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Araújo-Vila N, Toubes DR, Fraiz-Brea JA. The Age Factor in the Analysis of Occupational Risks in the Wood Industry. Healthcare (Basel) 2022; 10:healthcare10071355. [PMID: 35885881 PMCID: PMC9318104 DOI: 10.3390/healthcare10071355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Workers in the wood industry are continually exposed to a wide range of risks. Some risks are potentially high and may lead to serious work-related accidents or occupational diseases. It is a sector where physical work is predominant and where high-risk machinery is used. There is also the age factor, as the age of the workforce increases the risks of loss of skills, particularly physical skills. This study analyses the impact of age on the occupational safety and health management in the wood industry. To this end, a qualitative analysis was carried out through semi-structured in-depth interviews. A total of 52 interviews were conducted with wood-based entrepreneurs, occupational safety technicians and experts from Galicia (Spain). The results show that there is a growing concern to integrate the older group in occupational safety and health management due to the increasing work life. The older group is not the one with the greatest number of occupational accidents (8.3%), but rather the one that needs better working conditions in the face of physical deterioration, considering that a large proportion of senior workers is transferred to administrative tasks. Consequently, the proportion of older workers performing physical tasks, which are the tasks with the highest associated risk, is lower.
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2
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Abstract
PURPOSE OF REVIEW Baker's allergy and asthma continue to represent an important contributor of occupational asthma globally. This review identified recent studies related to the prevention of baker's allergy and asthma. RECENT FINDINGS Studies with respect to regulatory exposure standards, workplace control measures aimed at reduction of flour dust exposures, surveillance programmes (exposure monitoring, medical surveillance) and workplace information, education and training programmes were identified. SUMMARY Detailed knowledge on risk factors and detection methods to assess exposure and early identification of high-risk workers exist, but workplace control measures remain sub-optimal because they are rarely multifaceted. This is compounded by the lack of health-based exposure standards globally. Exposure level monitoring and medical surveillance are integral to assessing effectiveness of preventive strategies. Triage systems for optimizing the efficiency of medical surveillance programmes show promise, but need replication in different contexts. Future studies need to focus on evaluating the relevance and quantification of peak exposures in increasing risk; developing standardized respiratory questionnaires for medical surveillance; and further exploration of serial fractional exhaled nitric oxide (FeNO) measurements as an adjunct to allergic sensitization for the early identification of baker's asthma and assessing the long-term impact of interventions.
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3
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Tarlo SM, Quirce S. Impact of Identification of Clinical Phenotypes in Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3277-3282. [PMID: 32561498 DOI: 10.1016/j.jaip.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022]
Abstract
Phenotypic differences and similarities in the spectrum of occupational asthma (OA) subtypes reflect the underlying mechanisms of the diverse forms of the disease, and these phenotypes provide information as to diagnostic steps and approaches to management. In large part, the phenotype reflects the existence of immunologic mechanisms and the presence or absence of a specific IgE-antibody response to a work sensitizer. However, further differences occur between OA from high- and low-molecular-weight sensitizers (chemical sensitizers), which potentially might be relevant for nonoccupational asthma. Chemical sensitizers cause a specific response that is more likely to be a late asthmatic response and specific IgE can be identified only in a minority. Irritant-induced asthma is most easily recognized when it occurs with 1 or more high-level respiratory irritant exposure(s) but is also possible with chronic low-level exposures as in cleaners, farmers, and woodworkers, as suggested from epidemiologic studies. OA chronic obstructive pulmonary disease overlap is more common in older patients and with OA from low-molecular-weight sensitizers. Removal from exposure to the causative agent is currently advised for those with OA from sensitization: further studies with omalizumab and other biologic agents are needed to determine whether these might allow return to the same exposure.
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Affiliation(s)
- Susan M Tarlo
- Respiratory Division, Department of Medicine, University Health Network, Toronto Western Hospital, University of Toronto Department of Medicine and Dalla Lana Department of Public Health, Toronto, ON, Canada.
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases CIBERES, Madrid, Spain
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Abstract
PURPOSE OF REVIEW Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. RECENT FINDINGS Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). SUMMARY The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.
