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Koskela K, Riitta S, Panu O, Jukka U, Eeva M, Lauri L. High alveolar nitric oxide is associated with steeper lung function decline in foundry workers. J Breath Res 2021; 15. [PMID: 33770784 DOI: 10.1088/1752-7163/abf272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/26/2021] [Indexed: 11/12/2022]
Abstract
Occupational dust exposure induces inflammatory responses that often precede the onset of clinical disease. Inflammation in the peripheral part of the lung can be demonstrated by measuring the alveolar NO concentration (CANO) in exhaled breath. The aim of the study was to assess whether cumulative dust exposure affects the change in CANO during follow-up and whether baseline CANO can predict an impairment in lung function during follow-up in foundry workers. We examined 74 dust-exposed and 42 nonexposed foundry workers and measured CANO and lung function at baseline and after 7 years of follow-up. An increase in CANO during the follow-up period was positively associated with cumulative dust exposure in foundry work (p= 0.035). Furthermore, a higher baseline CANO was associated with an accelerated decline in the forced vital capacity (FVC) during the follow-up period (absolute decrease in FVCp= 0.021, relative decrease in FVCp= 0.017). Higher cumulative dust exposure in foundry work is associated with a greater increase in CANO during follow-up, suggesting ongoing pulmonary inflammation in these subjects. Importantly, a high baseline CANO is associated with an accelerated decline in lung function, suggesting that CANO measurements might serve as a screening tool for high-risk workers.
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Affiliation(s)
- Kirsi Koskela
- Finnish Institute of Occupational Health, PO Box 486, FI-33101 Tampere, Finland.,The Outpatient Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
| | - Sauni Riitta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Oksa Panu
- Finnish Institute of Occupational Health, PO Box 486, FI-33101 Tampere, Finland
| | - Uitti Jukka
- Finnish Institute of Occupational Health, PO Box 486, FI-33101 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Moilanen Eeva
- The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University, and Tampere University Hospital, Tampere, Finland
| | - Lehtimäki Lauri
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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2
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Kotsiou OS, Gourgoulianis KI, Zarogiannis SG. The role of nitric oxide in pleural disease. Respir Med 2021; 179:106350. [PMID: 33662805 DOI: 10.1016/j.rmed.2021.106350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
Nitric oxide (NO) regulates various physiological and pathophysiological functions in the lungs. However, there is much less information about the effects of NO in the pleura. The present review aimed to explore the available evidence regarding the role of NO in pleural disease. NO, has a double-edged role in the pleural cavity. It is an essential signaling molecule mediating various physiological cell functions such as lymphatic drainage of the serous cavities, the immune response to intracellular multiplication of pathogens, and downregulation of neutrophil migration, but also induces genocytotoxic and mutagenic effects when present in excess. NO is implicated in the pathogenesis of asbestos-related or exudative pleural disease and mesothelioma. From a clinical point of view, the fraction of exhaled NO has been suggested as a potential non-invasive tool for the diagnosis of benign asbestos-related disorders. Under experimental conditions, NO-mimetics were found to attenuate hypoxia-induced therapy resistance in mesothelioma. Similarly, hybrid agents consisting of an NO donor coupled with a parent anti-inflammatory drug showed an enhancement of the anti-inflammatory activity of anti-inflammatory drugs. However, given the paucity of research work performed over the last years in this area, further research should be undertaken to establish reliable conclusions with respect to the feasibility of determining or targeting the NO signaling pathway for pleural disease diagnosis and therapeutic management.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece; Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
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3
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Lehtimäki L, Karvonen T, Högman M. Clinical Values of Nitric Oxide Parameters from the Respiratory System. Curr Med Chem 2021; 27:7189-7199. [PMID: 32493184 DOI: 10.2174/0929867327666200603141847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/24/2020] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FENO) concentration reliably reflects central airway inflammation, but it is not sensitive to changes in the NO dynamics in the lung periphery. By measuring FENO at several different flow rates one can estimate alveolar NO concentration (CANO), bronchial NO flux (JawNO), bronchial wall NO concentration (CawNO) and the bronchial diffusivity of NO (DawNO). OBJECTIVE We aimed to describe the current knowledge and clinical relevance of NO parameters in different pulmonary diseases. METHODS We conducted a systematic literature search to identify publications reporting NO parameters in subjects with pulmonary or systemic diseases affecting the respiratory tract. A narrative review was created for those with clinical relevance. RESULTS Estimation of pulmonary NO parameters allows for differentiation between central and peripheral inflammation and a more precise analysis of central airway NO output. CANO seems to be a promising marker of parenchymal inflammation in interstitial lung diseases and also a marker of tissue damage and altered gas diffusion in chronic obstructive pulmonary disease and systemic diseases affecting the lung. In asthma, CANO can detect small airway involvement left undetected by ordinary FENO measurement. Additionally, CawNO and DawNO can be used in asthma to assess if FENO is increased due to enhanced inflammatory activity (increased CawNO) or tissue changes related to bronchial remodelling (altered DawNO). CONCLUSION NO parameters may be useful for diagnosis, prediction of disease progression and prediction of treatment responses in different parenchymal lung and airway diseases. Formal trials to test the added clinical value of NO parameters are needed.
