Respiratory symptoms and lung function in wool textile workers

Occupational and environmental risk factors for chronic rhinosinusitis in China: a multicentre cross-sectional study

Background

Chronic rhinosinusitis (CRS) is defined as a condition of inflammation in the paranasal sinus mucosa persisting for more than 12 weeks. We previously reported that the prevalence of CRS was about 8 % in China. Here, we aim to investigate the occupational and environmental risk factors associated with CRS.

Methods

Data were collected from seven Chinese cities: Urumqi, Changchun, Beijing, Wuhan, Chengdu, Huaian and Guangzhou. CRS was diagnosed according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP³OS) document. Participants were asked to complete a standardized questionnaire, which was developed by the Global Allergy and Asthma European Network (GA²LEN) project and covered sociodemographic characteristics, CRS-related symptoms and occupational and environmental exposures. We evaluated the association between CRS and various occupational and environmental factors using odds ratios (ORs) and 95 % confidence intervals (95 % CIs).

Results

The total study population consisted of 10,633 subjects, 850 (7.99 %) of whom were defined as having CRS according to the EP³OS criteria. We found that there were significant associations between occupational and environmental factors and CRS. Specifically, having a clearance-related job, occupational exposure to dust, occupational exposure to poisonous gas, a pet at home or carpet at home or at the workplace were risk factors for CRS. Additionally, the method used to keep warm in winter, the duration of time spent using air conditioning in summer and the frequency of exposure to mouldy or damp environments were significantly different in subjects with and without CRS.

Conclusions

Our data showed that some occupational and environmental exposures are strongly associated with CRS, which aids in understanding the epidemiology of CRS.

Occupational exposure to textile dust increases the risk of rheumatoid arthritis: results from a Malaysian population-based case-control study

Objectives

Lung exposures including cigarette smoking and silica exposure are associated with the risk of rheumatoid arthritis (RA). We investigated the association between textile dust exposure and the risk of RA in the Malaysian population, with a focus on women who rarely smoke.

Methods

Data from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis population-based case–control study involving 910 female early RA cases and 910 female age-matched controls were analysed. Self-reported information on ever/never occupationally exposed to textile dust was used to estimate the risk of developing anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative RA. Interaction between textile dust and the human leucocyte antigen DR β-1 (HLA-DRB1) shared epitope (SE) was evaluated by calculating the attributable proportion due to interaction (AP), with 95% CI.

Results

Occupational exposure to textile dust was significantly associated with an increased risk of developing RA in the Malaysian female population (OR 2.8, 95% CI 1.6 to 5.2). The association between occupational exposure to textile dust and risk of RA was uniformly observed for the ACPA-positive RA (OR 2.5, 95% CI 1.3 to 4.8) and ACPA-negative RA (OR 3.5, 95% CI 1.7 to 7.0) subsets, respectively. We observed a significant interaction between exposure to occupational textile dust and HLA-DRB1 SE alleles regarding the risk of ACPA-positive RA (OR for double exposed: 39.1, 95% CI 5.1 to 297.5; AP: 0.8, 95% CI 0.5 to 1.2).

Conclusions

This is the first study demonstrating that textile dust exposure is associated with an increased risk for RA. In addition, a gene–environment interaction between HLA-DRB1 SE and textile dust exposure provides a high risk for ACPA-positive RA.

Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review

BACKGROUND

Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease, with a likely multifactorial etiology potentially including hazardous occupational and environmental exposures. We completed a systematic review of the occupational and environmental literature to evaluate the quality of evidence of the role that hazardous exposures might play in CRS.

METHODS

We searched PubMed for studies of CRS and following exposure categories: occupation, employment, work, industry, air pollution, agriculture, farming, environment, chemicals, roadways, disaster, and traffic. We abstracted information from the final set of articles across 6 primary domains: study design; population; exposures evaluated; exposure assessment; CRS definition; and results.