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Curti S, Mattioli S, Baldasseroni A, Farioli A, Zanardi F, Lodi V, de Groene GJ, Christiani DC, Violante FS. Interventions for primary prevention of occupational asthma. Hippokratia 2017. [DOI: 10.1002/14651858.cd009674.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stefania Curti
- University of Bologna; Department of Medical and Surgical Sciences; UO Medicina del Lavoro - Policlinico Sant'Orsola-Malpighi Via Palagi 9 Bologna Italy 40138
| | - Stefano Mattioli
- University of Bologna; Department of Medical and Surgical Sciences; UO Medicina del Lavoro - Policlinico Sant'Orsola-Malpighi Via Palagi 9 Bologna Italy 40138
| | - Alberto Baldasseroni
- Regione Toscana; CeRIMP - Centro Regionale Infortuni e Malattie Professionali; via di S.Salvi, 12 Palazzina 14 Firenze Italy 50135
| | - Andrea Farioli
- University of Bologna; Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology; UO Medicina del Lavoro - Policlinico Sant'Orsola Malpighi Via Palagi 9 Bologna Italy 40138
| | - Francesca Zanardi
- University of Bologna; Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology; UO Medicina del Lavoro - Policlinico Sant'Orsola Malpighi Via Palagi 9 Bologna Italy 40138
| | - Vittorio Lodi
- Policlinico Sant'Orsola-Malpighi; Unità Operativa Medicina del Lavoro; Via Palagi 9 Bologna Italy 40138
| | - Gerda J de Groene
- Coronel Institute of Occupational Health, Academic Medical Center; Netherlands Center of Occupational Diseases; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - David C Christiani
- Harvard School of Public Health; Environmental Health; 665 Huntington Avenue, Building I Room 1407 Boston Massachusetts USA 02115
| | - Francesco S Violante
- University of Bologna; Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology; UO Medicina del Lavoro - Policlinico Sant'Orsola Malpighi Via Palagi 9 Bologna Italy 40138
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Piney M, Llewellyn D, O'Hara R, Saunders J, Cocker J, Jones K, Fishwick D. Reducing isocyanate exposure and asthma risk in motor vehicle repair. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2015. [DOI: 10.1108/ijwhm-10-2014-0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Exposure to isocyanates was the leading cause of occupational asthma in the UK. Motor vehicle repair (MVR) bodyshop paint sprayers were at greatest risk, despite widespread use of air-fed breathing apparatus and ventilated booths. Most paint sprayers work in small and medium enterprises (SMEs). The purpose of the Health and Safety Executive (HSE) project, described in this paper, is to improve exposure control measures in at least 20 per cent of MVR bodyshops, and reduce the risk of occupational asthma. The paper aims to discuss this issue.
Design/methodology/approach
– A three-stranded plan consisted of: Safety and Health Awareness Days (SHADs); workplace inspections; and third-party stakeholder communications. The impact of various parts of the project were evaluated.
Findings
– Approximately 18 per cent of bodyshops in the UK attended one of 32 SHADs, following which over 90 per cent of delegates expressed an “intention to act” to improve exposure control measures. A local assessment showed that at least 50 per cent of bodyshops improved exposure control measures. An evaluation of 109 inspections found that enforcement action was taken at 40 per cent of visits. Third-party engagement produced a joint HSE-industry designed poster, new agreed guidance on spray booths and dissemination of SHAD material. Knowledge of booth clearance time has become widespread, and 85 per cent of booths now have pressure gauges. Biological monitoring data show that, post-SHAD, exposures were lower.
Originality/value
– A sustained national project using clear, relevant, tested messages delivered via different routes, had a sector-wide impact in bodyshops. It is probable that the project has improved isocyanate exposure control in at least 20 per cent of bodyshops. The generic lessons could be applied to other widespread SME businesses.
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El-Helaly M, Balkhy HH, Waseem K, Khawaja S. Respiratory symptoms and ventilatory function among health-care workers exposed to cleaning and disinfectant chemicals, a 2-year follow-up study. Toxicol Ind Health 2015; 32:2002-2008. [PMID: 26525910 DOI: 10.1177/0748233715610043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous cross-sectional studies have shown that exposure to cleaning chemicals among health-care workers (HCWs) is associated with respiratory disorders and ventilatory function changes. This study aimed to further explore this association using a longitudinal approach. A prospective 2-year follow-up study was carried out at a tertiary care hospital in Saudi Arabia from June 2012 to June 2014 among 56 nurses who were responsible for disinfection and sterilization of medical instruments and equipment. The workplaces of the participants were assessed for engineering, environmental, and safety control measures. Self-administered questionnaires were distributed to all participants to assess their exposure to cleaning chemicals and their medical history. Spirometric parameters were measured for all nurses in 2012 (baseline) and again in 2014 (follow-up). The prevalence of work-related respiratory symptoms did not increase significantly over this time. Among all the spirometric parameters, only forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio decreased significantly, and only 10.7% of participants who were exposed to cleaning chemicals for more than 10 years had FEV1 and FVC less than their longitudinal normal limits at the end of the study. Smoking and gender were associated with statistically significant decreases in some of the spirometric parameters. Our 2-year follow-up study did not demonstrate significant association between exposure to cleaning chemicals among HCWs and changes in the prevalence of work-related respiratory symptoms, but indicated early effects on ventilatory function among them. The study highlights the importance of periodic spirometry, proper work practices, and effective control measures to protect HCWs against potentially harmful workplace chemicals for disinfection and sterilization.
