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Gaddour A, Chatti S, Chouchene A, Kacem I, Bouhoula M, Aloui A, Marnaoui M, Maoua M, Brahem A, Kalboussi H, El Maalel O, Mrizek N. [An epidemiological and evolutionary profile of occupational asthma of Tunisian workers]. Rev Mal Respir 2024; 41:227-236. [PMID: 38429194 DOI: 10.1016/j.rmr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 12/16/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study aims to identify the epidemiological and occupational characteristics of patients with occupational asthma (OA) and to assess their clinical evolution and occupational outcomes. METHODS We carried out a descriptive epidemiological study over a period of five years (from 2012 to 2016) about the OA cases in the private sector reported in the Tunisian region of Zaghouan. RESULTS All in all, 165 OA cases were reported during the study period, representing an annual incidence of 733.3 cases per 1,000,000 workers in the private sector. Our study population was composed predominantly (85.5%) of women, whose mean age was 41.5±6.8years. More than three quarters of the affected persons were working in the automobile industry, and most illnesses (77%) were attributable to isocyanates. The mean time to onset of the respiratory symptoms was longer for low molecular weight agents (13.6±3.1years) compared to high molecular weight agents (12.0±3.9years) (P=0.0006). The majority of OA cases (66.7%) lost their jobs. Job loss was significantly more frequent among asthmatic women and workers with OA due to isocyanates. Among the 62 cases of OA for whom risk factors were eliminated, 45 nonetheless remained symptomatic. CONCLUSION Effective prevention strategies involving the various actors need to be implemented in work environments so as to reduce the frequency and the medico-legal repercussions of a disabling condition.
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Affiliation(s)
- A Gaddour
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Ibn El Jazzar, Kairouan, Tunisie.
| | - S Chatti
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - A Chouchene
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - I Kacem
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - M Bouhoula
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - A Aloui
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - M Marnaoui
- Inspection médicale de travail, Zaghouan, Tunisie
| | - M Maoua
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - A Brahem
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - H Kalboussi
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - O El Maalel
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - N Mrizek
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
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Robin C, Vongmany N, Dewitte JD, Lodde B, Larabi L, Lucas D. Asthmes en relation avec le travail chez la femme : comparaison aux données masculines. Étude rétrospective des données issues du Réseau national de vigilance et de prévention des pathologies professionnelles (RNV3P). ARCH MAL PROF ENVIRO 2022. [DOI: 10.1016/j.admp.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thoré P, Tiotiu A. [Uncontrolled occupational asthma: Talking about comorbidities]. Rev Mal Respir 2019; 36:633-637. [PMID: 31204233 DOI: 10.1016/j.rmr.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Occupational asthma is a disease where the pathophysiological characteristics of asthma are linked to repeated exposure to a sensitizing agent present in the workspace. Assessment of patients with severe asthma to identify and manage comorbidities improves asthma control and is recommended in international guidelines on the management of severe asthma. CASE REPORT We report the case of a 49-year-old patient, nonsmoker, without atopy, who had severe work-related asthma due to exposure to isocyanates, which was uncontrolled despite the avoidance of the occupational exposure and maximal medical treatment. A systematic assessment for possible comorbidities revealed gastroesophageal reflux and obstructive sleep apnea syndrome. The specific management of these two comorbidities led to an improvement of asthma control with a reduction in the number of exacerbations, a reduced burden of treatment and a resumption of employment. CONCLUSIONS As with all cases of severe asthma, the assessment of comorbidities must be systematic in the presence of an occupational asthma which persists after the cessation of the occupational exposure. The management of these comorbidities can lead to an improvement in asthma control and severity.
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Affiliation(s)
- P Thoré
- Département de pneumologie, pôle des spécialités médicales, CHRU de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
| | - A Tiotiu
- Département de pneumologie, pôle des spécialités médicales, CHRU de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France; Unité EA3450-DevAH développement, adaptation et handicap, régulation cardiorespiratoire, université de Lorraine, faculté de Médecine de Nancy, laboratoire de Physiologie, 9 avenue de la foret de Haye CS 50184, 54505 Vandoeuvre-lès-Nancy, France
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Aloui A, El Maȃlel O, Maoua M, Kacem I, Hani Z, Aroui H, El Guedri S, Brahem A, Kalboussi H, Chatti S, Mrizek N. [Specificities of occupational asthma in women and its interactions with hormonal status]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:483-491. [PMID: 30420277 DOI: 10.1016/j.pneumo.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Occupational asthma (OA) is described as the most common respiratory disease in industrialized countries. A female predominance characterizes many populations of asthmatic workers. Differences in occupational exposures by gender as well as hormonal variations could affect OA in women. PURPOSE To identify the socio-occupational and medical characteristics of OA in women compared to men and to investigate a possible hormonal influence on OA in women. MATERIAL AND METHODS This is a retrospective study, based on medical records of out patients of the Department of Occupational Medicine during the period between 1st January 2009 and 30 June 2016 for OA completed by a phone call to collect missing data. RESULTS Over 222 cases of OA, a female predominance was noted (60.81%), which was predominantly in the textile sector (61.5%). Clinically, men had more exercise dyspnea and wheezing, whereas the association with rhinitis was significantly greater in women. The majority of women with asthma had irregular menstrual cycles (46.2%), they were multiparous in 54%, menopaused in 13% of cases with a mean age of menarche of 12±1.65 years. A worsening of OA was noted in 58% of women during their perimenstrual period, 75% during pregnancy and 14% of women when taking hormonal contraceptives. In asthmatic women, only the presence of non-specific bronchial hyperreactivity was significantly associated with menarche age (P=0.007). CONCLUSION Differences between men and women in OA with variability of symptoms during female genital life have been identified. Further studies to personalized care strategies for women need to be undertaken.
