Respiratory disorders and atopy in cotton, wool, and other textile mill workers in Denmark

Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper

Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV₁. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy.

Assessment of health implications related to processing and use of natural wool insulation products

This paper discusses possible health implications related to dust particles released during the manufacture of sheep's wool-based non-woven insulation material. Such insulation may replace traditional synthetic insulation products used in roofs, wall cavities, etc. A review of the literature concerning organic dusts in general and sheep's wool fiber summarizes dust exposure patterns, toxicological pathways and the hazards imposed by inhalation and explosion risk. This paper highlights a need for more research in order to refrain from overgeneralizing potential pulmonary and carcinogenic risks across the industries. Variables existing between industries such as the use of different wool types, processes, and additives are shown to have varying health effects. Within the final section of the paper, the health issues raised are compared with those that have been extensively documented for the rock and glass wool industries.

A potential therapeutic role for aldose reductase inhibitors in the treatment of endotoxin-related inflammatory diseases

INTRODUCTION

Aldose reductase (AR) was initially thought to be involved in the secondary diabetic complications because of its glucose-reducing potential. However, evidence from recent studies indicates that AR is an excellent reducer of a number of lipid peroxidation-derived aldehydes as well as their glutathione conjugates, which regulate inflammatory signals initiated by oxidants such as cytokines, growth factors and bacterial endotoxins, and revealed the potential use of AR inhibition as an approach to prevent inflammatory complications.

AREAS COVERED

An extensive Internet and Medline search was performed to retrieve information on understanding the role of AR inhibition in the pathophysiology of endotoxin-mediated inflammatory disorders. Overall, inhibition of AR appears to be a promising strategy for the treatment of endotoxemia, sepsis and other related inflammatory diseases.

EXPERT OPINION

Current knowledge provides enough evidence to indicate that AR inhibition is a logical therapeutic strategy for the treatment of endotoxin-related inflammatory diseases. Since AR inhibitors have already gone to Phase III clinical studies for diabetic complications and found to be safe for human use, their use in endotoxin-related inflammatory diseases could be expedited. However, one of the major challenges will be the discovery of AR-regulated clinically relevant biomarkers to identify susceptible individuals at risk of developing inflammatory diseases, thereby warranting future research in this area.

Nasal PMN response to repeated challenge with endotoxin in healthy volunteers

RATIONALE

We have employed nasal challenge with lipopolysaccharide (LPS) followed by nasal lavage (NL) to experimentally induce and examine upper airway inflammation in human volunteers. It is unclear however whether adaptation within individuals occurs following repeated nasal challenge. This was a pilot study to determine if repeated nasal LPS challenge yields attenuation of markers of inflammation (primarily neutrophil response) in the NL fluid of healthy humans.

METHODS

We employed a 3-day nasal LPS challenge protocol with NL using a "split nose" design. The control and LPS nares received two consecutive day saline (0.9% saline/day) and LPS (2 µg LPS/day) challenges, respectively followed by an LPS (2 µg/day) challenge to each nare on Day 3. NL was performed immediately pre Day 1 challenges and 6-h post nasal LPS challenges on both Days 1 and 3. Markers of inflammation (PMNs/mg, cytokines) were assessed in NL and the inflammatory response to LPS (measured as the difference between pre and post challenge) was evaluated in both nares on Day 3 and compared to Day 1.

RESULTS

Significant (p < 0.05) blunting of the LPS-induced polymorphonuclear leukocyte (PMN) response was observed in the nare that received repeated LPS challenges as compared to the control nare (67.60  ±  22.39 vs. 157.8  ±  76.04 PMN/mg) and initial LPS challenge on Day 1 (121 ± 32 PMN/mg). Decreased soluble CD14 and significantly decreased interleukin-8 were also found in the repeat LPS-treated nare. In the LPS-treated nare, the blunted PMN response on Day 3 correlated well with the observed PMN response on Day 1 (r = 0.58, p = 0.02).

CONCLUSIONS

We show attenuation of PMN response to repeated LPS in the nasal airways in healthy humans. Effect of repeat endotoxin exposure prior to allergen delivery on local airway inflammation in both healthy and atopic subjects can be studied.

