Work related distal airway obstruction in an agricultural population

High prevalence of obstructive lung disease in non-smoking farmers: The Irish farmers lung health study

BACKGROUND

Mortality rates within the Irish farming community are increasing, whilst that of the general population falls. The aim of this cross-sectional study was to determine the prevalence of respiratory disease amongst Irish farmers.

METHODS

All study participants were farming volunteers attending an agricultural exhibition. Data collected by questionnaire included baseline demographics, respiratory history, presence of respiratory symptoms and occupational exposures. Spirometry was performed on all participants.

RESULTS

Data from 372 farmers was analysed. The majority were male (76%) with median age of 55 years. 61% were never smokers. 13% were previously diagnosed with airway disease (Chronic Obstructive Pulmonary Disease(COPD)/Asthma/Inhaler use) with 14% reporting hayfever/allergies. Almost two-thirds reported one or more chronic respiratory symptom. Forty-four (12%) had obstructive spirometry using fixed FEV1/FVC < 0.70 criterion and 29 (7.8%) using FEV1/FVC < 5% lower limit of normal. The majority, two-thirds, were never smokers. Amongst never smokers with obstruction (13%), there was a significantly higher proportion with a prior diagnosis of airway disease and hayfever/allergies. There was no significant association between specific occupational exposures and obstruction.

CONCLUSION

The majority of Irish farmers are never smokers. They have a high prevalence of respiratory symptoms. 13% of never smokers have airflow obstruction (FEV1/FVC < 0.70). The presence of airflow obstruction is significantly associated with self-reported allergy history and prior airway disease. Further studies are needed to identify the workplace factors accounting for these findings.

Cross-Shift Changes in Lung Function Among Palestinian Farmers During High- and Low-Exposure Periods to Pesticides: A Longitudinal Study

The purpose of this study was to study cross-shift changes of lung function in relation to pesticide use. One hundred and ninety-five male farmers, from a total of 250 farmers, performed lung function tests both pre- and post-shift during high- and low-pesticide-exposure periods. There were no associations between lung function differences across shifts and estimated quantity of pesticides used. However, the cross-shift reduction in forced expiratory volume in 1 second (FEV1; ΔFEV1) was more pronounced during the period when pesticides were used on a larger scale, September 2006, compared with the exposure period with a lower level of pesticide use, April 2007, +50 mL (95% confidence interval [CI]: +24, +76) and +17 mL (95% CI: -13, +48), respectively. This contrast was statistically significant only among the subset of never-smoking participants below 50 years of age. This finding suggests a possible obstructive effect of pesticide exposure on lung function among this rural male population in Palestine. A follow-up of farmers' lung function in this part of the world along with high-quality measurements of exposure is needed.

R, Mohesh M.I. G, Kumar M. P. Effect of cigarette and cigar smoking on peak expiratory flow rate

BACKGROUND

Tobacco smoking in India has been increasing alarmingly. Smoking is a known risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular diseases and certain cancers, especially, the lung cancer. The percentage prevalence of cigarette smoking (18.5%) and cigar smoking (4%) in males is high in Andhra Pradesh compared to other southern states. There is not enough scientific literature to correlate about intensity of cigarette and cigar smoking and their impact on lung function though high prevalence is reported in Andhra Pradesh, India.

OBJECTIVES

The purpose of this study was to examine whether PEFR differs between cigarette and cigar smokers compared to non-smokers and also to estimate the intensity of cigarette and cigar smoking on PEFR.

METHODS

PEFR was recorded in cigarette smokers (n=49) and cigar smokers (n=10) as well as in non-smokers (n=64) using Wright's mini Peak Flow Meter.

RESULTS

PEFR is decreased in both cigarette as well in cigar smokers compared to non-smokers and the magnitude of decline was higher in cigar smoking elderly individuals.

CONCLUSION

The intensity of cigarette and cigar smoking (pack-years) emerged as the main variable to influence airway obstruction in smokers that caused greater reduction in PEFR.

Agricultural exposures and chronic bronchitis: findings from the AGRICAN (AGRIculture and CANcer) cohort

PURPOSE

Livestock farming has been recognized as a risk factor for chronic bronchitis (CB). The role of crop farming, however, has been less studied. We sought to assess the role of a large range of farming activities on the risk of CB in the French agricultural cohort AGRICAN (AGRIculture and CANcer).

