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Identification and Remediation of Environmental Exposures in Patients With Interstitial Lung Disease: Evidence Review and Practical Considerations. Chest 2021; 160:219-230. [PMID: 33609518 DOI: 10.1016/j.chest.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/07/2020] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
A relationship between inhalational exposure to materials in the environment and development of interstitial lung disease (ILD) is long recognized. Hypersensitivity pneumonitis is an environmentally -induced diffuse parenchymal lung disease. In addition to hypersensitivity pneumonitis, domestic and occupational exposures have been shown to influence onset and progression of other ILDs, including idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. A key component of the clinical evaluation of patients presenting with ILD includes elucidation of a complete exposure history, which may influence diagnostic classification of the ILD as well as its management. Currently, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures in home or workplace environments for patients with ILD. This review discusses evidence for environmental contributions to ILD pathogenesis and draws on asthma and occupational medicine literature to frame the potential utility of a professional evaluation for environmental factors contributing to the development and progression of ILD. Although several reports suggest benefits of environmental assessment for those with asthma or certain occupational exposures, lack of information about benefits in broader populations may limit application. Determining the feasibility, long-term outcomes, and cost-effectiveness of environmental evaluation and remediation in acute and chronic ILDs should be a focus of future research.
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Doney B, Kurth L, Halldin C, Hale J, Frenk SM. Occupational exposure and airflow obstruction and self-reported COPD among ever-employed US adults using a COPD-job exposure matrix. Am J Ind Med 2019; 62:393-403. [PMID: 30775792 PMCID: PMC6661888 DOI: 10.1002/ajim.22958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This study examined the association of spirometry-defined airflow obstruction and self-reported COPD defined as self-reported doctor diagnosed chronic bronchitis or emphysema, with occupational exposure among ever-employed US adults. METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian US population. Reported current and/or longest held job were used to create prevalence estimates and prevalence odds ratios (PORs) (adjusted for age, gender, race, and smoking status) for airflow obstruction and self-reported COPD by occupational exposure, determined using both NHANES participants' self-reported exposures and eight categories of COPD job exposure matrix (JEM) assigned exposures. RESULTS Significant PORs for airflow obstruction and self-reported COPD respectively were observed with self-reported exposure for ≥20 years to mineral dust (POR = 1.44; 95% confidence interval (CI) 1.13-1.85; POR = 1.69; 95% CI 1.17-2.43) and exhaust fumes (POR = 1.65; 95% CI 1.27-2.15; POR = 2.22; 95% CI 1.37-3.58). Airflow obstruction or self-reported COPD were also associated with COPD-JEM assigned high exposure to mineral dust, combined dust, diesel exhaust, vapor-gas, sensitizers, and overall exposure. CONCLUSION Airflow obstruction and self-reported COPD are associated with both self-reported and JEM-assigned exposures.
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Affiliation(s)
- Brent Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Laura Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Cara Halldin
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Janet Hale
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Steven M. Frenk
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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Taghiakbari M, Castano R, Parfi AA, Achore M, El-Zein M, Rhazi MS, Gautrin D, Suarthana E. A Cross-Sectional Assessment of Rhinitis Symptoms and Nasal Patency in Relation to Welding Exposure. Am J Respir Crit Care Med 2018; 198:958-961. [DOI: 10.1164/rccm.201802-0385le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Roberto Castano
- Hôpital du Sacré-Cœur de MontréalMontréal, Québec, Canada
- Université de MontréalMontréal, Québec, Canada
| | | | - Meshack Achore
- Hôpital du Sacré-Cœur de MontréalMontréal, Québec, Canada
| | | | - Mounia Senhaji Rhazi
- Institut National de la Recherche Scientifique–Institut Armand FrappierMontréal, Québec, Canada
| | - Denyse Gautrin
- Hôpital du Sacré-Cœur de MontréalMontréal, Québec, Canada
| | - Eva Suarthana
- Hôpital du Sacré-Cœur de MontréalMontréal, Québec, Canada
- Université de MontréalMontréal, Québec, Canada
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Balogun RA, Siracusa A, Shusterman D. Occupational rhinitis and occupational asthma: Association or progression? Am J Ind Med 2018; 61:293-307. [PMID: 29411403 DOI: 10.1002/ajim.22819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Occupational asthma is the most frequently reported occupational respiratory disease in registries, and is often co-diagnosed with occupational rhinitis. We undertook a systematic review of the English-language epidemiologic literature linking these two conditions, with emphasis on progression from occupational rhinitis to occupational asthma. METHODS PubMed and Embase were queried in a series of structured searches designed to identify studies comparing occupational asthma and occupational rhinitis incidence or prevalence in occupationally exposed individuals. RESULTS The searches yielded a total of 109 unique citations, 15 of which yielded inferential data on the occupational rhinitis-asthma relationship. Nine of fifteen studies showed statistically significant associations between the occurrence of occupational rhinitis and occupational asthma among individual workers. CONCLUSIONS Limited data support the notion that occupational rhinitis precedes the development of occupational asthma, particularly when high-molecular-weight (HMW) agents are involved. The relationship between the two conditions could not be evaluated in many relevant studies due to a lack of cross-tabulation of individual cases.
