Lung function and precipitating antibodies in low exposed wood trimmers in Sweden

Systematic review and meta-analysis of the potential threats to respiratory health from microbial Bioaerosol exposures

Infectious diseases are a part of everyday life, and acute respiratory diseases are the most common. Many agents carrying out respiratory infections are transmitted as bioaerosols through the air, usually, particulate matter containing living organisms. The purpose of the study is to conduct a systematic review and meta-analysis to assess the likelihood that people exposed to bioaerosols may experience severe respiratory diseases. Nine digital databases and bibliographies were assessed for papers conducted between January 1960 and April 2021. A total of 35 health and exposure studies were included from 825 studies for the systematic review, while only 17 contented the meta-inclusion analysis's criteria. This systematic review found higher bacterial bioaerosol concentrations in poultry farms, waste dumpsites, composting plants, and paper industries. The meta-analysis's Standard Mean Difference (SMD) measurement indicates a substantially positive association between bioaerosol exposure and respiratory disease outcomes in targeted populations. The value is 0.955 [95% CI, range 0.673-1.238; p < 0.001]. As per the Risk of Bias (ROB) findings, most of findings (30 out of 35 [85.71%]) were judged to have low ROB. From the random effect probit model, the total relative risk is 1.477 (95% CI, range 0.987-2.211), indicating a higher risk of respiratory diseases from bioaerosol exposure than the control groups. The total risk difference is 0.121 (95% CI, -0.0229 to 0.264), which means intervention groups may have a higher risk of respiratory diseases from continuous bioaerosol exposure than the control groups. The dose-response relationship revealed a strong positive linear coefficient correlation between bacterial & fungal bioaerosol exposure to respiratory health. Based on self-reported outcomes in those studies, The systematic review and meta-analysis stated that bioaerosol exposure had an effect on pulmonary health.

Route exposure and adverse effects monitoring of Aflatoxin B1 in the workers of wet waste management, the role of body redox system modulation

Exposure to dust, containing different fungi metabolites such as aflatoxins is a risk factor for developing liver and kidney health abnormalities. Occupational evaluation of the aflatoxin's exposure-induced health abnormalities should include the monitoring of bioaerosols in the workplace and personal air, and applying of appropriate blood biomarkers to assess Aflatoxin B₁ (AFB₁) detrimental effects on a worker's health. However, to the best of our knowledge, these appropriate methods, especially determining the associated-adverse effects on health, following exposure, haven't been well documented in the literature at the wet waste handling sites. In the current study, the AFB₁ quantity in the area, personal, and settled dust in wet household waste handling samples and AFB₁-Albumin levels in the serum of workers in comparison with the control group were determined using high-pressure liquid chromatography with a fluorescent detector (HPLC-FLD) methods. Moreover, the adverse effects of AFB₁ on the liver and kidney biochemical profiles of the exposed workers and its relation to antioxidant capacity in the household wet waste sorting were recorded in a consolidated investigation. The results demonstrated that the average airborne dust concentration and its associated AFB₁ content were significantly higher in wet waste management sections as compared to the control place, corresponding to the serum AFB₁-Albumin levels of workers. Furthermore, AFB₁-induced changes in the serum biochemicals evaluating liver and kidney function tests and antioxidant profiles of workers in wet waste handling sections were indicative of their function abnormalities. The results imply AFB₁-induced adverse effects on the liver and kidney functions may be mediated through the body redox system modulation.

Liver and kidney serum profile abnormalities in workers exposed to aflatoxin B1 in urban solid waste management centers

Many workers are exposed to health problems arising from molds, fungi, and their toxins during waste processing. Aflatoxin B₁ (AFB₁) level in airborne and settled dust, aflatoxin B₁-albumin (AFB₁-Alb) adduct in serum, liver and kidney biochemical tests, and body redox change of workers in municipal dry waste-processing sites were investigated. The surface, personal, and area air dust and the blood of workers' samples were collected from the plastic and bread waste-sorting sections in three recycling municipal dry waste sites. Digestion (only for serum samples), passed through SPE cartridge, elution, and collection with methanol, immune-affinity column clean-up, and HPLC system equipped with post-column derivatization method and fluorescence detection were performed for determination of AFB₁ and AFB₁-Alb levels in the samples. The mean level of dust and AFB₁ in the personal and area air, and in the settled dust and the AFB₁-Alb in the serum of workers in the bread waste sorting, was higher than plastic waste-sorting samples, in all of the sites. The differences in the biochemical profiles of subjects exposed to aflatoxin B₁ as compared to the control group especially in liver and kidney function parameters as well as antioxidant factors of the serum were significant. The workers in handling of municipal waste may be exposed to potentially hazardous levels of aflatoxin B₁. The adverse effects of AFB₁ on the kidney and liver may be caused by changes in the redox system.

