1
|
Iskandar IYK, Gawkrodger DJ, Byrne L, Gittins M, Carder M, Fishwick D, van Tongeren M. Trends in work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK: descriptive findings from The Health and Occupation Research (THOR) network 1996-2019. Occup Environ Med 2024; 81:220-224. [PMID: 38641364 DOI: 10.1136/oemed-2023-109066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Occupational exposure to metals can be associated with respiratory diseases which can adversely affect the individual's health, finances and employment. Despite this, little is known about the incidence of these respiratory conditions over prolonged periods of time. AIMS This study aimed to investigate the trends in the incidence of work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK. METHODS Cases of occupational respiratory diseases caused by nickel, chromium or cobalt reported to Surveillance of Work-related and Occupational Respiratory Disease (SWORD), the UK-based surveillance scheme between 1996 and 2019 (inclusive), were extracted and grouped into six 4-year time periods. Cases were characterised by causative metal exposure, occupational and industrial sector. Incidence rates diseases (adjusted for physician participation and response rate) were calculated using ONS employment data. RESULTS Of cases reported to SWORD during the study period, 1% (173 actual cases) of respiratory problems were attributed to nickel, chromium or cobalt. Diagnoses of asthma compromised the largest proportion of diagnoses (74.4%), followed by lung cancer (8.9%) and pneumoconiosis (6.7%). Cases had a mean age of 47 years (SD 13); 93% were men. The annual incidence fell from 1.6 per million employed in the first 4-year period, to 0.2 in the most recent period. CONCLUSIONS Over 24 years, a decline in the incidence of metal-related occupational respiratory diseases was observed in the UK. This could be attributed to improvements in working conditions which resulted in reduced metal exposure but could also be due to closure of industries that might have generated case returns.
Collapse
Affiliation(s)
- Ireny Y K Iskandar
- Division of Pharmacy & Optometry, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - David J Gawkrodger
- Department of Infection, Immunology and Cardiovascular Disease, The University of Sheffield Medical School, Sheffield, UK
| | - Laura Byrne
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Matthew Gittins
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - David Fishwick
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Department of Infection, Immunology and Cardiovascular Disease, The University of Sheffield Medical School, Sheffield, UK
- Science and Research Centre, Health and Safety Executive, Derbyshire, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| |
Collapse
|
2
|
Johansson E, Yadav JS. Differential Immunogenicity and Lung Disease-Inducing Potential of Mycobacterium immunogenum Genotypes and Impact of Co-Exposure with Pseudomonas: Optimizing a Mouse Model of Chronic Hypersensitivity Pneumonitis. Int J Mol Sci 2024; 25:2058. [PMID: 38396736 PMCID: PMC10889777 DOI: 10.3390/ijms25042058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Mycobacterium immunogenum (MI) colonizing metalworking fluids (MWFs) has been associated with chronic hypersensitivity pneumonitis (HP) in machinists. However, it is etiologically unclear why only certain mycobacteria-contaminated fluids induce this interstitial lung disease. We hypothesized that this may be due to differential immunogenicity and the HP-inducing potential of MI strains/genotypes as well as the confounding effect of co-inhaled endotoxin-producers. To test this hypothesis, we optimized a chronic HP mouse model in terms of MI antigen dose, timepoint of sacrifice, and form of antigen (cell lysates vs. live cells) and compared six different field-isolated MI strains. Overall, MJY10 was identified as the most immunogenic and MJY4 (or MJY13) as the least immunogenic genotype based on lung pathoimmunological changes as well as Th1 cellular response (IFN-γ release). Infection with MI live cells induced a more severe phenotype than MI cell lysate. Co-exposure with Pseudomonas fluorescens caused a greater degree of lung innate immune response and granuloma formation but a diminished adaptive (Th1) immune response (IFN-γ) in the lung and spleen. In summary, this study led to the first demonstration of differential immunogenicity and the disease-inducing potential of field strains of MI and an interfering effect of the co-contaminating Pseudomonas. The improved chronic MI-HP mouse model and the identified polar pair of MI strains will facilitate future diagnostic and therapeutic research on this poorly understood environmental lung disease.
Collapse
Affiliation(s)
| | - Jagjit S. Yadav
- Pulmonary Pathogenesis and Immunotoxicology Laboratory, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0056, USA
| |
Collapse
|
3
|
Pemberton MA, Arts JH, Kimber I. Identification of true chemical respiratory allergens: Current status, limitations and recommendations. Regul Toxicol Pharmacol 2024; 147:105568. [PMID: 38228280 DOI: 10.1016/j.yrtph.2024.105568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 01/18/2024]
Abstract
Asthma in the workplace is an important occupational health issue. It comprises various subtypes: occupational asthma (OA; both allergic asthma and irritant-induced asthma) and work-exacerbated asthma (WEA). Current regulatory paradigms for the management of OA are not fit for purpose. There is therefore an important unmet need, for the purposes of both effective human health protection and appropriate and proportionate regulation, that sub-types of work-related asthma can be accurately identified and classified, and that chemical respiratory allergens that drive allergic asthma can be differentiated according to potency. In this article presently available strategies for the diagnosis and characterisation of asthma in the workplace are described and critically evaluated. These include human health studies, clinical investigations and experimental approaches (structure-activity relationships, assessments of chemical reactivity, experimental animal studies and in vitro methods). Each of these approaches has limitations with respect to providing a clear discrimination between OA and WEA, and between allergen-induced and irritant-induced asthma. Against this background the needs for improved characterisation of work-related asthma, in the context of more appropriate regulation is discussed.