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Affiliation(s)
- Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Tuomas Karvonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, S-75185 Uppsala, Sweden
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Reference Ranges of 8-Isoprostane Concentrations in Exhaled Breath Condensate (EBC): A Systematic Review and Meta-Analysis. Int J Mol Sci 2020; 21:ijms21113822. [PMID: 32481492 PMCID: PMC7311981 DOI: 10.3390/ijms21113822] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Isoprostanes are physiopathologic mediators of oxidative stress, resulting in lipid peroxidation. 8-isoprostane seems particularly useful for measuring oxidative stress damage. However, no reference range values are available for 8-isoprosante in exhaled breath condensate (EBC) of healthy adults, enabling its meaningful interpretation as a biomarker. We conducted this systematic review and meta-analysis according to the protocol following PROSPERO (CRD42020146623). After searching and analyzing the literature, we included 86 studies. After their qualitative synthesis and risk of bias assessment, 52 studies were included in meta-analysis. The latter focused on studies using immunological analytical methods and investigated how the concentrations of 8-isoprostane differ based on gender. We found that gender had no significant effect in 8-isoprostane concentration. Among other studied factors, such as individual characteristics and factors related to EBC collection, only the device used for EBC collection significantly affected measured 8-isoprostane concentrations. However, adjustment for the factors related to EBC collection, yielded uncertainty whether this effect is due to the device itself or to the other factors. Given this uncertainty, we estimated the reference range values of 8-isoprostane stratified by gender and EBC collection device. A better standardization of EBC collection seems necessary; as well more studies using chemical analytical methods to extend this investigation.
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5
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Lassmann‐Klee PG, Lehtimäki L, Lindholm T, Malmberg LP, Sovijärvi AR, Piirilä PL. Converting F ENO by different flows to standard flow F ENO. Clin Physiol Funct Imaging 2019; 39:315-321. [PMID: 31058423 PMCID: PMC7003879 DOI: 10.1111/cpf.12574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/30/2019] [Indexed: 12/31/2022]
Abstract
In clinical practice, assessment of expiratory nitric oxide (FENO ) may reveal eosinophilic airway inflammation in asthmatic and other pulmonary diseases. Currently, measuring of FENO is standardized to exhaled flow level of 50 ml s-1 , since the expiratory flow rate affects the FENO results. To enable the comparison of FENO measured with different expiratory flows, we firstly aimed to establish a conversion model to estimate FENO at the standard flow level, and secondly, validate it in five external populations. FENO measurements were obtained from 30 volunteers (mixed adult population) at the following multiple expiratory flow rates: 50, 30, 100 and 300 ml s-1 , after different mouthwash settings, and a conversion model was developed. We tested the conversion model in five populations: healthy adults, healthy children, and patients with COPD, asthma and alveolitis. FENO conversions in the mixed adult population, in healthy adults and in children, showed the lowest deviation between estimatedF ^ ENO from 100 ml s-1 and measured FENO at 50 mL s-1 : -0·28 ppb, -0·44 ppb and 0·27 ppb, respectively. In patients with COPD, asthma and alveolitis, the deviation was -1·16 ppb, -1·68 ppb and 1·47 ppb, respectively. We proposed a valid model to convert FENO in healthy or mixed populations, as well as in subjects with obstructive pulmonary diseases and found it suitable for converting FENO measured with different expiratory flows to the standard flow in large epidemiological data, but not on individual level. In conclusion, a model to convert FENO from different flows to the standard flow was established and validated.