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Affiliation(s)
- Mohamed El-Helaly
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia .,Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hanan H Balkhy
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulla International Medical Research Center, King Saud University for Health Sciences, Riyadh, Saudi Arabia
| | - Khan Waseem
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sahdia Khawaja
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Clinical aspects of work-related asthma: past achievements, persistent challenges, and emerging triggers. J Occup Environ Med 2015; 56 Suppl 10:S40-4. [PMID: 25285975 DOI: 10.1097/jom.0000000000000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to address common clinical questions pertaining to work-related asthma (WRA). METHODS This review is based on a presentation on WRA at the American College of Chest Physicians Course on Clinical Aspects of Occupational and Environmental Lung Disease, held in Toronto in 2013, and supplemented by a PubMed search of publications to 2013. RESULTS Seven clinical questions are addressed in relation to definitions, causes, diagnosis, management and emerging triggers, and challenges of WRA. CONCLUSIONS Although knowledge is expanding in this area, there remain challenges and uncertainties, particularly in the prevention of WRA.
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9
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Tarlo SM. Trends in incidence of occupational asthma. Occup Environ Med 2015; 72:688-9. [PMID: 25896329 DOI: 10.1136/oemed-2015-102852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/25/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Susan M Tarlo
- Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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10
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Vandenplas O, Wiszniewska M, Raulf M, de Blay F, Gerth van Wijk R, Moscato G, Nemery B, Pala G, Quirce S, Sastre J, Schlünssen V, Sigsgaard T, Siracusa A, Tarlo SM, van Kampen V, Zock JP, Walusiak-Skorupa J. EAACI position paper: irritant-induced asthma. Allergy 2014; 69:1141-53. [PMID: 24854136 DOI: 10.1111/all.12448] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 01/18/2023]
Abstract
The term irritant-induced (occupational) asthma (IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA.
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Affiliation(s)
- O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - M. Wiszniewska
- Department of Occupational Diseases and Clinical Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Fédération de Médecine Translationnelle de Strasbourg; Strasbourg University; Strasbourg France
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - B. Nemery
- Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ); CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - V. Schlünssen
- Section of Environment, Occupation and Health; Department of Public Health; University of Aarhus; Aarhus Denmark
| | - T. Sigsgaard
- Section of Environment, Occupation and Health; Department of Public Health; University of Aarhus; Aarhus Denmark
| | - A. Siracusa
- Formerly Department of Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - S. M. Tarlo
- Department of Medicine and Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
- Respiratory Division; Toronto Western Hospital; Toronto ON Canada
- Gage Occupational and Environmental Health Unit; St Michael's Hospital; Toronto ON Canada
| | - V. van Kampen
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - J.-P. Zock
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Universitat Pompeu Fabra (UPF); Barcelona Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP); Madrid Spain
- Netherlands Institute of Health Services Research (NIVEL); Utrecht the Netherlands
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases and Clinical Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
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Baatjies R, Meijster T, Heederik D, Sander I, Jeebhay MF. Effectiveness of interventions to reduce flour dust exposures in supermarket bakeries in South Africa. Occup Environ Med 2014; 71:811-8. [PMID: 24899339 DOI: 10.1136/oemed-2013-101971] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RATIONALE A recent study of supermarket bakery workers in South Africa demonstrated that 25% of workers were sensitised to flour allergens and 13% had baker's asthma. Evidence on exposure reduction strategies using specifically designed interventions aimed at reducing the risk of baker's asthma is scarce. OBJECTIVES The aim of this study was to evaluate the effectiveness of different control measures to reduce airborne flour dust exposure using a randomised design. METHODS A group-randomised study design was used to assign 30 bakeries of a large supermarket chain store to two intervention groups and a control group, of which 15 bakeries were studied. Full-shift environmental personal samples were used to characterise exposure to flour dust and wheat and rye allergens levels pre-intervention (n=176) and post-intervention (n=208). RESULTS The overall intervention effect revealed a 50% decrease in mean flour dust, wheat and rye allergen exposure. The reduction in exposure was highest for managers (67%) and bakers (47%), and lowest for counterhands (23%). For bakers, the greatest reduction in flour dust was associated with control measures such as the use of the mixer lid (67%), divider oil (63%) or focused training (54%). However, the greatest reduction (80%) was observed when using a combination of all control measures. CONCLUSIONS A specially designed intervention strategy reduced both flour dust and allergen levels. Best results were observed when combining both engineering controls and training. Further studies will investigate the long-term health impact of these interventions on reducing the disease burden among this group of bakers.
