1
|
Ebrahimi PS, Bala MA, Tafreshi ZM, Piroti H, Mostafaei M, Ghahremani B, Shaverdi F, Porshokouh AI, Deravi N, Poudineh M, Roostaie M. Maternal occupational exposure to asthmogenic during pregnancy and the future risk of asthma in children: A meta-analysis. Turk J Obstet Gynecol 2024; 21:123-130. [PMID: 38853509 DOI: 10.4274/tjod.galenos.2024.50497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
The association between maternal occupational exposure during pregnancy and the subsequent development of asthma in their children has always been a matter of debate, and the results of cohort studies on this issue have been controversial. The current study is the first systematic review and meta-analysis aimed at evaluating the risk of developing subsequent asthma in children based on maternal occupational exposure during the gestation period. To retrieve eligible studies, an advanced literature search was performed up to August 10, 2023 from the following databases: PubMed, Scopus, and Google Scholars. The title and abstract of related articles were screened; hence, the full texts were reviewed. Data extraction was conducted; hence, the included articles were analyzed to assess the mention association. From a total of 10 cohort studies with a total record of 5372, it was found that there is no significant relationship between occupational exposure to asthmogenic during pregnancy and later asthma in children. The pooled odds ratio of asthmatic children in patients with maternal occupational exposure to asthmogenic during pregnancy was 1.03 (95% confidence interval, 0.97-1.09) I2= 13% p=0.62. It was concluded that there is no significant association between maternal occupational exposure and future asthma in children. However, future large-scale studies are required to support these results.
Collapse
Affiliation(s)
| | | | | | - Hana Piroti
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrsa Mostafaei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Faezeh Shaverdi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Niloofar Deravi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Minoo Roostaie
- Islamic Azad University Tehran Medical Branch, Tehran, Iran
| |
Collapse
|
2
|
Pinedo Sierra C, Curto Sánchez E, Diaz Campos R, Hermida Valverde T, Sánchez-Cuellar S, Fernández Tena A. [Asthma]. OPEN RESPIRATORY ARCHIVES 2024; 6:100324. [PMID: 38707659 PMCID: PMC11067451 DOI: 10.1016/j.opresp.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024] Open
Abstract
Asthma is a chronic inflammatory disease that affects about 5% of the world's population and generates high health and social costs. Proper management of the disease requires a correct diagnosis, based on objective measures of functional impairment, as well as symptom control and assessment of the future risk of exacerbations.It has been estimated that 18% of asthma patients in Western Europe have severe asthma and approximately 50% of them have poor control. The severity of asthma is established based on the minimum maintenance treatment needs to achieve control. Asthma clinical practice guidelines recommend classifying severe patients into allergic asthma (T2); eosinophilic asthma (T2) and non-T2 asthma in order to establish the most appropriate treatment.In recent decades, new biological therapies have been developed that can be applied according to the phenotype and endotype of asthma, allowing for selective and personalized treatment. These phenotypes and endotypes can change over time and therefore, the identification of biomarkers capable of predicting the severity, the course of the disease and the response to a given treatment seems essential. A large number of biomarkers have been studied in asthma, but so far only a few can be readily used in routine clinical practice. The application of omics technologies (epigenomics, genomics, transcriptomics, proteomics, metabolomics, lipidomics, etc.) for this purpose is still in the research phase.
Collapse
Affiliation(s)
- Celia Pinedo Sierra
- Servicio de Neumología. Hospital Universitario Clínico San Carlos. Universidad Complutense, Madrid, España
| | - Elena Curto Sánchez
- Servicio de Neumología. Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Rocio Diaz Campos
- U. de Asma Grave de Alta Complejidad. Servicio de Neumología. Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - Ana Fernández Tena
- Servicio de Neumología Ocupacional. Instituto Nacional de Silicosis, Oviedo, España
| |
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
|
Twinkle RH, Sain Y, Pinjar MJ, Manik KA, Mondal H. Comparative Dynamic Pulmonary Function Tests Between Apparently Healthy Young Adult Offspring of Asthmatic and Non-asthmatic Parents: A Pilot Study. Cureus 2023; 15:e44259. [PMID: 37772245 PMCID: PMC10526921 DOI: 10.7759/cureus.44259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background While the hereditary component of asthma has been established, its influence on early respiratory function changes in otherwise healthy offspring remains to be explored. Dynamic lung function tests assess airflow in and out of the lungs, providing valuable insights into respiratory health and detecting potential airflow limitations. This study aimed to compare the dynamic lung functions between offspring of asthmatic and non-asthmatic parents. Methodology A case-control design was employed comprising 30 cases (offspring of asthmatic parents) and 30 controls (offspring of non-asthmatic parents). Lung function parameters including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, forced expiratory flow between 25% and 75% of the FVC (FEF 25-75%), and maximum mid-expiratory flow at 50% of the FVC (Vmax 50%) were measured. Statistical analysis was conducted to compare the parameters between cases and controls using the unpaired t-test. Results The mean age of controls was 20.46 ± 2.82 years and the cases was 19.83 ± 1.41 years. The study revealed that cases exhibited lower FEV1 and Vmax 50% values compared to controls, indicating potential airflow limitations and altered mid-exhalation flow rates in the offspring of asthmatic parents. While trends were observed in FVC, FEV1/FVC ratio, and FEF 25-75%, these differences were not statistically significant. Conclusions The findings suggest a potential association between parental asthma and altered lung function parameters, specifically in FEV1 and Vmax 50%, among their offspring. These early respiratory function changes underscore the potential impact of hereditary factors on lung health. Healthcare professionals should take parental asthma into account when evaluating lung functions. This may lead to earlier detection and intervention. Further investigation is warranted to elucidate the underlying mechanisms and long-term implications of these findings.
Collapse
Affiliation(s)
| | - Yukta Sain
- Medical School, Great Eastern Medical School and Hospital, Ragolu, IND
| | | | - Khaleel Ahmed Manik
- Physiology, Integral Institute of Medical Sciences & Research, Faculty of Medicine & Health Sciences, Integral University, Lucknow, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| |
Collapse
|
5
|
Alhadlaq HW, Ateeq A, Shayea AMF, Gasana J. Occupational Asthma Prevalence among Migrant Workers Attending Shuaiba Industrial Medical Center in Kuwait. Healthcare (Basel) 2023; 11:2021. [PMID: 37510462 PMCID: PMC10379107 DOI: 10.3390/healthcare11142021] [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: 05/27/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Specific work environments, such as exposure to chemicals emitted during industrial processes, are related to occupational asthma. From 1985 to 2012, Kuwait was expected to have the highest asthma prevalence rate among Middle East nations, at 15%. This cross-sectional study was conducted using secondary data from occupational health physicians' records in the Shuaiba Industrial Medical Center (SIMC) extracted and analyzed using SPSS. Chi-square test and logistic regression were used to check the association between risk factors and bronchial asthma (BA). The data sample size was 3478 in 2018 and 3807 in 2019. In 2018, BA had a significant relationship with age categories, work year groups, and determinants of fitness. Migrant workers above 51 years of age had a high risk of developing BA (p-value = 0.012). There was a high risk of developing BA in workers who worked > 21 years (p-value < 0.001) and in workers who worked between 11 and 20 years (p-value = 0.042). Overweight workers had a risk of developing BA (p-value = 0.042). In 2019, BA had an associated relationship with age categories and determinants of fitness. Workers above 51 years of age had about a 39% risk of developing BA (p-value = 0.009). Otherwise, the BMI, working year groups, marital status, and smoking status had no association with BA. In conclusion, BA is prevalent among migrant workers at the SIMC. Long hours, low income, and a lack of PPE are just a few of the issues that migrant workers have been exposed to, raising their risk of poor health.
Collapse
Affiliation(s)
- Hussah Waleed Alhadlaq
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Safat 13110, Kuwait
| | - Alanoud Ateeq
- Shuaiba Medical Industrial Center, Occupational Health Department, Ministry of Health, Ahmadi 47005, Kuwait
| | - Abdulaziz M F Shayea
- Departments of Occupational Therapy, Faculty of Allied Health Science, Kuwait University, Kuwait City 12037, Kuwait
- Departments of Molecular Biology, Faculty of Graduate Studies, Kuwait University, Kuwait City 12037, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Safat 13110, Kuwait
| |
Collapse
|
6
|
Dalbøge A, Albert Kolstad H, Ulrik CS, Sherson DL, Meyer HW, Ebbehøj N, Sigsgaard T, Zock JP, Baur X, Schlünssen V. The Relationship Between Potential Occupational Sensitizing Exposures and Asthma: An Overview of Systematic Reviews. Ann Work Expo Health 2023; 67:163-181. [PMID: 36472234 DOI: 10.1093/annweh/wxac074] [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: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to identify, appraise, and synthesize the scientific evidence of the relationship between potential occupational sensitizing exposures and the development of asthma based on systematic reviews. METHODS The study was conducted as an overview of systematic reviews. A systematic literature search was conducted for systematic reviews published up to 9 February 2020. Eligibility study criteria included persons in or above the working age, potential occupational sensitizing exposures, and outcomes defined as asthma. Potential occupational sensitizing exposures were divided into 23 main groups comprising both subgroups and specific exposures. Two reviewers independently selected studies, extracted study data, assessed study quality, and evaluated confidence in study results and level of evidence of the relationship between potential occupational sensitizing exposures and asthma. RESULTS Twenty-seven systematic reviews were included covering 1242 studies and 486 potential occupational sensitizing exposures. Overall confidence in study results was rated high in three systematic reviews, moderate in seven reviews, and low in 17 reviews. Strong evidence for the main group of wood dusts and moderate evidence for main groups of mites and fish was found. For subgroups/specific exposures, strong evidence was found for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals, whereas moderate evidence was found for 52 subgroups/specific exposures. CONCLUSIONS This overview identified hundreds of potential occupational sensitizing exposures suspected to cause asthma and evaluated the level of evidence for each exposure. Strong evidence was found for wood dust in general and for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals.