Collapse
Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| |
Collapse
|
4
|
Calaras D, David A, Vasarmidi E, Antoniou K, Corlateanu A. Hypersensitivity Pneumonitis: Challenges of a Complex Disease. Can Respir J 2024; 2024:4919951. [PMID: 38283656 PMCID: PMC10810695 DOI: 10.1155/2024/4919951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/19/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease caused by chronic inhalation of a wide variety of antigens in susceptible and sensitized individuals, commonly associated with an occupational exposure. An impressive number of inciting antigens causing hypersensitivity pneumonitis have been found to cover a wide range of occupations. As working practices have changed over time, especially in industrialized countries, new names for occupational HP have emerged. This review emphasizes the main diagnostic issues arising from the high variability of clinical presentation and the broad spectrum of causal antigens. Furthermore, it provides an overview of current methods to unveil possible causes of hypersensitivity pneumonitis, highlights HP's current diagnostic and treatment challenges and the remaining areas of uncertainty, and presents prevention strategies.
Collapse
Affiliation(s)
- Diana Calaras
- Department of Pulmonology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - Aliona David
- Outpatient Department, Institute of Phtisiopneumology “Chiril Draganiuc”, Chisinau, Moldova
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pulmonology, School of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Antoniou
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pulmonology, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandru Corlateanu
- Department of Pulmonology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| |
Collapse
|
5
|
Spagnolo P, Ryerson CJ, Guler S, Feary J, Churg A, Fontenot AP, Piciucchi S, Udwadia Z, Corte TJ, Wuyts WA, Johannson KA, Cottin V. Occupational interstitial lung diseases. J Intern Med 2023; 294:798-815. [PMID: 37535448 DOI: 10.1111/joim.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Millions of workers are exposed to substances known to cause occupational interstitial lung diseases (ILDs), particularly in developing countries. However, the burden of the disease is likely to be underestimated due to under-recognition, under-reporting or both. The diagnosis of occupational ILD requires a high level of suspicion and a thorough occupational history, as occupational and non-occupational ILDs may be clinically, functionally and radiologically indistinguishable, leading to delayed diagnosis and inappropriate management. A potential occupational aetiology should always be considered in the differential diagnosis of ILD, as removal from the workplace exposure, with or without treatment, is a key therapeutic intervention and may lead to significant improvement. In this article, we provide an overview of the 'traditional' inorganic dust-related ILDs but also address idiopathic pulmonary fibrosis and the immunologically mediated chronic beryllium disease, sarcoidosis and hypersensitivity pneumonitis, with emphasis on the importance of surveillance and prevention for reducing the burden of these conditions. To this end, health-care professionals should be specifically trained about the importance of occupational exposures as a potential cause of ILD.
Collapse
Affiliation(s)
- Paolo Spagnolo
- Respiratory, Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Christopher J Ryerson
- Department of Medicine, St. Paul's Hospital, University of British Columbia and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Sabina Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P Fontenot
- Department of Medicine, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
| | - Sara Piciucchi
- Department of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Zarir Udwadia
- Hinduja Hospital and Research Center, Breach Candy Hospital, Mumbai, Maharashtra, India
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, University of Leuven, Leuven, Belgium
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Coordinating Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, UMR754, IVPC, Lyon, France
| |
Collapse
|
6
|
Fishwick D, Carder M, Iskandar I, Fishwick BC, van Tongeren M. Irritant asthma and work: cases from the UK SWORD reporting scheme from 1999 to 2018. Occup Environ Med 2023; 80:553-557. [PMID: 37770178 PMCID: PMC10579497 DOI: 10.1136/oemed-2023-108884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Acute irritant asthma is a preventable health consequence of a workplace exposure and has a number of adverse outcomes. While cases and case series are reported, little is known about the causes and incidence of this condition over prolonged periods of time. AIMS We aimed to estimate the reported incidence of irritant asthma referred to a national reporting scheme, and how this has changed over time. METHODS Cases of irritant asthma reported to SWORD, the UK-based Surveillance of Work-related Occupational Respiratory Diseases scheme, were grouped into four 5-year time periods from 1999 onwards. Likely causative exposures, job, work sector and incidence rates were analysed over time. RESULTS 307 actual cases equated to 1066 estimated cases; actual cases had a mean age of 46 years (SD 17.8); 70.7% were male. The annual incidence fell from 1.98 per million employed in the first 5-year period, to 0.56 in the most recent. Eleven occupational codes were associated with six or more attributed cases, and between them accounted for 38% of all cases. Thirteen exposure categories were associated with five or more cases. These were formaldehyde (n=5), cutting oils and coolants (n=6), isocyanates (n=6), pesticides and herbicides (n=6), welding fumes (n=7), paints (n=7), solder and colophony (n=7), solvents (n=9), fuel oil, diesel and ill-defined fumes (n=10), chlorine and hypochlorites (n=15), acids (n=23), smoke (n=25) and cleaning products and sterilising agents (n=39). CONCLUSIONS While the incidence of irritant asthma may have fallen, cases are persistently attributed to well-described causes. A persistence of cases attributed to cleaning agents was seen.
Collapse
Affiliation(s)
- David Fishwick
- Science Division, Health and Safety Executive Bootle Headquarters, Bootle, Sefton, UK
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - Ireny Iskandar
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | | | - Martie van Tongeren
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| |
Collapse
|
7
|
Kespohl S, Warfolomeow I, Merget R, Brüning T, Raulf M. Hypersensitivity pneumonitis due to metal working fluids: detection of specific IgG antibodies to microbial antigens. Respir Physiol Neurobiol 2023:104107. [PMID: 37451418 DOI: 10.1016/j.resp.2023.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Occupational exposure to microbially contaminated metal working fluids (MWF) can cause hypersensitivity pneumonitis (HP). An important step in the diagnosis of HP is to identify the triggering antigen by detection of corresponding specific IgG antibodies (sIgG). As commercial sIgG tests are currently not available, protein antigens were prepared from MWF-workplace samples and from MWF-typical bacterial isolates. In 57% of suspected HP-cases (n= 30) elevated sIgG concentrations were measured to at least one MWF-relevant antigen, of which Mycobacterium immunogenum was most prominent (88%), followed by Pseudomonas oleovorans and Pseudomonas spec (82% each), MWF-antigen mix and Pseudomonas alcaliphila (65% each). Elevated sIgG concentrations to other microorganisms were measured to Micropolyspora faeni (82%) and Aureobasidium pullulans (77%). Correlation of sIgG values of all tested microbial antigens showed a significant relationship of MWF-antigen mixture to Pseudomonas antigens, but a low correlation to moulds. These newly prepared MWF-antigens are useful tools for the diagnosis of patients with suspected MWF-HP and are available for further investigations.
