Current and new challenges in occupational lung diseases

Association Between Occupational Exposure to Disinfectants and Asthma in Young Adults Working in Cleaning or Health Services: Results From a Cross-Sectional Analysis in Germany

OBJECTIVE

To analyze the association of occupational disinfectants use with asthma and wheezing in young professionals.

METHODS

Three hundred sixty-five participants from the German Study on Occupational Allergy Risks II aged 20 to 24 years and working in cleaning or health services answered a questionnaire on respiratory health, occupational exposure to disinfectants, and potential confounders. By logistic regression, we calculated the association between duration of occupational disinfectants exposure and doctor-diagnosed asthma, current asthma, and current wheezing.

RESULTS

Individuals exposed to disinfectants for more than 12 months had almost three times the odds of doctor-diagnosed asthma compared with those not exposed (odds ratio [OR]: 2.99, 95% confidence interval [CI]: 1.36-6.55).

CONCLUSIONS

Our findings provide some further evidence for an association between occupational exposure to disinfectants and asthma, indicating that this association can be seen already after the first year of exposure.

Transplantation for work-related lung disease in the USA

OBJECTIVES

Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival.

METHODS

Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers' pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis.

RESULTS

The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers' pneumoconiosis and 78 were for silicosis. Patients with coal workers' pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers' pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers' pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis.

CONCLUSIONS

Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.

EGFR Mutation Analysis in Non-small Cell Lung Carcinoma from Tissue Samples Using the Fully Automated Idylla™ qPCR System

The introduction of tyrosine-kinase inhibitors (TKI) targeting specific EGFR mutations for the treatment non-small cell lung cancer patients (NSCLC) dramatically increased the clinical outcome in a subset of patients harboring specific activating EGFR mutations. Three different generations of TKI have been developed until now, demonstrating increasing progression-free survival as well as overall survival. However, to benefit of the treatment, the analysis of the genomic content of each patient is mandatory. Additionally, resistance mutations are prevalent and occur frequently and rapidly during treatment. Therefore, tests to detect EGFR mutations at initial diagnosis as well as during treatment, e.g., from liquid biopsies, have been developed and implemented in clinical daily practice for theranostic purpose.As EGFR mutation testing has to be highly reliable, fast, and easy to perform, the automatic qPCR system Idylla™ has been developed and implemented for clinical mutation testing from tissue samples and soon from circulating free DNA. Therefore, we here describe how the Idylla™ system can be used for the analysis of EGFR mutations in NSCLC patients. Importantly, as the results are massively influenced by the preanalytical steps, we also provide information on the correct sample selection to avoid nonconclusive results.

Occupational asthma: clinical phenotypes, biomarkers, and management

PURPOSE OF REVIEW

This review focuses on new findings in the clinical and inflammatory aspects that can help to better identify the different phenotypes of work-related asthma and the development of specific biomarkers useful in diagnosis and follow-up.

RECENT FINDINGS

Studies on phenotyping of occupational asthma, a subtype of work-related asthma, have mainly compared the clinical, physiological, and inflammatory patterns associated with the type of agent causing occupational asthma, namely, high-molecular-weight and low-molecular-weight agents. Most of this research has found that patients with occupational asthma due to high-molecular-weight agents have an associated presence of rhinitis, conjunctivitis, atopy, and a pattern of early asthmatic reactions during specific inhalation challenge. The inflammatory profile (blood eosinophils, sputum cell count, or exhaled nitric oxide) may be similar when occupational asthma is caused by either type of agent. In some studies, severity of asthma and exacerbations have been associated with exposure to low-molecular-weight agents. The most reliable biomarkers in diagnosis and follow-up are eosinophilia in induced sputum and exhaled nitric oxide.

SUMMARY

There are several phenotypes, characterized by its pathogenesis and inflammatory profile. Avoidance of the causative agents does not warrant complete recovery of occupational asthma. Treatment with biologic agents may be considered in severe occupational asthma.

Particle size and metal composition of gouging and lancing fumes

Metal gouging and lancing liberate particles of an unknown size and composition. Fumes are formed when vaporized materials condense in air, creating fine and ultrafine particles which can agglomerate. Particle sizes may be <1 µm in diameter. Inhalation of this mixture of metal fumes can lead to adverse health effects. This study characterized fumes by particle size fractions and metal composition. As particles may be in the submicron range, the nano-size fraction was included. Randomized, side-by-side area samples of fumes liberated during gouging and lancing were collected. Samplers included the conductive plastic Institute of Occupational Medicine (IOM) samplers (inhalable fraction), GK2.69 stainless steel thoracic cyclones (thoracic fraction), aluminum respirable cyclones (respirable fraction), Nanoparticle Respiratory Deposition (NRD) samplers (nano-size fraction), and open-face filter cassettes (particle size distribution-PSD). Samplers were mounted at a height of between 1.3 m and 1.7 m, in the worst-case scenario area (down-wind). Forty-six samples were collected during gouging and 26 during lancing. Mass concentrations per fraction ranges (excluding nano-size) were found to be 1.27-17.27 mg/m³ (inhalable), 1.83-13.96 mg/m³ (thoracic) and 0.88-15.82 mg/m³ (respirable) for gouging; and 2.34-5.60 mg/m³ (inhalable), 2.82-4.01 mg/m³ (thoracic), and 1.89-3.24 mg/m³ (respirable) for lancing. PSD analysis confirmed the presence of nano-size particles with a mean size of 171.76 (±56.27) nm during gouging and 32.33 (±7.17) nm during lancing. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis of samples indicated the presence of chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), nickel (Ni), and tin (Sn) in the respective particle size fractions (including nano-size) of both processes. Negative health effects associated with metal inhalation are well known, while nanoparticles' unique properties enable them to cause further detrimental health effects. The nano-size fraction should be included in personal exposure assessments and control measures.