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Affiliation(s)
- Roslynn Baatjies
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tim Meijster
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Dick Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr-University Bochum, Germany, Germany
| | - Mohamed F Jeebhay
- Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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12
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Abstract
Occupational asthma has been defined as asthma due to conditions attributable to work exposures, not to causes outside the workplace. This review focuses on current data on pathogenesis, evaluation, and management.
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Affiliation(s)
- Susan M Tarlo
- From the University Health Network, University of Toronto Department of Medicine and Dalla Lana School of Public Health, Toronto (S.M.T.); and Hôpital du Sacré Coeur de Montréal, Université de Montréal, Montreal (C.L.)
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13
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Abstract
BACKGROUND Occupational lung diseases remain common, and health surveillance is one approach used to assist identification of early cases. AIMS To identify areas of good practice within respiratory health surveillance and to formulate recommendations for practice. METHODS Published literature was searched since 1990 using a semi-systematic methodology. RESULTS A total of 561 documents were identified on Medline and Embase combined. Other search engines did not identify relevant documents that had not already been identified by these two main searches. Seventy-nine of these were assessed further and 36 documents were included for the full analysis. CONCLUSIONS Respiratory health surveillance remains a disparate process, even within disease type. A standard validated questionnaire and associated guidance should be developed. Lung function testing was common and generally supported by the evidence. Cross-sectional interpretation of lung function in younger workers needs careful assessment in order to best identify early cases of disease. More informed interpretation of the forced expiratory volume in 1 s/forced vital capacity ratio, for example by using a lower limit of normal for each worker, and of longitudinal lung function information is advised. Immunological tests appear useful in small groups of workers exposed to common occupational allergens. Education, training and improved occupational health policies are likely to improve uptake of health surveillance, to ensure that those who fail health surveillance at any point are handled appropriately.
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Affiliation(s)
- L Lewis
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
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15
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Folletti I, Zock JP, Moscato G, Siracusa A. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma 2013; 51:18-28. [PMID: 23931651 DOI: 10.3109/02770903.2013.833217] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Ilenia Folletti
- Occupational Allergology Unit, Department of Clinical and Experimental Medicine, University of Perugia , Perugia , Italy
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16
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Jares EJ, Baena-Cagnani CE, Gómez RM. Diagnosis of occupational asthma: an update. Curr Allergy Asthma Rep 2013; 12:221-31. [PMID: 22467203 DOI: 10.1007/s11882-012-0259-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, "Does asthma improve away from work?" is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.
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Affiliation(s)
- Edgardo J Jares
- Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Pcia de Buenos Aires, Argentina.