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Affiliation(s)
- Rahmat A. Balogun
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
| | | | - Dennis Shusterman
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
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Kurth L, Doney B, Weinmann S. Occupational exposures and chronic obstructive pulmonary disease (COPD): comparison of a COPD-specific job exposure matrix and expert-evaluated occupational exposures. Occup Environ Med 2016; 74:290-293. [PMID: 27777373 DOI: 10.1136/oemed-2016-103753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/03/2016] [Accepted: 10/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the occupational exposure levels assigned by our National Institute for Occupational Safety and Health chronic obstructive pulmonary disease-specific job exposure matrix (NIOSH COPD JEM) and by expert evaluation of detailed occupational information for various jobs held by members of an integrated health plan in the Northwest USA. METHODS We analysed data from a prior study examining COPD and occupational exposures. Jobs were assigned exposure levels using 2 methods: (1) the COPD JEM and (2) expert evaluation. Agreement (Cohen's κ coefficients), sensitivity and specificity were calculated to compare exposure levels assigned by the 2 methods for 8 exposure categories. RESULTS κ indicated slight to moderate agreement (0.19-0.51) between the 2 methods and was highest for organic dust and overall exposure. Sensitivity of the matrix ranged from 33.9% to 68.5% and was highest for sensitisers, diesel exhaust and overall exposure. Specificity ranged from 74.7% to 97.1% and was highest for fumes, organic dust and mineral dust. CONCLUSIONS This COPD JEM was compared with exposures assigned by experts and offers a generalisable approach to assigning occupational exposure.
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Affiliation(s)
- Laura Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Brent Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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Radon K, Nowak D, Vogelberg C, Ruëff F. Career Advice for Young Allergy Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:519-24. [PMID: 27581504 PMCID: PMC5012160 DOI: 10.3238/arztebl.2016.0519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND One-third of all young persons entering the work force have a history of atopic disease. Occupationally induced allergy and asthma generally arise in the first few months on the job, while pre-existing symptoms tend to worsen. Young persons with a history of an atopic disease should receive evidence-based advice before choosing a career. METHODS We systematically searched PubMed for cohort studies investigating the new onset of asthma, rhinitis, or hand eczema among job trainees from before the start of training and onward into the first few years on the job. The search revealed 514 articles; we read their abstracts and selected 85 full-text articles for further analysis. 24 of these met the inclusion criteria. RESULTS According to present evidence, atopy and a history of allergic disease (allergic rhinitis, atopic dermatitis) are the main risk factors for occupationally induced disease. The predictive value of a personal history of allergic diseases for the later development of an occupationally induced disease varies from 9% to 64% in the studies we analyzed. It follows that only young people with severe asthma or severe atopic eczema should be advised against choosing a job that is associated with a high risk of allergy, e.g., hairdressing or working with laboratory animals. Young people with a history of other atopic diseases should be counseled about their individual risk profile. CONCLUSION In view of the relatively poor predictive value of pre-existing atopic disease, secondary prevention is particularly important. This includes frequent medical follow-up of the course of symptoms over the first few years on the job. If sensitization or allergic symptoms arise, it should be carefully considered whether exposure reduction will enable the apprentice to stay on the job.