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Affiliation(s)
- A Aloui
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - O El Maȃlel
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - M Maoua
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - I Kacem
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie.
| | - Z Hani
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - H Aroui
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - S El Guedri
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - A Brahem
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - H Kalboussi
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - S Chatti
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
| | - N Mrizek
- Service de médecine du travail et pathologies professionnelles, CHU de Farhat-Hached, Sousse, Tunisie
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Plantier L, Beydon N, Chambellan A, Degano B, Delclaux C, Dewitte JD, Dinh-Xuan AT, Garcia G, Kauffmann C, Paris C, Perez T, Poussel M, Wuyam B, Zerah-Lancner F, Chenuel B. [Guidelines for methacholine provocation testing]. Rev Mal Respir 2018; 35:759-775. [PMID: 30097294 DOI: 10.1016/j.rmr.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/15/2018] [Indexed: 12/01/2022]
Abstract
Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The "Lung Function" thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.
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Affiliation(s)
- L Plantier
- CEPR/Inserm UMR1100, CHRU de Tours, service de pneumologie et explorations fonctionnelles respiratoires, université François-Rabelais, 37044 Tours cedex 9, France.
| | - N Beydon
- Unité fonctionnelle d'exploration fonctionnelle respiratoire et du sommeil, AP-HP, hôpital Armand-Trousseau, 75012 Paris, France
| | - A Chambellan
- Inserm UMR1087, explorations fonctionnelles et réhabilitation respiratoire, l'institut du thorax, CHU, 44093 Nantes cedex 1, France
| | - B Degano
- Service d'explorations fonctionnelles, hôpital Jean-Minjoz, 25000 Besançon, France
| | - C Delclaux
- Inserm U1141, DHU PROTECT, service de physiologie explorations fonctionnelles pédiatriques-CPPS, AP-HP, hôpital Robert-Debré, université Paris Diderot, 75019 Paris, France
| | - J-D Dewitte
- Santé au travail-laboratoire d'étude et de recherche en sociologie, UFR médecine et sciences de la santé, université de Bretagne occidentale, 29238 Brest cedex 3, France
| | - A T Dinh-Xuan
- Service de physiologie-explorations fonctionnelles, université Paris Descartes, AP-HP, hôpital Cochin, 75014 Paris, France
| | - G Garcia
- Service de physiologie, Inserm UMR999, AP-HP, hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre cedex, France
| | - C Kauffmann
- Service d'explorations fonctionnelles respiratoires, CHU, 63000 Clermont-Ferrand, France
| | - C Paris
- EA7892, service de pathologie professionnelle, université de Lorraine, CHU de Nancy, 54500 Vandœuvre-Les-Nancy, France
| | - T Perez
- Clinique de pneumologie, centre de compétences maladies pulmonaires rares, CHRU de Lille, hôpital Albert-Calmette, 59037 Lille, France
| | - M Poussel
- Antenne médicale de prévention du dopage, EA 3450, service des examens de la fonction respiratoire et de l'aptitude à l'exercice médecine du sport, CHRU de Nancy Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - B Wuyam
- Laboratoire HP2, Inserm 1042, service sport et pathologies, CHU de Grenoble, hôpital Sud, 38130 Echirolles, France
| | - F Zerah-Lancner
- Service de physiologie-explorations fonctionnelles, AP-HP, hôpital Henri-Mondor, 94000 Créteil, France
| | - B Chenuel
- Antenne médicale de prévention du dopage, EA 3450, service des examens de la fonction respiratoire et de l'aptitude à l'exercice médecine du sport, CHRU de Nancy Brabois, 54500 Vandœuvre-lès-Nancy, France
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Laborde-Castérot H, Villa AF, Rosenberg N, Dupont P, Lee HM, Garnier R. Occupational rhinitis and asthma due to EDTA-containing detergents or disinfectants. Am J Ind Med 2012; 55:677-82. [PMID: 22431256 DOI: 10.1002/ajim.22036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Detergents and disinfectants are an emerging cause of work-related rhinitis and asthma. These products may contain ethylenediamine tetraacetic acid (EDTA). The authors report 10 cases of EDTA-related asthma and/or rhinitis. METHODS Review of the medical charts of patients who presented with work-related rhinitis (alone or with asthma), with a history of exposure to aerosols of EDTA-containing products and who underwent a nasal provocation test (NPT) with tetrasodium EDTA (1-4%) in our occupational health unit. RESULTS Twenty-eight patients underwent a NPT with EDTA, which was positive in 10 cases. These patients, mostly cleaners or healthcare workers, used spray formulations of cleaning products. CONCLUSIONS This case series is the first report of EDTA-related respiratory disease, documented by a specific test. An irritant mechanism is unlikely. Further studies are required to distinguish between an immunoallergic response and a pharmacological mechanism possibly resulting from calcium chelation, as suggested by animal experiments. A ban of spray preparations would be sufficient to prevent respiratory disease induced by EDTA inhalation, regardless of its mechanism.
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Affiliation(s)
- Hervé Laborde-Castérot
- AP-HP, Paris Poison Centre, Occupational and Environmental Health Unit, Fernand Widal Hospital, Paris, France
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Current world literature. Curr Opin Allergy Clin Immunol 2010; 10:161-6. [PMID: 20357579 DOI: 10.1097/aci.0b013e32833846d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dalphin JC, Maitre J, Pairon JC. Les maladies respiratoires professionnelles : la fin d’une série… et une histoire sans fin. Rev Mal Respir 2009; 26:821-3. [DOI: 10.1016/s0761-8425(09)73677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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