Fungal Fragments and Fungal Aerosol Composition in Sawmills

Assessment of exposure to fungi has commonly been limited to fungal spore measurements that have shown associations between fungi and development or exacerbation of different airway diseases. Because large numbers of submicronic fragments can be aerosolized from fungal cultures under laboratory conditions, it has been suggested that fungal exposure is more complex and higher than that commonly revealed by spore measurements. However, the assessment of fungal fragments in complex environmental matrix remain limited due to methodological challenges. With a recently developed immunolabeling method for field emission scanning electron microscope (FESEM), we could assess the complex composition of fungal aerosols present in personal thoracic samples collected from two Norwegian sawmills. We found that large fungal fragments (length >1 µm) dominated the fungal aerosols indicating that the traditional monitoring approach of spores severely underestimate fungal exposure. The composition of fungal aerosols comprised in average 9% submicronic fragments, 62% large fragments, and 29% spores. The average concentrations of large and submicronic fragments (0.2–1 µm) were 3 × 10⁵ and 0.6 × 10⁵ particles m⁻³, respectively, and correlated weakly with spores (1.4 × 10⁵ particles m⁻³). The levels of fragments were 2.6 times higher than the average spore concentration that was close to the proposed hazardous level of 10⁵ spores per m³. The season influenced significantly the fungal aerosol concentrations but not the composition. Furthermore, the ratio of spores in the heterogeneous fungal aerosol composition was significantly higher in saw departments as compared to sorting of green timber departments where the fungal fragments were most prevalent. Being the dominating particles of fungal aerosols in sawmills, fungal fragments should be included in exposure-response studies to elucidate their importance for health impairments. Likewise, the use of fungal aerosol composition in such studies should be considered.

Respiratory health effects of exposure to low levels of airborne endotoxin - a systematic review

BACKGROUND

Elevated endotoxin levels have been measured in ambient air around livestock farms, which is a cause of concern for neighbouring residents. There is clear evidence that occupational exposure to high concentrations of airborne endotoxin causes respiratory inflammation, respiratory symptoms and lung function decline. However, health effects of exposure to low levels of endotoxin are less well described. The aim of this systematic review is to summarize published associations between exposure to relatively low levels of airborne endotoxin and respiratory health endpoints.

METHODS

Studies investigating respiratory effects of measured or modelled exposure to low levels of airborne endotoxin (average < 100 EU/m³) were eligible for inclusion. In total, 1362 articles were identified through a Pubmed database search, of which 31 articles were included in this review. Studies were included up to February 2017. Overview tables and forest plots were created, and study quality was assessed.

RESULTS

Twenty-two included studies had a cross-sectional design, others were designed as longitudinal observational (n = 7) or experimental (n = 2) studies. Most studies (n = 23) were conducted in an occupational setting, some involved domestic or experimental exposure. Several studies reported statistically significant effects of exposure to low levels of endotoxin on respiratory symptoms and lung function. However, considerable heterogeneity existed in the outcomes of the included studies and no overall estimate could be provided by meta-analysis to quantify the possible relationship. Instead, a best evidence synthesis was performed among studies examining the exposure-response relationship between endotoxin and respiratory outcomes. Significant exposure-response relationships between endotoxin and symptoms and FEV₁ were shown in several studies, with no conflicting findings in the studies included in the best evidence synthesis. Significantly different effects of endotoxin exposure were also seen in vulnerable subgroups (atopics and patients with broncho-obstructive disease) and smokers.

CONCLUSIONS

Respiratory health effects of exposure to low levels of airborne endotoxin (< 100 EU/m³) seem plausible. Future studies are needed to investigate ambient exposure to endotoxin and potential respiratory health effects, especially in vulnerable subgroups of the population.

Fungal contamination of the respiratory tract and associated respiratory impairment among sawmill workers in India

Wood processing workers are exposed to wood-associated microbiological contaminants, including fungi. Our aim was to study the potential association between sputum fungus and adverse respiratory effects in such workers. In a group of sawmill workers, we administered a respiratory questionnaire, performed lung function testing and quantified the proportions of leukocytes in spontaneously expectorated sputum samples. We identified fungal species by DNA sequencing. Of 54 sawmill workers, 19 yielded fungal positive sputum samples (mean age 42.5±10.4 years) and 35 were negative for fungus (mean age 36.9±5.2 years). The fungus was identified as Candida sp. in all samples. Those with fungal-positive sputum, compared to others, reported more cough (26% versus 63%) and haemoptysis (6% versus 37%) (both p<0.05), manifested reduced forced midexpiratory flow rates (FEF_25-75%) (82.3±4.5 versus 69.2±9.9% predicted, p<0.001), and had higher sputum eosinophil counts (median 9.25 versus 3.25%, p<0.01). Reduction of FEF_25-75% was associated both with fungus detection in sputum (-12.7%, 95% CI-8.5- -16.9%) and sputum eosinophils (-2.1% per 1% increase in eosinophils, 95% CI -1.5- -2.8%) (both p<0.001). In sawmill workers, Candida sp. detectable in sputum was associated with respiratory symptoms, sputum eosinophilia and reduced FEF_25-75%.