Collapse
Affiliation(s)
- Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany.
| | - Isabell Warfolomeow
- German Social Accident Insurance Institution for the Woodworking and Metalworking Industries, BGHM, Mainz
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| |
Collapse
|
8
|
Akkale T, Sarı G, Şimşek C. Occupational hypersensitivity pneumonia. Tuberk Toraks 2023; 71:94-104. [PMID: 36912413 PMCID: PMC10854060 DOI: 10.5578/tt.20239911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Hypersensitivity pneumonitis (HP) is an immunological lung disease that affects individuals who are sensitive and susceptible to occupational and environmental exposures. While clinical and radiological findings may resemble other interstitial lung diseases, identifying the causative agents can aid in the differential diagnosis. However, this can be challenging and may result in delayed diagnosis and poor prognosis. A gold standard test for diagnosis is currently unavailable, and therefore, a multidisciplinary approach involving a clinician, radiologist, and pathologist is necessary. Avoiding exposure is the first step in treatment, with immunosuppressive therapeutics also being used. Antifibrotic agents show promise for future treatment approaches. Despite recent advancements in data and guidelines, knowledge about managing occupational HP remains limited. This review provides a summary of the epidemiological, clinical, and radiological findings, as well as diagnostic and treatment principles of occupational HP based on current literature.
Collapse
Affiliation(s)
- Tuğba Akkale
- Clinic of Occupational Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Türkiye
| | - Gülden Sarı
- Clinic of Occupational Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Türkiye
| | - Ceprail Şimşek
- Clinic of Occupational Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Türkiye
| |
Collapse
|
9
|
Perečinský S, Murínová L, Tomčová J, Poľanová M, Legáth Ľ. Machine operator's lung outbreak due to Eikenella corrodens. Occup Med (Lond) 2022; 72:522-526. [PMID: 35932246 DOI: 10.1093/occmed/kqac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Outbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metalworking fluids (MWFs) are used. The recirculation of MWFs leads to microbiological contamination, which is responsible for outbreaks. Most outbreak reports come from USA and the UK; however, no similar reports have been published from Central Europe. AIMS To describe an outbreak of MWF-associated HP in workers from a compressor assembly manufacturing facility in Slovak Republic and to identify the potential antigens responsible for the outbreak. METHODS We investigated the history of worker's symptoms, physical examinations, lung function tests, radiographic scans and lung biopsies. The MWF samples were analysed for different strains of bacteria and fungi. Antigen extracts were produced from the microorganisms isolated from MWFs, and positive precipitin reactions were evaluated. RESULTS MWF-associated HP was diagnosed in 21 men and 6 women. All workers had work-related dyspnoea and cough with abnormal pulmonary diffusing capacity. Twenty-four cases had evidence of interstitial lung disease. Four cases were classified as having fibrotic HP. Nineteen microbial isolates (12 bacteria and 7 fungi) were cultured from the MWFs. Twenty-five cases had a positive response to at least one isolate. Eikenella corrodens and Bacillus subtilis were the most frequently reacting antigens (in 15 and 12 workers, respectively). CONCLUSIONS Despite decreasing reports of MWF-associated HP outbreaks over the past several decades, we describe one of the largest outbreaks in Europe. While the bacterium E. corrodens was found in the MWF samples, its relationship to the disease should be further investigated.
Collapse
Affiliation(s)
- S Perečinský
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Šafárik University and the L. Pasteur University Hospital, Rastislavova, Kosice, Slovak Republic
| | - L Murínová
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Šafárik University and the L. Pasteur University Hospital, Rastislavova, Kosice, Slovak Republic
| | - J Tomčová
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Šafárik University and the L. Pasteur University Hospital, Rastislavova, Kosice, Slovak Republic
| | - M Poľanová
- Department of Clinical Microbiology, The National Institute of Tuberculosis, Respiratory Diseases and Thoracic Surgery, Vyšné Hágy, Vysoké Tatry, Slovak Republic
| | - Ľ Legáth
- Department of Occupational Medicine and Clinical Toxicology, Medical Faculty, Pavol Jozef Šafárik University and the L. Pasteur University Hospital, Rastislavova, Kosice, Slovak Republic
| |
Collapse
|
10
|
He J, Zhang J, Ren X. Krebs von den lungen-6 as a clinical marker for hypersensitivity pneumonitis: A meta-analysis and bioinformatics analysis. Front Immunol 2022; 13:1041098. [PMID: 36532009 PMCID: PMC9748086 DOI: 10.3389/fimmu.2022.1041098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
Aim Hypersensitivity pneumonitis (HP), also referred to as exogenous allergic alveolitis, is one of the most common interstitial lung diseases (ILDs). A potential immune biomarker, Krebs von den lgen-6 (KL-6) characterizes the progression and severity of HP. The meta-analysis in this study was conducted to elucidate the variations in the concentrations of KL-6 in different types of HP. Methods A systematic search of various databases such as EMBASE, Pubmed, CNKI, VIP, Web of Science, and WanFang was carried out to find relevant published articles between January 1980 and August 2022 that explored the relationship between KL-6 and allergic pneumonia. Standardized mean difference (SMD) and 95% confidence interval (CI) were used as effect sizes for comparison among different groups. The GSE47460 and GSE150910 datasets were downloaded to extract and validate the differences in KL-6 mRNA expression between HP lung tissue and healthy controls. Furthermore, the single-cell sequencing dataset GSE135893 was downloaded to extract KL-6 mRNA expression in type II alveolar epithelial cells to validate the differences between HP and healthy controls. Two researchers evaluated the quality of the included studies by employing Newcastle-Ottawa Scale. All the qualified studies were subjected to statistical analyses carried out utilizing RevMan 5.2, Stata 11.0, and R software 4.1.3. Results Twenty studies aligned perfectly with the inclusion criteria of the meta. The concentrations of KL-6 were substantially higher in the blood of HP patients as compared to the control group. Subgroup analyses were carried out in accordance with the allergen source and the results revealed that patients with different allergens had higher blood KL-6 concentrations than healthy controls. Additionally, different subgroups of subjects were created for meta-analysis as per the fibrosis status, race, measurement method, and sample type. The concentration of KL-6 in blood was much higher in all HP subgroups than in healthy control groups. Moreover, the bioinformatics analysis revealed that KL-6 mRNA expression was higher in HP lung tissue and type II alveolar epithelial cells as compared to healthy controls. Conclusion The present meta-analysis and bioinformatics analysis suggested that the concentration levels of KL-6 varied between HP patients and healthy individuals, and the KL-6 concentrations may be higher in the blood samples of HP patients. Systematic review registration https://www.crd.york.ac.uk/prospero/, CRD42022355334.