Modulation of asthma by endotoxin

Asthma is a common inflammatory disease triggered by both allergic and non-allergic stimuli. The most common risk factor in the development of asthma is induction of IgE against indoor allergens and imbalance in the T-helper type 1 (Th1) and Th2 with skewing towards Th2 response. Interplay of genetic and environmental factors is involved in induction and propagation of asthma. Endotoxin is a common environmental pollutant and elicits a Th1 response. The amount of endotoxin varies with several factors but of significant interest has been the role of pets. Endotoxin not only protects against the development of asthma but also enhances an already established inflammation. The difference of outcomes is likely not only due to the time and dose of exposure but also as we discuss the variable interaction of genes with environment. We focus on studies since 2001 that have explored the role of endotoxin in asthma and the gene-environment interactions of the endotoxin effect.

Workplace determinants of endotoxin exposure in dental healthcare facilities in South Africa

OBJECTIVES

Aerosols generated during dental procedures have been reported to contain endotoxin as a result of bacterial contamination of dental unit water lines. This study investigated the determinants of airborne endotoxin exposure in dental healthcare settings.

METHODS

The study population included dental personnel (n = 454) from five academic dental institutions in South Africa. Personal air samples (n = 413) in various dental jobs and water samples (n = 403) from dental handpieces and basin taps were collected. The chromogenic-1000 limulus amebocyte lysate assay was used to determine endotoxin levels. Exposure metrics were developed on the basis of individually measured exposures and average levels within each job category. Analysis of variance and multivariate linear regression models were constructed to ascertain the determinants of exposure in the dental group.

RESULTS

There was a 2-fold variation in personal airborne endotoxin from the least exposed (administration) to the most exposed (laboratory) jobs (geometric mean levels: 2.38 versus 5.63 EU m(-3)). Three percent of personal samples were above DECOS recommended exposure limit (50 EU m(-3)). In the univariate linear models, the age of the dental units explained the most variability observed in the personal air samples (R(2) = 0.20, P < 0.001), followed by the season of the year (R(2) = 0.11, P < 0.001). Other variables such as institution and total number of dental units per institution also explained a modest degree of variability. A multivariate model explaining the greatest variability (adjusted R(2) = 0.40, P < 0.001) included: the age of institution buildings, total number of dental units per institution, ambient temperature, ambient air velocity, endotoxin levels in water, job category (staff versus students), dental unit model type and age of dental unit.

CONCLUSIONS

Apart from job type, dental unit characteristics are important predictors of airborne endotoxin levels in this setting.

Endotoxin exposure and respiratory symptoms in the cotton textile industry

One hundred fourteen male employees of a cotton spinning mill in western Germany participated in a cross-sectional study, the purpose of which was to clarify the dose effect of endotoxin exposure on respiratory symptoms. Airborne endotoxin exposures were classified as low (< or = 100 endotoxin units [EU]/m3), medium (> 100-450 EU/m3), or high (> 450 EU/m3), on the basis of endotoxin activity in the Limulus amoebocyte lysate assay. Age- and smoking-adjusted odds ratios (ORs) and confidence intervals (CIs) were estimated. The dose-response relationship between current endotoxin exposure and prevalence of wheezing (medium: OR = 2.15, 95% CI = 0.48-9.62; high: OR = 5.49, 95% CI = 1.17- 25.81) and cough (medium: OR = 2.11; 95% CI = 0.59-7.56; high: OR = 3.93; 95% CI = 1.02-15.12) was significant (test for linear trend: p values = 0.020 and 0.040, respectively). The association between exposure and wheezing was stronger among atopic workers. The higher prevalence of chest tightness and shortness of breath among workers with medium and high current endotoxin exposure did not reach statistical significance. The results suggested that there was a dose-dependent increase in bronchial symptoms, with significant effects occurring at exposures that exceeded 450 EU/m3.