Evaluation of exposure-response relationships for health effects of microbial bioaerosols - A systematic review

Studies suggest adverse health effects following exposure to bioaerosols in the environment and in particular at workplaces. However, there is still a lack of health-related exposure limits based on toxicological or epidemiological studies from environmental health or from the working environment. The aim of this study was to derive health-based exposure limits for bioaerosols that can protect the general population as group "at risk" via environmental exposure using analysis of peer-reviewed studies related to occupational medicine, indoor air and environmental health. The derivation of exposure limits should be conducted by the members of a bioaerosol expert panel according to established toxicological criteria. A systematic review was performed in Medline (PubMed) including studies containing both data on exposure measurements and observed health outcomes. In addition, literature recommended by the experts was considered. A comprehensive search strategy was generated and resulted in a total of n=1569 studies in combination with the literature recommendations. Subsequently, abstracts were screened using defined exclusion criteria yielding a final number of n=44 studies. A standardized extraction sheet was used to combine data on health effects and exposure to different bioaerosols. After full-text screening and extraction according to the defined exclusion criteria n=20 studies were selected all related to occupational exposures comprising the working areas wood processing, farming, waste processing and others. These studies were analyzed in collaboration with the bioaerosol expert network in terms of suitability for derivation of health-related exposure limits. The bioaerosol expert network concluded that none of the analyzed studies provided suitable dose-response relationships for derivation of exposure limits. The main reasons were: (1) lack of studies with valid dose-response data; (2) diversity of employed measuring methods for microorganisms and bioaerosol-emitting facilities; (3) heterogeneity of health effects; (4) insufficient exposure assessment. However, several indicator parameters and exposure concentrations could be identified for different bioaerosol-emitting facilities. Nevertheless, health-related exposure limits are urgently needed especially in approval procedures of facilities like composting plants or livestock farms emitting bioaerosols in the neighbourhood of residents. In the regulatory toxicology framework, it is common to use animal experimental studies for derivation of general exposure limits if appropriate environmental epidemiological studies on harmful substances are lacking. This might be another possibility to obtain health-related exposure limits for specific bioaerosol parameters. Furthermore, we recommend to use suitable measurable outcome parameters related to bioaerosols; to measure bioaerosols according to a protocol representative for exposure pattern and duration at the particular work place; to develop standardized detection methods for indicator parameters; to combine different detection methods to compensate for the limitations of each method; to apply new analysis methods to identify the real risk potential.

Endotoxin Exposure Assessment in Wood-Processing Industry: Airborne Versus Settled Dust Levels

Wood processing is usually performed in environments with large amounts of endotoxin-rich bioaerosols that are associated with a variety of health effects. The aim of this preliminary study was to assess the relation between endotoxin levels in settled and airborne dust in wood-processing industry. Ten pairs of airborne and settled dust samples were collected in a sawmill and parquet manufacture of two wood-processing plants in Croatia. Endotoxin was assayed with a chromogenic end-point LAL (Limulus amebocyte lysate) method. The results showed that endotoxin levels in airborne respirable dust were above the proposed occupational exposure limit of 125 EU m-3 and could be considered hazardous for the respiratory system. In settled dust they ranged between 229.7 EU mg-1 and 604.3 EU mg-1 and in airborne dust between 166.8 EU mg-1 and 671.6 EU m-3, but there was no significant correlation between them (Spearman's rho=0.358, P=0.310). This study points to sawmill settled dust as endotoxin reservoir and suggests that it may add to already high exposure to airborne endotoxins associated with wood processing. Investigations of the relation between settled and airborne endotoxin levels should be continued to better understand the sources and sites of endotoxin contamination in wood-processing industry.

