three survey occasions during 3 years or more of follow-up.

Results Typical fibrosis findings associated with pneumoconiosis was not observed on chest radiograms. No significant differences associated with toner exposure were noted in the frequency of new incidence of either non-specific findings on chest radiogram or serum fibrosis biomarkers (sialylated carbohydrate antigen KL-6 and surfactant protein D). However, the exposed subjects tended to show increases in the frequency of respiratory symptoms and reduced spirometry results during the follow-up compared with the control group, although significant differences were only seen in chronic cough.

Conclusions Under the current reasonably controlled work environmental conditions, lung fibrotic changes caused by inhaled dust exposure, including powdered toner, appear to be relatively uncommon; however, non-specific temporal irritation causing subjective symptoms and inflammatory responses might exist.

  • epidemiology
  • respiratory medicine (see thoracic medicine)

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors TN designed the study; TN and YY executed the data collection in annual surveys; YY, TY, SO and DN contributed to the data preparation and analyses; TN wrote the initial manuscript. All of the authors contributed to the revision of the manuscript and approved the final form of the manuscript for submission.

  • Funding This study was funded in part by Ricoh Co, Ltd, a photocopier industry company in Japan.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was conducted under the approval of the Institutional Review Board on Medical Ethics of Showa University School of Medicine (Authorisation No. 201).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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