RESULTS

We identified 41 articles from 1080 manuscripts: 37 occupational risk papers, 1 environmental risk paper, and 3 papers studying both categories of exposures. None of the 41 studies used a CRS definition consistent with current diagnostic guidelines. Exposure assessment was generally dependent on self-report or binary measurements of exposure based on industry of employment. Only grain, dairy, and swine operations among farmers were evaluated by more than 1 study using a common approach to defining CRS, but employment in these settings was not consistently associated with CRS. The multiple other exposures did not meet quality standards for reporting associations or were not evaluated by more than 1 study.

CONCLUSION

The current state of the literature allows us to make very few conclusions about the role of hazardous occupational or environmental exposures in CRS, leaving a critical knowledge gap regarding potentially modifiable risk factors for disease onset and progression.

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.

Chronic rhinosinusitis and occupational risk factors among 20- to 75-year-old Danes-A GA(2) LEN-based study

BACKGROUND

Very little is known about occupational risk factors for chronic rhinosinusitis (CRS). The aim of this study was to evaluate occupational and other potential risk factors for CRS in a Danish population.

METHODS

A cross sectional survey study among 4,554 Danes aged 20-75 years evaluated self-reported symptoms of CRS, asthma, and nasal allergy, along with information on smoking habits and occupation.

RESULTS

A total of 3,099 returned completed questionnaires (response rate 68.1%). The overall CRS prevalence was 7.8% with no significant differences related to age or gender. Risk ratio estimates revealed an increased risk of CRS among female blue collar workers compared to female white collar workers. Among men the effect of occupation depended on smoking status. Occupational exposure to gasses, fumes, dust, or smoke increased the overall risk of CRS. CRS was reported approximately four times as often in subjects with asthma and in subjects with nasal allergy. Current smoking doubled the CRS prevalence.

CONCLUSIONS

CRS prevalence was affected by occupation (blue vs. white collar), but the observed effect depended on gender and smoking status. Exposure to airway irritants (occupational or smoking) increased the CRS prevalence. Studies on larger cohorts are needed to fully assess these tendencies, for example, by more extensive use of Job Exposure Matrix models.

The relationship between chronic rhinosinusitis and occupation: the 1998, 2001, and 2005 Korea National health and nutrition examination survey (KNHANES)

OBJECTIVES

We examined the relationship between chronic rhinosinusitis and occupation.

METHODS

We analyzed data from the 1998, 2001, and 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Men and women aged 20-59 who participated in the three KNHANES were included to analyze the relationship between chronic rhinosinusitis and occupation. Trained interviewers visited subjects' homes and administered a standardized questionnaire on diagnosed diseases. Subjects were asked if they had experienced chronic rhinosinusitis during the previous year or had had rhinosinusitis for three or more consecutive months. Occupational classification followed the major groups of the Korean Standard Classification of Occupations (KSCO). We calculated the prevalence ratios (PRs) of chronic rhinosinusitis by major groups compared with clerical workers in the three KNHANES. Poisson regression with robust standard error was conducted, adjusting for age in 10-year strata.

RESULTS

There were significantly increased PRs of chronic rhinosinusitis in plant and machinery operators and assemblers, elementary occupations, crafts and related trade workers, and the unemployed.

CONCLUSIONS

These results support the relationship between chronic rhinosinusitis and occupational exposure at the macro level.

Gender and respiratory findings in workers occupationally exposed to organic aerosols: a meta analysis of 12 cross-sectional studies

BACKGROUND

Gender related differences in respiratory disease have been documented. The aim of this study was to investigate gender related differences in respiratory findings by occupation. We analyzed data from 12 of our previously published studies.

METHODS

Three thousand and eleven (3011) workers employed in "organic dust" industries (1379 female and 1632 male) were studied. A control group of 806 workers not exposed to any kind of dust were also investigated (male = 419, female = 387). Acute and chronic respiratory symptoms and lung function were measured. The weighted average method and the Mantel-Haentszel method were used to calculate the odds ratios of symptoms. Hedge's unbiased estimations were used to measure lung function differences between men and women.

