Toxin-induced Respiratory Distress

Occupational respiratory disorders in Iran: a review of prevalence and inducers

The link between occupational respiratory diseases (ORD) and exposure to harmful factors that are present in the workplace has been well shown. Factors such as physical activity, age and duration of occupational exposure playing important roles in ORD severity, should be identified in the workplace, their effects on workers health should be studied, and ultimately, exposure to them must be minimized. We carried out a literature review by searching PubMed, Scopus, and Web of Science databases to retrieve studies published from 1999 until the end of April 2023 reporting the prevalence and inducers of ORD in Iran. In Iranian workers, several ORD such as interstitial lung disease, silicosis, occupational asthma, pulmonary inflammatory diseases, chronic obstructive pulmonary diseases, and lung cancers have been reported. It was indicated that ORD mainly occur due to repeated and prolonged exposure to noxious agents in the workplace. We also extracted the prevalence of ORD in different regions of Iran from the retrieved reports. Based on our literature review, the prevalence of ORD among Iranian workers highlights the importance of regular assessment of the risk of exposure to noxious agents in the workplace to develop measures for preventing potential adverse effects.

Association of firefighting exposures with lung function using a novel job exposure matrix (JEM)

OBJECTIVES

Characterisation of firefighters' exposures to dangerous chemicals in smoke from non-wildfire incidents, directly through personal monitoring and indirectly from work-related records, is scarce. The aim of this study was to evaluate the association between smoke particle exposures (P) and pulmonary function.

METHODS

The study period spanned from January 2010 through September 2021. Routine firefighting P were estimated using fire incident characteristics, response data and emission factors from a novel job exposure matrix. Linear mixed effects modelling was employed to estimate changes in pulmonary function as measured by forced expiratory volume in one second (FEV1). Models controlled for age, race/ethnicity, height, smoking and weight.

RESULTS

Every 1000 kg P was associated with 13 mL lower FEV1 (β=-13.34; 95% CI=-13.98 to -12.70) over the entire 12-year follow-up period. When analysing exposures within 3 months before PFT measurements, 1000 kg P was associated with 27 mL lower FEV1 (β=-26.87; 95% CI=-34.54 to -19.20). When evaluating P estimated within 3 months of a pulmonary function test (PFT), stronger associations were observed among those most highly exposed to the World Trade Center (WTC) disaster (β=-12.90; 95% CI=-22.70 to -2.89); the association of cumulative exposures was similar for both highly and less highly exposed individuals.

DISCUSSION

Smoke particle exposures were observed to have modest short-term and long-term associations with pulmonary function, particularly in those who, previously, had high levels of WTC exposure. Future work examining the association between P and pulmonary function among non-WTC exposed firefighters will be essential for disentangling the effects of ageing, routine firefighting and WTC exposures.

Evaluation of nano-curcumin against inhaled paraquat-induced lung injury in rats

BACKGROUND

Acute lung injury (ALI) remains a significant source of morbidity and mortality in critically ill patients and currently there is no efficient therapy for this condition. The aim of this research was to evaluate the protective activity of nano-curcumin (nano-CU) as a natural anti-inflammatory and antioxidant agent, against inhaled paraquat (PQ)-induced lung injury.

METHODS

One group of rats was exposed to saline (control group, Ctrl) and six groups to PQ aerosol (54 mg/m³ on alternate days 8 times, each time for 30 min) treated with drinking water alone (group PQ), 2 and 8 mg/kg nano-CU (nano + CU(L) and nano + CU(H)), 5 mg/kg pioglitazone (PIO), nano-CU(L) + PIO or 0.03 mg/kg dexamethasone (Dexa) for 16 days after PQ exposure period. PIO and Dexa were intraperitoneal (ip) injected and nano-CU was administered orally (po), (6 rats in each group).

RESULTS

In the PQ group, total and differential WBC counts, malondialdehyde (MDA) in the bronchoalveolar lavage fluid (BALF), interferon gamma (INF-γ) and interleukin 10 (IL-10) levels in the lung tissues, lung pathological changes, and tracheal responsiveness were increased but the BALF thiol, catalase (CAT) and superoxide dismutase (SOD) levels were reduced. In treated groups with nano-CU(H) and PIO + nano-CU(L), all measured variables, in Dexa and nano-CU(L) treated groups, most variables and in the PIO group only a few variables were improved. The improvement of most variables in the PIO + nano-CU(L) group was significantly higher than in the PIO and nano-CU(L) groups alone.