Fungal spores: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

Fungal spores are ubiquitous in the environment. However, exposure levels in workplaces where mouldy materials are handled are much higher than in common indoor and outdoor environments. Spores of all tested species induced inflammation in experimental studies. The response to mycotoxin-producing and pathogenic species was much stronger. In animal studies, nonallergic responses dominated after a single dose. Allergic responses also occurred, especially to mycotoxin-producing and pathogenic species, and after repeated exposures. Inhalation of a single spore dose by subjects with sick building syndrome indicated no observed effect levels of 4 x 10(3) Trichoderma harzianum spores/m(3) and 8 x 10(3) Penicillium chrysogenum spores/m(3) for lung function, respiratory symptoms, and inflammatory cells in the blood. In asthmatic patients allergic to Penicillium sp. or Alternaria alternata, lowest observed effect levels (LOELs) for reduced airway conductance were 1 x 10(4) and 2 x 10(4) spores/m(3), respectively. In epidemiological studies of highly exposed working populations lung function decline, respiratory symptoms and airway inflammation began to appear at exposure levels of 10(5) spores/m(3). Thus, human challenge and epidemiological studies support fairly consistent LOELs of approximately 10(5) spores/m(3) for diverse fungal species in nonsensitised populations. Mycotoxin-producing and pathogenic species have to be detected specifically, however, because of their higher toxicity.

Longitudinal respiratory health study of the wood processing industry

BACKGROUND

A 5-year longitudinal study examined nonmalignant respiratory effects of wood processing dust exposure.

METHODS

Ten study plants, investigator selected from 447 candidate plants, included 1 sawmill-planing-plywood, 1 plywood, 1 milling, 3 cabinet and 4 furniture facilities. Personal dust samples (2363) were divided into three size fractions (extrathoracic, tracheobronchial, and respirable) which were apportioned into wood solids (WS) and residual particulate matter (RPM), and used to compute each individuals TWA exposure for the 6 exposure types. Serial spirometric tests and medical, smoking and occupational questionnaires were collected with 1,164 subjects having adequate follow-up (minimum 3 datapoints over at least 2.5 years) for analyses. Forward selection regression was used to evaluate the effect of exposure on annual change in FEV(1), FVC, FEF(25-75), and FEV(1)/FVC.

RESULTS

There were no significant adverse effects of WS exposures (overall means were 0.66, 0.32, and 0.05 mg/m(3), for extrathoracic, tracheobronchial, and respirable fractions, respectively). Statistically significant effects were only to respirable RPM in the milling facility (mean exposures of 0.147 mg/m(3) associated with changes in FEV(1) = -32 ml/year, FEV(1)/FVC = -0.48%/year, and FEF(25-75) = -0.11 l/s/year) and in the sawmill-planing-plywood facility (mean exposures of 0.255 mg/m(3) associated with changes in FEV(1) = -59 ml/year and FVC = -103 ml/year).

CONCLUSION

Exposure to WS was not associated with significant adverse effects. Respirable RPM was associated with an obstructive effect in the milling facility, and respirable RPM was also associated with a restrictive effect in the sawmill-planing plywood facility. Finally, this study does not exclude the possibility that other exposures common to this industry can cause respiratory effects, only that none were noted in this population for wood solids for the exposure levels and durations studied.

Effects of bioaerosol exposure on work-related symptoms among Swiss sawmill workers

OBJECTIVE

Exposure to bioaerosols in the occupational environment of sawmills could be associated with a wide range of health effects, in particular respiratory impairment, allergy and organic dust toxic syndrome. The objective of the study was to assess the frequency of medical respiratory and general symptoms and their relation to bioaerosol exposure.

METHOD

Twelve sawmills in the French part of Switzerland were investigated and the relationship between levels of bioaerosols (wood dust, airborne bacteria, airborne fungi and endotoxins), medical symptoms and impaired lung function was explored. A health questionnaire was distributed to 111 sawmill workers.

RESULTS

The concentration of airborne fungi exceeded the limit recommended by the Swiss National Insurance (SUVA) in the twelve sawmills. This elevated fungi level significantly influenced the occurrence of bronchial syndrome (defined by cough and expectorations). No other health effects (irritations or respiratory effects) could be associated to the measured exposures. We observed that junior workers showed significantly more irritation syndrome (defined by itching/running nose, snoring and itching/red eyes) than senior workers. Lung function tests were not influenced by bioaerosol levels nor dust exposure levels.

CONCLUSION

Results suggest that occupational exposure to wood dust in a Swiss sawmill does not promote a clinically relevant decline in lung function. However, the occurrence of bronchial syndrome is strongly influenced by airborne fungi levels.

Lung function in Pakistani wood workers

The lung function impairment is the most common respiratory problem in industrial plants and their vicinity. Therefore, the purpose was to study the affects of wood dust and its duration of exposure on lung function. This was a matched cross-sectional study of Spirometry in 46 non-smoking wood workers with age range 20 - 60 years, who worked without the benefit of wood dust control ventilation or respiratory protective devices. Pulmonary function test was performed by using an electronic Spirometer. Significant reduction was observed in the mean values of Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and Maximum Voluntary Ventilation (MVV) in wood workers relative to their matched controls. This impairment was increased with the duration of exposure to wood industries. It is concluded that lung function in wood workers is impaired and stratification of results shows a dose-response effect of years of wood dust exposure on lung function.