METHODS

Data on respiratory health and farming activities were collected by questionnaire from 2005 to 2007. Associations between farming activities and self-reported doctor's diagnosis of CB were estimated by a logistic regression adjusted for confounders.

RESULTS

CB was reported by 1207 farmers (8.4%). Two farming activities were associated with CB: cattle raising (odds ratio [OR] 1.24, 95% confidence interval 1.03-1.48), and potato production (OR 1.33, 95% confidence interval 1.13-1.57). Associations were more pronounced in small-scale cattle raising and in large-scale potato production, in particular among the longest exposed workers (≥20 years). Pesticide poisoning and exposure to pesticides in potato farmers were significantly associated with CB risk (OR 1.64 and OR 1.63, respectively).

CONCLUSIONS

This analysis suggests that other agricultural settings not previously reported, such as potato production, may be a risk factor for CB. The nature and circumstances of exposure to hazardous agents need to be further explored.

Respiratory findings in farmworkers

This investigation was designed to study respiratory problems in farmworkers. To better define the consequences of this work environment on respiratory health, 814 farmworkers (738 male and 76 female) were studied. The mean age of the men in this study was 38 years, and the mean duration of their employment was 15 years. For women, the mean age was 44 years and the mean duration of their employment was 10 years. Of the men, 56.5% were regular smokers, and 23.7% of the women were regular smokers. A group of 635 control workers without significant exposure to air pollutants were matched by sex, age, employment, and smoking habit. The prevalence of chronic symptoms among male farmworkers was greater (P < 0.01) than among male control subjects for chronic cough (24.8% vs 11.4%), chronic phlegm (22.8% vs 9.1%), and chronic bronchitis (20.1% vs 7.4%). Among women farmworkers, a significant difference was noted with controls for chest tightness (farmworkers, 21.1%; control subjects, 0%; P < 0.001). There was a high prevalence of acute symptoms among male and female farmworkers. In particular, farmworkers complained of more frequent cough, eye irritation, dyspnea, and throat irritation than did control subjects. For respiratory symptoms in male and female farmworkers, odds ratios were generally significant for smoking, age, and duration of employment. Ventilatory capacity tests were significantly reduced for farmworkers compared with predicted values. Regression analysis of ventilatory capacity tests in male farmworkers as a percentage of predicted values demonstrated significant coefficients for employment and smoking. Our data suggest that farmworkers are exposed to noxious agents that cause respiratory symptoms and ventilatory capacity impairment.

Work-related respiratory symptoms in New Zealand farmers

BACKGROUND

The first national survey of the respiratory health of New Zealand farmers looked at the prevalence of respiratory symptoms by farm type and work exposure.

METHODS

An 8-page questionnaire was mailed to 2,203 farmers randomly selected from all over New Zealand.

RESULTS

Response rate was 77.6% of 2,203, or 1,706 participants. Breathing problems at work were reported by 17.6% of farmers. Working with oats was strongly associated with work-related breathing problems (OR = 3.3, 2.1-5.2). Dyspnea was more common in female farmers, whereas chronic bronchitis was higher in males. Orchardists (OR = 2.3, 1.3-4.0), those growing oat crops (OR = 3.0, 1.7-5.4) and using the grain mill (OR = 2.8, 1.3-6.3) reported the highest symptom rates of ODTS/FL. Having hay fever or eczema, and smoking were risk factors for all respiratory symptoms.

CONCLUSIONS

Working in the areas of pigs, poultry, horses, grains, and hay are associated with respiratory symptoms in New Zealand farmers.

Respiratory symptoms of obstructive lung disease in European crop farmers

Crop farming as a risk factor for respiratory symptoms of obstructive lung disease was assessed. Random samples of crop farmers from four European countries were studied following a cross-sectional design. A questionnaire on respiratory symptoms and occupation was administered to determine prevalences, and the roles of the various crops as risk factors for respiratory symptoms were assessed through logistic regression modeling. The 4,793 crop farmers included in the study (response rate: 85.3%) reported the following respiratory symptoms: wheezing (14.9%), asthma (3.3%), nasal allergy (14.4%), chronic phlegm (12.4%), organic dust toxic syndrome (ODTS) (15.2%), and symptoms at work (22.0%). In the multivariate analysis, adjusting for age, sex, smoking, country, and exposure to other plants or livestock, flower growing was a risk factor for asthma (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1-3.9) and cultivating oil plants was associated with ODTS (OR 1.5, 95% CI 1.3-1.9), symptoms at work (OR 1.4, 95% CI 1.2- 1.7), and chronic phlegm (OR 1.3, 95% CI 1.1-1.6). Working inside greenhouses was a marginal risk factor for asthma (OR 2.1, 95% CI 0.9-4.5). We conclude that flower and oil plant production is associated with increased risk of respiratory symptoms in European crop farmers.