Collapse
Affiliation(s)
- Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - David Lee Sherson
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000 Odense, Denmark.,Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Harald William Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Niels Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
| | - Jan-Paul Zock
- National Institute for Public Health and the Environment (RIVM), Bilthoven, 3721 MA, The Netherlands
| | - Xaver Baur
- Institut für Arbeitsmedizin, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.,Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
| |
Collapse
|
7
|
Minov J. Occupational chronic obstructive pulmonary disorder: prevalence and prevention. Expert Rev Respir Med 2021; 16:429-436. [PMID: 34822743 DOI: 10.1080/17476348.2021.2011722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Occupational chronic obstructive pulmonary disorder, i.e. work-related asthma (WRA) and occupational chronic obstructive pulmonary disease (COPD), are the most common occupational lung diseases in the last decades worldwide. As in the case of the other occupational disorders, these diseases may be prevented. AREAS COVERED WRA is a heterogeneous entity that includes three subtypes, immunologic occupational asthma (OA), irritant-induced asthma (IIA), and work-exacerbated asthma (WEA), depending on the role of occupational exposures as a causing or aggravating factor of the disease. In addition, there is consistent evidence that a substantial proportion of COPD cases can be explained by exposure to noxious particles and gases other than tobacco smoke, such as workplace dusts, gases, fumes, and vapors. The articles cited in this paper were searched by keywords in several databases in the period up to May-July 2021. EXPERT OPINION The development of occupational chronic obstructive disorder is a matter of prevention. WRA and occupational COPD contribute significantly to the overall burden of asthma and COPD. Activities and measures targeted to elimination or reduction of harmful workplace exposures, as well as to early detection and early intervention in the course of the lung damage, can significantly reduce the burden caused by these diseases.
Collapse
Affiliation(s)
- Jordan Minov
- Department for Physiology of Work, Institute for Occupational Health of R. North Macedonia, Skopje, R. Macedonia
| |
Collapse
|
8
|
Reeb-Whitaker C, LaSee CR, Bonauto DK. Surveillance of work-related asthma including the emergence of a cannabis-associated case series in Washington State. J Asthma 2021; 59:1537-1547. [PMID: 34288786 DOI: 10.1080/02770903.2021.1955379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We conducted surveillance for work-related asthma (WRA) in Washington State to identify the industry sectors and asthma exposures most commonly affecting injured workers and in need of prevention activities. METHODS Using workers' compensation data as the primary data source, valid cases were classified as work-aggravated asthma (WAA) or new onset asthma that includes occupational asthma (OA) and reactive airways dysfunction syndrome (RADS). The source of exposure that caused the worker's asthma, their industry and occupation were determined. RESULTS There were 784 valid work-related asthma cases identified for the period 2009-2016, WAA (n = 529) was most common followed by occupational asthma (n = 127) and RADS (n = 12). The Health Care and Social Assistance industry had the highest number of cases (n = 170) with 82% classified as WAA. The highest overall proportions of new onset asthma are occurring in Agriculture, Forestry, Fishing and Hunting (33% of work related asthma cases), Manufacturing (31%) and Construction (30%). The leading substances associated with new onset asthma across all industries include hop plant dust, wood and cedar dust, mineral and inorganic dust, mold, and cleaning materials. We describe ten cases of cannabis-associated asthma including seven from workers in the legalized cannabis industry, four of whom had OA. CONCLUSION State-based work-related asthma surveillance is critical in identifying the workers and exposures associated with this occupational disease, including the detection of a case-series in the cannabis industry.
Collapse
Affiliation(s)
- Carolyn Reeb-Whitaker
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, WA, USA
| | - Claire R LaSee
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, WA, USA
| | - David K Bonauto
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, WA, USA
| |
Collapse
|
9
|
Schyllert C, Andersson M, Backman H, Lindberg A, Rönmark E, Hedman L. Childhood onset asthma is associated with lower educational level in young adults - A prospective cohort study. Respir Med 2021; 186:106514. [PMID: 34198167 DOI: 10.1016/j.rmed.2021.106514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/19/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Asthma is associated with low socioeconomic status among both children and adults, and adolescents with asthma report more school absenteeism than those without. However, it is unclear whether asthma in childhood and adolescence affects socioeconomic status in adulthood. METHODS Within the Obstructive Lung disease In Northern Sweden Studies, all children in grade 1 and 2 in three municipalities were invited to a questionnaire survey, 97% participated (n = 3430). They were followed annually until age 19, and thereafter at age 28 years. In this study, participants at ages 8 y, 12 y, 19 y and 28 y (n = 2017) were included. Asthma was categorized into childhood onset (up to age 12 y) and adolescent onset (from 12 to 19 y). Data for assessment of socioeconomic status was collected at 28 y and included educational level, occupation, and occupational exposure to gas, dust and/or fumes (GDF). RESULTS Childhood onset asthma was associated with having compulsory school as the highest educational level at age 28 y, also after adjustment for sex, smoking and BMI at age 19 y and socioeconomic factors in childhood (OR 4.84 95%CI 2.01-11.65), and the pattern was the same among men and women. However, we found no significant associations between asthma in childhood or adolescence and socioeconomic groups, occupational groups or occupational exposure to GDF at age 28 y. CONCLUSIONS Even though asthma in high-income countries, such as Sweden, is well recognised and treated, this study highlight that childhood onset asthma may have a negative long-term effect with regard to educational level in young adulthood.
Collapse
Affiliation(s)
- Christian Schyllert
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden; Department of Health Sciences, Division of Nursing, Luleå University of Technology, 971 87, Luleå, Sweden.
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden; Department of Health Sciences, Division of Nursing, Luleå University of Technology, 971 87, Luleå, Sweden.
| |
Collapse
|
10
|
Forster F, Kreißl S, Wengenroth L, Vogelberg C, von Mutius E, Schaub B, Nowak D, Weinmann T, Radon K, Gerlich J. Third Follow-Up of the Study on Occupational Allergy Risks (SOLAR III) in Germany: Design, Methods, and Initial Data Analysis. Front Public Health 2021; 9:591717. [PMID: 33748056 PMCID: PMC7969718 DOI: 10.3389/fpubh.2021.591717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Asthma and allergies are complex diseases affected by genetic and environmental factors, such as occupational and psychosocial factors, as well as interactions between them. Although childhood is a critical phase in the development of asthma and allergies, few cohort studies on occupational outcomes followed up participants from childhood onwards. We present design, methods, and initial data analysis for the third follow-up of SOLAR (Study on Occupational Allergy Risks), a prospective and population-based German asthma and allergy cohort. Methods: The SOLAR cohort was initially recruited in 1995-1996 for Phase II of the German branch of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up three times since, in 2002-2003, 2007-2009, and 2017-2018. During the third follow-up (SOLAR III), participants were between 29 and 34 years old. Since SOLAR focuses on occupational exposures, follow-ups were conducted at important points in time of the development of participants' career. To evaluate the potential of selection bias, responders and non-responders were compared based on variables from earlier study phases. In responders, frequency and pattern of missing values were examined and compared within the subsets of paper and online versions of the used questionnaires. Results: In total, 1,359 participants completed the questionnaire of the third follow-up (47.3% of eligible participants). Initially, the cohort started with 6,399 participants from the ISAAC II questionnaire study. A selection process led to a study population that is more female, higher educated, smokes less and has a higher proportion of certain asthma and allergy symptoms (also in their parents) than the initial cohort. Pattern and frequency of missing values were different for paper and online questionnaires. Discussion: The third follow-up of the SOLAR cohort offers the opportunity to analyze the course of asthma and allergies and their associations to environmental, occupational and psychosocial risk factors over more than 20 years from childhood to adulthood. Selection processes within the cohort might lead to bias that needs to be considered in future analyses.
Collapse
Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Sylvia Kreißl
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Erika von Mutius
- Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany.,Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Bianca Schaub
- Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany.,Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| |
Collapse
|
11
|
Golden E, Maertens M, Hartung T, Maertens A. Mapping Chemical Respiratory Sensitization: How Useful Are Our Current Computational Tools? Chem Res Toxicol 2020; 34:473-482. [PMID: 33320000 DOI: 10.1021/acs.chemrestox.0c00320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chemical respiratory sensitization is an immunological process that manifests clinically mostly as occupational asthma and is responsible for 1 in 6 cases of adult asthma, although this may be an underestimate of the prevalence, as it is under-diagnosed. Occupational asthma results in unemployment for roughly one-third of those affected due to severe health issues. Despite its high prevalence, chemical respiratory sensitization is difficult to predict, as there are currently no validated models and the mechanisms are not entirely understood, creating a significant challenge for regulatory bodies and industry alike. The Adverse Outcome Pathway (AOP) for respiratory sensitization is currently incomplete. However, some key events have been identified, and there is overlap with the comparatively well-characterized AOP for dermal sensitization. Because of this, and the fact that dermal sensitization is often assessed by in vivo, in chemico, or in silico methods, regulatory bodies are defaulting to the dermal sensitization status of chemicals as a proxy for respiratory sensitization status when evaluating chemical safety. We identified a data set of known human respiratory sensitizers, which we used to investigate the accuracy of a structural alert model, Toxtree, designed for skin sensitization and the Centre for Occupational and Environmental Health (COEH)'s model, a model developed specifically for occupational asthma. While both models had a reasonable level of accuracy, the COEH model achieved the highest balanced accuracy at 76%; when the models agreed, the overall accuracy was 87%. There were important differences between the models: Toxtree had superior performance for some structural alerts and some categories of well-characterized skin sensitizers, while the COEH model had high accuracy in identifying sensitizers that lacked identified skin sensitization reactivity domains. Overall, both models achieved respectable accuracy. However, neither model addresses potency, which, along with data quality, remains a hurdle, and the field must prioritize these issues to move forward.
