Occupational asthma in the city of São Paulo, 1995-2000, with special reference to gender analysis

Does green mean clean? Volatile organic emissions from regular versus green cleaning products

Cleaning products emit a range of volatile organic compounds (VOCs), including some which are hazardous or can undergo chemical transformations to generate harmful secondary pollutants. In recent years, "green" cleaners have become increasingly popular, with an implicit assumption that these are better for our health and/or the environment. However, there is no strong evidence to suggest that they are better for indoor air quality compared to regular products. In this study, the VOC composition of 10 regular and 13 green cleaners was examined by headspace analysis. Monoterpenes were the most prevalent VOCs, with average total monoterpene concentrations of 8.6 and 25.0 mg L-1 for regular and green cleaners, respectively. Speciated monoterpene emissions were applied to a detailed chemical model to investigate the indoor air chemistry following a typical cleaning event. Green cleaners generally emitted more monoterpenes than regular cleaners, resulting in larger increases in harmful secondary pollutant concentrations following use, such as formaldehyde (up to 7%) and PAN species (up to 6%). However, emissions of the most reactive monoterpenes (α-terpinene, terpinolene and α-phellandrene), were observed more frequently from regular cleaners, resulting in a disproportionately large impact on the concentrations of radical species and secondary pollutants that were formed after cleaning occurred.

Airway inflammatory profile among cleaning workers from different workplaces

Background

Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles.

Methods

We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey—ECRS and the International Study of Asthma and Allergies in Childhood—ISAAC).

Results

Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group.

Conclusions

Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01949-5.

Work-related asthma

Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.

History of work-related health problems in a population-based sample of women: An exploratory factor analysis

BACKGROUND

Beyond the health-enhancing effects, work also has the potential of causing or worsening different health conditions in the same individual. However, research on within-worker aggregation of work-related health problems is scarce.

OBJECTIVE

To describe the history and aggregation of work-related health problems in a population-based sample of women.

METHODS

A total of 4330 women were asked whether they had ever had "a physical or mental health problem that was caused or made worse by your work". The aggregation of work-related health problems was assessed using an exploratory factor analysis.

RESULTS

Five groups were identified. Factor 1 included all items on musculoskeletal disorders - lower socioeconomic position, higher BMI, smokers and history of occupational accidents. Factor 2 included mental disorders together with headache and/or eyestrain - higher socioeconomic position. Factor 3 included the other disorders item with some loading from digestive disorders - older and public sector workers. Factor 4 included respiratory disorders - lower socioeconomic position and history of occupational accidents. Factor 5 included hearing and ear problems - blue-collar workers.

CONCLUSION

There was a relevant aggregation of work-related health problems, which may inform the selection of specific components for interventions that aim to improve women's work-related health.

Gender and occupational allergy: Report from the task force of the EAACI Environmental and Occupational Allergy Interest Group

Women's work has traditionally been considered less hazardous to health in comparison with men's work. The increased women's participation in the workforce has led to an increased attention to women's working conditions. Women and men are unequally represented in individual professions or sectors (horizontal segregation), with women also under-represented in leadership positions (vertical segregation). The selection of specific occupations can result in differences between types and levels of occupational exposures among women and men and can affect prevalence of occupational allergy. Gender distribution of work-related asthma appears to vary across countries without clear global difference. Occupational rhinitis tends to be higher in women, although is not clear if this is related to a sex/gender effect or to differences in work exposure. Women are more likely to have occupational contact dermatitis, mainly due to wet work. No clear effects of gender on rates of hypersensitivity pneumonitis have been shown. Besides variation in exposures, physical and physiological characteristics, different behaviours and health consciousness have an impact on the occupational health hazards of women and men. Occupational allergy health promotion strategies need to consider approaches for women and men adjusted by gender, and legislative actions similarly could be implemented in a more gender-sensitive way.

Occupational asthma: diagnostic challenges and management dilemmas

PURPOSE OF REVIEW

Work-related asthma encompasses both sensitizer-induced and irritant-induced occupational asthma as well as work-exacerbated asthma. This review summarizes current diagnostic and management strategies for occupational asthma.

RECENT FINDINGS

Occupational asthma is the most common occupational lung disease in the industrialized world. Over 400 agents have been described to cause occupational asthma. Specific inhalation challenge is often considered the reference method for diagnosis of occupational asthma but specific inhalation challenge as well as other diagnostic tests all generate false positive or false negative results. Definitive avoidance of the inciting agent is the preferred strategy for sensitizer-induced occupational asthma and reduction of exposure is the next best step. Immunotherapy is not currently well established and can cause systemic reactions.