Elevated concentrations of endotoxin in indoor air due to cigarette smoking

Exposure to environmental tobacco smoke (ETS) is an important worldwide public health issue. The present study demonstrates that cigarette smoke can be a major source of endotoxin (lipopolysaccharide, LPS) in indoor environments. Gas-chromatography/mass-spectrometry was used to determine 3-hydroxy fatty acids as markers of endotoxin in air-borne house dust in homes of smokers and non-smokers. Air concentrations of endotoxin were 4-63 times higher in rooms of smoking students than in identical rooms of non-smoking students. The fact that cigarette smoke contains large amounts of endotoxin may partly explain the high prevalence of respiratory disorders among smokers and may also draw attention to a hitherto neglected risk factor of ETS.

Airway responses to the inhalation of cotton dust and cotton bract extracts

BACKGROUND

Exposure to dust in the cotton industry is associated with respiratory dysfunction. Healthy subjects challenged with cotton bract extract (CBE) develop transient airway hyperresponsiveness. CBE, a major component of cotton dust, is potentially an important agent for studying byssinosis.

OBJECTIVES

To compare airway responses to cotton dust extract (CDE) and CBE in healthy subjects.

METHODS

In 21 healthy, non-smoking subjects we compared the effects of CBE and CDE in a double-blind random order, following a 10-min aerosol inhalation. The response to methacholine (MCh) 2 h following CBE or CDE was measured. Lung function was recorded using maximal (MEFV) and partial expiratory flow volume (PEFV) curves, measuring MEF at 60% of baseline vital capacity below total lung capacity [MEF40%(P)] on the PEFV curve. Responders were subjects who developed a 20% or greater fall in MEF40%(P) following extract challenge. Endotoxin levels were low for CBE (5.71 EU/mg) and CDE (31.88 EU/mg).

RESULTS

There were 18 responders to CBE and 17 responders to CDE. The average maximal falls in MEF40%(P) were 70 +/- 4.9 and 70 +/- 4.4% of baseline (nonsignificant) following CBE and CDE, respectively. All subjects enhanced their MCh response following CBE or CDE. The MCh dose which reduced MEF40%(P) by 40% was identical for CBE and CDE (1.3 microg/ml).

CONCLUSIONS

We conclude that CBE and CDE exert similar physiologic effects.

Longitudinal study on the relationship between cat allergen and endotoxin exposure, sensitization, cat-specific IgG and development of asthma in childhood--report of the German Multicentre Allergy Study (MAS 90)

BACKGROUND

Controversial data have emerged regarding the question whether cat exposure in childhood favours or decreases the risk of sensitization and allergic airway disease. In a prospective birth-cohort study, we assessed the association between longitudinal cat allergen exposure, sensitization (immunoglobulin E, IgE), IgG antibody (ab) levels to cat and the development of asthma in children up to the age of 10 years.

METHODS

Of 1314 newborn infants enrolled in five German cities in 1990, follow-up data at age 10 years were available for 750 children. Assessments included yearly measurements of specific serum IgE to cat and at age 6 and 18 months, 3, 4 and 10 years measurement of cat allergen Fel d 1 in house dust samples. Additionally, Fel d 1-specific IgG ab were determined in 378 serum samples of 207 children. Endotoxin exposure in mattress dust was measured in a subgroup of 153 children at age 10 years. From age 4 years on, International Study of Asthma and Allergy in Childhood (ISAAC) questionnaires were completed yearly in order to assess the prevalence of wheeze and asthma.

RESULTS

Serum IgG-levels to cat showed a large variation, however, intraindividually values showed rather constant concentration over a longer time period. The IgG levels at school-age correlated with cat allergen exposure during the first 2 years of life. Specific IgE to cat was clearly associated with wheeze ever, current wheeze and bronchial hyperresponsiveness (BHR), this was also observed for children with specific IgE ab to cat (>0.35 kU/l) plus IgG levels above 125 U/ml. A large percentage of very highly exposed children showed high IgG but no IgE responses to cat, however, not all highly exposed children were found to be protected from sensitization. Children with IgG but without IgE ab to cat showed the lowest prevalence of wheeze ever and current wheeze despite high cat allergen exposure, however, this trend did not achieve significance. While homes of cat owners showed higher Fel d 1 concentrations than homes without cats, homes of cat owners were not found to have higher endotoxin levels in carpet dust samples than homes without cats.