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Affiliation(s)
- Paul G. Lassmann‐Klee
- Unit of Clinical PhysiologyHelsinki University Central Hospital and University of HelsinkiHelsinkiFinland
| | - Lauri Lehtimäki
- Allergy CentreTampere University HospitalFaculty of Medicine and Health TechnologyUniversity of TampereTampereFinland
| | - Tuula Lindholm
- Department of Clinical PhysiologyFinnish Institute of Occupational HealthHelsinkiFinland
| | - Leo Pekka Malmberg
- Laboratory of Clinical PhysiologySkin and Allergy HospitalHelsinki University HospitalHelsinkiFinland
| | - Anssi R.A. Sovijärvi
- Unit of Clinical PhysiologyHelsinki University Central Hospital and University of HelsinkiHelsinkiFinland
| | - Päivi Liisa Piirilä
- Unit of Clinical PhysiologyHelsinki University Central Hospital and University of HelsinkiHelsinkiFinland
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6
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Brusselmans L, Arnouts L, Millevert C, Vandersnickt J, van Meerbeeck JP, Lamote K. Breath analysis as a diagnostic and screening tool for malignant pleural mesothelioma: a systematic review. Transl Lung Cancer Res 2018; 7:520-536. [PMID: 30450290 PMCID: PMC6204411 DOI: 10.21037/tlcr.2018.04.09] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a tumour related to a historical exposure to asbestos fibres. Currently, the definite diagnosis is made only by the histological examination of a biopsy obtained through an invasive thoracoscopy. However, diagnosis is made too late for curative treatment because of non-specific symptoms mainly appearing at advanced stage disease. Hence, due to its biologic aggressiveness and the late diagnosis, survival rate is low and the patients' outcome poor. In addition, radiological imaging, like computed tomographic scans, and blood biomarkers are found not to be sensitive enough to be used as an early diagnostic tool. Detection in an early stage is assumed to improve the patients' outcome but is hampered due to non-specific and late symptomology. Hence, there is a need for a new screening and diagnostic test which could improve the patients' outcome. Despite extensive research has focused on blood biomarkers, not a single has been shown clinically useful, and therefore research recently shifted to "breathomics" techniques to recognize specific volatile organic compounds (VOCs) in the breath of the patient as potential non-invasive biomarkers for disease. In this review, we summarize the acquired knowledge about using breath analysis for diagnosing and monitoring MPM and asbestos-related disorders (ARD). Gas chromatography-mass spectrometry (GC-MS), the gold standard of breath analysis, appears to be the method with the highest accuracy (97%) to differentiate MPM patients from at risk asbestos-exposed subjects. There have already been found some interesting biomarkers that are significantly elevated in asbestosis (NO, 8-isoprostane, leukotriene B4, α-Pinene…) and MPM (cyclohexane) patients. Regrettably, the different techniques and the plethora of studies suffer some limitations. Most studies are pilot studies with the inclusion of a limited number of patients. Nevertheless, given the promising results and easy sampling methods, we can conclude that breath analysis may become a useful tool in the future to screen for MPM, but further research is warranted.
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Affiliation(s)
- Lisa Brusselmans
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Lieselot Arnouts
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Charissa Millevert
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Joyce Vandersnickt
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
| | - Jan P. van Meerbeeck
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
- Internal Medicine, Ghent University, Ghent, Belgium
- Department of Pneumology, Antwerp University Hospital, Edegem, Belgium
| | - Kevin Lamote
- Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Wilrijk, Belgium
- Internal Medicine, Ghent University, Ghent, Belgium
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Högman M, Thornadtsson A, Liv P, Hua-Huy T, Dinh-Xuan AT, Tufvesson E, Dressel H, Janson C, Koskela K, Oksa P, Sauni R, Uitti J, Moilanen E, Lehtimäki L. Effects of growth and aging on the reference values of pulmonary nitric oxide dynamics in healthy subjects. J Breath Res 2017; 11:047103. [PMID: 28612760 DOI: 10.1088/1752-7163/aa7957] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The lung just like all other organs is affected by age. The lung matures by the age of 20 and age-related changes start around middle age, at 40-50 years. Exhaled nitric oxide (FENO) has been shown to be age, height and gender dependent. We hypothesize that the nitric oxide (NO) parameters alveolar NO (CANO), airway flux (JawNO), airway diffusing capacity (DawNO) and airway wall content (CawNO) will also demonstrate this dependence. Data from healthy subjects were gathered by the current authors from their earlier publications in which healthy individuals were included as control subjects. Healthy subjects (n = 433) ranged in age from 7 to 78 years. Age-stratified reference values of the NO parameters were significantly different. Gender differences were only observed in the 20-49 age group. The results from the multiple regression models in subjects older than 20 years revealed that age, height and gender interaction together explained 6% of variation in FENO at 50 ml s-1 (FENO50), 4% in JawNO, 16% in CawNO, 8% in DawNO and 12% in CANO. In conclusion, in this study we have generated reference values for NO parameters from an extended NO analysis of healthy subjects. This is important in order to be able to use these parameters in clinical practice.
