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Lai PS, Hang JQ, Valeri L, Zhang FY, Zheng BY, Mehta AJ, Shi J, Su L, Brown D, Eisen EA, Christiani DC. Endotoxin and gender modify lung function recovery after occupational organic dust exposure: a 30-year study. Occup Environ Med 2015; 72:546-552. [PMID: 25666844 DOI: 10.1136/oemed-2014-102579] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/19/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this study is to determine the trajectory of lung function change after exposure cessation to occupational organic dust exposure, and to identify factors that modify improvement. METHODS The Shanghai Textile Worker Study is a longitudinal study of 447 cotton workers exposed to endotoxin-containing dust and 472 silk workers exposed to non-endotoxin-containing dust. Spirometry was performed at 5-year intervals. Air sampling was performed to estimate individual cumulative exposures. The effect of work cessation on forced expiratory volume in 1 s (FEV1) was modelled using generalised additive mixed effects models to identify the trajectory of FEV1 recovery. Linear mixed effects models incorporating interaction terms were used to identify modifiers of FEV1 recovery. Loss to follow-up was accounted for with inverse probability of censoring weights. RESULTS 74.2% of the original cohort still alive participated in 2011. Generalised additive mixed models identified a non-linear improvement in FEV1 for all workers after exposure cessation, with no plateau noted 25 years after retirement. Linear mixed effects models incorporating interaction terms identified prior endotoxin exposure (p=0.01) and male gender (p=0.002) as risk factors for impaired FEV1 improvement after exposure cessation. After adjusting for gender, smoking delayed the onset of FEV1 gain but did not affect the overall magnitude of change. CONCLUSIONS Lung function improvement after cessation of exposure to organic dust is sustained. Endotoxin exposure and male gender are risk factors for less FEV1 improvement.
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Affiliation(s)
- Peggy S Lai
- Massachusetts General Hospital, Boston, MA, United States.,Harvard School of Public Health, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Jing-Qing Hang
- Shanghai Putuo District People's Hospital, Shanghai, China
| | - Linda Valeri
- Harvard School of Public Health, Boston, MA, United States
| | | | - Bu-Yong Zheng
- Shanghai Putuo District People's Hospital, Shanghai, China
| | - Amar J Mehta
- Harvard School of Public Health, Boston, MA, United States
| | - Jing Shi
- China Institute of Industrial Relations, Beijing, China
| | - Li Su
- Harvard School of Public Health, Boston, MA, United States
| | - Dan Brown
- School of Public Health, University of California, Berkeley, CA, United States
| | - Ellen A Eisen
- Harvard School of Public Health, Boston, MA, United States.,School of Public Health, University of California, Berkeley, CA, United States
| | - David C Christiani
- Massachusetts General Hospital, Boston, MA, United States.,Harvard School of Public Health, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Lai PS, Hang JQ, Zhang FY, Lin X, Zheng BY, Dai HL, Su L, Cai T, Christiani DC. Gender differences in the effect of occupational endotoxin exposure on impaired lung function and death: the Shanghai Textile Worker Study. Occup Environ Med 2013; 71:118-125. [PMID: 24297825 DOI: 10.1136/oemed-2013-101676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Airborne endotoxin exposure has adverse and protective health effects. Studies show men have augmented acute inflammatory responses to endotoxin. In this longitudinal cohort study we investigated the effect of long-term exposure to endotoxin in cotton dust on health, and determined whether these effects differ by gender. METHODS In the Shanghai Textile Worker Study, 447 cotton and 472 control silk textile workers were followed from 1981 to 2011 with repeated measures of occupational endotoxin exposure, spirometry and health questionnaires. Impaired lung function was defined as a decline in forced expiratory volume in one second to less than the 5th centile of population predicted. Death was ascertained by death registries. We used Cox proportional hazards models to assess the effect of endotoxin exposure on the time to development of impaired lung function and death. RESULTS 128 deaths and 164 diagnoses of impaired lung function were ascertained between 1981 and 2011. HRs for the composite end point of impaired lung function or death was 1.47 (95% CI 1.09 to 1.97) for cotton vs silk workers and 1.04 (95% CI 1.01 to 1.07) per 10 000 endotoxin units (EU)/m(3)-years increase in exposure. HRs for all-cause mortality was 1.36 (95% CI 0.93 to 1.99) for cotton vs silk workers and 1.04 (95% CI 0.99 to 1.08) per 10 000 EU/m(3)-years. The risk associated with occupational endotoxin exposure was elevated only in men. CONCLUSIONS Occupational endotoxin exposure is associated with an increase in the risk of impaired lung function and all-cause mortality in men.
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Affiliation(s)
- Peggy S Lai
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Jing-Qing Hang
- Shanghai Putuo District People's Hospital, Shanghai, China
| | | | - Xinyi Lin
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Bu-Yong Zheng
- Shanghai Putuo District People's Hospital, Shanghai, China
| | - Hei-Lian Dai
- Shanghai Putuo District People's Hospital, Shanghai, China
| | - Li Su
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - David C Christiani
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Over 60 million people worldwide work in the textile or clothing industry. Recent studies have recognized the contribution of workplace exposures to chronic lung diseases, in particular chronic obstructive pulmonary disease (COPD). Early studies in textile workers have focused on the relationship between hemp or cotton dust exposure and the development of a syndrome termed byssinosis. The purpose of this review is to evaluate the effect of long-term exposure to organic dust in textile workers on chronic respiratory disease in the broader context of disease classifications, such as reversible or irreversible obstructive lung disease (i.e. asthma or COPD), and restrictive lung disease. RECENT FINDINGS Cessation of exposure to cotton dust leads to improvement in lung function. Recent animal models have suggested a shift in the lung macrophage:dendritic cell population ratio as a potential mechanistic explanation for persistent inflammation in the lung due to repeated cotton dust-related endotoxin exposure. Other types of textile dust, such as silk, may contribute to COPD in textile workers. SUMMARY Textile dust-related obstructive lung disease has characteristics of both asthma and COPD. Significant progress has been made in the understanding of chronic lung disease due to organic dust exposure in textile workers.