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Affiliation(s)
- Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, AllergieZENTRUM, Klinikum der Universität München
- Comprehensive Pneumology Center, DZL, Deutsches Zentrum für Lungenforschung, München
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, AllergieZENTRUM, Klinikum der Universität München
- Comprehensive Pneumology Center, DZL, Deutsches Zentrum für Lungenforschung, München
| | | | - Franziska Ruëff
- Department of Dermatology and Allergology, AllergieZENTRUM, Klinikum der Universität München
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Postapprenticeship isocyanate exposure and risk of work-related respiratory symptoms using an asthma-specific job exposure matrix, self-reported and expert-rated exposure estimates. J Occup Environ Med 2014; 56:125-7. [PMID: 24504247 DOI: 10.1097/jom.0000000000000075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lillienberg L, Dahlman-Höglund A, Schiöler L, Torén K, Andersson E. Exposures and asthma outcomes using two different job exposure matrices in a general population study in northern Europe. ANNALS OF OCCUPATIONAL HYGIENE 2014; 58:469-81. [PMID: 24504176 DOI: 10.1093/annhyg/meu002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We have recently published a study on new-onset asthma in a large population in northern Europe using a modified job exposure matrix (N-JEM) to better reflect exposure assignment in these countries. The aim of this paper was to investigate how the N-JEM differs in exposure assignment and asthma risks from an already established JEM. METHOD The study comprised 6253 men and 7031 women from northern Europe, born 1945-1973, who had answered both a screening (1989-1992) and a follow-up questionnaire (1999-2001). During the study period (1980-2000), there were 136 men and 293 women with new-onset asthma. Hazard ratios of new-onset asthma were calculated for both JEMs using Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. Cohen's kappa (κ) was used to show agreements in exposure assignment (yes/no) between the JEMs. Population attributable risks (PARs) were calculated as well. RESULTS The agreement in exposure assignment between the JEMs was substantial for the group 'any exposure' to asthma agents (κ = 0.78). The agreement between comparable exposure groups in the JEMs varied from κ = 1.00 (pharmaceutical product antigens, textile dust, cleaning agents) to κ = 0.27 (low molecular weight agents). Significant increased asthma risks were seen for men exposed to isocyanates and accidental peak exposure with both JEMs. With the N-JEM, increased asthma risks were seen for men exposed to plant-associated antigens (all and non-atopic), epoxy compounds (all and non-atopic), and acrylates (non-atopic). With the other JEM, increased asthma risks were seen in men and women exposed to 'possible exposure to irritant gases or fumes' (all and non-atopic), a group classified as having low asthma risk. Men and women exposed to cleaning agents also showed significant asthma risks with both JEMs. PAR with the N-JEM was 14.3% for men and 6.6% for women, compared with 12.9% and 8.3% with the other JEM. CONCLUSIONS Acrylates, epoxy compounds, and isocyanates are three exposure groups in the modified asthma JEM that might better reflect exposure situations in northern Europe than the already established JEM. Exposure to 'possible exposure to irritant gases or fumes', a low asthma risk group in the established JEM, seems to be a group with high asthma risk in northern Europe. It is important to continuously update JEMs, which are based only on occupational titles, in order to find new risk groups and to better reflect changes in work exposures when old risks disappear and new emerge.
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Affiliation(s)
- Linnéa Lillienberg
- 1. Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, SE-40530 Göteborg, Sweden
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Pandalai SP, Schulte PA, Miller DB. Conceptual heuristic models of the interrelationships between obesity and the occupational environment. Scand J Work Environ Health 2013; 39:221-32. [PMID: 23588858 DOI: 10.5271/sjweh.3363] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Research and interventions targeting the relationship between work, its attendant occupational hazards, and obesity are evolving but merit further consideration in the public health arena. In this discussion paper, conceptual heuristic models are described examining the role of obesity as both a risk factor and health outcome in the occupational setting. METHODS PubMed was searched using specific criteria from 2000 and onwards for evidence to support conceptual models in which obesity serves as a risk factor for occupational disease or an outcome of occupational exposures. Nine models are presented: four where obesity is a risk factor and five where it is an adverse effect. RESULTS A broad range of work-related health effects are associated with obesity including musculoskeletal disorders, asthma, liver disease, and cardiovascular disease, among others. Obesity can be associated with occupational hazards such as shift work, sedentary work, job stress, and exposure to some chemicals. CONCLUSION Identification of combinations of risk factors pertinent to obesity in the occupational environment will provide important guidance for research and prevention.
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Affiliation(s)
- Sudha P Pandalai
- National Institute for Occupational Safety and Health Centers for Disease Control and Prevention, 4676 Columbia Parkway, MS C-15, Cincinnati, OH 45226, USA.
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Lillienberg L, Andersson E, Janson C, Dahlman-Höglund A, Forsberg B, Holm M, Glslason T, Jögi R, Omenaas E, Schlünssen V, Sigsgaard T, Svanes C, Torén K. Occupational exposure and new-onset asthma in a population-based study in Northern Europe (RHINE). ACTA ACUST UNITED AC 2012. [PMID: 23204511 PMCID: PMC3622438 DOI: 10.1093/annhyg/mes083] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. Methods: The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 1989–1992 and again 1999–2001. Asthma was defined as ‘Asthma diagnosed by a physician’ with reported year of diagnose. Hazard ratios (HR), for new-onset adult asthma during 1980–2000, were calculated using a modified job-exposure matrix as well as high-risk occupations in Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. Results: During the observation period there were 429 subjects with new-onset asthma with an asthma incidence of 1.3 cases per 1000 person-years for men and 2.4 for women. A significant increase in new-onset asthma was seen for men exposed to plant-associated antigens (HR = 3.6; 95% CI [confidence interval] = 1.4–9.0), epoxy (HR = 2.4; 95% CI = 1.3–4.5), diisocyanates (HR = 2.1; 95% CI = 1.2–3.7) and accidental peak exposures to irritants (HR = 2.4; 95% CI = 1.3–4.7). Both men and women exposed to cleaning agents had an increased asthma risk. When stratifying for atopy an increased asthma risk were seen in non-atopic men exposed to acrylates (HR = 3.3; 95% CI = 1.4–7.5), epoxy compounds (HR = 3.6; 95% CI = 1.6–7.9), diisocyanates and accidental peak exposures to irritants (HR = 3.0; 95% CI = 1.2–7.2). Population attributable risk for occupational asthma was 14% for men and 7% for women. Conclusions: This population-based study showed that men exposed to epoxy, diisocyanates and acrylates had an increased risk of new-onset asthma. Non-atopics seemed to be at higher risk than atopics, except for exposure to high molecular weight agents. Increased asthma risks among cleaners, spray painters, plumbers, and hairdressers were confirmed.