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Affiliation(s)
- M Högman
- Dept. of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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8
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Karvonen T, Kankaanranta H, Saarelainen S, Moilanen E, Lehtimäki L. Comparison of feasibility and estimates of central and peripheral nitric oxide parameters by different mathematical models. J Breath Res 2017; 11:047102. [DOI: 10.1088/1752-7163/aa7cc0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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9
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Glycoprotein YKL-40 Levels in Plasma Are Associated with Fibrotic Changes on HRCT in Asbestos-Exposed Subjects. Mediators Inflamm 2017; 2017:1797512. [PMID: 28588347 PMCID: PMC5446868 DOI: 10.1155/2017/1797512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 01/28/2023] Open
Abstract
YKL-40 is a chitinase-like glycoprotein produced by alternatively activated macrophages that are associated with wound healing and fibrosis. Asbestosis is a chronic asbestos-induced lung disease, in which injury of epithelial cells and activation of alveolar macrophages lead to enhanced collagen production and fibrosis. We studied if YKL-40 is related to inflammation, fibrosis, and/or lung function in subjects exposed to asbestosis. Venous blood samples were collected from 85 men with moderate or heavy occupational asbestos exposure and from 28 healthy, age-matched controls. Levels of plasma YKL-40, CRP, IL-6, adipsin, and MMP-9 were measured with enzyme-linked immunosorbent assay (ELISA). Plasma YKL-40 levels were significantly higher in subjects with asbestosis (n = 19) than in those with no fibrotic findings in HRCT following asbestos exposure (n = 66) or in unexposed healthy controls. In asbestos-exposed subjects, plasma YKL-40 correlated negatively with lung function capacity parameters FVC (Pearson's r −0.259, p = 0.018) and FEV1 (Pearson's r −0.240, p = 0.028) and positively with CRP (Spearman's rho 0.371, p < 0.001), IL-6 (Spearman's rho 0.314, p = 0.003), adipsin (Spearman's rho 0.459, p < 0.001), and MMP-9 (Spearman's rho 0.243, p = 0.025). The present finding suggests YKL-40 as a biomarker associated with fibrosis and inflammation in asbestos-exposed subjects.
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Högman M, Lehtimäki L, Dinh-Xuan AT. Utilising exhaled nitric oxide information to enhance diagnosis and therapy of respiratory disease - current evidence for clinical practice and proposals to improve the methodology. Expert Rev Respir Med 2017; 11:101-109. [PMID: 28076986 DOI: 10.1080/17476348.2017.1281746] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION A non-invasive tool to diagnose respiratory diseases and to follow treatment has long been looked-for. Exhaled nitric oxide (NO) is a promising marker of inflammation in asthma but nearly 25-years of research has shown that it works in only certain endotypes of asthma. The modelling of NO dynamics of the lung can give more information than a single FENO value. Areas covered: The estimation of the NO production in the conducting airways and in the gas exchange area has given new insight of the NO production in diseases beyond asthma. In this article, we discuss the importance of methodology for NO measurement in the exhaled breath and the indication of applying this technique to detect respiratory disorders. This narrative review is an attempt to examine and discuss the physiological basis underlying exhaled NO measurements and the clinical evidence of the usefulness of this method in asthma and various other respiratory disorders. Expert commentary: Estimation of the NO parameters would aid in our understanding of the NO dynamics of the lung and thereby give more knowledge how to interpret the measured FENO value in clinical practice.
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Affiliation(s)
- Marieann Högman
- a Department of Medical Sciences, Lung- Allergy- and Sleep Research , Uppsala University , Uppsala , Sweden
| | - Lauri Lehtimäki
- b Allergy Centre , Tampere University Hospital , Tampere , Finland.,c Medical School , University of Tampere , Tampere , Finland
| | - Anh Tuan Dinh-Xuan
- d Department of Respiratory Physiology , Cochin Hospital & Paris Descartes University , Paris , France
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11
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Pelclova D, Zdimal V, Kacer P, Fenclova Z, Vlckova S, Komarc M, Navratil T, Schwarz J, Zikova N, Makes O, Syslova K, Belacek J, Zakharov S. Leukotrienes in exhaled breath condensate and fractional exhaled nitric oxide in workers exposed to TiO
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nanoparticles. J Breath Res 2016; 10:036004. [DOI: 10.1088/1752-7155/10/3/036004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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12
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Bioanalytical techniques for detecting biomarkers of response to human asbestos exposure. Bioanalysis 2016; 7:1157-73. [PMID: 26039812 DOI: 10.4155/bio.15.53] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Asbestos exposure is known to cause lung cancer and mesothelioma and its health and economic impacts have been well documented. The exceptionally long latency periods of most asbestos-related diseases have hampered preventative and precautionary steps thus far. We aimed to summarize the state of knowledge on biomarkers of response to asbestos exposure. Asbestos is not present in human biological fluids; rather it is inhaled and trapped in lung tissue. Biomarkers of response, which reflect a change in biologic function in response to asbestos exposure, are analyzed. Several classes of molecules have been studied and evaluated for their potential utility as biomarkers of asbestos exposure. These studies range from small molecule oxidative stress biomarkers to proteins involved in immune responses.