Risk factors associated with asthma and rhinoconjunctivitis among Swedish farmers

BACKGROUND

Earlier studies have shown a high prevalence of respiratory symptoms in farming communities and that storage mites constitute important allergens. We examined risk factors associated with asthma and rhinoconjunctivitis among Swedish farmers.

METHODS

A population of 1015 small-scale dairy farmers was part of an epidemiologic survey. After selection based on symptom reports in a questionnaire, 461 of the farmers attended a medical examination, which comprised SPT, RAST analyses, and lung-function measurements. Risk factors for sensitization to different allergens, and development of asthma and rhinoconjunctivitis were assessed by multiple logistic regression.

RESULTS

The prevalence of atopy was 26.7% among the farmers. For both asthma and rhinoconjunctivitis, sensitization to mites (OR = 5.8 vs. OR = 3.8) and pollens (OR = 10.3 vs. OR=5.8) was a significant risk factor. There was a significant relationship between sensitization to mites and working time (OR = 5.2). Environmental tobacco smoke and exposure to different animal species at the farm did not appear to affect the risk of allergen sensitization or respiratory symptoms. Farmers smoked less than the general population, but they more frequently had reduced FEV1.

CONCLUSIONS

Allergen sensitization, especially to mites and pollens, was significantly associated with asthma and rhinoconjunctivitis in a farming community. The results point to allergen avoidance as a major goal for the prevention of occupational respiratory diseases among the farming population.

Asthma and allergy in New Zealand farmers

AIMS

To examine the prevalence of symptoms of asthma and allergy in different farming groups in New Zealand.

METHODS

A postal questionnaire was sent to a random sample of 2,500 farmers throughout New Zealand.

RESULTS

The response rate was 77% (1,706 of 2,203 eligibles). The 12-month period prevalence of current asthma was 11.8% overall, compared with 15% in the general population. Asthma prevalence was higher for horse breeders/groomers (16.5%), pig farmers (18.2%), poultry farmers (17.4%), and those working with oats (17.4%). Asthma was also significantly elevated among those working with cleaning powders (14.7%). Women were more likely to report current asthma than were men (OR 1.8, 95% CI 1.3-2.5). Hay fever was significantly higher in deer and crop farmers, and farmers working with horses and goats; eczema was higher for goat and deer farmers.

CONCLUSIONS

The lower overall prevalence of asthma in farmers may be due to the healthy worker effect. Among farmers, the types of farming associated with an elevated prevalence of asthma and allergy in New Zealand are deer and goat farming, working with horses, poultry, pigs, and crop farming. Females reported more current asthma than males.

Current issues in the management of chronic obstructive pulmonary diseases

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, especially among smokers. Many guidelines that have recently been issued emphasize that COPD is not inaccessible to therapeutic measures: although few interventions are capable of affecting its natural history (i.e. smoking cessation and, in patients with severe resting hypoxaemia, oxygen therapy), several others have a demonstrated effect on symptoms and, thereby, quality of life. The effects of inhaled corticosteroids, and alpha 1-antitrypsin replacement therapy in emphysema due to alpha 1-antitrypsin deficiency are currently being studied. When there is a marked increase in mucus production, chest physiotherapy using controlled expiration and directed cough may be useful. Inhaled bronchodilators are frequently effective on dyspnoea, anticholinergic agents being more suitable for continuous symptoms. Rehabilitation, which includes education and psychosocial care, chest physiotherapy, nutritional care and exercise training, also improves quality of life. When there is persistent severe alveolar hypoventilation despite oxygen therapy, long-term mechanical ventilation may be considered. Surgical options in the treatment of emphysema include resection of giant bullae and lung volume reduction surgery. Lung transplantation should be proposed only in patients with end-stage disease, the difficulty here being to define what 'end-stage' means. Finally, all preventive and some therapeutic interventions are likely to be more effective early in the course of the disease. Thus, efforts should be made to detect airways obstruction early in subjects at risk, such as smokers.