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Papadopoulos NG, Agache I, Bavbek S, Bilo BM, Braido F, Cardona V, Custovic A, Demonchy J, Demoly P, Eigenmann P, Gayraud J, Grattan C, Heffler E, Hellings PW, Jutel M, Knol E, Lötvall J, Muraro A, Poulsen LK, Roberts G, Schmid-Grendelmeier P, Skevaki C, Triggiani M, Vanree R, Werfel T, Flood B, Palkonen S, Savli R, Allegri P, Annesi-Maesano I, Annunziato F, Antolin-Amerigo D, Apfelbacher C, Blanca M, Bogacka E, Bonadonna P, Bonini M, Boyman O, Brockow K, Burney P, Buters J, Butiene I, Calderon M, Cardell LO, Caubet JC, Celenk S, Cichocka-Jarosz E, Cingi C, Couto M, Dejong N, Del Giacco S, Douladiris N, Fassio F, Fauquert JL, Fernandez J, Rivas MF, Ferrer M, Flohr C, Gardner J, Genuneit J, Gevaert P, Groblewska A, Hamelmann E, Hoffmann HJ, Hoffmann-Sommergruber K, Hovhannisyan L, Hox V, Jahnsen FL, Kalayci O, Kalpaklioglu AF, Kleine-Tebbe J, Konstantinou G, Kurowski M, Lau S, Lauener R, Lauerma A, Logan K, Magnan A, Makowska J, Makrinioti H, Mangina P, Manole F, Mari A, Mazon A, Mills C, Mingomataj E, Niggemann B, Nilsson G, Ollert M, O'Mahony L, O'Neil S, Pala G, Papi A, Passalacqua G, Perkin M, Pfaar O, Pitsios C, Quirce S, Raap U, Raulf-Heimsoth M, Rhyner C, Robson-Ansley P, Alves RR, Roje Z, Rondon C, Rudzeviciene O, Ruëff F, Rukhadze M, Rumi G, Sackesen C, Santos AF, Santucci A, Scharf C, Schmidt-Weber C, Schnyder B, Schwarze J, Senna G, Sergejeva S, Seys S, Siracusa A, Skypala I, Sokolowska M, Spertini F, Spiewak R, Sprikkelman A, Sturm G, Swoboda I, Terreehorst I, Toskala E, Traidl-Hoffmann C, Venter C, Vlieg-Boerstra B, Whitacker P, Worm M, Xepapadaki P, Akdis CA. Research needs in allergy: an EAACI position paper, in collaboration with EFA. Clin Transl Allergy 2012; 2:21. [PMID: 23121771 PMCID: PMC3539924 DOI: 10.1186/2045-7022-2-21] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/23/2012] [Indexed: 12/16/2022] Open
Abstract
In less than half a century, allergy, originally perceived as a rare disease, has become a major public health threat, today affecting the lives of more than 60 million people in Europe, and probably close to one billion worldwide, thereby heavily impacting the budgets of public health systems. More disturbingly, its prevalence and impact are on the rise, a development that has been associated with environmental and lifestyle changes accompanying the continuous process of urbanization and globalization. Therefore, there is an urgent need to prioritize and concert research efforts in the field of allergy, in order to achieve sustainable results on prevention, diagnosis and treatment of this most prevalent chronic disease of the 21st century.The European Academy of Allergy and Clinical Immunology (EAACI) is the leading professional organization in the field of allergy, promoting excellence in clinical care, education, training and basic and translational research, all with the ultimate goal of improving the health of allergic patients. The European Federation of Allergy and Airways Diseases Patients' Associations (EFA) is a non-profit network of allergy, asthma and Chronic Obstructive Pulmonary Disorder (COPD) patients' organizations. In support of their missions, the present EAACI Position Paper, in collaboration with EFA, highlights the most important research needs in the field of allergy to serve as key recommendations for future research funding at the national and European levels.Although allergies may involve almost every organ of the body and an array of diverse external factors act as triggers, there are several common themes that need to be prioritized in research efforts. As in many other chronic diseases, effective prevention, curative treatment and accurate, rapid diagnosis represent major unmet needs. Detailed phenotyping/endotyping stands out as widely required in order to arrange or re-categorize clinical syndromes into more coherent, uniform and treatment-responsive groups. Research efforts to unveil the basic pathophysiologic pathways and mechanisms, thus leading to the comprehension and resolution of the pathophysiologic complexity of allergies will allow for the design of novel patient-oriented diagnostic and treatment protocols. Several allergic diseases require well-controlled epidemiological description and surveillance, using disease registries, pharmacoeconomic evaluation, as well as large biobanks. Additionally, there is a need for extensive studies to bring promising new biotechnological innovations, such as biological agents, vaccines of modified allergen molecules and engineered components for allergy diagnosis, closer to clinical practice. Finally, particular attention should be paid to the difficult-to-manage, precarious and costly severe disease forms and/or exacerbations. Nonetheless, currently arising treatments, mainly in the fields of immunotherapy and biologicals, hold great promise for targeted and causal management of allergic conditions. Active involvement of all stakeholders, including Patient Organizations and policy makers are necessary to achieve the aims emphasized herein.
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:150-6. [PMID: 21368622 DOI: 10.1097/aci.0b013e3283457ab0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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