SUMMARY

An accurate diagnosis made in a timely fashion can positively impact the health and socioeconomic burden associated with occupational asthma. Newer diagnostic tools are promising, but much work needs to be done to standardize and validate these testing methods. Primary, secondary, and tertiary prevention strategies are crucial for effective management of sensitizer-induced occupational asthma.

Identification and quantification of carbonyl-containing α-pinene ozonolysis products using O-tert-butylhydroxylamine hydrochloride

The yields of carbonyl-containing reaction products from the ozonolysis of α-pinene have been investigated using concentrations of ozone found in the indoor environment ([O₃] ≤ 100 ppb). An impinger was used to collect gas-phase oxidation products in water, where the derivatization agent O-tert-butylhydroxylamine hydrochloride (TBOX) and gas chromatography-mass spectrometry were used to identify carbonyl-containing species. Seven carbonyl-containing products were observed. The yield of the primary product, pinonaldehyde was measured to be 76 %. Using cyclohexane as a hydroxyl radical (OH) scavenger, the yield of pinonaldehyde decreased to 46 %, indicating the influence secondary OH radicals have on α-pinene ozonolysis products. Furthermore, the use of TBOX, a small molecular weight derivatization agent, allowed for the acquisition of the first mass spectral data of oxopinonaldehyde, a tricarbonyl reaction product of α-pinene ozonolysis. The techniques described herein allow for an effective method for the collection and identification of terpene oxidation products in the indoor environment.

Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies

OBJECTIVE

This article presents a systematic review of epidemiological studies linking cleaning work and risk of asthma and rhinitis.

METHODS

Published reports were identified from PubMed covering the years from 1976 through June 30, 2012. In total, we identified 24 papers for inclusion in the review. The quality of studies was evaluated using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist of 22 items for cross-sectional, cohort and case-control studies.

RESULTS

Increased risk of asthma or rhinitis has been shown in 79% of included epidemiological studies. In four studies the increased risk of asthma in cleaning workers was confirmed by objective tests, such as bronchial hyper-reactivity or airflow obstruction. Level of exposure to cleaning products, cleaning sprays, bleach, ammonia, mixing products and specific job tasks has been identified as specific causes of asthma and rhinitis.

CONCLUSIONS

Possible preventive measures encompass the substitution of cleaning sprays, bleach and ammonia, avoidance of mixing products, the use of respiratory protective devices, worker education and medical surveillance.

Cleaning Agents: The Divide – Human Friendly vs Environmentally Friendly

The choice of purchasing an environmentally friendly or “green” cleaning product appears to be one that consumers are increasingly happy to make, however the reality is that environmentally friendly cleaners may contain ingredients that can adversely affect those people suffering from asthma and allergies. Confirming that a product will not adversely affect a user is not straightforward, there is little point to a cleaning product that is harmless to the consumer but is ineffective in its cleaning performance. However, adhering to strict guidelines regarding allowable concentrations of chemicals and other constituents may allow consumers to purchase a product that is both human (and environment) friendly as well as being effective. We discuss the basis by which cleaners may be assessed for suitability for those with asthma and allergies.

Immunotoxicity and pulmonary toxicity induced by paints in Egyptian painters

Associations between painting, sensitization, and respiratory disease have received little attention, despite the extensive use of paint and paint removal products. The objectives of this study were to investigate the possible immunotoxicity and pulmonary toxicity induced by paints in Egyptian painter workers. This study was carried out on 60 adult males. Subjects were designated as controls (n = 30 healthy persons) or paint-exposed workers (n = 30). The controls and workers were then divided into four equal groups (15 individuals/group): Group I, Control group-never smoked; Group II, Smoker controls; Groups III, paint-exposed non-smoking workers; and Group IV, paint-exposed smoker workers. A complete physical examination, chest radiograph, and pulmonary function test (PFT) were performed with each subject. Serum levels of immunoglobulin (Ig) E and interleukin (IL)-4, -6, and -10, WBC sub-set counts, total numbers of WBC, and leukocyte differentials were also assessed. The pulmonary toxicity due to the paint exposures appeared in the form of allergic manifestations in the respiratory tract, significant reductions in FVC, FEV1, FEV1/FVC ratio and PEF parameters, and a reticular pattern in both lung fields. Immunotoxicity was evidenced by increases in total leukocyte levels, total lymphocytes, CD8(+) T-lymphocytes, B (CD19(+))-lymphocytes, NK (CD3(+)CD16(+)CD56(+)) cells, and eosinophils, as well as a significant decrease in CD4+ T-lymphocyte; there were also significant elevations in serum IgE, IL-4, and IL-6, and a significant reduction in IL-10, levels in these hosts. Based on these results, we assert that repeated paint exposure is associated with pulmonary and immune system toxicities that may lead to an augmentation of allergic diseases.