CONCLUSIONS

We could confirm that high cat allergen exposure in a cohort with lower community prevalence of cats is associated with higher serum IgG and IgE levels to cat in schoolchildren. Sensitization to cat allergen (IgE) is a risk factor for childhood asthma. While exposure to cat allergen during infancy is associated with sensitization (IgE), only in the very highly exposed children the likelihood of sensitization (IgE) is decreased and high IgG levels to cat without IgE were associated with low risk of wheeze. However, cat-specific IgG ab levels did not protect children with IgE-mediated sensitization from wheeze.

Endotoxin and the lung: Insight into the host-environment interaction

Understanding the pathophysiology and basic mechanisms of asthma and chronic obstructive pulmonary disease (COPD) has been an intense source of investigation over the years. For decades, research in these fields has focused on the control of inflammation. However, new evidence has emerged demonstrating that airway inflammation is just the surface of a more complex pathobiological relationship between the disease and its host. Specifically, the relationship is a unique interaction of one's genetic background and the environment. The airway response to inhaled endotoxin serves as an effective model for studying the pathobiology of asthma as well as the importance of host genetic susceptibility. In this review, we provide a brief overview on the role of endotoxin in asthma and COPD, highlighting a few of the major discoveries, but also discussing future directions.

Differential responses of rat alveolar macrophages to carpet dust in vitro

Epidemiological studies of workers in carpet weaving units in carpet industries have shown a direct relation between the concentration of carpet dust in the air and respiratory symptoms. To predict the health risk of carpet weavers, this preliminary study was conducted to evaluate the toxic potential of different types of workplace dust by using alveolar macrophages (AMs). Several parameters were observed for cytotoxicity such as cell viability, the release of lactate dehydrogenase (LDH) in rat AMs treated with different concentration of carpet dust and haemolytic potential of erythrocytes. In addition, reactive oxygen/nitrogen species-inducing effects of carpet dust were assessed by nitric oxide (NO), reduced glutathione (GSH) release and hydrogen peroxide (H2O2) generation in AMs. Results of cell viability and hemolytic assay showed a direct correlation between increasing the dust concentration with enhancing the toxic effect. Knotted and tufted carpet dust increases the release of LDH, NO, GSH and H2O2 production with increasing dust concentration. Present observations have revealed that dusts collected from tufted carpet weaving units exhibited more toxicity to AMs than knotted carpet dust. These data further suggest that injurious effects of carpet dust to AMs could pave a way to evaluate the toxic potential of the different types of workplace dusts and component(s) involved in it.

Pulmonary toxicity of dust generated during weaving of carpets

The dust generated during weaving (carpet dust) tibbati, knotted and tuffted carpets in carpet industry was studied for its toxicity in vitro and in vivo. Carpet dust (0.5, 1.0, 2.5 and 5.0 mg/1 x 10(6) cells) caused in vitro cytotoxicity in rat alveolar macrophages (AM) in a concentration-dependent manner. The cytotoxic, inflammatory and oxidative responses were observed in bronchoalveolar lavage fluid (BALF) of rats at 1, 4, 8 and 16 days after exposure. Rats were intratracheally exposed at 5 mg/rat individually to all three types of carpet dust. All types of carpet dusts produced increased AM, lymphocytes (PMN) population in BALF suggesting their inflammatory reactions. Cytotoxic nature of carpet dust was shown by the increased activities of lactate dehydrogenase (LDH) and acid phosphatase (AP) in BALF. Increased AM population and in vitro cytotoxicity due to carpet dusts have shown some correlation with the levels of LDH and AP activities in BALF. The gradual enhanced profile of hydrogen peroxide (H2O2) and nitric oxide (NO) along with depletion of reduced glutathione (GSH) in AM due to these carpet dusts are suggestive of their oxidant nature. The enzyme activities of both glutathione peroxidase (GPx) and glutathione reductase (GR) in AM were marginally reduced in exposed rats. In conclusion, the data suggest the cytotoxic, inflammatory and oxidant nature of carpet dusts. It is extrapolated that health effects on carpet weavers would be associated with the concentration and nature of airborne dust generated during weaving of carpets.