Collapse
Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College. Chengdu, Sichuan, China,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China,*Correspondence: Jie He,
| | - Jiangliu Zhang
- Clinical Medical College of Chengdu Medical College. Chengdu, Sichuan, China,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Xinyi Ren
- Clinical Medical College of Chengdu Medical College. Chengdu, Sichuan, China,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| |
Collapse
|
11
|
Kespohl S, Riebesehl J, Grüner J, Raulf M. Impact of climate change on wood and woodworkers- Cryptostroma corticale (sooty bark disease): A risk factor for trees and exposed employees. Front Public Health 2022; 10:973686. [PMID: 36330129 PMCID: PMC9623262 DOI: 10.3389/fpubh.2022.973686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/21/2022] [Indexed: 01/21/2023] Open
Abstract
Climate changes have promoted an increased fungal infection of maple trees with Cryptostroma corticale, the causative agent of sooty bark disease. The hosts of C. corticale are maples, and since the early 2000s the fungus has been appearing more frequently in European forests, due to the droughts and hot summers of recent years. Infestation by C. corticale discolors the wood and makes it unusable for further processing, which leads to considerable economic damage in the timber industry. Therefore, the occurrence and spread of sooty bark disease raise serious problems. In addition to forestry and economic problems, the conidiospores of C. corticale can also cause health problems in exposed wood workers and they can trigger hypersensitivity pneumonitis (HP). Since the spores, which are deposited over the entire area under the bark of infected trees, can spread during processing, exposed workers must take special precautions to protect themselves against exposure. If an occupational disease is nevertheless suspected following exposure to C. corticale, valid diagnostics are required to confirm possible HP and derive appropriate therapies and exposure reduction or avoidance. Diagnosis of HP is based on several criteria, one of them is the detection of specific IgG in patient's serum against the potentially triggering antigens, in this case C. corticale antigens. To produce a diagnostic tool to measure C. corticale specific IgG, which is not commercially available so far, spores and mycelial material from ITS-sequenced strains of C. corticale was prepared and analyzed. These biochemically characterized extracts of spore and mycelial antigens were biotinylated and coupled to Streptavidin-ImmunoCAPs. To validate these diagnostic test tools the first step is to measure the concentration of C. corticale specific IgG in sera of healthy non-exposed and healthy exposed subjects to establish cut-off values. Suitable participants were recruited and the individual exposure to C. corticale and symptoms experienced during or after working with infected maple trees were recorded using questionnaires. Finally, diagnostic tools for serological testing in suspected cases of HP by C. corticale were created and evaluated. The following article provides recommendations for the treatment and disposal of infected damaged wood and for occupational health protection procedures. Secondly, the diagnosis of HP induced by exposure to C. corticale as an occupational disease is described including the verification of newly developed serological test tools for antigens of C. corticale.
Collapse
Affiliation(s)
- Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the DGUV, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany,*Correspondence: Sabine Kespohl
| | - Janett Riebesehl
- Julius Kühn Institute (JKI)—Federal Research Centre for Cultivated Plants, Institute for Plant Protection in Horticulture and Forests, Braunschweig, Germany
| | - Jörg Grüner
- Department of Forest Protection, Forest Research Institute of Baden-Württemberg (FVA), Freiburg, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the DGUV, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| |
Collapse
|
12
|
Fishwick D, Carder M, Iskandar I, Fishwick BC, van Tongeren M. Occupational inhalational accidents: analysis of cases from the UK SWORD reporting scheme from 1999 to 2018. Occup Environ Med 2022; 79:oemed-2021-107947. [PMID: 35383119 DOI: 10.1136/oemed-2021-107947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the reported UK incidence of occupational inhalation accidents, and to consider changes of incidence and potential causes over time. METHODS Cases of occupational inhalation accident reported to Surveillance of Work Related Occupational Respiratory Diseases (SWORD) over 20 years were grouped into four 5-year time periods. Cases were characterised by causative exposure, occupation and industrial sector. Incidence rates were calculated using Office of National Statistics employment data. RESULTS The 172 actual cases reported to SWORD equated to an estimated 502 cases after adjusting for reporting frequency. Their mean age was 41.3 years (SD 12.3); 77% were male. The annual incidence fell from 1.7 per million employed in the first 5-year period, to 0.5 in the most recent. The most common occupations, responsible for 35% of all cases, were in descending order (number, % of total cases): Labourers in process and plant operations (8, 4.7), welding trades (8, 4.7), fire service officers (8, 4.7), heavy goods vehicle drivers (7, 4.1), metal working production and maintenance fitters (7, 4.1), civil service administrative officers and assistants (7, 4.1), food, drink and tobacco process operatives (6, 3.5), and three summated categories of elementary and service occupations including cleaners and domestics (10, 5.8).Three of 40 exposure categories were common to all time periods; acids (19.6% of all cases 1999-2004, 2.3% 2005-2009, 6.3% 2010-2013, 6.3% 2014-2018), chlorine/hypochlorites (7.2%, 7.0%, 2.5%, 6.3%, respectively) and solvents (14.4%, 11.6%, 12.5%, 6.3%, respectively). CONCLUSIONS The incidence of inhalation accidents appears to have fallen, although certain exposures appear to be persistently linked to cases.