Trends in adult asthma hospitalization: gender-age effect

Background

Hospital admissions due to asthma are a reliable source of information on the morbidity of the disease which, after the increase observed in the last quarter of the last century, shows a declining trend in the last few years. The aim of this study was to look at hospital admission trends due to asthma in our community and analyze some of its associated factors.

Methods

Retrospective analysis of all hospital admissions involving adults aged 15 years and older with asthma as the primary or secondary diagnosis (if the first diagnosis was respiratory failure or respiratory infection) in Public Health Service hospitals in the Galician region of Spain between the years 1995-2009 (total 24,766 admissions).

Results

The majority of patients admitted were female (71%), over 60 years of age (64%), and admission occurred predominantly in the winter months. The hospitalization rate due to asthma tripled over the period studied, this being mainly accounted for by women aged over 60 years. Mean hospital stay was 9.2 days, longer in older patients or those admitted over the weekend.

Conclusions

A significant increase in hospital admissions due to asthma over the last few years has been observed in our community, mainly involving older women. The mean stay seems long, increasing with patients' age and admission over the weekend.

Associação de variáveis meteorológicas com os afastamentos do trabalho devido a doenças respiratórias: um estudo entre trabalhadores dos correios de Santa Catarina

INTRODUÇÃO: As doenças do aparelho respiratório (DAR) em trabalhadores são, com frequência, atribuídas ao ambiente de trabalho ou ao tipo de atividade. Poucos estudos relacionam as DAR com as condições de tempo. OBJETIVO: Este artigo tem como objetivo identificar a existência desta relação através da comparação da taxa de afastamento do trabalho com as médias mensais de variáveis meteorológicas. MÉTODOS: Para tanto, calculou-se a correlação dos afastamentos com as médias mensais de temperatura e umidade, com os valores mínimos mensais de temperatura e umidade e com a maior queda de temperatura em 24h ocorrida no mês. A série de dados meteorológicos com melhor correlação foi dividida em quartis (25%) para identificar os valores típicos de afastamento em situações extremas de temperatura ou umidade. Os afatamentos por DAR foram calculados em trabalhadores dos Correios de Santa Catarina e os dados meteorológicos foram obtidos da reanálise de modelos numéricos. O período analisado compreendeu janeiro de 2001 a dezembro de 2007, totalizando 84 meses. RESULTADOS: Os afastamentos do trabalho devido às DAR obtiveram melhor associação, em ordem de importância, com a temperatura média do mês, a temperatura mínima do mês e o maior declínio de temperatura do mês. Todas essas correlações obtiveram significância estatística de 0,1%. A umidade do ar não demonstrou associação com a taxa de afastamento. CONCLUSÃO: Conclui-se que as maiores taxas de afastamento do trabalho devido às DAR ocorrem nos meses mais frios e secos.

Reducing hazardous cleaning product use: a collaborative effort

Workplace hazards affecting vulnerable populations of low-wage and immigrant workers present a special challenge to the practice of occupational health. Unions, Coalition for Occupational Safety and Health (COSH) groups, and other organizations have developed worker-led approaches to promoting safety. Public health practitioners can provide support for these efforts. This article describes a successful multiyear project led by immigrant cleaning workers with their union, the Service Employees International Union (SEIU) Local 615, and with support from the Massachusetts COSH (MassCOSH) to address exposure to hazardous chemicals. After the union had identified key issues and built a strategy, the union and MassCOSH invited staff from the Massachusetts Department of Public Health's Occupational Health Surveillance Program (OHSP) to provide technical information about health effects and preventive measures. Results included eliminating the most hazardous chemicals, reducing the number of products used, banning mixing products, and improving safety training. OHSP's history of public health practice regarding cleaning products enabled staff to respond promptly. MassCOSH's staff expertise and commitment to immigrant workers allowed it to play a vital role.

An interdisciplinary analysis of sex and gender in relation to the pathogenesis of bronchial asthma

BACKGROUND

An increasing number of studies confirm that pathogenesis and prevalence of bronchial asthma are age and sex dependent. Detailed physiological mechanisms of the changing sex ratios with age are not fully known, however, the gender (socio-cultural) factors are also imperative. Although multiple factors definitely influence the pathogenesis of asthma, only individual or few combinations of these have been investigated.