Airborne fungi and endotoxin concentrations in different areas within textile plants in Taiwan: a 3-year study

Bioaerosols have been found in many occupational environments, including animal feeding houses, poultry slaughter houses, and cotton textile plants. This study was undertaken to examine a group of bioaerosols, the endotoxins, fungi, and bacteria, inside two textile factories over 3 years in Taiwan, where temperature and humidity are usually high year-round. Airborne dust was collected with filter cassettes attached to personal pumps and analyzed by the Kinetic Limulus Assay with Resistant-parallel-line Estimation. For fungi and bacteria determination, samples were collected using duplicated single-stage impactors, and organisms were counted after incubation. Endotoxin was the major contamination inside textile plants. Indoor levels were substantially higher than outdoor concentrations by 63- to 278-fold. The average values of fungi inside and outside the plants were not significantly different. Airborne bacteria levels were higher inside the plants as compared to outside. The carding sites, using only cotton, had extremely high endotoxin levels, greater than those at sites using synthetic fibers. Cotton, may be a major source of endotoxin contamination. In conclusion, the early stage of textile processing seems to generate high endotoxin and bacteria contamination. Priorities should be given to occupational hygiene programs for workers at various sites in textile plants.

Occupational exposure to cotton dust in cottonseed oil mills

Air samples were collected at breathing height in the hulling-separation department of a modern cottonseed oil mill in Uzbekistan. The average elutriated mass concentration measured by standard cotton dust samplers was 4.6 mg/m3, much lower than the average total dust concentration measured by stationary personal samplers, 12.49 mg/m3, and by personal samplers attached to workers, 14.53 mg/m3. Differences in readings among the vertical elutriators, stationary personal samplers, and roving personal samplers are attributed to the distinct sampling nature and dynamics of these samplers. The data suggest that most of the dust consisted of particles larger than 15 microm, the particle size cutoff of the vertical elutriator. Differences in readings among stationary and roving personal samplers are statistically significant, presumably representing biased sampling by the roving personal samplers of regions characterized by high dust concentration (due to machines malfunctioning), the nonstatic nature of the sampling, and the interaction between the sampler and the worker (the personal cloud). Cotton dust concentrations in the hulling-separation room were nonuniform, peaking in front of and between the huller-separator pairs. The high total mass readings show that workers were exposed to very high levels of nonthoracic airborne dust, which upon inhalation tends to deposit in the extrathoracic airways. The high elutriated mass concentrations suggest that workers were exposed to respirable cotton dust at levels higher than 1 mg/m3 mean concentration, the current Occupational Safety and Health Administration (OSHA) Permissible Exposure Limit (PEL) for cotton dust. Regressions between dust concentrations measured by stationary vertical elutriators and by personal samplers attached to workers serve for estimating the potential occupational exposure to cotton dust of workers in the hulling-separation room.

Does environmental endotoxin exposure prevent asthma?

The evidence as to whether exposure to environmental airborne endotoxin plays a protective or an inducing role in the development of asthma is reviewed. Studies of endotoxin and atopy, endotoxin and asthma, and farming and asthma are considered and, in each instance, a distinction is made between evidence of primary causation and evidence of secondary causation. It is concluded that, although it is plausible that bacterial endotoxin may protect against the development of asthma, there is considerable reason for caution regarding this hypothesis.