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13
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Abstract
OBJECTIVE To assess whether cumulative dust exposure in foundry work is associated with airway inflammation measured by the analysis of fractionated exhaled nitric oxide (NO) concentration, or by inflammatory markers in exhaled breath condensate or serum. METHODS We examined 476 dust-exposed and nonexposed foundry workers, and assessed the individual cumulative exposure to dusts and respirable quartz. Bronchial and alveolar NO production and inflammatory markers in exhaled breath condensate and in serum samples were also analyzed. RESULTS After adjusting for pack-years of smoking, increased levels of alveolar NO, serum C-reactive protein, and interleukin-8 were associated with a higher level of cumulative exposure to dust. The referents had higher serum myeloperoxidase levels, bronchial NO output, and 8-isoprostane levels in exhaled breath condensate than in the dust-exposed groups. CONCLUSIONS Dust exposure in foundry work may induce both systemic and alveolar inflammation.
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14
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Alfonso H, Franklin P, Ching S, Croft K, Burcham P, Olsen N, Reid A, Joyce D, de Klerk N, Musk AWB. Effect of N-acetylcysteine supplementation on oxidative stress status and alveolar inflammation in people exposed to asbestos: A double-blind, randomized clinical trial. Respirology 2015; 20:1102-7. [DOI: 10.1111/resp.12592] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/10/2015] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Helman Alfonso
- School of Population Health; University of Western Australia; Perth Western Australia Australia
- School of Public Health; Curtin University; Perth Western Australia Australia
| | - Peter Franklin
- School of Population Health; University of Western Australia; Perth Western Australia Australia
| | - Simon Ching
- Department of Clinical Biochemistry; Path West Laboratory Medicine; Perth Western Australia Australia
| | - Kevin Croft
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
| | - Phil Burcham
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
| | - Nola Olsen
- School of Population Health; University of Western Australia; Perth Western Australia Australia
| | - Alison Reid
- School of Population Health; University of Western Australia; Perth Western Australia Australia
- Centre for Medical Research; University of Western Australia; Perth Western Australia Australia
| | - David Joyce
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
| | - Nick de Klerk
- School of Population Health; University of Western Australia; Perth Western Australia Australia
- Institute of Child Health Research; University of Western Australia; Perth Western Australia Australia
| | - AW Bill Musk
- School of Population Health; University of Western Australia; Perth Western Australia Australia
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
- Department of Respiratory Medicine; Sir Charles Gairdner Hospital; Perth Western Australia Australia
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15
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Xu J, Alexander DB, Iigo M, Hamano H, Takahashi S, Yokoyama T, Kato M, Usami I, Tokuyama T, Tsutsumi M, Tamura M, Oguri T, Niimi A, Hayashi Y, Yokoyama Y, Tonegawa K, Fukamachi K, Futakuchi M, Sakai Y, Suzui M, Kamijima M, Hisanaga N, Omori T, Nakae D, Hirose A, Kanno J, Tsuda H. Chemokine (C-C motif) ligand 3 detection in the serum of persons exposed to asbestos: A patient-based study. Cancer Sci 2015; 106:825-32. [PMID: 25940505 PMCID: PMC4520633 DOI: 10.1111/cas.12687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/14/2015] [Accepted: 04/27/2015] [Indexed: 12/11/2022] Open
Abstract
Exposure to asbestos results in serious risk of developing lung and mesothelial diseases. Currently, there are no biomarkers that can be used to diagnose asbestos exposure. The purpose of the present study was to determine whether the levels or detection rate of chemokine (C-C motif) ligand 3 (CCL3) in the serum are elevated in persons exposed to asbestos. The primary study group consisted of 76 healthy subjects not exposed to asbestos and 172 healthy subjects possibly exposed to asbestos. The secondary study group consisted of 535 subjects possibly exposed to asbestos and diagnosed with pleural plaque (412), benign hydrothorax (10), asbestosis (86), lung cancer (17), and malignant mesothelioma (10). All study subjects who were possibly exposed to asbestos had a certificate of asbestos exposure issued by the Japanese Ministry of Health, Labour and Welfare. For the primary study group, levels of serum CCL3 did not differ between the two groups. However, the detection rate of CCL3 in the serum of healthy subjects possibly exposed to asbestos (30.2%) was significantly higher (P < 0.001) than for the control group (6.6%). The pleural plaque, benign hydrothorax, asbestosis, and lung cancer groups had serum CCL3 levels and detection rates similar to that of healthy subjects possibly exposed to asbestos. The CCL3 chemokine was detected in the serum of 9 of the 10 patients diagnosed with malignant mesothelioma. Three of the patients with malignant mesothelioma had exceptionally high CCL3 levels. Malignant mesothelioma cells from four biopsy cases and an autopsy case were positive for CCL3, possibly identifying the source of the CCL3 in the three malignant mesothelioma patients with exceptionally high serum CCL3 levels. In conclusion, a significantly higher percentage of healthy persons possibly exposed to asbestos had detectable levels of serum CCL3 compared to healthy unexposed control subjects.