Monoterpene and wood dust exposures: work-related symptoms among Finnish sawmill workers

BACKGROUND

Monoterpenes and wood dust are released into the work environment during sawing of fresh wood. Symptoms related to exposure to monoterpenes and wood dust include irritation of the eyes, mucous membrane, and skin.

METHODS

We studied 22 sawhouse workers who process pine and spruce in 1997-99. Exposure to monoterpenes was assessed by determining monoterpenes in air and verbenols in urine by gas chromatography using flame ionization detection. Wood dust was determined gravimetrically. A questionnaire was used to evaluate work-related subjective symptoms.

RESULTS

Exposures to monoterpenes (geometric mean, GM) among sawhouse workers were 61-138 mg/m(3) and 2.0-13 mg/m(3) during processing of pine and spruce, respectively. Urinary verbenol correlated well with worker exposure to the alpha-pinene fraction of monoterpenes. The inhalable dust concentration in the breathing zone was 0.5- 2.2 mg/m(3) during pine processing and 0.4-1.9 mg/m(3) during spruce processing. The prevalence of symptoms, in the eyes or respiratory tract, was high during both seasons and in connection with either tree species.

CONCLUSIONS

The highest monoterpene concentration (GM), in the breathing zone, measured during processing of pine, was less than one-fourth of the Finnish occupational exposure limit (OEL, 570 mg/m(3)). Verbenol concentrations in postshift urine samples reflected accurately the exposure to monoterpenes. The concentrations of inhalable dust (GM) were less than one-half the Finnish OEL (5 mg/m(3)). No significant differences in dust exposure were observed among tree species processed. Work-related symptoms appeared to correlate with monoterpene exposure during processing of pine and with wood dust exposure during processing of spruce.

Worker exposures to airborne dust, endotoxin and beta(1,3)-glucan in two New Zealand sawmills

BACKGROUND

Sawmill workers have an increased risk of developing occupational asthma and other respiratory symptoms. Wood dust and microorganisms have both been suggested to play a role, but few studies have measured microbial exposure levels in sawmills.

METHODS

The preliminary study reported in this paper assessed airborne dust, bacterial endotoxin and beta(1,3)-glucan levels in 37 samples from two New Zealand sawmills.

RESULTS

Nearly one-third of the measured dust levels exceeded 1 mg/m(3) and only one sample exceeded the legal limit of 5 mg/m(3). Endotoxin levels were clearly elevated with 50% of all measured exposures above 50 EU/m(3) (range: 7-588 EU/m(3)). beta(1,3)-glucan levels were comparable with levels measured in other industries where workers are exposed to organic dust. Workers in the planing department had the highest mean exposures to dust, endotoxin and beta(1,3)-glucan. Dust levels were only weakly correlated with endotoxin and beta(1,3)-glucan levels.

CONCLUSIONS

Endotoxin exposures in sawmill workers are at levels sufficient to potentially contribute to the development of respiratory symptoms. Moreover, measurement of dust exposure is a poor proxy for beta(1,3)-glucan and endotoxin exposure in sawmill workers.

Symptoms, airway responsiveness, and exposure to dust in beech and oak wood workers

OBJECTIVES

To investigate the relation between levels of cumulative exposure to wood dust and respiratory symptoms and the occurrence of bronchial hyperresponsiveness among beech and oak workers.

METHODS

114 Male woodworkers from five furniture factories and 13 male unexposed controls were examined. The unexposed control group was supplemented by 200 male historical controls. Statistical analyses were performed excluding and including the historical controls. Dust concentration was measured by personal sampling methods. Cumulative exposure to dust was calculated for each woodworker by multiplying the duration of the work by the intensity of exposure (years. mg/m(3)). Bronchial hyperresponsiveness was assessed by the methacholine bronchial challenge test. Subjects were labelled methacholine bronchial challenge positive if forced expiratory volume in 1 second (FEV(1)) fell by >/=20%. The linear dose-response slope was calculated as the last dose divided by the total dose given.

RESULTS

443 Dust samples were collected. The median cumulative exposure to dust was 110 years.mg/m(3) with lower and upper quartiles at 70 and 160 years.mg/m(3) Overall, no declines in FEV(1) and forced vital capacity (FVC) were found with increasing exposures. A dose-response relation was found between intensity of exposure on the one hand, and sore throat, increased prevalence of positive methacholine bronchial challenge tests, and steeper dose-response slope, on the other.

CONCLUSION

Exposure to oak and beech dust may lead to the development of sore throat and bronchial hyperresponsiveness.

Work-related symptoms and dose-response relationships for personal exposures and pulmonary function among woodworkers

BACKGROUND

Four sawmills, a wood chipping mill, and five joineries in New South Wales, Australia, were studied for the effects of personal exposure to wood dust, endotoxins. (1-->3)-beta-D-glucans, Gram-negative bacteria, and fungi on lung function among woodworkers.