Potential pulmonary effects of man-made organic fiber (MMOF) dusts

In the first half of the twentieth century epidemiologic evidence linked elevated incidences of pulmonary fibrosis and cancer with inhalation of chrysotile and crocidolite asbestos, a family of naturally occurring inorganic fibrous materials. As the serpentine and amphibole forms of asbestos were phased out, synthetic vitreous fibers (SVFs; fiber glass, mineral wool, and refractory fiber) became increasingly utilized, and concerns were raised that they too might cause adverse health effects. Extensive toxicological research on SVFs has demonstrated that their pulmonary effects are directly related to fiber dose in the lung over time. This is the result of deposition (thin fibers deposit in the lower lung more efficiently than thick fibers) and lung-persistence ("biopersistence" is directly related to fiber length and inversely related to dissolution and fragmentation rates). In rat inhalation studies, asbestos was determined to be 7- to 10-fold more biopersistent in the lung than SVFs. Other than its effect on biopersistence, fiber composition did not appear to play a direct role in the biological activity of SVFs. Recently, the utilization of man-made organic fibers (MMOFs) (also referred to by some as synthetic organic fibers) has increased rapidly for a variety of applications. In contrast to SVFs, research on the potential pulmonary effects of MMOFs is relatively limited, because traditionally MMOFs were manufactured in diameters too thick to be respirable (inhalable into the lower lung). However, new developments in the MMOF industry have resulted in the production of increasingly fine-diameter fibers for special applications, and certain post-manufacturing processes (e.g., chopping) generate respirable-sized MMOF dust. Until the mid-1990s, there was no consistent evidence of human health affects attributed to occupational exposure to MMOFs. Very recently, however, a unique form of interstitial lung disease has been reported in nylon flock workers in three different plants, and respirable-sized nylon shreds (including fibers) were identified in workplace air samples. Whether nylon dust or other occupational exposures are responsible for the development of lung disease in these workers remains to be determined. It is also unknown whether the biological mechanisms that determine the respirability and toxicity of SVFs apply to MMOFs. Thus, it is appropriate and timely to review the current data regarding MMOF workplace exposure and pulmonary health effects, including the database on epidemiological, exposure assessment, and toxicology studies.

Endotoxin-stimulated innate immunity: A contributing factor for asthma

Exposure to airborne endotoxin in infancy may protect against asthma by promoting enhanced T(H)1 response and tolerance to allergens. On the other hand, later in life, it adversely affects patients with asthma. Endotoxin binding to receptors on macrophages and other cells generates IL-12, which inhibits IgE responses. It also generates cytokines like IL-1, TNF-alpha, and IL-8, which cause inflammation. These signal transduction pathways resemble those leading to the generation of cytokines, such as IL-4, IL-13, and IL-5, which are responsible for the inflammation of IgE-mediated allergic disease. The main difference seems to be that endotoxin recruits neutrophils, but IgE recruits eosinophils, and the details of the tissue injury from these granulocytes differ. Sources of airborne endotoxin include many agricultural dusts, aerosols from contaminated water in many industrial plants, contaminated heating and air-conditioning systems, mist-generating humidifiers, and damp or water-damaged homes. Acute inhalation of high concentrations of endotoxin can cause fever, cough, and dyspnea. Chronic inhalation of lesser amounts causes chronic bronchitis and emphysema and is associated with airway hyperresponsiveness. Airborne endotoxin adversely affects patients with asthma in 3 ways: (1) by increasing the severity of the airway inflammation; (2) by increasing the susceptibility to rhinovirus-induced colds; and (3) by causing chronic bronchitis and emphysema with development of irreversible airway obstruction after chronic exposure of adults. The most effective management is mitigating exposure. The potential of drug treatments requires further clinical investigation.

Evaluation of chronic respiratory effects in the potato processing industry: indications of a healthy worker effect?

OBJECTIVE

To investigate the occurrence of chronic respiratory effects of exposure to organic dust in the potato processing industry.

METHODS

Self reported chronic respiratory symptoms and spirometric lung function were assessed in a cross sectional study among 135 potato processing workers. A comprehensive study of current exposure to dust, endotoxin, and potato antigens had been performed previously. Workers were grouped into low and high exposure categories for each of the three exposure indices. Relations between exposure concentrations and respiratory health variables were investigated either by calculating prevalence rate ratios or by performing linear regression analyses. Atopy was assessed by measuring total immunoglobulin E (IgE) and specific IgE to five common aeroallergens in serum samples of workers.

RESULTS

Evident relations between current exposure indices and respiratory health in the entire group were not found. Workers employed < or = 5 years showed a two-fold higher prevalence of respiratory symptoms, lower lung function, and higher endotoxin exposure than workers employed for > 5 years. Also, atopy was more prevalent in workers employed < or = 5 years. After stratification for duration of employment, negative effects of endotoxin on lung function among workers employed < or = 5 years were suggested.