Collapse
Affiliation(s)
- David Fishwick
- Centre for Workplace Health, Health and Safety Executive Bootle Headquarters, Bootle, UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | - Ireny Iskandar
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| | | | - Martie van Tongeren
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
| |
Collapse
|
13
|
Armentia A, Fernández S, San Miguel Rodríguez A, San Miguel Hernández A, Corell A, Gayoso M. Occupational hypersensitivity pneumonitis caused by fossil-containing rocks. Clin Chim Acta 2022; 524:139-145. [PMID: 34774826 DOI: 10.1016/j.cca.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022]
Abstract
AIMS We present a hypersensitivity immune response to inhalation of antigens from fossil soils frequently used in tile manufacture. We found that the soil polished by a worker affected by pneumonitis was a paleosol containing bivalves from the cretaceous period called Hippurites. METHODS We made a diagnostic study for pneumonitis (analysis, microbiology, radiology, high-resolution CT, bronchoalveolar lavage, pulmonary biopsy. A biochemical study of the polishing materials used (magnesium hexafluorosilicate crystallizer), steel spoilage, washing liquid and Bilbao red limestone) after scraping of the same. Allergy study included skin tests with extracts from fossil soils, determination of IgG and IgE to mollusks, IgE-immunodetection with soil extracts with the patient's serum and non-atopic controls. Histology was made using scanning electron microscopy of the lung biopsy and the fossil soil to determine the presence of remains of mollusks, fungi, pollen or other fossil elements. RESULTS SDS-PAGE IgE Immunoblotting assay detecting IgE binding in soil extract between 66 and 35 kDa. Likewise, IgE-Immunblotting assay with extracts from bivalve mollusks (razor shell, mussel and scallop) and gastropod (sea snail), detecting IgE binding between 100 kDa - 30 kDa, as well as in some bands with molecular mass between 20 and 14 kDa, proving sensitization to mollusks. CONCLUSIONS Bivalve proteins preserved in fossil soils may produce an immune hypersensitivity response. This may impact on the precautions exposed workers, in this case fossil soil cutters and polishers, should take.
Collapse
Affiliation(s)
- Alicia Armentia
- Allergy Unit, Hospital Universitario Río Hortega. Valladolid, Spain
| | - Sara Fernández
- Allergy Unit, Hospital Universitario Río Hortega. Valladolid, Spain
| | - Angel San Miguel Rodríguez
- Clinical Analysis Service. Río Hortega University Hospital. Valladolid. International University of La Rioja, Spain
| | - Angel San Miguel Hernández
- Clinical Analysis Service. Río Hortega University Hospital. Valladolid. International University of La Rioja, Spain.
| | | | | |
Collapse
|
14
|
Kawano-Dourado L, Glassberg MK, Assayag D, Borie R, Johannson KA. Sex and gender in interstitial lung diseases. Eur Respir Rev 2021; 30:30/162/210105. [PMID: 34789464 DOI: 10.1183/16000617.0105-2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022] Open
Abstract
Sex and gender differences influence key domains of research, lung health, healthcare access and healthcare delivery. In interstitial lung diseases (ILDs), mouse models of pulmonary fibrosis are clearly influenced by sex hormones. Additionally, short telomeres, a biomarker of telomere regulation gene mutations, are impacted by sex, while heritability unexplained by genetic variation may be attributable to gendered environmental factors that drive epigenetic control. Diseases like idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, occupational ILDs, connective tissue-associated ILDs and lymphangioleiomyomatosis have different prevalence and prognosis between men and women. These differences arise from a complex interplay between biological sex and sociocultural gender influencing genetics, epigenomic modifiers, hormones, immune function, response to treatment and interaction with healthcare systems. Much work remains to be done to systematically integrate sex and gender analysis into relevant domains of science and clinical care in ILD, from strategic considerations for establishing research priorities to guidelines for establishing best clinical practices. Accounting for sex and gender in ILD is essential to the practice of individualised, patient-centred medicine.