Collapse
Affiliation(s)
- Emily Golden
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
| | - Mikhail Maertens
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
| | - Thomas Hartung
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States.,CAAT-Europe, University of Konstanz, 78464 Konstanz, Germany
| | - Alexandra Maertens
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
| |
Collapse
|
12
|
Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma. J Occup Environ Med 2020; 61:453-460. [PMID: 30855523 DOI: 10.1097/jom.0000000000001562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001). CONCLUSION The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.
Collapse
|
13
|
Hoy R, Burdon J, Chen L, Miles S, Perret JL, Prasad S, Radhakrishna N, Rimmer J, Sim MR, Yates D, Zosky G. Work-related asthma: A position paper from the Thoracic Society of Australia and New Zealand and the National Asthma Council Australia. Respirology 2020; 25:1183-1192. [PMID: 33020986 PMCID: PMC7702173 DOI: 10.1111/resp.13951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Work-related asthma (WRA) is one of the most common occupational respiratory conditions, and includes asthma specifically caused by occupational exposures (OA) and asthma that is worsened by conditions at work (WEA). WRA should be considered in all adults with asthma, but especially those with new-onset or difficult to control asthma. Improvement in asthma symptoms when away from work is suggestive of WRA. Clinical history alone is insufficient to diagnose WRA; therefore, objective investigations are required to confirm the presence of asthma and the association of asthma with work activities. Management of WRA requires pharmacotherapy similar to that of non-WRA, however, also needs to take into account control of the causative workplace exposure. Ongoing exposure will likely lead to decline in lung function and worsening asthma control. WRA is a preventable condition but this does rely on increased awareness of WRA and thorough identification and control of all potential occupational respiratory hazards.
Collapse
Affiliation(s)
- Ryan Hoy
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ling Chen
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Susan Miles
- Department of Medicine, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Shivonne Prasad
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Deborah Yates
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Graeme Zosky
- Menzies Institute for Medical Research, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia
| |
Collapse
|
14
|
Schyllert C, Lindberg A, Hedman L, Stridsman C, Andersson M, Ilmarinen P, Piirilä P, Krokstad S, Lundbäck B, Rönmark E, Backman H. Low socioeconomic status relates to asthma and wheeze, especially in women. ERJ Open Res 2020; 6:00258-2019. [PMID: 32963998 PMCID: PMC7487352 DOI: 10.1183/23120541.00258-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/31/2020] [Indexed: 11/05/2022] Open
Abstract
Low socioeconomic status (SES) has been associated with asthma and wheezing. Occupational group, educational level and income are commonly used indicators for SES, but no single indicator can illustrate the entire complexity of SES. The aim was to investigate how different indicators of SES associate with current asthma, allergic and nonallergic, and asthmatic wheeze. In 2016, a random sample of the population aged 20-79 years in Northern Sweden were invited to a postal questionnaire survey, with 58% participating (n=6854). The survey data were linked to the national Integrated Database for Labour Market Research by Statistics Sweden for the previous calendar year, 2015. Included SES indicators were occupation, educational level and income. Manual workers had increased risk for asthmatic wheeze, and manual workers in service for current asthma, especially allergic asthma. Primary school education associated with nonallergic asthma, whereas it tended to be inversely associated with allergic asthma. Low income was associated with asthmatic wheeze. Overall, the findings were more prominent among women, and interaction analyses between sex and income revealed that women, but not men, with low income had an increased risk both for asthmatic wheeze and current asthma, especially allergic asthma. To summarise, the different indicators of socioeconomic status illustrated various aspects of associations between low SES and asthma and wheeze, and the most prominent associations were found among women.
Collapse
Affiliation(s)
- Christian Schyllert
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Caroline Stridsman
- Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Martin Andersson
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Steinar Krokstad
- HUNT Research Centre, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Helena Backman
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| |
Collapse
|
15
|
Stoleski S, Minov J, Karadzinska-Bislimovska J, Mijakoski D, Atanasovska A, Bislimovska D. Work-related Asthma in Crop Farmers. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The objective of the study was to evaluate the influence of occupational exposure on asthma development among crop farmers.
METHODS: A cross-sectional study was performed, comprising 87 crop farmers, and 80 office workers, matched by gender and age. Evaluation of subjects included completion of a standard questionnaire on chronic respiratory symptoms, spirometry tests, histamine challenge, serial peak expiratory flow rates (PEFR) measurements, and skin prick tests to occupational and common inhalant allergens.
RESULTS: The prevalence of chronic respiratory symptoms in the past 12 months was higher, while the mean values of spirometric parameters were lower in crop farmers. Sensitization to workplace and common inhalant allergens was similar in both groups, whereas frequencies of bronchial hyperresponsiveness (BHR) and asthma were non-significantly higher in crop farmers. The prevalence of allergic was significantly higher compared to non-allergic asthma in both groups. Asthma was registered in 8% of crop farmers and was significantly associated with atopy, and positive family history of asthma. Occupational allergic asthma (OA) was registered in 2.3% of crop farmers, while the frequency of work-aggravated asthma was 5.7%. A causal relationship between workplace and asthma, suggesting allergic OA, was documented in two crop farmers with asthma, based on serial PEFR monitoring, but specific workplace agent causing asthma in the affected subjects was not identified.
CONCLUSION: The obtained results can contribute in the detection of critical points for action, and serve as a predictive factor in the development of work-related asthma, indicating the need for reduction of adverse occupational exposures through adequate preventive measures, regular health examinations, obligatory use of respiratory protective equipment, and implementation of engineering controls.
Collapse
|
16
|
Chemicals inhaled from spray cleaning and disinfection products and their respiratory effects. A comprehensive review. Int J Hyg Environ Health 2020; 229:113592. [PMID: 32810683 DOI: 10.1016/j.ijheh.2020.113592] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
Spray cleaning and disinfection products have been associated with adverse respiratory effects in professional cleaners and among residents doing domestic cleaning. This review combines information about use of spray products from epidemiological and clinical studies, in vivo and in vitro toxicological studies of cleaning chemicals, as well as human and field exposure studies. The most frequent chemicals in spray cleaning and disinfection products were compiled, based on registrations in the Danish Product Registry. The chemicals were divided into acids, bases, disinfectants, fragrances, organic solvents, propellants, and tensides. In addition, an assessment of selected cleaning and disinfectant chemicals in spray products was carried out. Chemicals of concern regarding respiratory effects (e.g. asthma) are corrosive chemicals such as strong acids and bases (including ammonia and hypochlorite) and quaternary ammonium compounds (QACs). However, the evidence for respiratory effects after inhalation of QACs is ambiguous. Common fragrances are generally not considered to be of concern following inhalation. Solvents including glycols and glycol ethers as well as propellants are generally weak airway irritants and not expected to induce sensitization in the airways. Mixing of certain cleaning products can produce corrosive airborne chemicals. We discuss different hypotheses for the mechanisms behind the development of respiratory effects of inhalation of chemicals in cleaning agents. An integrative assessment is needed to understand how these chemicals can cause the various respiratory effects.
Collapse
|
17
|
Laditka JN, Laditka SB, Arif AA, Hoyle JN. Work-related asthma in the USA: nationally representative estimates with extended follow-up. Occup Environ Med 2020; 77:617-622. [PMID: 32404531 DOI: 10.1136/oemed-2019-106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/10/2020] [Accepted: 04/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life. METHODS We used the nationally representative Panel Study of Income Dynamics (1968-2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life. RESULTS The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18-65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk. CONCLUSION Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.
Collapse
Affiliation(s)
- James N Laditka
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah B Laditka
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Ahmed A Arif
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessica N Hoyle
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| |
Collapse
|
18
|
Ilgaz A, Moore VC, Robertson AS, Walters GI, Burge PS. Occupational asthma; the limited role of air-fed respiratory protective equipment. Occup Med (Lond) 2020; 69:329-335. [PMID: 31269209 DOI: 10.1093/occmed/kqz074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence-based reviews have found that evidence for the efficacy of respiratory protective equipment (RPE) in the management of occupational asthma (OA) is lacking. AIMS To quantify the effectiveness of air-fed RPE in workers with sensitizer-induced OA exposed to metal-working fluid aerosols in a car engine and transmission manufacturing facility. METHODS All workers from an outbreak of metal-working fluid-induced OA who had continuing peak expiratory flow (PEF) evidence of sensitizer-induced OA after steam cleaning and replacement of all metal-working fluid were included. Workers kept 2-hourly PEF measurements at home and work, before and after a strictly enforced programme of RPE with air-fed respirators with charcoal filters. The area-between-curve (ABC) score from the Oasys plotter was used to assess the effectiveness of the RPE. RESULTS Twenty workers met the inclusion criteria. Records were kept for a mean of 24.6 day shifts and rest days before and 24.7 after the institution of RPE. The ABC score improved from 26.6 (SD 16.2) to 17.7 (SD 25.4) l/min/h (P > 0.05) post-RPE; however, work-related decline was <15 l/min/h in only 12 of 20 workers, despite increased asthma treatment in 5 workers. CONCLUSIONS Serial PEF measurements assessed with the ABC score from the Oasys system allowed quantification of the effect of RPE in sensitized workers. The RPE reduced falls in PEF associated with work exposure, but this was rarely complete. This study suggests that RPE use cannot be relied on to replace source control in workers with OA, and that monitoring post-RPE introduction is needed.
Collapse
Affiliation(s)
- Aslihan Ilgaz
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK.,Department of Respiratory Disease, Middle East Technical University Medical Center, Cankaya, Ankara, Turkey
| | - Vicky C Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Gareth I Walters
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - P Sherwood Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| |
Collapse
|
19
|
Use of population data for assessing trends in work-related asthma mortality. Curr Opin Allergy Clin Immunol 2020; 19:98-104. [PMID: 30601151 DOI: 10.1097/aci.0000000000000508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. RECENT FINDINGS A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data. SUMMARY Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.