CONCLUSIONS

This study does not show chronic respiratory effects of exposure to organic dust in the potato processing industry, despite the fact that the levels of exposure to endotoxin found in this industry have been reported to be associated with decreases in lung function in other occupational settings. A likely explanation for not detecting apparent effects might be that many symptomatic workers drop out of this industry a few years after starting the job, suggesting a healthy worker effect.

Respiratory symptoms and pulmonary function in a group of women weavers in South Africa

Respiratory symptoms and ventilatory capacity were studied in 97 women carpet weavers in a hand-made carpet weaving industry in Umtata, Transkei, South Africa. The controls were from a bottling plant in the same city. Both groups were Black Africans from the Xhosa-speaking population. The population we studied were non-smokers and there was no significant difference in age, race or height between the groups. The exposed weavers had significantly lower forced expiratory indices than the control group. Mean forced expiratory volume in 1 second (FEV1), forced mid-expiratory flow (FEF 25-75%), forced expiratory flow between 200 ml and 1200 ml of forced vital capacity (FEF 200-1200), and peak expiratory flow (PEF) were: 26.0%, 39.0%, 36.4% and 28.5% lower respectively in the exposed group compared with the controls. Mean forced vital capacity (FVC) and forced expiratory ratio (FEV1/FVC x 100) were 22.0% and 6.6% lower respectively in the exposed group compared with the controls. The percentage predicted (%pred) values of FVC, FEV1, FEV1/FVC ratio, FEF 25-75%, FEF 200-1200, and PEF in the exposed group were 82.9%, 77.1%, 95.6%, 64.6%, 72.2% and 82.8%, respectively. The prevalence of FEV1/FVC ratio less than 70% in the exposed group was 37.2%, while in the controls it was 12%. The exposed group reported a significantly higher prevalence of respiratory symptoms compared to the control. The prevalence of nasal symptoms and cough was 62.8% and 58.1%, respectively in the weavers. Weavers who reported cough, breathlessness, and wheezing had significantly (p < 0.01) lower pulmonary function than those who did not report these symptoms. The present study demonstrates that the continual exposure to dust in weavers in this industry is associated with significantly lower pulmonary function, higher prevalence of respiratory symptoms, and weavers show signs of airway obstruction compared to workers not exposed to this type of dust. Women in the weaving industry have a significant occupationally related respiratory impairment.

Immunological reactions and respiratory function in wool textile workers

Immunological status and respiratory function were studied in a group of 64 wool textile workers (52 women and 12 men). A group of 46 workers not exposed to wool dust served as a control for the respiratory symptoms and immunologic testing. Skin testing was performed with different wool allergens (domestic and Australian) as well as with common allergens. Ventilatory capacity was measured in wool workers on Mondays before and after the work shift. The prevalence of positive skin tests to all allergens was higher in wool than in control workers, although the difference was statistically significant only for washed domestic wool (wool workers: 42.2%; control workers: 19.6%; p < 0.05). Increased serum IgE levels were more frequent in wool (26.6%) than in control workers (3.1%) (p < 0.01). In wool textile workers there was a high prevalence of acute and chronic respiratory symptoms. Significant across-shift reductions in ventilatory capacity tests, as well as abnormal baseline lung function, were recorded in wool textile workers. Individual data demonstrated that many of the wool workers had FEF25 lower than 70% of predicted. In general, the prevalence of symptoms and the lung function abnormalities did not correlate with the results of specific (wool) skin tests. Our data indicate that exposure to wool dust in some workers may be associated with the development of acute and chronic respiratory symptoms and impairment of lung function. Immunologic abnormalities, although frequent in this group, do not appear to be associated with the severity of these changes.