METHODS

Personal inhalable and respirable dust sampling was carried out. The lung function tests of workers were conducted before and after a workshift.

RESULTS

The mean percentage cross-shift decrease in lung function was markedly high for woodworkers compared with the controls. Dose-response relationships among personal exposures and percentage cross-shift decrease in lung function and percentage predicted lung function were more pronounced among joinery workers compared with sawmill and chip mill workers. Woodworkers had markedly high prevalence of regular cough, phlegm, and chronic bronchitis compared with controls. Significant associations were found between percentage cross-shift decrease in FVC and regular phlegm and blocked nose among sawmill and chip mill workers. Both joinery workers and sawmill and chip mill workers showed significant relationships between percentage predicted lung function (FVC, FEV1, FEV1/FVC, FEF25-75%) and respiratory symptoms.

CONCLUSIONS

Wood dust and biohazards associated with wood dust are potential health hazards and should be controlled.

Acute effects of exposure to air contaminants in a sawmill on healthy volunteers

OBJECTIVES

To study whether air contaminants in sawmills can induce acute changes in the upper and lower airways of previously non-exposed subjects.

METHODS

Nineteen healthy volunteers were examined to find the concentration of interleukin 6 (IL-6) in nasal lavage fluid and lung function before and after five hour exposure to dusts and fumes generated in a sawmill where timber from Scots pine was sawed. When exposed, the subjects had respirators with and without a particle filter.

RESULTS

The median for daily time weighted average concentration of total dust for subjects with respirators without a filter was 0.13 mg/m3, which was significantly higher than the median of 0.04 mg/m3 for subjects who had respirators with a filter. The median for the concentration of IL-6 in the nasal lavage fluid increased after exposure from 0.5 to 5.9 pg/ml in subjects with respirators without a particle filter (P < 0.05). The increase of the concentration of IL-6 was significantly correlated with the dust concentration. A decrease in transfer factor of the lung was significantly correlated with daily time weighted average concentrations of terpenes.

CONCLUSION

The findings suggest that healthy volunteers, exposed to air contaminants in a sawmill, show a slight inflammatory reaction. Also, the results of the study indicate the importance of decreasing the concentrations of wood dust in the work environment.

An Indicator for Assessing Respirable Soot Particles in Diesel Exhaust during Occupational Exposures

Both acute and chronic impairments of lung function have been demonstrated in humans after exposure to diesel exhaust. The concentration of soot particles in the diesel exhaust is significantly related to its effects on health. The aim of the present analysis was to study the relationship between the concentration of respirable dust as an indicator of exposure to soot particles in diesel exhaust and a biologic exposure indicator variable, i.e., transient lung function decrease. Daily time-weighted average concentrations of carbon monoxide and nitrogen dioxide amounted to 9 % and 25% of the applicable hygienic limit values. Time-weighted average concentration and the proportion of respirable dust in total dust during a workshift were significantly correlated with across-shift decreases in lung function. In the absence of a suitable measure for total diesel exhaust exposure, the ratio of the proportion of respirable dust in total dust in a workplace may serve as an indicator of the concentration of soot particles in diesel exhaust.

Sorting and recycling of domestic waste. Review of occupational health problems and their possible causes

In order to reduce the strain on the environment from the deposition of waste in landfills and combustion at incineration plants, several governments throughout the industrialized world have planned greatly increased recycling of domestic waste by the turn of the millennium. To implement the plans, new waste recycling facilities are to be built and the number of workers involved in waste sorting and recycling will increase steadily during the next decade. Several studies have reinforced the hypothesis that exposure to airborne microorganisms and the toxic products thereof are important factors causing a multitude of health problems among workers at waste sorting and recycling plants. Workers at transfer stations, landfills and incineration plants may experience an increased risk of pulmonary disorders and gastrointestinal problems. High concentrations of total airborne dust, bacteria, faecal coliform bacteria and fungal spores have been reported. The concentrations are considered to be sufficiently high to cause adverse health effects. In addition, a high incidence of lower back injuries, probably due to heavy lifting during work, has been reported among workers at landfills and incineration plants. Workers involved in manual sorting of unseparated domestic waste, as well as workers at compost plants experience more or less frequent symptoms of organic dust toxic syndrome (ODTS) (cough, chest-tightness, dyspnoea, influenza-like symptoms such as chills, fever, muscle ache, joint pain, fatigue and headache), gastrointestinal problems such as nausea and diarrhoea, irritation of the skin, eye and mucous membranes of the nose and upper airways, etc. In addition cases of severe occupational pulmonary diseases (asthma, alveolitis, bronchitis) have been reported. Manual sorting of unseparated domestic waste may be associated with exposures to large quantities of airborne bacteria and endotoxin. Several work functions in compost plants can result in very high exposure to airborne fungal spores and thermophilic actinomycetes. At plants sorting separated domestic waste, e.g. the combustible fraction of waste composed of paper, cardboard and plastics, the workers may have an increased risk of gastrointestinal symptoms and irritation of the eyes and skin. At such plants the bioaerosol exposure levels are in general low, but at some work tasks, e.g. manual sorting and work near the balers, exposure levels may occasionally be high enough to be potentially harmful. Workers handling the source-sorted paper or cardboard fraction do not appear to have an elevated risk of occupational health problems related to bioaerosol exposure, and the bioaerosol exposure is generally low.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects within the week on forced vital capacity are correlated with long term changes in pulmonary function: reanalysis of studies on car painters exposed to isocyanate