Collapse
|
20
|
Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, Murgia N, Naidoo RN, Reynolds CJ, Sigsgaard T, Torén K, Vinnikov D, Redlich CA. The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2020; 199:1312-1334. [PMID: 31149852 PMCID: PMC6543721 DOI: 10.1164/rccm.201904-0717st] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.
Collapse
|
21
|
Florath I, Glass DC, Rhazi MS, Parent ME, Fritschi L. Inter-rater Agreement Between Exposure Assessment Using Automatic Algorithms and Using Experts. Ann Work Expo Health 2020; 63:45-53. [PMID: 30304470 DOI: 10.1093/annweh/wxy084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/19/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To estimate the inter-rater agreement between exposure assessment to asthmagens in current jobs by algorithms based on task-based questionnaires (OccIDEAS) and by experts. Methods Participants in a cross-sectional national survey of exposure to asthmagens (AWES-Asthma) were randomly split into two subcohorts of equal size. Subcohort 1 was used to determine the most common asthmagen groups and occupational groups. From subcohort 2, a random sample of 200 participants was drawn and current occupational exposure (yes/no) was assessed in these by OccIDEAS and by two experts independently and then as a consensus. Inter-rater agreement was estimated using Cohen's Kappa coefficient. The null hypothesis was set at 0.4, because both the experts and the automatic algorithm assessed the exposure using the same task-based questionnaires and therefore an agreement better than by chance would be expected. Results The Kappa coefficients for the agreement between the experts and the algorithm-based assessments ranged from 0.37 to 1, while the agreement between the two experts ranged from 0.29 to 0.94, depending on the agent being assessed. After discussion by both experts the Kappa coefficients for the consensus decision and OccIDEAS were significantly larger than 0.4 for 7 of the 10 asthmagen groups, while overall the inter-rater agreement was greater than by chance (P < 0.0001). Conclusions The web-based application OccIDEAS is an appropriate tool for automated assessment of current exposure to asthmagens (yes/no), and requires less time-consuming work by highly-qualified research personnel than the traditional expert-based method. Further, it can learn and reuse expert determinations in future studies.
Collapse
Affiliation(s)
- Ines Florath
- School of Public Health, Curtin University, Perth, Australia
| | - Deborah C Glass
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Lin Fritschi
- School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|
22
|
Al Badri FM, Baatjies R, Jeebhay MF. Assessing the health impact of interventions for baker's allergy and asthma in supermarket bakeries: a group randomised trial. Int Arch Occup Environ Health 2020; 93:589-599. [PMID: 31927662 DOI: 10.1007/s00420-019-01511-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the impact of an intervention for baker's allergy and asthma in supermarket bakeries. METHODS A group randomised trial conducted in 31 bakeries (n = 337 bakers) that were randomly assigned to one of two intervention groups (n = 244 bakers) and a control group (n = 93 bakers). Health data collected prior to and 1-year after the intervention included information obtained from an ECRHS questionnaire; tests for atopy and serum-specific IgE to cereal flours; fractional exhaled nitric oxide (FeNO). Data from the two intervention groups were combined to form one intervention group for purposes of the statistical analysis. RESULTS At 1 year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO > 25 ppb) was similar in both intervention and control groups. The mean FeNO difference was also similar across both groups (2.2 ppb vs 1.7 ppb, p = 0.86). In those with FeNO > 25 ppb at baseline, the decline was greater in the intervention compared to control group (16.9 ppb vs 7.7 ppb, p = 0.24). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO > 25 ppb) did not demonstrate an appreciable FeNO decline (≥ 10%) in the intervention compared to control group. However, stratification by the presence of work-related ocular-nasal symptoms in bakers at baseline demonstrated a significant FeNO decline (≥ 10%) in the intervention compared to the control group (OR 3.73, CI 1.22-11.42). CONCLUSION This study demonstrates some evidence of an intervention effect on FeNO 1 year after an intervention, particularly in bakers with work-related ocular-nasal symptoms.
Collapse
Affiliation(s)
- F M Al Badri
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Occupational Medicine Department, Armed Forces Medical Services, Muscat, Oman
| | - R Baatjies
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Department of Environmental and Occupational Studies, Cape Peninsula University of Technology (CPUT), Cape Town, South Africa
| | - Mohamed F Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.
| |
Collapse
|
23
|
Dumas O, Boggs KM, Quinot C, Varraso R, Zock J, Henneberger PK, Speizer FE, Le Moual N, Camargo CA. Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study. Am J Ind Med 2020; 63:44-50. [PMID: 31692020 DOI: 10.1002/ajim.23067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses. METHODS The Nurses' Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index. RESULTS Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence. CONCLUSIONS In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect.
Collapse
Affiliation(s)
- Orianne Dumas
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Krislyn M. Boggs
- Channing Division of Network Medicine, Department of MedicineBrigham & Women's Hospital and Harvard Medical SchoolBoston Massachusetts
- Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Catherine Quinot
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Raphaëlle Varraso
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Jan‐Paul Zock
- Barcelona Institute for Global Health (ISGlobal)Barcelona Spain
- Universitat Pompeu Fabra (UPF)Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP)Madrid Spain
| | - Paul K. Henneberger
- Respiratory Health DivisionNational Institute for Occupational Safety and HealthMorgantown West Virginia
| | - Frank E. Speizer
- Channing Division of Network Medicine, Department of MedicineBrigham & Women's Hospital and Harvard Medical SchoolBoston Massachusetts
| | - Nicole Le Moual
- INSERM, U1168, VIMA‐Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuif France
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le Bretonneux France
| | - Carlos A. Camargo
- Channing Division of Network Medicine, Department of MedicineBrigham & Women's Hospital and Harvard Medical SchoolBoston Massachusetts
- Department of Emergency MedicineMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
| |
Collapse
|
24
|
Henneberger PK, Kurth LM, Doney B, Liang X, Andersson E. Development of an Asthma-Specific Job Exposure Matrix for Use in the United States. Ann Work Expo Health 2020; 64:82-95. [PMID: 31746973 PMCID: PMC9990745 DOI: 10.1093/annweh/wxz089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/25/2019] [Accepted: 11/04/2019] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Existing asthma-specific job-exposure matrices (JEMs) do not necessarily reflect current working conditions in the USA and do not directly function with occupational coding systems commonly used in the USA. We initiated a project to modify an existing JEM to address these limitations, and to apply the new JEM to the entire US employed population to estimate quantitatively the extent of probable work-related asthma exposures nationwide. METHODS We started with an asthma-specific JEM that was developed for northern Europe (the N-JEM) and modified it to function with the 2010 US Standard Occupational Classification (SOC-2010) codes and to reflect working conditions in the USA during the post-2000 period. This involved cross walking from the 1988 International Standard Classification of Occupations (ISCO-88) codes used in the N-JEM to the SOC-2010 codes, transferring the N-JEM exposure assignments to the SOC-2010 codes, and modifying those assignments to reflect working conditions in the USA. The new US asthma JEM (USA-JEM) assigns exposures to 19 agents organized into five categories. The USA-JEM and N-JEM were applied to the same sample of working adults with asthma to compare how they performed, and the USA-JEM was also applied to the entire 2015 US working population to estimate the extent of occupational asthma exposures nationally. RESULTS The USA-JEM assigns at least one asthma-related probable exposure to 47.5% and at least one possible exposure to 14.9% of the 840 SOC-2010 detailed occupations, and 9.0% of the occupations have both probable exposure to at least one agent and possible exposure to at least one other agent. The USA-JEM has greater sensitivity for cleaning products, highly reactive disinfectants and sterilants, and irritant peak exposures than the N-JEM. When applied to the entire 2015 US working population, the USA-JEM determined that 42.6% of workers had probable exposure to at least one type of occupational asthma agent. DISCUSSION A new asthma-specific JEM for application in the USA was developed. Additional work is needed to compare its performance to similar JEMs and, if possible, to exposure assessments generated on a case-by-case basis.
Collapse
Affiliation(s)
- Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Laura M Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Brent Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Eva Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
25
|
Velasquez N, Moore JA, Boudreau RM, Mady LJ, Lee SE. Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol 2019; 10:175-182. [PMID: 31661614 DOI: 10.1002/alr.22477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous work has shown that chronic rhinosinusitis (CRS) severity may be associated with particulate matter 2.5 (PM2.5 ) and black carbon (BC) in CRS patients without nasal polyps (CRSsNP). Data regarding occupational exposures, however, are lacking. We assessed the impact of PM2.5 , BC, as well as occupational airborne exposure on CRS disease severity. METHODS Patients with CRS with nasal polyps (CRSwNP), CRSsNP, and aspirin-exacerbated respiratory disease (AERD) were identified from an institutionwide database. Spatial modeling from 37 pollutant monitoring sites in Allegheny County was used to estimate exposures. Patient occupations using the 2010 Standard Occupation Classification (SOC10) and airborne occupation exposures to vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) or diesel fumes were recorded. Disease severity was measured by modified Lund-Mackay score (LMS), systemic corticosteroid therapy, and incidence of functional endoscopic sinus surgery (FESS). RESULTS Two hundred thirty-four patients were included (CRSwNP, n = 113; CRSsNP, n = 96; AERD, n = 25). The prevalence of AERD among those with CRSwNP was 18%. Patients exposed to VGDFFiM or diesel fumes required higher steroid doses vs nonexposed patients (p = 0.015 and p = 0.03, respectively); patients with VGDFFiM levels >5% were more likely to undergo FESS vs nonexposed patients (p = 0.0378). There was no difference in PM2.5 and BC with regard to disease severity and FESS between CRSwNP, CRSsNP, and AERD patients. Steroid use was significantly higher in CRSwNP and AERD vs CRSsNP (p = 0.001). LMS was significantly higher in AERD as compared with CRSwNP and CRSsNP (p = 0.001). CONCLUSION Occupational airborne exposure to VGDFFiM correlated with increased prevalence of FESS and need for corticosteroids in CRS patients. There was no difference in PM2.5 and BC levels and disease severity outcome measures between CRS subtypes in this subset.