CONCLUSIONS

Nano-CU ameliorated lung damage induced by inhaled PQ similar to dexa and a synergic effect between nano-CU and PIO was observed, suggesting, a possible PPAR-γ receptor-mediated effect of curcumin.

Development of a job-exposure matrix (JEM) for exposure to smoke particle mass among firefighters of the Fire Department of the City of New York (FDNY)

OBJECTIVES

A refined job exposure matrix (JEM) based on incident types and severities and response characteristics was developed for firefighters to estimate quantities of smoke particles emitted during structural and non-structural fire incidents from 2010 to 2021.

METHODS

The cohort included a subset of 3237 Fire Department of the City of New York firefighters who responded to at least one incident between 2010 and 2021, prior to retirement. Fire incident data included dates, type, severity (alarm level) and location. Response data included dates worked, firehouse, position titles and shift lengths for each firefighter. The quantity of smoke particle mass generated during structural and non-structural fires adjusted by individual firefighter engagement was computed using the United States Environmental Protection Agency AP-42 emissions framework. Correlations between years of employment, fire responses and career total particle mass concentration by firefighter were examined. Linear regression models were fit and corresponding R² values were calculated.

RESULTS

Firefighters responded to a median of 424.7 (IQR=202.3-620.0) annual incidents/person; 17.6% were fire incidents (median=77.1; IQR=40.4-114.0). Structural fires were the most common type of fire incident (72.5% of annual incidents/person; median=55.9; IQR=29.6-85.5). Incident severity (alarm level) and firefighter engagement (position title) appeared to differentiate between high and low exposure regimes (R²=0.43). Incident severity explained most of the variability of particle exposures (R²=0.90).

CONCLUSIONS

Using the JEM, job-related smoke particle concentrations were estimated to vary by incident type, incident severity and firefighter engagement, highlighting the importance of using refined measures, so that future studies can more accurately evaluate associations between firefighting and health outcomes.

Death After Poison Ivy Smoke Inhalation

ABSTRACT

Urushiol, the active antigen in poison ivy ( Toxicodendron radicans ), is frequently associated with type I and type III hypersensitivity reactions. These reactions most often result in cutaneous symptoms that vary in severity and may at times require medical interventions. Injuries involving other body systems associated with urushiol exposure are far less common. Here, we present 2 unrelated cases of urushiol respiratory exposure status after burning of poison ivy that resulted in cardiopulmonary arrest and ultimately death. In both cases, the history, circumstances, and autopsy findings are consistent with urushiol smoke inhalation having either caused or contributed to death. The cases are unique in that they represent the first cases of death related to poison ivy smoke exposure. Clinicians and forensic pathologists should be aware of the fact that urushiol smoke exposure may lead to morbidity and mortality.

Exposure to Ambient NO2 Increases the Risk of Dry Eye Syndrome in Females: An 11-Year Population-Based Study

Previous studies have indicated that women suffer from dry eye syndrome (DES) more significantly than men. Therefore, we specifically explore the associations between air pollutant levels and the risks of DES for women. The study obtained 27,605 participants from the 29 recruitment centers of the Taiwan Biobank, which was established in October 2012. A large scale cross-sectional study involving DES sufferers and age- and education-matched control groups without DES was designed. Based on the municipality of residence, the predicted concentration levels of various air pollutants, including PM_2.5, sulfur dioxide (SO₂), ozone (O₃), and nitrogen dioxide (NO₂) were estimated by using hybrid kriging/LUR model. Multiple logistic regressions were applied to estimate the prevalence ratios (PR) of DES and 95% confidence interval. Hormone supplementations, DBP, allergies, and arthritis were considered as important comorbidities for increased PR risk of DES. In addition, with each standard deviation (SD) increment of PM_2.5 and temperature, women had significant increases in PRs of DES of 1.09- and 1.07-fold, respectively; conversely, each SD increment of relative humidity (RH) had a protective effect against the risk of DES. After considering hormone supplementation, arthritis, and allergy, the SD increment of NO₂ and temperature were associated with the PRs of DES. In conclusion, significant associations of ambient NO₂ concentration, RH and temperature with DES indicated the importance of increased environmental protection in the female population. Female exposure to high levels of NO₂ when receiving hormone supplementation, or suffering with allergies or arthritis, had significantly increased risk of DES.