OBJECTIVES

To examine if car painters who work with polyurethane paints that contain hexamethylenediisocyanate (HDI) and hexamethylenediisocyanate biuret trimer (HDI-BT) develop acute as well as chronic impairment of lung function.

METHODS

In this study data were reanalysed from two earlier studies on a group of car painters to see if a decrease in lung function within the week is a marker of vulnerability in those workers. Data on changes in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) within the week were available for 20 car painters who were also examined six years later.

RESULTS

10 men showed a decline in FVC within the week. There were no significant differences in age, duration of employment, exposures during the follow up period, or smoking between car painters who had decline in lung function within the week and car painters who had not. A significant correlation was found between the change in FVC within the week and the long term (six year) change in FVC, standardised for the effects of aging and smoking, and adjusted for the number of peak exposures.

CONCLUSIONS

The results suggest that the decrease in FVC within the week might serve as a guide to identify car painters at risk of a further decrement in lung function above the effects of aging, smoking, and exposure.

The significance of an across-shift decrease in vital capacity--a re-analysis of a study on subjects exposed to diesel exhaust

Occupational exposure to diesel exhaust may develop acute as well as chronic lung function impairment. In this study, data from an earlier study on a group of subjects working at tunnel construction site were analyzed. The aim of the analysis was to examine the significance of an across-shift decrease in vital capacity with concern to other lung physiological measurements. There were no statistically significant differences, either in the average age, time of employment, vital capacity before a working shift after two days of no exposure, or the distributions of smoking habits and respiratory symptoms, between the eight workers who had an across-shift decrease in vital capacity and the five workers who had not. Subjects with an across-shift decrease in vital capacity had a significantly greater across-shift decrease in residual volume and total lung capacity than subjects without an across-shift decrease in vital capacity. The pathophysiological mechanisms for this across-shift decrease in residual volume is not fully understood. However, an altered defence mechanism in the lung may play a role for a prolonged retention time for the particles in the inhaled diesel exhaust, resulting in the across-shift decrease in residual volume. The results thus suggest that measurements of across-shift vital capacity is of importance in identifying susceptible subjects with occupational exposure to diesel exhaust.

Sawdust-induced inflammatory changes in rat lung: effects on alveolar and interstitial cells in relation to time

Exposure to sawdust and its contaminants, e.g., terpenes, may cause respiratory tract and lung parenchymal inflammation. To monitor these changes over time. Sprague-Dawley rats were exposed at one occasion to 2.5 mg sawdust or saline by intratracheal instillation. Flow cytometry analyses were done on bronchoalveolar lavage (BAL) cells. Lung tissue specimens were analyzed histologically and immunohistochemically. After one week, the number of BAL polymorphonuclear leukocytes was increased (P < 0.05, N = 8), followed at six weeks by increases of macrophages and lymphocytes (both P < 0.01, N = 8). Enhanced expressions of class II antigens and complement receptors on macrophages after one week were even more pronounced at six weeks, indicating cellular activation. The BAL findings, also including increased (P < 0.001, N = 8) concentrations of hyaluronan with progressing changes over time, confirmed the signs of inflammation, as did the histological analysis of the lung tissue specimens with an accumulation of polymorphonuclears, macrophages, and hyaluronan in the interstitium.