Collapse
Affiliation(s)
| | - John A Moore
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Stella E Lee
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
26
|
Henneberger PK, Patel JR, de Groene GJ, Beach J, Tarlo SM, Pal TM, Curti S. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev 2019; 10:CD006308. [PMID: 31593318 PMCID: PMC6781842 DOI: 10.1002/14651858.cd006308.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of workplace interventions on the outcome of occupational asthma is not well understood. OBJECTIVES To evaluate the effectiveness of workplace interventions on occupational asthma. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019. SELECTION CRITERIA We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. MAIN RESULTS We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes. AUTHORS' CONCLUSIONS Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.
Collapse
Affiliation(s)
- Paul K Henneberger
- National Institute for Occupational Safety and HealthRespiratory Health Division1095 Willowdale RoadMorgantownWest VirginiaUSA26505
| | - Jenil R Patel
- University of Texas School of Public HealthDepartment of Epidemiology, Human Genetics and Environmental Sciences1200 Pressler ST#W1004aHoustonTexasUSATX 77030
- University of Arkansas for Medical SciencesDepartment of Epidemiology4301 W Markham St, Slot#820Little RockArkansasUSA72205
| | - Gerda J de Groene
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Jeremy Beach
- University of AlbertaDepartment of MedicineEdmontonABCanada
| | - Susan M Tarlo
- University of TorontoDepartment of Medicine, and Dalla Lana School of Public HealthToronto Western Hospital EW7‐449399 Bathurst StTorontoONCanadaM5T 2S8
| | - Teake M Pal
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Stefania Curti
- University of BolognaDepartment of Medical and Surgical SciencesUO Medicina del Lavoro ‐ Policlinico Sant'Orsola‐MalpighiVia Palagi 9BolognaItaly40138
| | | |
Collapse
|
27
|
Li RWH, Lipszyc JC, Prasad S, Tarlo SM. Work-related asthma from cleaning agents versus other agents. Occup Med (Lond) 2019; 68:587-592. [PMID: 30423151 DOI: 10.1093/occmed/kqy137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Cleaning agents have been commonly implicated as causative or triggering factors in work-related asthma (WRA), mainly from epidemiologic studies. Relatively few clinical series have been reported. Aims We aimed to compare socio-demographic and clinical features among tertiary clinic patients with WRA exposed to cleaning and non-cleaning products. Methods Analyses were conducted on a patient database containing 208 patients with probable WRA referred to the asthma and airway centre at a tertiary centre hospital in Canada from 2000 to 2014. Chi-squared and independent samples t-tests were used to analyse categorical and continuous data, respectively. Results Twenty-two (11%) WRA cases were attributed to a variety of cleaning product exposures, 12 were diagnosed as occupational asthma (OA) and 10 as work-exacerbated asthma (WEA) (10% of all OA and 11% of all WEA). There were multiple exposures and the responsible agent(s) could seldom be clearly identified. Most frequent categories of exposure were surfactants, alcohols, disinfectants and acids. Compared to WRA with other exposures, those with cleaning agent exposures had a significantly larger proportion of females (82 versus 35%, P < 0.001), included a higher percentage of workers in healthcare (41 versus 4%, P < 0.001), and submitted more workers' compensation claims (86 versus 64%, P = 0.05). Other characteristics were comparable. Conclusions In a tertiary referral clinic, patients with WRA from cleaning agent exposure had clinical characteristics that were similar to those with WRA from other causes. Most frequent exposures were surfactants, alcohols, disinfectants and acids.
Collapse
Affiliation(s)
- R W H Li
- Toronto Western Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J C Lipszyc
- Toronto Western Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Prasad
- Toronto Western Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S M Tarlo
- Toronto Western Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Hachim MY, Hachim IY, Elemam NM, Hamoudi RA. Toxicogenomic analysis of publicly available transcriptomic data can predict food, drugs, and chemical-induced asthma. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:181-199. [PMID: 31692590 PMCID: PMC6717055 DOI: 10.2147/pgpm.s217535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/30/2019] [Indexed: 02/04/2023]
Abstract
Background : With the increasing incidence of asthma, more attention is focused on the diverse and complex nutritional and environmental triggers of asthma exacerbations. Currently, there are no established risk assessment tools to evaluate asthma triggering potentials of most of the nutritional and environmental triggers encountered by asthmatic patients. Purpose The objective of this study is to devise a reliable workflow, capable of estimating the toxicogenomic effect of such factors on key player genes in asthma pathogenesis. Methods Gene expression extracted from publicly available datasets of asthmatic bronchial epithelium were subjected to a comprehensive analysis of differential gene expression to identify significant genes involved in asthma development and progression. The identified genes were subjected to Gene Set Enrichment Analysis using a total of 31,826 gene sets related to chemical, toxins, and drugs to identify common agents that share similar asthma-related targets genes and signaling pathways. Results Our analysis identified 225 differentially expressed genes between severe asthmatic and healthy bronchial epithelium. Gene Set Enrichment Analysis of the identified genes showed that they are involved in response to toxic substances and organic cyclic compounds and are targeted by 41 specific diets, plants products, and plants related toxins (eg adenine, arachidonic acid, baicalein, caffeic acid, corilagin, curcumin, ellagic acid, luteolin, microcystin-RR, phytoestrogens, protoporphyrin IX, purpurogallin, rottlerin, and salazinic acid). Moreover, the identified chemicals share interesting inflammation-related pathways like NF-κB. Conclusion Our analysis was able to explain and predict the toxicity in terms of stimulating the differentially expressed genes between severe asthmatic and healthy epithelium. Such an approach can pave the way to generate a cost-effective and reliable source for asthma-specific toxigenic reports thus allowing the asthmatic patients, physicians, and medical researchers to be aware of the potential triggering factors with fatal consequences.
Collapse
Affiliation(s)
- Mahmood Yaseen Hachim
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ibrahim Yaseen Hachim
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Noha M Elemam
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Rifat A Hamoudi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates.,Division of Surgery and Interventional Science, University College London, London, UK
| |
Collapse
|
29
|
Walters GI, Burge PS, Sahal A, Robertson AS, Moore VC. Hospital Attendances and Acute Admissions Preceding a Diagnosis of Occupational Asthma. Lung 2019; 197:613-616. [PMID: 31256235 DOI: 10.1007/s00408-019-00249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Occupational exposures are a common cause of adult-onset asthma; rapid removal from exposure to the causative agent offers the best chance of a good outcome. Despite this, occupational asthma (OA) is widely underdiagnosed. We aimed to see whether chances of diagnosis were missed during acute hospital attendances in the period between symptom onset and the diagnosis of OA. METHODS Patients diagnosed with OA at the regional occupational lung disease service in Birmingham between 2007 and 2018 whose home address had a Birmingham postcode were included. Emergency department (ED) attendances and acute admission data were retrieved from acute hospitals in the Birmingham conurbation for the period between symptom onset and diagnosis. RESULTS OA was diagnosed in 406 patients, 147 having a Birmingham postcode. Thirty-four percent (50/147) had acute hospital attendances to a Birmingham conurbation hospital preceding their diagnosis of OA, including 35 (24%) with respiratory illnesses, which resulted in referral for investigation of possible OA in 2/35. The median delay between symptom onset and diagnosis of OA was 30 months (IQR = 13-60) and between first hospital attendance with respiratory illness and diagnosis 12 months (IQR = 12-48, range 3-96 months) CONCLUSIONS: The chance to reduce the delay in the diagnosis of OA was missed in 33/35 patients admitted or seen in ED with respiratory symptoms in the period between symptom onset and diagnosis of OA. The diagnosis of OA was delayed by a median of 12 months by failure to ask about employment and work relationship of symptoms.
Collapse
Affiliation(s)
- Gareth I Walters
- Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, 151 Great Charles Street, Birmingham, B3 3HX, UK. .,Occupational and Environmental Medicine, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - P Sherwood Burge
- Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, 151 Great Charles Street, Birmingham, B3 3HX, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Adeel Sahal
- Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Dudley Road, Birmingham, B18 7QH, UK
| | - Alastair S Robertson
- Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, 151 Great Charles Street, Birmingham, B3 3HX, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Vicky C Moore
- Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, 151 Great Charles Street, Birmingham, B3 3HX, UK
| |
Collapse
|
30
|
Influence of Childhood Asthma and Allergies on Occupational Exposure in Early Adulthood: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122163. [PMID: 31248069 PMCID: PMC6617119 DOI: 10.3390/ijerph16122163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
We aimed to determine whether history of asthma/allergies in childhood was associated with avoidance of jobs with exposure to asthmagens in early adulthood. The Melbourne Atopic Cohort Study recruited 620 children at high risk of allergic diseases at birth (1990–1994). Asthma, hay fever and eczema were evaluated by questionnaires during childhood. A follow-up in early adulthood (mean age: 18 years) collected information on the current job. Occupational exposure to asthmagens/irritants was evaluated using a job-exposure matrix. The association between history of asthma/allergies in childhood and working in a job with exposure to asthmagens/irritants was evaluated by logistic regression, adjusted for age, sex and parental education. Among 363 participants followed-up until early adulthood, 17% worked in a job with exposure to asthmagens/irritants. History of asthma (35%) was not associated with working in an exposed job (adjusted OR: 1.16, 95% CI: 0.65–2.09). Subjects with history of hay fever (37%) and eczema (40%) were more likely to enter exposed jobs (significant for hay fever: 1.78, 1.00–3.17; but not eczema: 1.62, 0.91–2.87). In conclusion, young adults with history of allergies were more likely to enter exposed jobs, suggesting no avoidance of potentially hazardous exposures. Improved counselling against high risk jobs may be needed for young adults with these conditions.