Respiratory symptoms and lung function in wool textile workers

Our study investigated a group of 216 wool textile workers (158 women and 58 men). Respiratory symptoms were assessed by questionnaire in wool textile workers and in 130 not exposed (control) workers. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on Monday before and after the work shift. Forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on the MEFV curves. Analysis of the data demonstrated a significantly higher prevalence of all chronic respiratory symptoms in wool workers than in controls, being the highest in wool workers for nasal catarrh (M: 63.8%; F: 44.9%) and for sinusitis (M: 62.1%; F: 43.0%). A high prevalence of acute symptoms, associated with the work shift, was also noted in wool workers. Exposure to wool dust caused significant across-shift reductions of ventilatory capacity varying from 1.4% for FEV1 to 9.1% for FEF50. Textile workers exposed to wool for > 10 years in the workplace had similar across-shift reductions of ventilatory capacity tests as those with shorter exposures. In a large number of these wool workers, FEF50 and FEF25 were below 70% of predicted normal values. Smokers had acute and chronic lung function changes similar to those of nonsmokers, indicating that smoking did not account for all the respiratory effects seen in wool processing workers. Our data suggest that dust exposures in wool textile mills may be associated with the development of chronic respiratory symptoms and impaired lung function.

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)

Longitudinal study of the health of cotton workers

OBJECTIVES

To follow up a group of newly employed workers in a cotton mill, and to report changes in symptoms over time.

METHODS

A group of 110 mill workers at a cotton mill in Shijiazhuang, China, was investigated by questionnaire, skin testing, and spirometric measurements of airway responsiveness through forced expiratory volume in one second (FEV1). The workers were examined before starting work, at 10 weeks, and at one year.

RESULTS

Decreases in FEV1 over shifts were small at 10 weeks and one year, and slightly higher among people with skin reactions to cotton dust extracts. Airway responsiveness, defined as the average decrease in FEV1 after 1.25 mg methacholine was increased at 10 weeks. It remained about the same after one year, except in the workers positive for the skin test, in whom it was further increased. Subjective symptoms of chest tightness and cough with phlegm increased progressively at 10 weeks and one year; nasal irritation remained unchanged and dry cough decreased between 10 weeks and one year.

CONCLUSION

The results suggest that the airway inflammation caused by cotton dust increases with increasing exposure time and that the changes are more notable in workers with reactivity to cotton dust extract.

Lung function changes among recycling workers exposed to organic dust

This study examines the workshift changes in lung function among 99 recycling workers, and correlates these findings with measurements of total dust and endotoxins. Exposure to organic dust caused a fall in FEV1 over the workshift, and this was significantly associated with the exposure to organic dust. No significant association was found between endotoxin exposure and lung function decrements. This lack of association could be due to the low concentrations of endotoxins to which the workers were exposed, as no workers were exposed to more than 100 ng/m3.

Is a low serum concentration of alpha 1-antitrypsin associated with an increased susceptibility for byssinosis in cotton mill workers? Considerations regarding analytical quality requirements and economical consequences

We have previously demonstrated an association between development of the cotton lung disease byssinosis and endotoxin concentrations in the work environment. Endotoxin has been shown to exert its effects through granulocyte activation and hence release of elastase and other proteases at the bronchoalveolar surface. alpha 1-Antitrypsin is a protease inhibitor, and hence, alpha 1-Antitrypsin concentrations in the blood and then on the alveolar surface might be important for the protection against endotoxin effects. Airborne endotoxin concentrations in the work place and S-alpha 1-Antitrypsin (a1A) was measured in 226 workers in cotton mills in Vejle and of these 206 were further phenotyped. The following models were considered: Model 1. The S-a1A concentration is determining the risk for development of byssinosis. The lower the concentration, the higher the risk. Model 2. The degree of exposure to endotoxin is determining. The higher the airborne concentration and the longer time working in that, the higher is the risk. Model 3. The phenotype of a1-A is determining. Only MS and/or MZ phenotypes represent a risk disposition. The goals for analytical quality for a1-A measurements were estimated in the two relevant models. The specifications are: Regarding model 1: analytical coefficient of variation CVA < 3% and analytical bias--1 mumol/L < BA < +1 mumol/L. Model 2: a1-A is not of significant importance and specifications cannot be evaluated. Regarding model 3: There is a direct relationship between cut-off point and analytical performance, e.g. an imprecision of SA 3 mumol/L and cut-off of 38 mumol/L will allow for a BA of -1 mumol/L.