Acute effects on forced expiratory volume in one second and longitudinal change in pulmonary function among wood trimmers

Wood trimmers are exposed to molds that periodically grow on timber, and may develop acute as well as chronic pulmonary function impairment. This study examined whether these acute changes in pulmonary function are predictors for a longitudinal deterioration in pulmonary function, beyond normal aging and exposure. Across-shift changes in pulmonary function, measured during a working week, were evaluated in 15 wood trimmers with a follow-up time of 27 months. Twenty-six sawmill workers, employed at the same plants as the wood trimmers, served as control subjects. The highest concentration of viable mold spores for the wood trimmers was 10(6) colony-forming units (cfu)/m3, i.e., several times higher than the corresponding value for the sawmill workers. At the follow-up, wood trimmers had a lower forced vital capacity (FVC) on average, after adjustment for age and height, compared to the sawmill workers. In addition, a correlation was found between the across-week change in forced expiratory volume in 1 second (FEV1) and the decline in FEV1 between the first and the second occasion, after adjusting for normal aging in nonsmoking wood trimmers (r2 = 84%, p < 0.001). The results from the present study suggest that across-shift decrease in FEV1 (measured during a working week) might serve as a guide to identify subjects being at risk for a further decrement in pulmonary function over and above the effects of normal aging and exposure to mold spores in the wood trimming department.

Serum IgG antibodies to mold spores in two Norwegian sawmill populations: relationship to respiratory and other work-related symptoms

Wood trimmers and planing operators from two separate sawmill populations (N = 303 and 170) were studied by serology assessment and a self-administered questionnaire. IgG antibodies to Rhizopus microsporus ssp. rhizopodiformis, Paecilomyces variotii, and Aspergillus fumigatus were measured by ELISA. The questionnaire included questions about general respiratory symptoms and symptoms after handling moldy timber. Personal exposure of wood trimmers to mold spores and wood dust was measured in one part of the sawmills. R. microsporus was the most prevalent mold assessed by serology. Antibody levels were higher and symptoms suggestive of mucous membrane irritation, chronic nonspecific lung disease, allergic alveolitis, and organic dust toxic syndrome were more frequently reported by wood trimmers than by planing operators. The mean level of IgG antibodies to R. microsporus in sawmill workers working in the same work area was the best predictor of symptoms in both populations. The consistent results indicate that exposure to spores of R. microsporus may cause several respiratory symptoms in wood trimmers.

Terpenes enhance metabolic activity and alter expression of adhesion molecules (Mac-1 and L-selectin) on human granulocytes

Granulocytes from healthy blood donors were exposed to terpenes dissolved in ethanol. Flow cytometry was used to measure the expression of the cell surface receptors Mac-1 L-selectin, and CR1, which were detected by monoclonal antibodies. The phagocytic activity was determined by using C3b-coated yeast particles as prey. The metabolic activity was measured by determining the intracellular hydrogen peroxide production using dichlorofluorescein diacetate. After terpene exposure the expression of Mac-1 and CR1 increased (P < 0.001 and P < 0.01, respectively) and the expression of L-selectin decreased (P < 0.001). There was also an increased metabolic activity (P < 0.001). The cell viability, the cell count, and the phagocytic activity remained unchanged. These findings suggest that terpene exposure triggers the granulocytes to a higher degree of activation in terms of an altered expression of the adhesion molecules and an increased metabolic activity.

Controlled short-time terpene exposure induces an increase of the macrophages and the mast cells in bronchoalveolar lavage fluid

Eight healthy nonsmoking volunteers underwent terpene exposure (450 mg/m3 air) on 4 different occasions within a 2 week period. Total exposure time was 12 hours. Before and after the sequences of exposure, bronchoalveolar lavage was performed. Twenty hours after the exposure there was a significant (p < 0.05) increase of the alveolar cell concentration (median pre-exposure value 76 x 10(6) cells/L, post-exposure value 126 x 10(6) cells/L), predominantly due to an increment of the macrophages (from 72 x 10(6) cells/L to 121 x 10(6) cells/L). The mast cells also increased from 1/10 to 5/10 visual fields. No elevated concentrations of albumin, fibronectin, hyaluronan (hyaluronic acid), and tryptase were observed. We conclude that terpene exposure, in a concentration regarded as moderate, induces an acute alveolar cellular reaction in healthy subjects.

Lung function and exposure to paper dust in bookbinders--a pilot study

Lung function deterioration has been reported among workers exposed to heavy exposure to paper dust (greater than 5 mg/m3). This pilot study was undertaken in order to evaluate the health effects of low exposure to paper dust (less than or equal to 1 mg/m3) in bookbinders. The study population consisted of 20 exposed subjects and 18 local office subjects. They were studied during identical conditions by means of dynamic and static spirometry, single breath wash-out with nitrogen (N2) and carbon monoxide (CO). The 90th percentile for daily average values of total dust was 0.6 mg/m3. Non-smoking exposed subjects had on the average an increase in FEV% (forced expiratory volume in one second in percentage of vital capacity) when compared to non-smoking local control subjects. We found a weak correlation between the increase in FEV% and daily average values of total dust (probably reflecting a higher exposure in the past). The results suggest that a low exposure to paper dust in bookbinders with a time of employment more than 10 years might cause a slight lung function deterioration without a clinical relevance.