Collapse
Affiliation(s)
- Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coracao, Sao Paulo, Brazil.,Pulmonary Division, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.,INSERM 1152, University of Paris, Paris, France
| | - Marilyn K Glassberg
- Pulmonary, Critical Care, and Sleep Medicine Division, Dept of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Raphaël Borie
- Pulmonary Division, Hospital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Kerri A Johannson
- Depts of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada .,Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
15
|
Ferreira TS, Carneiro APS, Mancuzo EV. Occupational exposure to pesticides and chronic hypersensitivity pneumonia: a case report. Rev Bras Med Trab 2021; 19:249-252. [PMID: 34603422 PMCID: PMC8447645 DOI: 10.47626/1679-4435-2020-672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022] Open
Abstract
Hypersensitivity pneumonia is an immune-mediated inflammation of the lung parenchyma that occurs in previously susceptible individuals, after inhalation of antigens, usually organic. In recent years, various chemical agents have been described as inducers of hypersensitivity pneumonia, including exposure to high concentrations of pesticides. The objective of the present case report was to describe a possible association of hypersensitivity pneumonia with pesticide chronic inhalation and to draw attention to the importance of early diagnosis. The patient was 72-year-old man who worked for over 30 years as a health agent fumigating pesticides in rural and urban areas. He had progressive dyspnea and cough for the past 3 years. Chest tomography demonstrated parenchymal bands, honeycombing, and diffuse air trapping. Spirometry showed a severe restrictive pattern. Surgical lung biopsy was indicated, which confirmed the diagnosis of hypersensitivity pneumonia. Due to the wide use of pesticides in Brazil, the knowledge of their association with hypersensitivity pneumonia is of great importance in warning the teams involved in health care and surveillance of these workers, providing earlier diagnoses, with better prognosis. On the contrary, late diagnoses, such as that of the case reported, have important health impacts. As a priority, preventive measures must be taken to protect exposed individuals.
Collapse
Affiliation(s)
- Tadeu Sartini Ferreira
- Serviço Especializado em Saúde do Trabalhador, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula Scalia Carneiro
- Serviço Especializado em Saúde do Trabalhador, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eliane Viana Mancuzo
- Departamento de Pneumologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
16
|
Kongsupon N, Walters GI, Sadhra SS. Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium. Occup Med (Lond) 2021; 71:255-259. [PMID: 34370035 PMCID: PMC8486273 DOI: 10.1093/occmed/kqab082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Hypersensitivity pneumonitis (HP) is caused by a variety of antigens and low-molecular-weight chemicals, often through occupational exposure. Making a diagnosis of HP and identifying a cause are challenging. Cryptogenic cases are frequently reported, and missing or incomplete exposure histories can cause misclassification. Aims To provide an evidence-based compendium of sources of exposure and causes of HP for the clinician, through systematic review of medical literature. Methods Articles related to HP causative agents and occupational exposure were searched from the databases OVID Medline (1946 to October 2020) and EMBASE (1974 to October 2020). Abstracts and full texts of articles were screened by two reviewers. Data on causative antigens, occupational source of exposure and any associated eponymous name were extracted and grouped according to source of exposure. Results A total of 1790 articles were identified, from which 305 articles met the inclusion criteria. An additional 22 articles were identified from citation lists of the selected review articles. Sources of exposure identified for HP were sorted into 14 categories of work (agricultural, plant matter processing, wood, animal-related, foodstuff, food processing, metal processing, polymers, other manufacturing, chemicals, aerosolized water, service, waste and sewage and wind instruments). Conclusions This work is a comprehensive list of occupational causative agents and exposures causing HP. Cases are grouped by source of exposure, allowing an immediately accessible compendium of causes for use during occupational exposure assessment, which could also form the basis for a clinical questionnaire.
Collapse
Affiliation(s)
- N Kongsupon
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B152TT, UK
| | - G I Walters
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B152TT, UK.,Birmingham NHS Regional Occupational Lung Disease Service, Birmingham Chest Clinic, 151 Great Charles Street, Birmingham B3 3HX, UK
| | - S S Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B152TT, UK
| |
Collapse
|
17
|
Abstract
Fibrotic hypersensitivity pneumonitis (fHP) is a chronic, often progressive fibrosing form of interstitial lung disease caused by inhaled antigenic exposures. fHP can lead to impaired respiratory function, reduced disease-related quality of life, and early mortality. Management of fHP should start with exposure remediation where possible, with systemic immunosuppression and antifibrotic therapy considered in patients with symptomatic or progressive disease. Nonpharmacologic and supportive management should be offered and, in cases of treatment-resistant, progressive illness, lung transplant should be considered.
Collapse
Affiliation(s)
- Hayley Barnes
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Nett RJ, Stanton M, Grimes GR. Occupational respiratory and skin diseases among workers exposed to metalworking fluids. Curr Opin Allergy Clin Immunol 2021; 21:121-127. [PMID: 33394701 DOI: 10.1097/aci.0000000000000717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To examine respiratory and skin diseases that occur among workers exposed to metalworking fluids (MWFs) used during machining processes. RECENT FINDINGS Five cases of a severe and previously unrecognized lung disease characterized by B-cell bronchiolitis and alveolar ductitis with emphysema (BADE) were identified among workers at a machining facility that used MWFs, although MWF exposure could not be confirmed as the etiology. In the United Kingdom, MWF is now the predominant cause of occupational hypersensitivity pneumonitis (HP). Under continuous conditions associated with respiratory disease outbreaks, over a working lifetime of 45 years, workers exposed to MWF at 0.1 mg/m3 are estimated to have a 45.3% risk of acquiring HP or occupational asthma under outbreak conditions and a 3.0% risk assuming outbreak conditions exist in 5% of MWF environments. In addition to respiratory outcomes, skin diseases such as allergic and irritant contact dermatitis persist as frequent causes of occupational disease following MWF exposure. SUMMARY Healthcare providers need to consider MWF exposure as a potential cause for work-related respiratory and skin diseases. Additional work is necessary to more definitively characterize any potential association between MWF exposures and BADE. Medical surveillance should be implemented for workers regularly exposed to MWF.
Collapse
Affiliation(s)
- Randall J Nett
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia
| | - Marcia Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia
| | - George R Grimes
- Division of Field Studies and Engineering, NIOSH, CDC, Cincinnati, Ohio, USA
| |
Collapse
|
19
|
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.
