Respiratory symptoms and pulmonary function among Chinese rice-granary workers

Chronic Cough Due to Stable Chronic Bronchitis: CHEST Expert Panel Report

BACKGROUND

Chronic cough due to chronic bronchitis (CB) causes significant impairment in quality of life, and effective treatment strategies are needed. We conducted a systematic review on the management of chronic cough due to CB to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic.

METHODS

This systematic review asked three questions: (1) What are the clinical features of the history that suggest a patient's cough-phlegm syndrome is due to CB? (2) Can treatment of stable CB improve or eliminate chronic cough? (3) Can therapy that targets chronic cough due to CB prevent or reduce the occurrence of acute CB exacerbations? Studies of adult patients with CB were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the CHEST organization methodology.

RESULTS

The search strategy used an assortment of descriptors and assessments to identify studies of chronic cough due to CB.

CONCLUSIONS

The evidence supporting the management of chronic cough due to CB is limited overall and of low quality. This article provides guidance on treatment by presenting suggestions based on the best currently available evidence and identifies gaps in our knowledge and areas for future research.

Evaluation of Dust Exposure among the Workers in Agricultural Industries in North-East India

This study aims to quantify dust exposure among the workers in four different industrial settings: rice mills, flour mills, oil mills, and tea factories and to compare the obtained data with the permissible exposure limit (PEL) of Indian Union Ministry of Labour as well as to compare the dust exposure across activities and seasons. RespiCon(TM) particle sampler was used for collecting dust concentration in the breathing zone of the workers. In total, 149 workers participated in the study and 204 samples were collected. Samples were collected in the vicinity of different processing operations. Samples in the rice mills were collected for two consecutive years in two seasons; however samples from other industries were collected for 1 year. The results indicate that geometric mean (GM) of dust exposure was significantly (P < 0.0001) different among industrial settings. Respirable dust were 8.22, 5.76, 2.98, and 6.34mg m(-3) and total dust exposure were 81.05, 111.02, 56.68, and 39.85mg m(-3) in the rice mills, oil mills, flour mills, and tea factories, respectively. Considerable variations in dust exposure were observed in different activities in the rice and oil mills; however variation was relatively less in the flour mills and tea factories. In the rice mills, dust concentration was higher in winter than those obtained in autumn and it is significantly different (P < 0.05) for inhalable dust and total dust. Positive correlation was obtained in thoracic dust (r (2) = 0.94) and inhalable dust (r (2) = 0.97) with total dust and thoracic dust with inhalable dust (r (2) = 0.89). The results show that majority of the workers are exposed to higher level of respirable dust as compared to the PEL, while total dust exposure to all the workers were higher than the PEL; thus, immediate reduction of dust exposure among the workers is necessary for preventing respiratory system impairment.

Past dust and GAS/FUME exposure and COPD in Chinese: the Guangzhou Biobank Cohort Study

The impact of occupational dust and gas/fume exposure on chronic obstructive pulmonary disease (COPD) in developing countries has not been quantified. We examined the relationship between past dust and fume exposure and prevalence of COPD and respiratory symptoms in a cross-sectional analysis of a large Chinese population sample. Participants in the Guangzhou Biobank Cohort Study (n = 8216; 27.3% men, mean age 61.9 ± 6.8 years) had spirometry and a structured interview including exposures, symptoms, and lifestyle. Self-reported intensity and duration of dust and gas/fume exposure was used to derive cumulative exposure. COPD was diagnosed from spirometry using lower limit of normal based on prediction equations. COPD was associated with high exposure to dust or gas/fume (exposed: 87/1206 v non-exposed: 191/3853; adjusted odds ratio: 1.41; 95% confidence interval (CI) 1.06, 1.87) with no evidence of effect modification by smoking. Respiratory symptoms were associated with exposures to dust and gas/fume, with adjusted odds ratios for chronic cough/phlegm of 1.57 (1.13, 2.17) and 1.39 (1.20, 1.60) for dyspnoea. The overall population attributable fraction for COPD due to occupational exposure was 10.4% (95% CI -0.9%, 19.5%). Occupational dust and gas/fume exposure is associated with an increased prevalence of COPD in this Chinese sample, independent of smoking. The population attributable fraction in Chinese is similar to that in Western populations.

Indoor mold, toxigenic fungi, and Stachybotrys chartarum: infectious disease perspective

Damp buildings often have a moldy smell or obvious mold growth; some molds are human pathogens. This has caused concern regarding health effects of moldy indoor environments and has resulted in many studies of moisture- and mold-damaged buildings. Recently, there have been reports of severe illness as a result of indoor mold exposure, particularly due to Stachybotrys chartarum. While many authors describe a direct relationship between fungal contamination and illness, close examination of the literature reveals a confusing picture. Here, we review the evidence regarding indoor mold exposure and mycotoxicosis, with an emphasis on S. chartarum. We also examine possible end-organ effects, including pulmonary, immunologic, neurologic, and oncologic disorders. We discuss the Cleveland infant idiopathic pulmonary hemorrhage reports in detail, since they provided important impetus for concerns about Stachybotrys. Some valid concerns exist regarding the relationship between indoor mold exposure and human disease. Review of the literature reveals certain fungus-disease associations in humans, including ergotism (Claviceps species), alimentary toxic aleukia (Fusarium), and liver disease (Aspergillys). While many papers suggest a similar relationship between Stachybotrys and human disease, the studies nearly uniformly suffer from significant methodological flaws, making their findings inconclusive. As a result, we have not found well-substantiated supportive evidence of serious illness due to Stachybotrys exposure in the contemporary environment. To address issues of indoor mold-related illness, there is an urgent need for studies using objective markers of illness, relevant animal models, proper epidemiologic techniques, and examination of confounding factors.