Influence of Childhood Asthma and Allergies on Occupational Exposure in Early Adulthood: A Prospective Cohort Study

We aimed to determine whether history of asthma/allergies in childhood was associated with avoidance of jobs with exposure to asthmagens in early adulthood. The Melbourne Atopic Cohort Study recruited 620 children at high risk of allergic diseases at birth (1990–1994). Asthma, hay fever and eczema were evaluated by questionnaires during childhood. A follow-up in early adulthood (mean age: 18 years) collected information on the current job. Occupational exposure to asthmagens/irritants was evaluated using a job-exposure matrix. The association between history of asthma/allergies in childhood and working in a job with exposure to asthmagens/irritants was evaluated by logistic regression, adjusted for age, sex and parental education. Among 363 participants followed-up until early adulthood, 17% worked in a job with exposure to asthmagens/irritants. History of asthma (35%) was not associated with working in an exposed job (adjusted OR: 1.16, 95% CI: 0.65–2.09). Subjects with history of hay fever (37%) and eczema (40%) were more likely to enter exposed jobs (significant for hay fever: 1.78, 1.00–3.17; but not eczema: 1.62, 0.91–2.87). In conclusion, young adults with history of allergies were more likely to enter exposed jobs, suggesting no avoidance of potentially hazardous exposures. Improved counselling against high risk jobs may be needed for young adults with these conditions.

Non-malignant respiratory disease among workers in the rubber manufacturing industry: A systematic review and meta-analysis

BACKGROUND

Non-malignant respiratory disease (NMRD) cases have occurred among rubber manufacturing workers. We examined exposure to rubber manufacturing emissions as a risk factor for NMRD.

METHODS

From a systematic literature review, we identified case reports and assessed cross-sectional and mortality studies for strength of evidence of positive association (strong, intermediate, non-significant positive association, none) between exposure to rubber manufacturing emissions and NMRD-related morbidity and mortality, and conducted two meta-analyses.

RESULTS

We analyzed 62 articles. We identified 11 cases of NMRD. Nine (30%) of 30 cross-sectional studies and one (4%) of 26 mortality studies had strong evidence. The summary odds ratio and SMR for the cross-sectional and mortality meta-analyses were 3.83 (95% confidence interval [CI], 2.28-6.51) and 0.90 (95%CI, 0.82-0.99), respectively.

CONCLUSION

Available evidence supports rubber manufacturing emissions as a potential risk factor for NMRD-related morbidity. Further investigations with longer follow-up periods and inclusion of short-tenured workers could further define risks for NMRD and identify prevention strategies.

Emerging concepts and challenges in implementing the exposome paradigm in allergic diseases and asthma: a Practall document

Exposome research can improve the understanding of the mechanistic connections between exposures and health to help mitigate adverse health outcomes across the life span. The exposomic approach provides a risk profile instead of single predictors and thus is particularly applicable to allergic diseases and asthma. Under the PRACTALL collaboration between the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma, and Immunology (AAAAI), we evaluated the current concepts and the unmet needs on the role of the exposome in allergic diseases and asthma.

Air Pollution and Noncommunicable Diseases: A Review by the Forum of International Respiratory Societies' Environmental Committee, Part 1: The Damaging Effects of Air Pollution

Air pollution poses a great environmental risk to health. Outdoor fine particulate matter (particulate matter with an aerodynamic diameter < 2.5 μm) exposure is the fifth leading risk factor for death in the world, accounting for 4.2 million deaths and > 103 million disability-adjusted life years lost according to the Global Burden of Disease Report. The World Health Organization attributes 3.8 million additional deaths to indoor air pollution. Air pollution can harm acutely, usually manifested by respiratory or cardiac symptoms, as well as chronically, potentially affecting every organ in the body. It can cause, complicate, or exacerbate many adverse health conditions. Tissue damage may result directly from pollutant toxicity because fine and ultrafine particles can gain access to organs, or indirectly through systemic inflammatory processes. Susceptibility is partly under genetic and epigenetic regulation. Although air pollution affects people of all regions, ages, and social groups, it is likely to cause greater illness in those with heavy exposure and greater susceptibility. Persons are more vulnerable to air pollution if they have other illnesses or less social support. Harmful effects occur on a continuum of dosage and even at levels below air quality standards previously considered to be safe.