METHODS

The terms 'sex', 'gender' and plausible combinations of both were systematically researched in selected databases (Medline, Scopus) or other sources, including publications from January 2000 to June 2007. Generated articles were categorized, either as endogenous or exogenous factors influencing the pathogenesis of asthma, and divided into the following subgroups: genetic, immunological, hormonal, gynaecological, nutritional, and environmental parameters.

RESULTS

An increasing number of studies investigate the influence of sex and gender in the aetiology, therapy and prevention of asthma. While their results are still debatable, others regarding its initiation, perpetuation and cessation have been clarified. Recent insights into interactions at biomolecular and immunological levels greatly contribute to clarifying sex-specific influences. Despite occasional oversimplifications, a trend for explanations considering the complex interplay of different factors can be observed. This work is in line with this trend and offers explanation models from our point of view.

CONCLUSIONS

Some disagreements regarding the patho-physiology, diagnosis, treatment and prevention of asthma still prevail. Nevertheless, in order to better appreciate its complexity, openness to and persistent consideration for interdisciplinary as well as sex- and gender-related factors is required of the medical-research community in future investigations.

[Occupational asthma]

Work-related asthma is one of the principal occupational respiratory diseases in terms of prevalence. Innumerable chemical substances used in various production processes can cause or aggravate occupational asthma. This chapter contains a brief description of the definition and classification of work-related asthma, as well as the epidemiological repercussions, natural course, diagnostic criteria, progression and legal aspects of the disease, with the objective of raising an alert regarding this disease and its implications for workers.

Rhinitis and asthma symptoms in non-domestic cleaners from the Sao Paulo metropolitan area, Brazil

BACKGROUND

Exposure to cleaning products has frequently been reported as a symptom trigger by workers with work-related asthma diagnosed in workers' health clinics in the city of São Paulo, Brazil.

OBJECTIVES

To estimate rhinitis and asthma symptoms prevalence and to analyse associated risk factors.

METHOD

A respiratory symptoms questionnaire (Medical Research Council 1976) and the International Study of Asthma and Allergies in Childhood questionnaire were applied to 341 cleaners working in the city of São Paulo, along with obtaining full occupational histories, skin prick tests and spirometry. Timing their symptoms onset in relation to occupational history allowed estimation of work-related asthma and/or rhinitis. Risk factors related to selected outcomes were analysed by logistic regression.

RESULTS

11% and 35% of the cleaners had asthma and rhinitis, respectively. The risk of work-related asthma/rhinitis increased with years of employment in non-domestic cleaning (OR 1.09, 95% CI 1.00 to 1.18, >0.92-3 years; OR 1.28, 95% CI 1.01 to 1.63, >3-6.5 years; OR 1.71, 95% CI 1.02 to 2.89, >6.5 years). Atopy was associated with asthma and rhinitis (OR 2.91, 95% CI 1.36 to 6.71; OR 2.06, 95% CI 1.28 to 3.35, respectively). There was a higher risk of rhinitis in women (OR 2.07, 95% CI 1.20 to 3.70).

CONCLUSIONS

Cleaning workers are at risk of contracting work-related asthma and/or rhinitis, and the risk increases with years of employment in non-domestic cleaning. Women present higher risk of rhinitis than men.

Occupation and adult-onset asthma among Chinese women in a population-based cohort

BACKGROUND

Exposure to industrial irritants is believed to have contributed to the increasing prevalence of asthma worldwide. We examined the associations between occupation and asthma among women in a case-control study nested in the population-based Shanghai Women's Health Study cohort in China.

METHODS

Cases were 1,050 women who reported a physician-diagnosed asthma as adults. Controls were 4,200 women matched to the cases by year of birth and age at diagnosis. Lifetime occupational histories were obtained. Logistic regression was applied to estimate odds ratios (ORs) adjusting for smoking, education, family income, and concurrent chronic bronchitis.

RESULTS

Asthma is more prevalent in production industries for metal tools (OR = 2.4; 1.3-4.7), metal products for everyday use (OR = 1.6; 1.1-2.4), ships (OR = 2.6; 1.0-6.8), and clocks (OR = 1.9; 1.0-3.4), and in occupations as farm workers (OR = 4.0; 1.2-13.0), laboratory technicians and analyzers (OR = 2.2; 1.2-3.9), and installation and maintenance workers for weaving and knitting machineries (OR = 2.4; 1.1-5.4). Other associations less commonly reported were identified for electricians (OR = 2.1; 1.1-4.1), performers (OR = 3.2; 1.4-7.4), administrative workers in organizations and enterprises (OR = 1.8; 1.1-2.8), and postal and telecommunication workers (OR = 3.5; 1.6-7.6).

CONCLUSIONS

Our findings suggest that occupational exposures contribute to the development of asthma in women.