Collapse
|
31
|
Thapa N, Tomasi SE, Cox‐Ganser JM, Nett RJ. Non-malignant respiratory disease among workers in the rubber manufacturing industry: A systematic review and meta-analysis. Am J Ind Med 2019; 62:367-384. [PMID: 30775791 DOI: 10.1002/ajim.22959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-malignant respiratory disease (NMRD) cases have occurred among rubber manufacturing workers. We examined exposure to rubber manufacturing emissions as a risk factor for NMRD. METHODS From a systematic literature review, we identified case reports and assessed cross-sectional and mortality studies for strength of evidence of positive association (strong, intermediate, non-significant positive association, none) between exposure to rubber manufacturing emissions and NMRD-related morbidity and mortality, and conducted two meta-analyses. RESULTS We analyzed 62 articles. We identified 11 cases of NMRD. Nine (30%) of 30 cross-sectional studies and one (4%) of 26 mortality studies had strong evidence. The summary odds ratio and SMR for the cross-sectional and mortality meta-analyses were 3.83 (95% confidence interval [CI], 2.28-6.51) and 0.90 (95%CI, 0.82-0.99), respectively. CONCLUSION Available evidence supports rubber manufacturing emissions as a potential risk factor for NMRD-related morbidity. Further investigations with longer follow-up periods and inclusion of short-tenured workers could further define risks for NMRD and identify prevention strategies.
Collapse
Affiliation(s)
- Nirmala Thapa
- Respiratory Health DivisionNational Institute for Occupational Safety and Health (NIOSH)Centers for Disease Control and Prevention (CDC)MorgantownWest Virginia
| | - Suzanne E. Tomasi
- Respiratory Health DivisionNational Institute for Occupational Safety and Health (NIOSH)Centers for Disease Control and Prevention (CDC)MorgantownWest Virginia
- Epidemic Intelligence ServiceCenter for Surveillance, Epidemiology and Laboratory ServicesCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
| | - Jean M. Cox‐Ganser
- Respiratory Health DivisionNational Institute for Occupational Safety and Health (NIOSH)Centers for Disease Control and Prevention (CDC)MorgantownWest Virginia
| | - Randall J. Nett
- Respiratory Health DivisionNational Institute for Occupational Safety and Health (NIOSH)Centers for Disease Control and Prevention (CDC)MorgantownWest Virginia
| |
Collapse
|
32
|
Lee J, Kang YJ. Bermuda grass pollen allergen implicated in clinically relevant cross-reactivity to multiple grains: A case report. J Occup Health 2019; 61:128-134. [PMID: 30698335 PMCID: PMC6499365 DOI: 10.1002/1348-9585.12038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 12/05/2022] Open
Abstract
Background Anaphylaxis is a severe and potentially fatal type of allergic reaction and is characterized by the rapid development of symptoms in the respiratory and circulatory systems, possibly leading to death if not treated properly. Occupational anaphylaxis, which does not exhibit significant differences in pathogenesis from the nonoccupational form, develops in response to work‐related triggers. However, the onset of occupational anaphylaxis can also be triggered by other factors. Therefore, an unexpected episode may occur due to exposure to a previously sensitized antigen or cross‐reaction in the occupational environment, even if the direct trigger has been removed. Accordingly, it is difficult to diagnosis and treat such cases and ensure avoidance of potential triggers. Case presentation An adult male patient developed anaphylaxis following exposure to grass antigens while replacing and burying sewer pipes at a theme park. He later developed cross‐reactivity to other grains. Despite symptomatic treatment, his total serum level of allergen‐specific immunoglobulin E (Ig E) antibodies continuously increased, and thus, he was admitted with severe hypersensitivity, at which time his serum levels of Ig E antibodies specific for Bermuda grass, wheat, and rice had also increased. Conclusion In Korea, Bermuda grass is rarely seen and is generally found in athletic fields or theme parks. Following exposure to this relatively rare grass, our patient exhibited new anaphylactic responses to various external antigens. Therefore, we attribute his severe anaphylaxis to sensitization caused by Bermuda grass exposure and cross‐reactive hypersensitivity to other grains.
Collapse
Affiliation(s)
- Jihye Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Republic of Korea
| | - Young Joong Kang
- Department of Occupational and Environmental Medicine, COMWEL Incheon Hospital, Korea Workers' Compensation & Welfare Service, Incheon, Republic of Korea
| |
Collapse
|
33
|
LaSee CR, Reeb-Whitaker CK. Work-related asthma surveillance in Washington State: time trends, industry rates, and workers' compensation costs, 2002-2016. J Asthma 2019; 57:421-430. [PMID: 30701998 DOI: 10.1080/02770903.2019.1571084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Washington State's work-related asthma (WRA) surveillance program utilizes workers' compensation (WC) data as its primary data source and has spanned a 15-year time period. This study analyses trends for WRA claim incidence rates compared to all WC claim incidence rates. WRA claim incidence rates and WC costs are analyzed by industry. Methods: Potential WRA cases were identified through the WC system and through direct provider report and classified by industry, age, and year of illness onset. WRA claim rates by industry and year were calculated using total work hours reported by employers covered by the WC system. Claim costs for accepted claims were compared by industry and year. Results: WRA claim incidence rates decreased 8.9% (95% CI: -10.6, -7.2) annually for the time period 2002-2016. The decline in WRA claim incidence rate is slightly faster than the incidence rate for all WC claims which had its steepest decrease from 2007 to 2010 at an estimated annual 8.4% decrease (95% CI: -11.8, -5.0). WRA claim rates were highest for workers in Public Administration, Manufacturing, and the Agricultural, Forestry, Fishing and Hunting industries. Median claim costs for WRA did not change significantly by year (p = 0.2, range $595-$1442) and the distribution of WRA WC claim costs by industry were highest in Manufacturing (21.3%) and Construction (16.4%) industries. Conclusion: WRA claim incidence rates are declining in Washington State. The cause for the decline is unclear. Workers across all industries in Washington remain at risk for WRA.
Collapse
Affiliation(s)
- Claire R LaSee
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP), Olympia, Washington, USA
| | - Carolyn K Reeb-Whitaker
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP), Olympia, Washington, USA
| |
Collapse
|
34
|
Taponen S, Uitti J, Karvala K, Luukkonen R, Lehtimäki L. Asthma diagnosed in late adulthood is linked to work disability and poor employment status. Respir Med 2019; 147:76-78. [PMID: 30704704 DOI: 10.1016/j.rmed.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Age at asthma onset is associated with severity and outcomes of the disease. OBJECTIVE We studied if age at asthma diagnosis is related to employment and outcomes in working career. PATIENTS AND METHODS A questionnaire was sent to 2613 adults with asthma in Tampere, Finland, and a follow-up questionnaire was sent after six years. Asthmatics were divided into groups based on their employment status: working full-time or work disability. Logistic regression was used to study the association of age at asthma diagnosis with employment status at baseline and with the risk of exiting full-time work during follow-up period. RESULTS In cross-sectional analysis, asthma diagnosed in late adulthood (50 + years) was associated with higher OR for having work-disability compared to childhood onset asthma (OR [95% CI] 3.60 [1.43-9.06]). During follow-up, asthma diagnosed in late adulthood was associated with higher OR for exiting full time work compared to childhood-onset asthma (OR 10.87 [3.25-36.40]). CONCLUSIONS Asthma diagnosed in late adulthood is a higher risk for poor employment than asthma diagnosed earlier in life. Adult-onset of asthma is an important factor in view of work ability and early rehabilitation procedures.
Collapse
Affiliation(s)
- Saara Taponen
- Valmet Occupational Health, Valmet Technologies Inc., Lentokentänkatu 11, 33101 Tampere, Finland; Faculty of Medicine and Life Sciences, 33014 University of Tampere, Tampere, Finland.
| | - Jukka Uitti
- Faculty of Medicine and Life Sciences, 33014 University of Tampere, Tampere, Finland; Finnish Institute of Occupational Health, PO Box 40, 00251, Helsinki, Finland.
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, PO Box 40, 00251, Helsinki, Finland.
| | - Ritva Luukkonen
- Clinicum, Faculty of Medicine, PO Box 63, 00014, University of Helsinki, Finland.
| | - Lauri Lehtimäki
- Faculty of Medicine and Life Sciences, 33014 University of Tampere, Tampere, Finland; Allergy Centre, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland.
| |
Collapse
|
35
|
Ellis PR, Walters GI. Missed opportunities to identify occupational asthma in acute secondary care. Occup Med (Lond) 2019; 68:56-59. [PMID: 29165600 DOI: 10.1093/occmed/kqx167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Occupational asthma (OA) accounts for one in six cases of new-onset adult asthma. Despite this it remains under-recognized in the UK. Delayed and missed diagnoses of OA lead to poor health outcomes for workers at significant cost to the UK economy. The burden of occupational aetiology on hospital admissions with asthma is not known. Aims To measure how frequently medical professionals consider occupational aetiology in patients presenting to secondary care with acute asthma symptoms. Methods We reviewed electronic records of working-age patients with asthma symptoms, presenting to three sites at a large West Midlands acute hospital NHS trust. We searched emergency department (ED) and acute medical unit (AMU) admission documents, looking specifically at documentation of employment status, job role and work effect on symptoms. We also examined the effect of using a prompt for enquiry about occupation contained within the clerking pro-forma. Results We searched 100 ED and 100 AMU admission documents. Employment status was established in only 20-31% of patients and none were asked about the effect of their work on current asthma symptoms. The use of a clerking pro-forma, including a prompt for occupation, increased documentation to 63% from 10 to 14% where an enhanced pro-forma was not used. Conclusions Enquiry into employment status and work effect in working-age patients with asthma symptoms presenting to the ED and the AMU is poor. These may be missed opportunities to identify OA. We propose medical education about high-risk exposures and the use of pro-formas including prompts about occupational exposures.