Establishing a Dedicated Lung Cancer Biobank at the University Center Hospital of Nice (France). Why and How?

Lung cancer is the major cause of death from cancer in the world and its incidence is increasing in women. Despite the progress made in developing immunotherapies and therapies targeting genomic alterations, improvement in the survival rate of advanced stages or metastatic patients remains low. Thus, urgent development of effective therapeutic molecules is needed. The discovery of novel therapeutic targets and their validation requires high quality biological material and associated clinical data. With this aim, we established a biobank dedicated to lung cancers. We describe here our strategy and the indicators used and, through an overall assessment, present the strengths, weaknesses, opportunities and associated risks of this biobank.

Ensuring the Safety and Security of Frozen Lung Cancer Tissue Collections through the Encapsulation of Dried DNA

Collected specimens for research purposes may or may not be made available depending on their scarcity and/or on the project needs. Their protection against degradation or in the event of an incident is pivotal. Duplication and storage on a different site is the best way to assure their sustainability. The conservation of samples at room temperature (RT) by duplication can facilitate their protection. We describe a security system for the collection of non-small cell lung cancers (NSCLC) stored in the biobank of the Nice Hospital Center, France, by duplication and conservation of lyophilized (dried), encapsulated DNA kept at RT. Therefore, three frozen tissue collections from non-smoking, early stage and sarcomatoid carcinoma NSCLC patients were selected for this study. DNA was extracted, lyophilized and encapsulated at RT under anoxic conditions using the DNAshell technology. In total, 1974 samples from 987 patients were encapsulated. Six and two capsules from each sample were stored in the biobanks of the Nice and Grenoble (France) Hospitals, respectively. In conclusion, DNA maintained at RT allows for the conservation, duplication and durability of collections of interest stored in biobanks. This is a low-cost and safe technology that requires a limited amount of space and has a low environmental impact.

Allergen component analysis as a tool in the diagnosis and management of occupational allergy

We are now in the epoch of "molecular allergology" and numerous clinically relevant allergenic molecules are available improving the performance of in vitro allergen tests and allergen detection methods. This review is focusing on characterized occupational allergens and their implementation into the in vitro diagnosis for occupational allergy and in allergen detection methods. More than 400 occupational agents are identified and documented as being 'respiratory sensitizers', but currently only a limited number of them are characterized on the molecular level and available for routine diagnosis as native or recombinant allergens. One exception, however, is natural rubber latex (NRL) from Hevea brasiliensis still remaining an important occupational allergen source. Characterization of 15 NRL allergens led to the development of assays for the determination of allergen content of NRL materials and the implementation of component-resolved diagnosis (CRD) for specific IgE antibody measurement. Microarray or singleplex using recombinant or native allergens are reliable tools for NRL allergy diagnosis. In addition, NRL allergy is an excellent model for improving extract-based specific IgE measurement by amplification of NRL extract preparation with stable recombinant major allergen rHev b 5. Despite the many efforts to characterize the occupationally relevant wheat allergens for baker's asthma, the most frequently occurring forms of occupational asthma, the results are highly diverse. Wheat sensitization profiles of bakers showed great interindividual variability and no wheat allergen could be classified as the major allergen. For diagnosis of baker's asthma, a whole wheat extract is still the best option for specific IgE determination. But single wheat allergens might help to discriminate between wheat-induced food allergy, grass pollen allergy and baker's asthma. For workplace-related allergens like coffee, wood, soybean, seafood and moulds allergens are characterized and few of them are available, but their relevance for occupational sensitization routes should be verified in the further studies.

Silicosis in Turkey: Is it an Endless Nightmare or is There Still Hope?

Silicosis is an ancient but still life-threatening occupational lung disease because of its incurable nature. Although its risks are known in many occupational settings and effective control strategies are well established, new cases, even epidemics, continue to occur in different sectors of Turkey. Before taking action, defining the magnitude of the problem is essential. In this concise review, we aimed to present the current situation of silicosis in Turkey. According to the data available to date, silicosis continues to be a major health problem in different sectors. Sandblasting seems to have the highest risk for the development of silicosis. Disease onset at early age and history of short exposure duration may indicate intense silica exposure. After denim sandblasters, dental technicians seem to be the new and recently recognized high-risk occupation group as per the increasing reports. Because of the lack of a definite treatment of silicosis, prevention of the disease should be the main target. Better occupational disease registry systems would be useful to assess the magnitude of the problem. In addition to implementing the necessary regulations, a close inspection of the workplaces for potential risks is essential. Other social and economic factors related with the occurrence of disease, such as unregistered employment rate and unlicensed and uninsured work, should also be considered. Finally, optimal healthcare and better living conditions for patients with silicosis should be ensured.