Collapse
|
20
|
Sesé L, Khamis W, Jeny F, Uzunhan Y, Duchemann B, Valeyre D, Annesi-Maesano I, Nunes H. Adult interstitial lung diseases and their epidemiology. Presse Med 2020; 49:104023. [PMID: 32437842 DOI: 10.1016/j.lpm.2020.104023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Lucile Sesé
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France; Service de physiologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Sorbonne Universités, UPMC Université Paris 06, 75013 Paris, France
| | - Warda Khamis
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Florence Jeny
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Yurdagul Uzunhan
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Boris Duchemann
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France
| | - Dominique Valeyre
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Isabella Annesi-Maesano
- Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Sorbonne Universités, UPMC Université Paris 06, 75013 Paris, France
| | - Hilario Nunes
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France.
| |
Collapse
|
21
|
Creamer AW, Barratt SL. Prognostic factors in chronic hypersensitivity pneumonitis. Eur Respir Rev 2020; 29:29/156/190167. [DOI: 10.1183/16000617.0167-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/03/2020] [Indexed: 12/11/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an immunologically mediated lung disease resulting from exposure to inhaled environmental antigens. Prognosis is variable, with a subset of patients developing progressive fibrosis leading to respiratory failure and death. Therefore, there is an urgent need to identify factors which predict prognosis and survival in patients with HP. We undertook a narrative review of existing evidence to identify prognostic factors in patients with chronic HP. Patient demographics, smoking history, extent of antigen exposure and comorbidities all have reported associations with disease outcome, and physiological, radiological and laboratory markers have been shown to predict overall survival. While no single marker has been demonstrated to accurately and reliably predict prognosis, older age, more severe impairment of pulmonary function at baseline and established fibrosis on either biopsy or high-resolution computed tomography are consistently associated with worse survival. The vast majority of existing studies are retrospective, and this review identifies a need for prospective longitudinal studies with serial assessment of respiratory health to ascertain factors associated with nonfatal deterioration. Future developments, including the development of HP-specific composite scores may help further improve our ability to predict outcomes for individual patients.
Collapse
|
22
|
Leone PM, Richeldi L. Current Diagnosis and Management of Hypersensitivity Pneumonitis. Tuberc Respir Dis (Seoul) 2020; 83:122-131. [PMID: 32185914 PMCID: PMC7105432 DOI: 10.4046/trd.2020.0012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILDs) is characterized by exposure to an inhaled inciting antigen that leads to a host immunologic reaction determining interstitial inflammation and architectural distortion. The underlying pathogenetic mechanisms are unclear. The absence of international shared diagnostic guidelines and the lack of a "gold-standard" test for HP combined with the presence of several clinical and radiologic overlapping features makes it particularly challenging to differentiate HP from other ILDs, also in expert contests. Radiology is playing a more crucial role in this process; recently the headcheese sign was recognized as a more specific for chronic-HP than the extensive mosaic attenuation. Several classification proposals and diagnostic models have been advanced by different groups, with no prospective validation. Therapeutic options for HP have been limited to antigen avoidance and immunosuppressant drugs over the last decades. Several questions about this condition remain unanswered and there is a need for more studies.
Collapse
Affiliation(s)
- Paolo Maria Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
23
|
Clinical characteristics and outcomes of hypersensitivity pneumonitis: a population-based study in China. Chin Med J (Engl) 2019; 132:1283-1292. [PMID: 31021982 PMCID: PMC6629344 DOI: 10.1097/cm9.0000000000000256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Backgrounds: Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) that develops in response to the inhalation of various antigens. The clinical pathologies are very complex and undetermined. The clinical features and outcomes of HP have not been fully elucidated. The aim of this study was to analyze the incidence, clinical features, and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP (CHP). Methods: The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017. The patients were categorized into acute HP (AHP, n = 72) and CHP (n = 29) groups according to the updated international criteria. The clinical, imaging, treatment, and follow-up data were retrospectively reviewed. All patients were followed up until December 31, 2017. Statistical analysis was performed, and a clinical scoring system for CHP was constructed by SPSS 20.0 software. Results: The incidence of HP was 2.4% in ILD inpatients in our center. Patients in the CHP group were older (t = −2.212, P = 0.029), had more smokers (χ2 = 8.428, P = 0.004), and longer duration of symptoms (t = −4.852, P < 0.001) than those in the AHP group. Weight loss, crackles, digital clubbing, and cyanosis were more common in the CHP group than those in the AHP group (χ2 = 5.862, P < 0.001; χ2 = 8.997, P = 0.003; χ2 = 11.939, P = 0.001; and χ2 = 4.025, P = 0.045, respectively). On chest high-resolution computed tomography (HRCT), reticular patterns, traction bronchiectasis, and accompanying honeycombing were more common in CHP cases than those in AHP cases (χ2 = 101.000, P < 0.001; χ2 = 32.048, P < 0.001; and χ2 = 36.568, P < 0.001, respectively). The clinical scoring system for CHP was established based on the clinical variables (age [A], duration of symptoms [D], smoking history [S], unidentified exposure [U], and chest HRCT [C]; ADSUC) (area under the curve 0.935, 95% confidence interval: 0.883–0.987, P < 0.001). Eleven patients (15.3%) in the AHP group developed CHP, and unidentified exposure was an independent risk factor for the progression of disease (P = 0.038). The survival of patients with CHP, smoking history, unidentified antigens and fibrosis on Chest HRCT were significantly worse (P = 0.011, P = 0.001, P = 0.005, and P = 0.011, respectively) by Kaplan-Meier analysis. Cox multivariate regression analysis revealed that unidentified exposure and total lung volume (TLC pred%) were independent prognostic predictors for HP patients (P = 0.017 and P = 0.017, respectively). Conclusions: The clinical features and outcomes of the CHP patients differ from those of the AHP patients. ADSUC is a simple and feasible clinical model for CHP. Unidentified exposure is an independent risk factor for the progression of AHP to CHP. Unidentified exposure and a low baseline TLC pred% are independent predictors for survival in HP patients.