Collapse
Affiliation(s)
- P R Ellis
- Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - G I Walters
- Regional NHS Occupational Lung Disease Service, Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| |
Collapse
|
36
|
Dharmage SC, Perret JL, Custovic A. Epidemiology of Asthma in Children and Adults. Front Pediatr 2019; 7:246. [PMID: 31275909 PMCID: PMC6591438 DOI: 10.3389/fped.2019.00246] [Citation(s) in RCA: 519] [Impact Index Per Article: 103.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and mortality in severe cases. We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while adult asthma is more common in women, and the reversal of this sex difference in prevalence occurs around puberty suggesting sex hormones may play a role in the etiology of asthma. The global epidemic of asthma that has been observed in both children and adults is still continuing, especially in low to middle income countries, although it has subsided in some developed countries. As a heterogeneous disease, distinct asthma phenotypes, and endotypes need to be adequately characterized to develop more accurate and meaningful definitions for use in research and clinical settings. This may be facilitated by new clustering techniques such as latent class analysis, and computational phenotyping methods are being developed to retrieve information from electronic health records using natural language processing (NLP) algorithms to assist in the early diagnosis of asthma. While some important environmental determinants that trigger asthma are well-established, more work is needed to define the role of environmental exposures in the development of asthma in both children and adults. There is increasing evidence that investigation into possible gene-by-environment and environment-by-environment interactions may help to better uncover the determinants of asthma. Therefore, there is an urgent need to further investigate the interrelationship between environmental and genetic determinants to identify high risk groups and key modifiable exposures. For children, asthma may impair airway development and reduce maximally attained lung function, and these lung function deficits may persist into adulthood without additional progressive loss. Adult asthma may accelerate lung function decline and increase the risk of fixed airflow obstruction, with the effect of early onset asthma being greater than late onset asthma. Therefore, in managing asthma, our focus going forward should be firmly on improving not only short-term symptoms, but also the long-term respiratory and other health outcomes.
Collapse
Affiliation(s)
- Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, United Kingdom
| |
Collapse
|
37
|
Lee JH, Kim SH, Choi Y, Trinh HKT, Yang EM, Ban GY, Shin YS, Ye YM, Izuhara K, Park HS. Serum Periostin Levels: A Potential Serologic Marker for Toluene Diisocyanate-Induced Occupational Asthma. Yonsei Med J 2018; 59:1214-1221. [PMID: 30450856 PMCID: PMC6240562 DOI: 10.3349/ymj.2018.59.10.1214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Toluene diisocyanate (TDI) is a leading cause of occupational asthma (OA). Periostin is a matricellular protein implicated in type 2 immunity-driven asthma. Its pathogenic role in TDI-OA has not been completely elucidated. The present study was performed to investigate the role of periostin in TDI-OA. MATERIALS AND METHODS Serum periostin levels were measured in subjects with TDI-OA, asymptomatic TDI-exposure controls (AECs), non-occupational asthmatics (NAs), and unexposed normal controls (NCs). To understand the mechanism by which TDI induces periostin production, primary small airway epithelial cells (SAECs) were cultured under stimulation of TDI and neutrophils from asthmatic patients. RESULTS Fifty-three subjects with TDI-OA, 71 AECs, 67 NAs, and 83 NCs were enrolled. Serum periostin levels were significantly higher in TDI-OA subjects than in AECs (p=0.001), NAs (p<0.001), and NCs (p<0.001). In TDI-exposed subjects (TDI-OA and AEC), the PC₂₀ methacholine levels were significantly lower in subjects with a higher periostin level than in those with a lower periostin level. TDI exposure did not increase periostin production directly by SAECs; however, periostin production increased significantly after co-culture with TDI and neutrophils, which was suppressed by an antioxidant. In addition, increased release of TGF-β1 was noted from SAECs when exposed to TDI and neutrophils, which was also suppressed by an antioxidant. CONCLUSION These results suggest that an increased periostin level may contribute to the progression of airway inflammation to remodeling in TDI-exposed workers. A high serum periostin level is a potential serologic marker of the phenotype of TDI-OA.
Collapse
Affiliation(s)
- Ji Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Youngwoo Choi
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Yang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
38
|
Pedersen JE, Ugelvig Petersen K, Ebbehøj NE, Bonde JP, Hansen J. Risk of asthma and chronic obstructive pulmonary disease in a large historical cohort of Danish firefighters. Occup Environ Med 2018; 75:871-876. [PMID: 30323012 DOI: 10.1136/oemed-2018-105234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Firefighters are exposed to numerous respiratory hazards, but large studies on the risk of pulmonary disease are scarce. The objective of this study was to examine incidence of asthma and chronic obstructive pulmonary disease (COPD) in a nationwide cohort of Danish firefighters. METHODS We used individual historical employment records on 11 968 Danish male firefighters primarily supplied by trade unions and fire agencies. Furthermore, we used the Supplementary Pension Fund Register to form an occupational reference group consisting of military employees. Information on respiratory incidence was retrieved from the nationwide Danish National Patient Registry. Age and calendar time standardised incidence ratio (SIR) and Poisson regression analyses (incidence rate ratio) were used for estimation of risks, including 95% CIs. RESULTS Compared with military employees, the overall age and calendar-time adjusted risk for asthma was significantly increased among full-time firefighters (SIR=1.58, 95% CI 1.32 to 1.88), but not among part-time/volunteer firefighters. Full-time firefighters' risk for asthma did not vary by duration of employment. No consistent evidence of an increased risk for chronic obstructive pulmonary disease was detected. CONCLUSION Danish firefighters have an increased risk of asthma, but the causes, whether occupational or not, remain to be established.
Collapse
Affiliation(s)
- Julie Elbæk Pedersen
- The Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, Denmark
| | - Kajsa Ugelvig Petersen
- The Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, Denmark
| | - Niels Erik Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Johnni Hansen
- The Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, Denmark
| |
Collapse
|
39
|
Caridi MN, Humann MJ, Liang X, Su FC, Stefaniak AB, LeBouf RF, Stanton ML, Virji MA, Henneberger PK. Occupation and task as risk factors for asthma-related outcomes among healthcare workers in New York City. Int J Hyg Environ Health 2018; 222:211-220. [PMID: 30327176 DOI: 10.1016/j.ijheh.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/23/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies have suggested an association of asthma onset and exacerbation with cleaning and disinfecting activities in a number of industries, including healthcare. The objective of the current study was to investigate the association of asthma and related outcomes with occupations and tasks in urban healthcare workers in the United States. METHODS A questionnaire was implemented in a sample of workers from nine healthcare occupations in New York City. We used regression models to examine the association of post-hire asthma, current asthma, exacerbation of asthma, a symptom algorithm for bronchial hyper-responsiveness (BHR-related symptoms), a symptom-based asthma score, and the symptom wheeze with occupation and four healthcare tasks, while adjusting for other risk factors and potential confounders. RESULTS A total of 2030 participants completed the questionnaire. The task of cleaning fixed surfaces was significantly associated with most outcome variables, including current asthma (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.26-2.68), moderate exacerbation (OR = 3.10, 95% CI 1.25-7.67), and BHR-related symptoms (OR = 1.38, 95% CI 1.08-1.77). In comparison to nursing assistants, the occupations environmental service workers and registered nurses were at higher risk for current asthma, and licensed practical nurses were at higher risk for moderate exacerbation. Other tasks associated with outcomes were administering aerosolized medications with current asthma and moderate exacerbation, and sterilizing medical equipment with BHR-related symptoms. CONCLUSIONS These findings add to the growing body of evidence for the association of asthma with cleaning and other activities in healthcare. Further research is especially needed to investigate the association of asthma-related outcomes with exposure metrics based on tasks, products, and chemical exposures in healthcare.
Collapse
Affiliation(s)
- Morgan N Caridi
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Michael J Humann
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Feng-Chiao Su
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Aleksandr B Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Ryan F LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Marcia L Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Morgantown, WV, United States.
| |
Collapse
|
40
|
El-Zaemey S, Carey RN, Darcey E, Reid A, Glass DC, Driscoll TR, Crewe J, Abramson MJ, Si S, Benke G, Fritschi L. The prevalence of exposure to high molecular weight asthmagens derived from plants among workers in Australia. Am J Ind Med 2018; 61:824-830. [PMID: 30168149 DOI: 10.1002/ajim.22903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Limited information is available on exposure to high molecular weight (HMW) asthmagens derived from plants and on the main occupations and tasks that result in such exposure among workers. METHODS Data were collected as part of the Australian Work Exposures Study-Asthma. We estimated adjusted prevalence ratios (aPR) using modified Poisson regression models to determine which factors were associated with exposure. RESULTS A 12.8% of 4878 workers were exposed to HMW asthmagens derived from plants. The highest prevalence of exposure was found among farmers/animal workers, education workers, and food processing workers. The main circumstances of exposure were through handling flour, freesias, or through raising livestock. Exposure was more common among female workers (aPR = 1.26, 1.10-1.43) than males, while it was lower among workers born overseas (aPR = 0.70, 0.57-0.86) than those born in Australia. CONCLUSION Prevention of exposure to HMW asthmagens derived from plants requires a broad strategy targeting different tasks and occupations.