RESULTS

There were high prevalences of acute and chronic respiratory symptoms in all the "dusty" studied groups compared to controls. Significantly less chronic cough, chronic phlegm as well as chronic bronchitis were found among women than among men after the adjustments for smoking, age and duration of employment. Upper respiratory tract symptoms by contrast were more frequent in women than in men in these groups. Significant gender related lung function differences occurred in the textile industry but not in the food processing industry or among farmers.

CONCLUSION

The results of this study suggest that in industries processing organic compounds there are gender differences in respiratory symptoms and lung function in exposed workers. Whether these findings represent true physiologic gender differences, gender specific workplace exposures or other undefined gender variables not defined in this study cannot be determined. These data do not suggest that special limitations for women are warranted for respiratory health reasons in these industries, but the issue of upper respiratory irritation and disease warrants further study.

An ergonomic study of women workers in a woolen textile factory for identification of health-related problems

The observational cross-sectional study conducted on a sample of 100 women workers who volunteered, outlines their cardio-respiratory and musculo-skeletal profile before, during and at end of work. In addition, information on their health status in general was collected in advance.Contrary to expectation, there was no significant change in respiratory function. However, the musculo-skeletal problems were found to be abundantly present with pain in 91% of the subjects. Region-wise mapping of pain revealed that postural pain in low back was present in 47% while in neck was 19%. Scapular muscles on the right side were involved in stabilizing shoulder, which never went overhead. On the contrary, left shoulder was raised as high (>90 degrees) in spinning action, while pulling thread. This muscle work involved trapezius, deltoid and triceps action concentrically in lifting and while coming to starting position slowly, eccentrically. There was no pause since the wheel continued to spin the thread continuously, unless a worker opted to stop the work. Accordingly, left wrist and hand were in holding contraction while the right wrist and hand holding the handle were also in a fixed position with wrist in flexion with supinated forearm. Though the overall job was light as per peak HR, there was pain due to fatigue and grip strength weakened by around 10%, at the end of the day's work. In conclusion, pain and fatigue were found to be the main problems for women in the spinning section of the small-scale industry under this study. Women have to take up dual responsibility of a full-time job as well as the domestic work. It was considered that ergonomic factors such as provision of a backrest and frequent rest periods could remediate the musculo-skeletal symptoms.

Immunological and respiratory changes in tobacco workers

BACKGROUND

Tobacco workers develop respiratory changes following occupational exposure to tobacco dust.

METHODS

This study investigated 102 tobacco workers as well as a group of 30 matched control workers. Immunological testing, symptom questionnaire, and lung function measurements were performed in all workers.

RESULTS

Increased total IgE was found in 12.7% of tobacco workers but in none of the controls (P < 0.05). Increased specific IgE (tobacco allergen) was recorded in 26.7% of tobacco workers with positive skin tests to tobacco extract but in none of the controls (P < 0.05). Regression analysis of ventilatory tests in female tobacco workers indicated a significant association of FEF75 to employment and smoking among workers with positive skin tests to tobacco. There were, however, no other associations between positive immunologic findings and lung function abnormalities and symptoms.

CONCLUSIONS

Our study found increased immunological reactions in the tobacco workers. However, with the possible exception of lung function at low lung volume in female workers, these reactions do not appear to contribute significantly to the symptoms and lung function abnormalities seen in these workers. Am. J. Ind. Med. 45:76-83, 2004.

Synergistic effects of dust and ammonia on the occupational health effects of poultry production workers

OBJECTIVE

As production methods for livestock and poultry moved towards large industrial-scale confinement facilities, the occupational health community reported risks for respiratory illnesses in workers. Likely, greater risks for respiratory disease will occur with the continuing trend towards full-time confinement workers, who inspire a combination of bioaerosols, particulates, and gases. Although there have been numerous studies on the individual health effects of air contaminants inside confined animal production facilities, there have been no reports on the effects of combined exposures. The objective of this study was to investigate the combined health effects of air contaminants on poultry production workers.