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Affiliation(s)
- Jiegou Xu
- Nanotoxicology Project, Nagoya City University, Nagoya, Japan.,Department of Immunology, College of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | | | - Masaaki Iigo
- Nanotoxicology Project, Nagoya City University, Nagoya, Japan
| | - Hirokazu Hamano
- Nutritional Science Institute, Morinaga Milk Industry Co., Ltd., Zama, Japan
| | - Satoru Takahashi
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takako Yokoyama
- Department of Respiratory Medicine, Asahi Rosai Hospital, Owariasahi, Japan
| | - Munehiro Kato
- Department of Respiratory Medicine, Asahi Rosai Hospital, Owariasahi, Japan
| | - Ikuji Usami
- Department of Respiratory Medicine, Asahi Rosai Hospital, Owariasahi, Japan
| | - Takeshi Tokuyama
- Department of Internal Medicine, Saiseikai Chuwa Hospital, Sakura, Japan
| | | | - Mouka Tamura
- Department of Internal Medicine, Nara Medical Center, National Hospital Organization, Nara, Japan
| | - Tetsuya Oguri
- Diivision of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, Nagoya, Japan
| | - Akio Niimi
- Diivision of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshimitsu Hayashi
- Department of Medicine, Nagoya-Shi Koseiin Medical Welfare Center, Nagoya, Japan
| | - Yoshifumi Yokoyama
- Department of Medicine, Nagoya-Shi Koseiin Medical Welfare Center, Nagoya, Japan
| | - Ken Tonegawa
- Department of Physical Medicine and Rehabilitation, Nagoya-Shi Koseiin Medical Welfare Center, Nagoya, Japan
| | - Katsumi Fukamachi
- Department of Molecular Toxicology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsuru Futakuchi
- Department of Molecular Toxicology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuto Sakai
- Department of Molecular Toxicology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masumi Suzui
- Department of Molecular Toxicology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Michihiro Kamijima
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naomi Hisanaga
- Center for Campus Health and Environment, Aichi University of Education, Kariya, Japan
| | - Toyonori Omori
- Department of Health Care Policy and Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Dai Nakae
- Department of Nutritional Science and Food Safety, Faculty of Applied Biosciences, Tokyo University of Agriculture, Tokyo, Japan
| | - Akihiko Hirose
- Division of Risk Assessment, Biological Safety Research Center, Biological Safety Research Center, National Institute of Health Sciences, Tokyo, Japan
| | - Jun Kanno
- Division of Cellular and Molecular Toxicology, Biological Safety Research Center, National Institute of Health Sciences, Tokyo, Japan
| | - Hiroyuki Tsuda
- Nanotoxicology Project, Nagoya City University, Nagoya, Japan
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16
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Weissman DN. Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature. Semin Respir Crit Care Med 2015; 36:433-48. [PMID: 26024350 DOI: 10.1055/s-0035-1547348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review provides an update on literature published over the past 5 years that is relevant to using chest computed tomography (CT) as a tool for preventing occupational respiratory disease. An important area of investigation has been in the use of low-dose CT (LDCT) to screen asbestos-exposed populations for lung cancer. Two recent systematic reviews have reached conclusions in support of screening. Based on the limited evidence that is currently available, the Finnish Institute of Occupational Health has recommended LDCT screening in asbestos-exposed individuals if their personal combination of risk factors yields a risk for lung cancer equal to that needed for entry into the National Lung Screening Trial. It has also recommended further research, such as to document the optimal frequency of screening and the effectiveness of screening. Recent literature continues to support high-resolution CT (HRCT) as being more sensitive than chest radiography in detecting pneumoconiosis. However, there are insufficient data to determine the effectiveness of HRCT screening in improving individual outcomes if used in screening for pneumoconiosis and its routine use for this purpose cannot be recommended. However, if HRCT is used to evaluate populations, recent literature shows that the International Classification of HRCT for Occupational and Environmental Respiratory Diseases provides an important tool for reproducible evaluation and recording of findings. HRCT is an important tool for individual patient management and recent literature has documented that chest HRCT findings are significantly associated with outcomes such as pulmonary function and mortality.
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Affiliation(s)
- David N Weissman
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia
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17
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Exhaled nitric oxide in interstitial lung diseases. Respir Physiol Neurobiol 2014; 197:46-52. [DOI: 10.1016/j.resp.2014.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 11/22/2022]
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18
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Lamote K, Nackaerts K, van Meerbeeck JP. Strengths, weaknesses, and opportunities of diagnostic breathomics in pleural mesothelioma-a hypothesis. Cancer Epidemiol Biomarkers Prev 2014; 23:898-908. [PMID: 24706728 DOI: 10.1158/1055-9965.epi-13-0737] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Past and present asbestos use will reflect in increasing numbers of mesothelioma cases in the next decades, diagnosed at a late stage and with a dismal prognosis. This stresses the need for early detection tools, which could improve patients' survival. Recently, breath analysis as a noninvasive and fast diagnostic tool has found its way into biomedical research. High-throughput breathomics uses spectrometric, chromatographic, and sensor techniques to diagnose asbestos-related pulmonary diseases based upon volatile organic compounds (VOC) in breath. This article reviews the state-of-the-art available breath analyzing techniques and provides the insight in the current use of VOCs as early diagnostic or prognostic biomarkers of mesothelioma to stimulate further research in this field. Cancer Epidemiol Biomarkers Prev; 23(6); 898-908. ©2014 AACR.