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Burch JB, Svendsen E, Siegel PD, Wagner SE, von Essen S, Keefe T, Mehaffy J, Martinez AS, Bradford M, Baker L, Cranmer B, Saito R, Tessari J, Linda P, Andersen C, Christensen O, Koehncke N, Reynolds SJ. Endotoxin exposure and inflammation markers among agricultural workers in Colorado and Nebraska. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2010; 73:5-22. [PMID: 19953416 DOI: 10.1080/15287390903248604] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The adverse respiratory effects of agricultural dust inhalation are mediated in part by endotoxin, a constituent of gram-negative bacterial cell walls. This study quantified personal work-shift exposures to inhalable dust, endotoxin, and its reactive 3-hydroxy fatty acid (3-OHFA) constituents among workers in grain elevators, cattle feedlots, dairies, and on corn farms. Exposures were compared with post-work-shift nasal lavage fluid inflammation markers and respiratory symptoms. Breathing-zone personal air monitoring was performed over one work shift to quantify inhalable dust (Institute of Medicine samplers), endotoxin (recombinant factor C [rFC] assay), and 3-OHFA (gas chromatography/mass spectrometry). Post-shift nasal lavage fluids were assayed for polymorphonuclear neutrophils (PMN), myeloperoxidase (MPO), interleukin 8 (IL-8), albumin, and eosinophilic cation protein (ECP) concentrations. The geometric mean (GSD) of endotoxin exposure (rFC assay) among the 125 male participants was 888 +/- (6.5) EU/m(3), and 93% exceeded the proposed exposure limit (50 EU/m(3)). Mean PMN, MPO, albumin, and ECP levels were two- to threefold higher among workers in the upper quartile of 3-OHFA exposure compared to the lowest exposure quartile. Even numbered 3-OHFA were most strongly associated with nasal inflammation. Symptom prevalence was not elevated among exposed workers, possibly due to endotoxin tolerance or a healthy worker effect in this population. This is the first study to evaluate the relationship between endotoxin's 3-OHFA constituents in agricultural dust and nasal airway inflammation. More research is needed to characterize the extent to which these agents contribute to respiratory disease among agricultural workers.
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Affiliation(s)
- James B Burch
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Center for Colon Cancer Research, University of South Carolina, Columbia, SC 29208, USA.
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Bakirci N, Kalaca S, Francis H, Fletcher AM, Pickering CAC, Tumerdem N, Cali S, Oldham L, Niven R. Natural history and risk factors of early respiratory responses to exposure to cotton dust in newly exposed workers. J Occup Environ Med 2008; 49:853-61. [PMID: 17693783 DOI: 10.1097/jom.0b013e3180dca598] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A prospective study of newly exposed cotton workers was performed to investigate the natural history of respiratory symptoms and lung function changes. METHODS A total of 157 workers naive to cotton dust exposure were investigated by questionnaire, spirometry, and skin tests. They were examined before employment (baseline) and at the end of the first week, and the first, third, sixth, and 12th month after starting work. Acute airway response was defined as either a cross-first-shift or a cross-week fall in forced expiratory volume in one second (FEV1). The longitudinal change of lung function over the year was also calculated. Five hundred seventy-two personal dust sampling and 191 endotoxin measurements were performed to assess the exposure. RESULTS Forty percent of workers reported work-related symptoms in the first week of the study. Smoking, endotoxin, and dust concentrations were risk factors for all work-related symptoms. Acute airway responses were witnessed after immediate exposure. Female status was the only factor found to be predictive of acute airway response. The mean longitudinal fall in FEV1 at 1 year was 65.5 mL (standard error = 37.2). Age, early respiratory symptoms, and early fall in cross-week FEV1 were found to predict the 12-month fall in FEV1. Cross-first-shift and cross-week falls in FEV1 reduced in magnitude during the course of the study. CONCLUSIONS This study of workers naive to cotton dust exposure has demonstrated that respiratory symptoms and acute airway responses develop early following first exposure, and a tolerance effect develops in those workers with the continued exposure. Current smoking and increasing exposure predicts the development of work-related lower respiratory tract symptoms, while early symptoms and acute airway changes across the working week predict the longitudinal loss of lung function at 1 year.
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Affiliation(s)
- Nadi Bakirci
- Department of Public Health, School of Medicine, Marmara University, Haydarpasa, Istanbul, Turkey.
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Workplace Health Promotion Interventions ConcerningWomenWorkers' Occupational Hazards. PROMOTING HEALTH FOR WORKING WOMEN 2008. [PMCID: PMC7121914 DOI: 10.1007/978-0-387-73038-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- D Heederik
- Division Environmental and Occupational Health, IRAS, Utrecht University, PO Box 80178, 3508 TD Utrecht, Netherlands.
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