SAMPLE POPULATION

Two hundred and fifty-seven poultry production workers participated in this study. The workers represented various areas of the poultry industry, including turkey growing, broiler production, egg laying, and unloading/shakeling in poultry processing. Worker procedures pulmonary function testing was conducted before and after a four-hour work shift. The work environment was assessed for total and respirable dust, ammonia, endotoxin and CO2. The relationship of simultaneous total dust and ammonia exposures was examined by correlation, logistic modeling, and synergy index calculations.

RESULTS

Synergy between ammonia levels and airborne dust explained up to 43% and 63% of the decline (respectively for Forced Expiratory Volume (FEV) in one second and Forced Expiratory Flow (FEF25-75) in pulmonary function over the work shift. Furthermore, assessing the synergy index indicated the combined effect of dust and ammonia is from 53 to 156% (greater combined than individually). The proportion of health effect due to synergy is 35%-61%.

CONCLUSIONS

Synergy of simultaneous dust and ammonia exposures in a working environment raises the question of redefining exposure limits for organic dust and ammonia when workers are exposed simultaneously to these substances.

CLINICAL RELEVANCE

Control of both dust and ammonia in livestock facilities is extremely important. Lack of control of both these contaminants will increase the risk of respiratory dysfunction to all exposed to this environment, including workers and veterinarians.

Experimental study on fibrogenic effect of fur dust on rat lung

OBJECTIVE

The fibrogenicity of fur dust was studied in rat lung tissues.

METHODS

Intratracheal instillation of fur dust, morphologic examination of lungs and analysis of collagen content were performed in Wistar rats.

RESULTS

Morphologic examination revealed that the earliest changes consisted of alveolar edema, increased numbers of intraalveolar macrophages, and marked thickening of interalveolar septa with mixed cellular infiltrate. After sixth months, there was moderate thickening of the alveolar walls and the peribronchioli. After 12 months, interstitial positive fibrosis of the alveolar wall and the peribronchioli were weakly seen. In the carding dust group (silica content 17.6%), interstitial nodules were observed composed of fibroblasts, reticular fibers, and collagen fibers. Electron microscopic examination also showed that alveolar walls became thickened and collagen fiber bundles were seen around bronchioles and small vessels in the carding groups after 12 months. At all stages of analysis, the collagen content in lungs of the fur dust groups was significantly higher than that of the control group.

CONCLUSIONS

Our study suggested that fur dust might induce weak interstitial fibrosis in the lung.

Pulmonary function in fur-processing workers: a dose-response relationship

Pulmonary function tests were conducted in 212 male workers exposed to fur dust in a fur-processing factory, and in 148 unexposed male workers. The authors used the cumulative dose of dust exposure (mg-yr) as an exposure index to relate to pulmonary function injury, as measured by pulmonary function tests, in exposed workers. The results showed that fur workers had lower percentages of predicted pulmonary function, as measured by forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1.0), and maximal flow rate of expiration at 50% and 25% of forced vital capacity (V50 and V25, respectively), compared with controls (p < 0.01). As the cumulative dose of fur dust exposure increased, average levels of pulmonary function declined significantly (p < 0.01), and pulmonary function abnormalities (i.e., < 80% of predicted FVC and FEV1.0, or < 70% of predicted V50 and V25) increased significantly (p < 0.05). Multiple-regression results identified fur dust exposure as the leading risk factor associated with the decline in pulmonary function in the exposed group. The results demonstrated a dose-response relationship between fur dust exposure and respiratory system injury, as measured by pulmonary function tests in fur-processing workers. On the basis of this dose-response relationship and the use of lifetables, the authors proposed an exposure limit of 4 mg/m3 for fur dust.

Beneficial effect of tomato juice drinking on anti-mutagenicity of saliva

OBJECTIVES

The purpose of this study was to investigate the effect of tomato juice drinking on the antimutagenicity of saliva.