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Affiliation(s)
- Linnéa Lillienberg
- Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE-405 30 Gothenburg, Sweden.
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Schulte PA, Pandalai S, Wulsin V, Chun H. Interaction of occupational and personal risk factors in workforce health and safety. Am J Public Health 2011; 102:434-48. [PMID: 22021293 DOI: 10.2105/ajph.2011.300249] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health. We present 32 examples illustrating 4 combinatorial models of occupational hazards and personal risk factors (genetics, age, gender, chronic disease, obesity, smoking, alcohol use, prescription drug use). Models that address occupational and personal risk factors and their interactions can improve our understanding of health hazards and guide research and interventions.
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Affiliation(s)
- Paul A Schulte
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA.
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Moscato G, Pala G, Boillat MA, Folletti I, Gerth van Wijk R, Olgiati-Des Gouttes D, Perfetti L, Quirce S, Siracusa A, Walusiak-Skorupa J, Tarlo SM. EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers. Allergy 2011; 66:1164-73. [PMID: 21557751 DOI: 10.1111/j.1398-9995.2011.02615.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Apprenticeship is a period of increased risk of developing work-related respiratory allergic diseases. There is a need for documents to provide appropriate professional advice to young adults aiming to reduce unsuitable job choices and prevent impairment from their careers. The present document is the result of a consensus reached by a panel of experts from European and non-European countries addressed to allergologists, pneumologists, occupational physicians, primary care physicians, and other specialists interested in this field, which aims to reduce work-related respiratory allergies (rhinoconjunctivitis and asthma) among allergic or nonallergic apprentices and other young adults entering the workforce. The main objective of the document is to issue consensus suggestions for good clinical practice based on existing scientific evidence and the expertise of a panel of physicians.
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Affiliation(s)
- G Moscato
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Italy
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Gautrin D, Malo JL. Risk factors, predictors, and markers for work-related asthma and rhinitis. Curr Allergy Asthma Rep 2010; 10:365-72. [PMID: 20589483 DOI: 10.1007/s11882-010-0131-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The burden of asthma attributable to occupational exposures is significant. A better evaluation of markers of asthma and rhinitis in occupational settings may help reduce the frequency of occupational asthma (OA) and rhinitis (OR). This publication reviews articles published in 2008 and 2009 to provide an update on aspects related to markers of asthma and rhinitis. Markers derived from occupational exposure assessment, questionnaires, clinical data, and noninvasive tests such as functional tests or measures of serum antibodies are used to develop prediction models for the likelihood of OA and OR development. Findings from prospective studies highlight the course of preclinical signs and markers of airway inflammation in the natural history of OA and OR. Airway inflammation, evaluated by quantification of cells and mediators in induced sputum or nasal lavage and by exhaled nitric oxide, is associated with OA and OR; however, the sensitivity and specificity of these means, especially exhaled nitric oxide, have not been sufficiently assessed.
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Affiliation(s)
- Denyse Gautrin
- Université de Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Boulevard West, Montreal, Quebec, Canada.
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Castano R, Malo JL. Occupational rhinitis and asthma: where do we stand, where do we go? Curr Allergy Asthma Rep 2010; 10:135-42. [PMID: 20425505 DOI: 10.1007/s11882-010-0092-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review provides an overview of current and emerging issues regarding occupational rhinitis (OR) and occupational asthma (OA), focusing on studies discussing concepts and results that are relevant to both diseases. OA and OR are conditions that affect the upper and lower airways, are characterized by reduced airway caliber and hyperresponsiveness and by inflammation, and are caused by agents present in the workplace. To explain disease expression, research is moving from the T-helper type 1/type 2 cells paradigm to consider the contribution of diverse alternative pathways such as neural inflammation, a dysfunctional epithelial barrier, and autoimmune mechanisms, among others. Objective assessment of OR and OA has been improved and tested for research and, currently, clinical application. Further developments in the field of OR are expected to lead to more generalized clinical applications, following the example of what has been achieved for OA.
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Affiliation(s)
- Roberto Castano
- Department of Otolaryngology/Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, J-3185, Montréal, Québec, H4J 1C5, Canada.
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