Physicochemical studies of direct interactions between lung surfactant and components of electronic cigarettes liquid mixtures

Direct physicochemical interactions between the major components of electronic cigarette liquids (e-liquids): glycerol (VG) and propylene glycol (PG), and lung surfactant (LS) were studied by determining the dynamic surface tension under a simulated breathing cycle using drop shape method. The studies were performed for a wide range of concentrations based on estimated doses of e-liquid aerosols (up to 2500 × the expected nominal concentrations) and for various VG/PG ratios. The results are discussed as relationships among mean surface tension, surface tension amplitude, and surface rheological properties (dilatational elasticity and viscosity) versus concentration and composition of e-liquid. The results showed that high local concentrations (>200 × higher than the estimated average dose after a single puffing session) may induce measurable changes in biophysical activity of LS; however, only ultra-high e-liquid concentrations inactivated the surfactant. Physiochemical characterization of e-liquids provide additional insights for the safety assessment of electronic nicotine delivery systems (ENDS).

ADMET Evaluation in Drug Discovery. Part 17: Development of Quantitative and Qualitative Prediction Models for Chemical-Induced Respiratory Toxicity

As a dangerous end point, respiratory toxicity can cause serious adverse health effects and even death. Meanwhile, it is a common and traditional issue in occupational and environmental protection. Pharmaceutical and chemical industries have a strong urge to develop precise and convenient computational tools to evaluate the respiratory toxicity of compounds as early as possible. Most of the reported theoretical models were developed based on the respiratory toxicity data sets with one single symptom, such as respiratory sensitization, and therefore these models may not afford reliable predictions for toxic compounds with other respiratory symptoms, such as pneumonia or rhinitis. Here, based on a diverse data set of mouse intraperitoneal respiratory toxicity characterized by multiple symptoms, a number of quantitative and qualitative predictions models with high reliability were developed by machine learning approaches. First, a four-tier dimension reduction strategy was employed to find an optimal set of 20 molecular descriptors for model building. Then, six machine learning approaches were used to develop the prediction models, including relevance vector machine (RVM), support vector machine (SVM), regularized random forest (RRF), extreme gradient boosting (XGBoost), naïve Bayes (NB), and linear discriminant analysis (LDA). Among all of the models, the SVM regression model shows the most accurate quantitative predictions for the test set (q²_ext = 0.707), and the XGBoost classification model achieves the most accurate qualitative predictions for the test set (MCC of 0.644, AUC of 0.893, and global accuracy of 82.62%). The application domains were analyzed, and all of the tested compounds fall within the application domain coverage. We also examined the structural features of the compounds and important fragments with large prediction errors. In conclusion, the SVM regression model and the XGBoost classification model can be employed as accurate prediction tools for respiratory toxicity.

Impact of acute exposure to WTC dust on ciliated and goblet cells in lungs of rats

Clinical studies and the World Trade Center (WTC) Health Registry have revealed increases in the incidence of chronic (non-cancer) lung disorders among first responders (FR) who were at Ground Zero during the initial 72 h after the collapse. Our previous analyses of rats exposed to building-derived WTC dusts using exposure scenarios/levels that mimicked FR mouth-breathing showed that a single WTC dust exposure led to changes in expression of genes whose products could be involved in the lung ailments, but few other significant pathologies. We concluded that rather than acting as direct inducers of many of the FR health effects, it was more likely inhaled WTC dusts instead may have impacted on toxicities induced by other rescue-related co-pollutants present in Ground Zero air. To allow for such effects to occur, we hypothesized that the alkaline WTC dusts induced damage to the normal ability of the lungs to clear inhaled particles. To validate this, rats were exposed on two consecutive days (2 h/d, by intratracheal inhalation) to WTC dust (collected 12-13 September 2001) and examined over a 1-yr period thereafter for changes in the presence of ciliated cells in the airways and hyperplastic goblet cells in the lungs. WTC dust levels in the lungs were assessed in parallel to verify that any changes in levels of these cells corresponded with decreases in host ability to clear the particles themselves. Image analyses of the rat lungs revealed a significant decrease in ciliated cells and increase in hyperplastic goblet cells due to the single series of WTC dust exposures. The study also showed there was only a nominal non-significant decrease (6-11%) in WTC dust burden over a 1-yr period after the final exposure. These results provide support for our current hypothesis that exposure to WTC dusts caused changes in airway morphology/cell composition; such changes could, in turn, have led to potential alterations in the clearance/toxicities of other pollutants inhaled at Ground Zero in the critical initial 72-h period.