METHODS

Subjects were 22 healthy male university students. They were divided into tomato group and control group. The tomato group drank tomato juice for 10 days. The anti-mutagenicity of saliva was measured using the umu test.

RESULTS

In the tomato group, there was a significant increase in the inhibiting capacity of saliva on the mutagenicity of AF-2 after tomato juice drinking for 10 days. This increase was, however, temporary. In the control group, there was no such change in the inhibiting capacity of saliva.

CONCLUSIONS

These findings suggest the significant effect of tomato juice drinking on the anti-mutagenicity of saliva. In addition, lycopene may have played an important role in its mechanism.

Pharmacologic properties of brewery dust extracts in vitro

STUDY OBJECTIVES

To study the effects of extracts of brewery dust on isolated guinea pig tracheal smooth muscle in vitro.

DESIGN

Parallel pharmacologic intervention on guinea pig tracheal rings that were obtained from the same animal.

SETTING

Mount Sinai School of Medicine, Department of Pulmonary Medicine.

MATERIAL

The isolated guinea pig tracheal tissue of 18 guinea pigs.

INTERVENTIONS

Pretreatment of guinea pig rings by mediator-modifying agents before challenge with the brewery dust extracts.

MEASUREMENTS AND RESULTS

The effect of brewery dust extracts on isolated guinea pig tracheal smooth muscle was studied using water-soluble extracts of dust obtained from brewery materials, including hops, barley, and brewery yeast. Dust extracts were prepared as a 1:10 (wt/vol) aqueous solution. Dose-related contractions of nonsensitized guinea pig tracheas were demonstrated using these extracts. The dust extracts contained significant quantities of bacterial components (eg, endotoxin and n-formyl-methionyl-leucyl-phenylalanine), but these agents were not thought to contribute directly to the constrictor effect of the dusts. Pharmacologic studies were performed by pretreating guinea pig tracheal tissue with the following drugs known to modulate smooth muscle contraction: atropine; indomethacin; pyrilamine; LY171883; nordihydroguaiaretic acid; captopril; thiorphan; verapamil; and TMB8. The constrictor effects of the dust extracts were inhibited by a wide variety of agents, the patterns of which depended on the dust extract. Atropine consistently and strikingly reduced the contractile effects of these extracts. These observations may suggest an interaction of the extracts with parasympathetic nerves or, more directly, with muscarinic receptors. The inhibition of contraction by the blocking of other mediators was less effective and varied with the dust extract.

CONCLUSIONS

We suggest that brewery dust extracts cause a dose-related airway smooth muscle constriction by nonimmunologic mechanisms involving a variety of airway mediators and, possibly, cholinergic receptors. This effect is not dependent on presensitization of the guinea pigs.

Respiratory findings in workers not exposed to air pollutants

The prevalences of acute and chronic respiratory symptoms and lung function changes were studied in a group of 806 workers working in a "clean environment." Acute symptoms during the work shift were reported by smokers but were essentially absent in nonsmokers. Chronic respiratory-symptom prevalences were similar to those reported in community-based populations, with smokers experiencing more chronic symptoms than nonsmokers. Baseline lung function measurements indicated no significant differences with values obtained from prediction equations based on community populations. There were significant across-shift increases in all ventilatory capacity tests (forced vital capacity, 1-second forced expiratory volume, and maximum expiratory flow rates at 50% and the last 25% of the vital capacity) varying from +1.9% to +9.8% of the preshift values. Workers older than 40 years of age and those employed for more than 10 years had similar across-shift changes compared with younger workers and those with longer durations of employment. Our data indicate that workers in clean work environments (with the exception of smokers) complain of few acute or chronic respiratory symptoms and have normal lung function. These workers experience increases in lung function across the work shift, probably reflecting normal diurnal variation. Smokers, although significantly more affected than nonsmokers, do not appear to have work-related findings, and smoking appears to be the most significant risk factor for the development of lung disease in unexposed workers. In this study, community-based control data was equivalent to worker control data in unexposed workers.

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.