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Affiliation(s)
- Kevin Lamote
- Authors' Affiliations: Department of Respiratory Medicine, Ghent University Hospital, Ghent; Department of Internal Medicine, Ghent University, Ghent; Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven; and Thoracic Oncology/MOCA, Antwerp University Hospital, Edegem, BelgiumAuthors' Affiliations: Department of Respiratory Medicine, Ghent University Hospital, Ghent; Department of Internal Medicine, Ghent University, Ghent; Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven; and Thoracic Oncology/MOCA, Antwerp University Hospital, Edegem, Belgium
| | - Kristiaan Nackaerts
- Authors' Affiliations: Department of Respiratory Medicine, Ghent University Hospital, Ghent; Department of Internal Medicine, Ghent University, Ghent; Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven; and Thoracic Oncology/MOCA, Antwerp University Hospital, Edegem, Belgium
| | - Jan P van Meerbeeck
- Authors' Affiliations: Department of Respiratory Medicine, Ghent University Hospital, Ghent; Department of Internal Medicine, Ghent University, Ghent; Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven; and Thoracic Oncology/MOCA, Antwerp University Hospital, Edegem, BelgiumAuthors' Affiliations: Department of Respiratory Medicine, Ghent University Hospital, Ghent; Department of Internal Medicine, Ghent University, Ghent; Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven; and Thoracic Oncology/MOCA, Antwerp University Hospital, Edegem, Belgium
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Abstract
OBJECTIVE Studies of fractional exhaled NO (FeNO) or induced sputum are now well standardized and the exponential increase in publications about exhaled breath condensate reflects growing interest in a noninvasive diagnosis of pulmonary diseases in occupational medicine. METHODS This review describes current techniques (FeNO, induced sputum, and exhaled breath condensate) for the study of inflammation and oxidative stress biomarkers. RESULTS These biomarkers are FeNO, cytokines, H2O2, 8-isoprostane, malondialdehyde, and nitrogen oxides. These techniques also include the study of markers of the toxic burden in the lungs (heavy metals and mineral compounds) that are important in occupational health exposure assessment. CONCLUSIONS In occupational medicine, the study of both volatile and nonvolatile respiratory biomarkers can be useful in medical surveillance of exposed workers, the early identification of respiratory diseases, or the monitoring of their development.
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20
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Induced Sputum, Exhaled Nitric Oxide, and Particles in Exhaled Air in Assessing Airways Inflammation in Occupational Exposures. Clin Chest Med 2012; 33:771-82. [DOI: 10.1016/j.ccm.2012.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Lung function predicts mortality: 10-year follow-up after lung cancer screening among asbestos-exposed workers. Int Arch Occup Environ Health 2012; 86:667-72. [PMID: 22865327 DOI: 10.1007/s00420-012-0803-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the predictive value of lung function impairment on mortality among asbestos-exposed workers. METHODS A total of 590 workers originally screened for occupational lung disease including spirometry and pulmonary diffusing capacity measurements were followed up for mortality data (ICD-10 classification). The mean follow-up time was 10.5 years. Associations of different lung function parameters with mortality from all causes and from cardiovascular (I00-I99) and non-malignant respiratory diseases (J00-J99) were analysed. Factor analysis was used to create obstructive and restrictive factors. RESULTS A total of 191 deaths were found altogether. Most measured lung function variables were associated with increased mortality when studied separately. Both decreased forced expiratory flow in one second (hazard ratio/measurement unit = 0.977, 95 % CI 0.969-0.988, p < 0.001) and impaired diffusing capacity (0.973, 0.965-0.981, p < 0.001) were independently associated with mortality from all causes, as well as from cardiovascular and non-malignant respiratory diseases. Both obstructive factor alone and the sum of obstructive and restrictive factors were associated with all studied mortality categories. The restrictive factor alone was associated with all-cause and respiratory mortality. CONCLUSIONS Deteriorated lung function predicts deaths. The reasons for impaired lung function should be medically explored to enable restoring measures aiming thus to prevent premature deaths.