Collapse
Affiliation(s)
- Sonia El-Zaemey
- School of Public Health; Curtin University; Bentley Western Australia Australia
| | - Renee N. Carey
- School of Public Health; Curtin University; Bentley Western Australia Australia
| | - Ellie Darcey
- School of Public Health; Curtin University; Bentley Western Australia Australia
| | - Alison Reid
- School of Public Health; Curtin University; Bentley Western Australia Australia
| | - Deborah C. Glass
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Tim R. Driscoll
- School of Public Health; University of Sydney; Sydney New South Wales Australia
| | - Julie Crewe
- Lions Eye Institute; Nedlands Western Australia Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Si Si
- School of Public Health; Curtin University; Bentley Western Australia Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Lin Fritschi
- School of Public Health; Curtin University; Bentley Western Australia Australia
| |
Collapse
|
41
|
New-Onset Asthma in Adults: What Does the Trigger History Tell Us? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:898-905.e1. [PMID: 30240884 DOI: 10.1016/j.jaip.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adult-onset asthma is an important asthma phenotype and, in contrast to childhood asthma, is often associated with specific triggers of onset. It is unknown whether these triggers correspond with specific phenotypic characteristics or predict a specific asthma outcome. OBJECTIVE To compare clinical, functional, and inflammatory characteristics between patients with different triggers of asthma onset, and relate these triggers to asthma outcome. METHODS Two hundred adults with recently diagnosed (<1 year) asthma were prospectively followed for 5 years. The trigger of asthma onset was patient reported and defined by the question: "What, in your opinion, elicited your asthma?" Asthma remission was defined as no asthma symptoms and no asthma medication use for ≥1 year. Kruskal-Wallis and Fisher's exact test were used to compare categories containing >10 patients. RESULTS Ten categories of triggers were identified, of which 5 contained >10 patients. Clinical and inflammatory characteristics and remission rates differed significantly between categories. "New allergic sensitization" (11%) was associated with mild atopic asthma and a relatively young age at onset; "pneumonia" (8%) with previous smoking, low IgE, and the highest remission rates (one third); "upper respiratory symptoms" (22%) with high exhaled NO and eosinophilia; "no trigger identified" (38%) did not show any specific characteristics; and "stressful life event" (7%) with high medication usage, low type 2 markers, and no disease remission. CONCLUSIONS Patients with adult-onset asthma can be characterized by the trigger that seemingly incited their asthma. These triggers might represent underlying mechanisms and may be important to phenotype patients and predict disease outcome.
Collapse
|
42
|
Winkel JS, Damkier P, Hallas J, Henriksen DP. Treatment with montelukast and antidepressive medication-a symmetry analysis. Pharmacoepidemiol Drug Saf 2018; 27:1409-1415. [PMID: 30136330 DOI: 10.1002/pds.4638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/26/2018] [Accepted: 07/17/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Leukotriene receptor antagonists are used in asthma and rhinitis treatment. Pharmacovigilance data have suggested an association between montelukast and depression, but the association has not been established in controlled study designs. We described the association between initiation of montelukast and depression, using prescriptions of antidepressants as a surrogate marker, and assessed whether the association was related to the underlying asthma disease. METHODS We performed a symmetry analysis, with a study period from January 1, 2000 to December 31, 2016, using 3 nationwide Danish registers. We included all adults, who filled their first prescription of montelukast and antidepressants within an interval of 1 year. In the absence of an association between montelukast and antidepressant use, a symmetrical distribution of prescriptions is expected before and after montelukast initiation (ie, a sequence ratio [rc ] of 1.0). We subcategorized the subjects after the severity of underlying asthma disease. RESULTS In total, 4450 subjects filled their first prescriptions of both montelukast and antidepressants within a 1-year interval: 2434 redeemed their first prescription of montelukast before antidepressants, and 2016 redeemed the medications in the opposite order (rc 1.21 [95% CI 1.14-1.28]). We found rc above unity in groups with long-acting asthma treatment, but no increase in antidepressant prescription, when stratifying by the asthma severity. CONCLUSION We found a weak association between the use of montelukast and the risk of being prescribed an antidepressant, unlikely to be of clinical relevance. Stratified analyses suggest that this association may relate to asthma, rather than to montelukast.
Collapse
Affiliation(s)
- Jane Sterndorff Winkel
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Daniel Pilsgaard Henriksen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
43
|
Domingos Neto J, Myung E, Murta G, Lima PR, Vieira A, Lessa LA, Carvalho BRTD, Buzzini R, Bernardo WM. Asthma and occupation: Diagnosis using serial peak flow measurements. ACTA ACUST UNITED AC 2018; 64:95-99. [PMID: 29641668 DOI: 10.1590/1806-9282.64.02.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
Affiliation(s)
| | - Eduardo Myung
- Associação Nacional de Medicina do Trabalho, São Paulo, SP, Brazil
| | - Guilherme Murta
- Associação Nacional de Medicina do Trabalho, São Paulo, SP, Brazil
| | | | - Anielle Vieira
- Associação Nacional de Medicina do Trabalho, São Paulo, SP, Brazil
| | | | | | | | | | | |
Collapse
|
44
|
Incidence of Occupational Asthma and Exposure to Toluene Diisocyanate in the United States Toluene Diisocyanate Production Industry. J Occup Environ Med 2018; 59 Suppl 12:S22-S27. [PMID: 29200135 PMCID: PMC5763544 DOI: 10.1097/jom.0000000000000890] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective This study examines asthma risk in facilities producing toluene diisocyanate (TDI). Methods A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures. Results The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV1). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68). Conclusions There is evidence that cumulative and peak exposures are associated with TDI-induced asthma.
Collapse
|
45
|
Tarlo SM, Arif AA, Delclos GL, Henneberger P, Patel J. Opportunities and obstacles in translating evidence to policy in occupational asthma. Ann Epidemiol 2018; 28:392-400. [PMID: 28434545 PMCID: PMC5953844 DOI: 10.1016/j.annepidem.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. METHODS In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. RESULTS AND CONCLUSIONS Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.
Collapse
Affiliation(s)
- Susan M Tarlo
- Department of Medicine, University Health Network, University of Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Ontario, Canada.
| | - Ahmed A Arif
- UNC Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| | | | - Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| |
Collapse
|
46
|
Schyllert C, Andersson M, Hedman L, Ekström M, Backman H, Lindberg A, Rönmark E. Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes. Eur Clin Respir J 2018; 5:1468715. [PMID: 29785256 PMCID: PMC5954483 DOI: 10.1080/20018525.2018.1468715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/13/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.
Collapse
Affiliation(s)
- Christian Schyllert
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden.,Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Magnus Ekström
- Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| |
Collapse
|
47
|
Comparison of Psychological, Quality of Life, Work-Limitation, and Socioeconomic Status Between Patients With Occupational Asthma and Work-Exacerbated Asthma. J Occup Environ Med 2018; 59:697-702. [PMID: 28692003 DOI: 10.1097/jom.0000000000001066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to compare psychological status, quality of life (QoL), work limitation, and socioeconomic status between patients with occupational asthma (OA) and work-exacerbated asthma (WEA). METHODS The following questionnaires were administered to participants: Beck anxiety and depression (II) inventories, Marks' Asthma Quality of Life Questionnaire, and Work Limitations Questionnaire. Cross-sectional analyses between OA and WEA subgroups were completed. RESULTS There were 77 participants. WEA subjects had a trend to higher anxiety scores (OA = 9.2 ± 8.0, WEA = 12.8 ± 8.3, P = 0.07, Cohen d = 0.4). Depression scores trended higher for those with WEA (OA = 9.6 ± 10.3, WEA = 13.4 ± 13.5, P = 0.2, Cohen d = 0.3). QoL was comparable between groups. WEA subjects had fewer work limitations (N = 50, OA = 25.1 ± 27.3, WEA = 20.6 ± 24.4, P = 0.56, Cohen d = 0.3) and OA subjects were more likely to have reduced income. CONCLUSION In a tertiary clinic, there were some modest differences for specific variables between OA and WEA subjects that may help inform management.
Collapse
|
48
|
Mazurek JM, Syamlal G. Prevalence of Asthma, Asthma Attacks, and Emergency Department Visits for Asthma Among Working Adults - National Health Interview Survey, 2011-2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:377-386. [PMID: 29621204 PMCID: PMC5889242 DOI: 10.15585/mmwr.mm6713a1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC
| | - Girija Syamlal
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC
| |
Collapse
|
49
|
Riviere S, Delmas MC, Iwatsubo Y. [Asthma and socioeconomic characteristics in France in 2012]. Rev Mal Respir 2018; 35:287-294. [PMID: 29602479 DOI: 10.1016/j.rmr.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prevalence of adult asthma is around 6-7% in France. This disease is multifactorial and is related in particular to occupational factors. Using data from The French Health, Health Care and Insurance Survey (ESPS), this study aimed to describe asthma prevalence in France according to socio-economic status in 2012. METHODS This analysis included the population aged 15 years and over. Current asthma, defined by a declaration of having asthma in the last 12 months, was analyzed according to socio-economic variables available in the ESPS survey. RESULTS Among the 23,047 subjects interviewed, 12,565 were included in the analysis. Current asthma frequency was 7.4%. Higher risk of asthma was observed in unemployed, non-qualified persons, with a lower income, or having free healthcare insurance. Regarding occupations, in men, trade and commerce employees, personal services employees and administrative employees were associated with a higher level of current asthma prevalence. CONCLUSIONS These results show that subjects with lower socio-economic status are more likely to suffer from asthma. New epidemiological tools in France, including cohorts (Constances, COSET) will be helpful to study more precisely the associations between asthma and occupational factors.
Collapse
Affiliation(s)
- S Riviere
- Santé publique France, 94415 Saint-Maurice, France.
| | - M-C Delmas
- Santé publique France, 94415 Saint-Maurice, France
| | - Y Iwatsubo
- Santé publique France, 94415 Saint-Maurice, France
| |
Collapse
|
50
|
Occupational exposure and asthma. Ann Allergy Asthma Immunol 2018; 120:468-475. [PMID: 29580845 DOI: 10.1016/j.anai.2018.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
|