Collapse
|
24
|
Barber CM, Burge PS, Feary JR, Parfrey H, Renzoni EA, Spencer LG, Walters GI, Wiggans RE. Identifying causation in hypersensitivity pneumonitis: a British perspective. BMJ Open Respir Res 2019; 6:e000469. [PMID: 31803475 PMCID: PMC6890382 DOI: 10.1136/bmjresp-2019-000469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/10/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP). Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP. Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’. Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP. Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients.
Collapse
Affiliation(s)
| | - P Sherwood Burge
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
| | - Jo R Feary
- Department of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Helen Parfrey
- Cambridge ILD Service, Royal Papworth Hospital NHSFT, Cambridge, UK
| | - Elizabeth A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, University Hospital Aintree, Liverpool, UK
| | - Gareth I Walters
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
| | | | | |
Collapse
|
25
|
Goodwin AT, Singanayagam A, Jenkins G. Review of the British Thoracic Society Winter Meeting 2018, 5-7 December 2018, London, UK. Thorax 2019; 74:1168-1173. [PMID: 31383777 DOI: 10.1136/thoraxjnl-2019-213680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The Winter Meeting of the British Thoracic Society (BTS) is a platform for the latest clinical and scientific research in respiratory medicine. This review summarises some key symposia and presentations from the BTS Winter Meeting 2018. METHODS Key symposia and research presentations from the BTS Winter Meeting 2018 were attended and reviewed by the authors. RESULTS The seminal messages from the latest clinical and scientific research covering a range of respiratory diseases, including asthma, interstitial lung disease, infection, cystic fibrosis, pulmonary vascular disease, pleural disease and occupational lung disease were summarised in this review. DISCUSSION The BTS Winter Meeting 2018 brought the very best of respiratory research to an audience of scientists, physicians, nurses and allied health professionals. The Winter Meeting continues to be a highlight of the UK respiratory research calendar, and we look forward to the next meeting in December 2019.
Collapse
Affiliation(s)
- Amanda T Goodwin
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Aran Singanayagam
- COPD and Asthma Section, National Heart and Lung Institute, Imperial College London, London, London, UK
| | - Gisli Jenkins
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
| |
Collapse
|
26
|
Walters GI, Mokhlis JM, Moore VC, Robertson AS, Burge GA, Bhomra PS, Burge PS. Characteristics of hypersensitivity pneumonitis diagnosed by interstitial and occupational lung disease multi-disciplinary team consensus. Respir Med 2019; 155:19-25. [DOI: 10.1016/j.rmed.2019.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/12/2022]
|
27
|
Olson AL, Gifford AH, Inase N, Fernández Pérez ER, Suda T. The epidemiology of idiopathic pulmonary fibrosis and interstitial lung diseases at risk of a progressive-fibrosing phenotype. Eur Respir Rev 2018; 27:27/150/180077. [DOI: 10.1183/16000617.0077-2018] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022] Open
Abstract
The availability of epidemiological data relating to interstitial lung diseases (ILDs) has increased over recent years, but information on the prevalence and incidence of ILDs of different aetiologies remains limited. Despite global distribution, the proportion of patients who develop a progressive phenotype across different ILDs is not well known. Disease behaviour is well documented in idiopathic pulmonary fibrosis but idiosyncratic in other ILDs that may present a progressive fibrosing phenotype. Possible reasons may include the heterogeneous nature of the aetiology, the complexity of diagnosis (and subsequent documentation of cases) and the methods employed to retrospectively analyse patient databases. This review presents a broad overview of the epidemiological data available for ILDs that may present a progressive-fibrosing phenotype, collectively and stratified according to clinical classification. We also note where further data are needed in comparison to the well-studied IPF indication.
Collapse
|
28
|
James PL, Cannon J, Barber CM, Crawford L, Hughes H, Jones M, Szram J, Cowman S, Cookson WOC, Moffatt MF, Cullinan P. Metal worker's lung: spatial association with Mycobacterium avium. Thorax 2017; 73:151-156. [PMID: 28851756 PMCID: PMC5801647 DOI: 10.1136/thoraxjnl-2017-210226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Outbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metal working fluid (MWF) is used to facilitate metal turning. Inhalation of microbe-contaminated MWF has been assumed to be the cause, but previous investigations have failed to establish a spatial relationship between a contaminated source and an outbreak. OBJECTIVES After an outbreak of five cases of HP in a UK factory, we carried out blinded, molecular-based microbiological investigation of MWF samples in order to identify potential links between specific microbial taxa and machines in the outbreak zone. METHODS Custom-quantitative PCR assays, microscopy and phylogenetic analyses were performed on blinded MWF samples to quantify microbial burden and identify potential aetiological agents of HP in metal workers. MEASUREMENTS AND MAIN RESULTS MWF from machines fed by a central sump, but not those with an isolated supply, was contaminated by mycobacteria. The factory sump and a single linked machine at the centre of the outbreak zone, known to be the workstation of the index cases, had very high levels of detectable organisms. Phylogenetic placement of mycobacterial taxonomic marker genes generated from these samples indicated that the contaminating organisms were closely related to Mycobacterium avium. CONCLUSIONS We describe, for the first time, a close spatial relationship between the abundance of a mycobacterium-like organism, most probably M. avium, and a localised outbreak of MWF-associated HP. The further development of sequence-based analytic techniques should assist in the prevention of this important occupational disease.
Collapse
Affiliation(s)
- Phillip L James
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Julie Cannon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK
| | | | | | | | - Meinir Jones
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK
| | - Joanna Szram
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK
| | - Steven Cowman
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - William O C Cookson
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Miriam F Moffatt
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Paul Cullinan
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK.,MRC-PHE Centre for Environment and Health, St Mary's Campus, Imperial College, London, UK
| |
Collapse
|