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Leivo-Korpela S, Lehtimäki L, Nieminen R, Oksa P, Vierikko T, Järvenpää R, Uitti J, Moilanen E. Adipokine adipsin is associated with the degree of lung fibrosis in asbestos-exposed workers. Respir Med 2012; 106:1435-40. [PMID: 22832039 DOI: 10.1016/j.rmed.2012.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 06/28/2012] [Accepted: 07/02/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Asbestos-exposure causes an inflammatory response driven by alveolar macrophages that can lead to pulmonary fibrosis. In addition to classical inflammatory cytokines, macrophages produce adipokines which regulate the inflammatory response. We studied if adipokines are related to the degree of parenchymal fibrosis, impaired lung function and inflammation in asbestos-exposed subjects. METHODS Eighty-five males with moderate to heavy occupational exposure to asbestos and unexposed controls were studied. We measured plasma levels of adipokines adiponectin, adipsin, leptin and resistin, IL-6, IL-8, erythrocyte sedimentation rate (ERS), spirometry and D(L,CO). Degree of interstitial lung fibrosis (septal thickening, subpleural lines, parenchymal bands or honeycombing) was scored in classes 0-5 according to a validated scoring system. The subjects were divided into three groups: normal parenchymal finding (fibrosis class 0), borderline changes (classes 0.5-1.5) and fibrosis (i.e. asbestosis; classes 2-5). RESULTS Adipsin correlated positively with parenchymal fibrosis (rho=0.412, p<0.001) and there was a linear increasing trend of mean plasma adipsin levels among the three groups of asbestos-exposed subjects (from normal parenchymal finding to borderline changes and to fibrosis) (p<0.0001). Accordingly, plasma adipsin levels correlated positively with the extent of pleural plaques (r=0.245, p=0.043), and negatively with D(L,CO) (r=-0.246, p=0.023). Also, a positive correlation was found between adipsin and inflammatory markers ESR (r=0.315, p=0.008) and IL-6 (r=0.256, p=0.018). CONCLUSIONS Adipsin was associated with the degree of parenchymal fibrosis, impairment of pulmonary diffusing capacity and with inflammatory activity in asbestos-exposed subjects suggesting that adipsin may have a role in the pathogenesis or as a biomarker in asbestos-induced lung disease.
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Affiliation(s)
- Sirpa Leivo-Korpela
- Department of Respiratory Medicine, Tampere University Hospital, PL 2000, 33521 Tampere, Finland.
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Kazani S, Israel E. Utility of Exhaled Breath Condensates across Respiratory Diseases. Am J Respir Crit Care Med 2012; 185:791-2. [DOI: 10.1164/rccm.201202-0212ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Lung and pleural fibrosis in asbestos-exposed workers: a risk factor for pneumonia mortality. Epidemiol Infect 2012; 140:1987-92. [DOI: 10.1017/s0950268811002810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYLungs exposed to occupational dust may be especially vulnerable to fatal infections. We followed up asbestos-exposed workers (n=590) originally screened for lung cancer with computed tomography and scored for pleuropulmonary fibrosis. We checked these workers' influenza and pneumonia mortality data (ICD-10 codes J10–J18) in the national register. In total, 191 deaths, including 43 deaths from infectious pneumonia, occurred in 6158 person-years of follow-up (mean follow-up time 10·44 years). ‘Some interstitial fibrosis’ [hazard ratio (HR) 2·26, 95% confidence interval (CI) 0·98–5·19, P=0·06] and ‘definite interstitial fibrosis’ (HR 3·70, 95% CI 1·22–11·23, P=0·02) were associated with an increased risk of death from pneumonia compared to no fibrosis. Asbestosis patients, i.e. those with both asbestos exposure and lung fibrosis, therefore appear to be particularly at risk for death from pneumonia. These patients should be vaccinated against influenza and Pneumococcus.
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Chapman EA, Thomas PS, Yates DH. Breath analysis in asbestos-related disorders: a review of the literature and potential future applications. J Breath Res 2010; 4:034001. [PMID: 21383477 DOI: 10.1088/1752-7155/4/3/034001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Asbestos usage was very common worldwide in the last century and continues in several countries today. Several diseases occur due to asbestos exposure, including malignant tumours such as malignant mesothelioma of the pleura and lung cancer, which have a very poor prognosis. Asbestos inhalation may also result in more benign conditions such as asbestosis (or pulmonary fibrosis due to asbestos), pleural plaques and pleural thickening. It is predicted that asbestos-associated mortality and morbidity will continue to increase, but methods for diagnosing asbestos-related disease are currently invasive and unsuitable for an increasingly elderly population. New non-invasive methods such as analysis of exhaled breath biomarkers e.g. exhaled nitric oxide (F(E)NO), exhaled breath condensate or of exhaled volatile organic compounds could potentially be extremely useful in these conditions. This article reviews the current literature on this topic and suggests areas for their application in the future.
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Affiliation(s)
- Eleanor A Chapman
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Kensington, NSW 2052, Australia
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