The proportion of self-reported asthma associated with work in three States: California, Massachusetts, and Michigan, 2001

OBJECTIVES

To assess the proportion of adult asthma at the state level that may be related to work.

DESIGN

Work-related asthma questions were added to the 2001 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire in California, Massachusetts, and Michigan.

RESULTS

Findings indicate 7.4-9.7% of those with current asthma reported that their asthma may be work related. These results estimate that approximately 137,000 adults in California, 39,000 in Massachusetts, and 63,000 in Michigan have asthma that may be work related.

CONCLUSIONS

These findings are unique in providing population-based estimates at the state level that illustrate that a substantial portion of adult asthma morbidity is due to exposures in the work environment.

Control chart for monitoring occupational asthma

INTRODUCTION

Work-related asthma has become the most prevalent occupational respiratory disease in the developed world. Occupational asthma is thought to affect 5%-10% of people worldwide. The first step in the diagnosis of occupational asthma is to establish work-relatedness. Although considerable research has been conducted in the area of occupational asthma, no simple, effective, and statistically sound method has been developed that can be used as an initial step to effectively identify the workers at risk for occupational asthma. The purpose of this research was to investigate whether Shewhart control chart method can be used as an effective method to detect occupational asthma.

METHOD

Forty-five workers who completed the study and provided usable peak expiratory flow (a lung function marker) recordings while at work and away from work were included in this study. Control charts were developed using Shewhart's Method. The lower control limit of at work control chart (LCL(W)) was compared to each subject's Personal Best (PB) value.

RESULTS

Reviewing the results of this comparison showed LCL(W)<60% PB to have a sensitivity of 85.71%, specificity of 87.50%, and an error rate of 13.33%. When the subjects suspected for false positive and false negative diagnoses were identified, the test produced a sensitivity of 95.24%, a specificity of 95.83% and an error rate of 4.44%.

CONCLUSIONS

Our results were as good as, and in some cases better than, published clinical guidelines.

IMPACT ON INDUSTRY

Our research showed that the control chart method is an effective, simple, and inexpensive tool for early intervention in workers suspected for occupational asthma.

A population-based study of asthma, quality of life, and occupation among elderly Hispanic and non-Hispanic whites: a cross-sectional investigation

BACKGROUND

The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population.

METHODS

Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category), current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12), and various occupations.

RESULTS

The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3-7.2) and 9.0% (95%CI: 7.8-10.1) respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2-37.4) or probable asthma (35.3, 34.0-36.6) had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1-43.1). In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12-2.38) as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24-2.55) greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77-4.21) greater among current smokers as compared to non-smokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038). The odds of current asthma were significantly greater for farm-related occupations (adjusted OR = 2.09, 95%CI: 1.00-4.39); whereas the odds were significantly lower among those who reported teaching as their longest held occupation (adjusted OR = 0.36, 95%CI = 0.18-0.74).

CONCLUSION

This study found that asthma is a common medical condition in the elderly and it significantly impacts quality of life and general health status. Results support adopting an integrated approach in identifying and controlling asthma in this population.

Occupational asthma

Substantial epidemiologic and clinical evidence indicates that agents inhaled at work can induce asthma. In industrialized countries, occupational factors have been implicated in 9 to 15% of all cases of adult asthma. Work-related asthma includes (1) immunologic occupational asthma (OA), characterized by a latency period before the onset of symptoms; (2) nonimmunologic OA, which occurs after single or multiple exposures to high concentrations of irritant materials; (3) work-aggravated asthma, which is preexisting or concurrent asthma exacerbated by workplace exposures; and (4) variant syndromes. Assessment of the work environment has improved, making it possible to measure concentrations of several high- and low-molecular-weight agents in the workplace. The identification of host factors, polymorphisms, and candidate genes associated with OA is in progress and may improve our understanding of mechanisms involved in OA. A reliable diagnosis of OA should be confirmed by objective testing early after its onset. Removal of the worker from exposure to the causal agent and treatment with inhaled glucocorticoids lead to a better outcome. Finally, strategies for preventing OA should be implemented and their cost-effectiveness examined.

Women and occupational lung disease: sex differences and gender influences on research and disease outcomes

We have attempted to describe the current state of knowledge regarding occupational lung disease in women. A large section of this article was devoted to describing the methodologic challenges that face researchers when evaluating gender differences in occupational lung disease. The findings of the presented studies are likely limited by many of the methodologic problems that were identified earlier. To accurately identify the true risk of occupational lung disease in women workers, these findings must be replicated in future studies with special attention paid to the various aspects of occupational lung disease research that are susceptible to gender-related bias.