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Keleb A, Daba C, Asmare L, Bayou FD, Arefaynie M, Mohammed A, Tareke AA, Kebede N, Tsega Y, Endawkie A, Kebede SD, Abera KM, Abeje ET, Enyew EB. The association between children's exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis. Front Public Health 2024; 12:1402908. [PMID: 38868160 PMCID: PMC11167956 DOI: 10.3389/fpubh.2024.1402908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
Background Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children. Methods A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique. Result A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14-1.35) with extreme heterogeneity (I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14-1.57), with high heterogeneity (I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45-2.21) with nonsignificant low heterogeneity (I 2 = 30%, p-value = 0.18). Conclusion This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.
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Affiliation(s)
- Awoke Keleb
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Lakew Asmare
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Fekade Demeke Bayou
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anissa Mohammed
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health in Africa, COVID-19 Vaccine/EPI Technical Assistant at West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kaleab Mesfin Abera
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Eyob Tilahun Abeje
- Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University, Dessie, Ethiopia
| | - Ermias Bekele Enyew
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Jestin-Guyon N, Raherison-Semjen C. [Pesticide exposure and chronic respiratory diseases]. Rev Mal Respir 2024; 41:343-371. [PMID: 38594123 DOI: 10.1016/j.rmr.2024.03.004] [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: 10/26/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Pesticides are used worldwide, mainly in agriculture as a means of controlling pests and protecting crops. That said, the entire world population is ultimately subject to pesticide exposure (consumption of fruits and vegetables, living near treated fields…), with varying degrees of toxicity involved. STATE OF THE ART In recent decades, epidemiological studies have contributed to the identification of chemical pesticide families with detrimental effects on human health: cognitive disorders, Parkinson's disease, prostate cancer… and impairment in respiratory functioning. Current scientific evidence points to the implication of the active substances in insecticides, herbicides and fungicides in chronic respiratory diseases, two examples being chronic obstructive pulmonary disease (COPD) in exposed workers, and asthmatic wheezing in children during prenatal or postnatal exposure. PERSPECTIVES The safety of individuals exposed to pesticides is of key importance in public health. Further epidemiological investigations are needed to identify the chemical families affecting certain populations. CONCLUSIONS The scientific literature suggests strong links between pesticide exposure and respiratory health. Whether it be environmental or occupational, pesticide exposure can lead to respiratory disorders and symptoms of varying severity.
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Affiliation(s)
- N Jestin-Guyon
- UMR1219 Bordeaux Population Health Centre de Recherche, ISPED, université de Bordeaux, 146, rue Léo-Saignat, 33000 Bordeaux, France.
| | - C Raherison-Semjen
- UMR1219 Bordeaux Population Health Centre de Recherche, ISPED, université de Bordeaux, 146, rue Léo-Saignat, 33000 Bordeaux, France; Centre hospitalier universitaire de la Guadeloupe, 97159 Pointe-à-Pitre, Guadeloupe
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Goldfarb DG, Prezant DJ, Zeig-Owens R, Hall CB, Schwartz T, Liu Y, Kavouras IG. Association of firefighting exposures with lung function using a novel job exposure matrix (JEM). Occup Environ Med 2024; 81:84-91. [PMID: 38233128 DOI: 10.1136/oemed-2023-109155] [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: 08/10/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Abstract
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.
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Affiliation(s)
- David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Environmental and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York city, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Theresa Schwartz
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Yang Liu
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York, USA
| | - Ilias G Kavouras
- Department of Environmental and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York city, New York, USA
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Markevych I, Zhao T, Fuertes E, Marcon A, Dadvand P, Vienneau D, Garcia Aymerich J, Nowak D, de Hoogh K, Jarvis D, Abramson MJ, Accordini S, Amaral AF, Bentouhami H, Jacobsen Bertelsen R, Boudier A, Bono R, Bowatte G, Casas L, Dharmage SC, Forsberg B, Gislason T, Gnesi M, Holm M, Jacquemin B, Janson C, Jogi R, Johannessen A, Keidel D, Leynaert B, Maldonado Perez JA, Marchetti P, Migliore E, Martínez-Moratalla J, Orru H, Pin I, Potts J, Probst-Hensch N, Ranzi A, Sánchez-Ramos JL, Siroux V, Soussan D, Sunyer J, Urrutia Landa I, Villani S, Heinrich J. Residential greenspace and lung function decline over 20 years in a prospective cohort: The ECRHS study. ENVIRONMENT INTERNATIONAL 2023; 178:108036. [PMID: 37336027 DOI: 10.1016/j.envint.2023.108036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The few studies that have examined associations between greenspace and lung function in adulthood have yielded conflicting results and none have examined whether the rate of lung function decline is affected. OBJECTIVE We explored the association between residential greenspace and change in lung function over 20 years in 5559 adults from 22 centers in 11 countries participating in the population-based, international European Community Respiratory Health Survey. METHODS Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry when participants were approximately 35 (1990-1994), 44 (1999-2003), and 55 (2010-2014) years old. Greenness was assessed as the mean Normalized Difference Vegetation Index (NDVI) in 500 m, 300 m, and 100 m circular buffers around the residential addresses at the time of lung function measurement. Green spaces were defined as the presence of agricultural, natural, or urban green spaces in a circular 300 m buffer. Associations of these greenspace parameters with the rate of lung function change were assessed using adjusted linear mixed effects regression models with random intercepts for subjects nested within centers. Sensitivity analyses considered air pollution exposures. RESULTS A 0.2-increase (average interquartile range) in NDVI in the 500 m buffer was consistently associated with a faster decline in FVC (-1.25 mL/year [95% confidence interval: -2.18 to -0.33]). These associations were especially pronounced in females and those living in areas with low PM10 levels. We found no consistent associations with FEV1 and the FEV1/FVC ratio. Residing near forests or urban green spaces was associated with a faster decline in FEV1, while agricultural land and forests were related to a greater decline in FVC. CONCLUSIONS More residential greenspace was not associated with better lung function in middle-aged European adults. Instead, we observed slight but consistent declines in lung function parameters. The potentially detrimental association requires verification in future studies.
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Affiliation(s)
- Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andre Fs Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hayat Bentouhami
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Randi Jacobsen Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France; Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Faculty of Allied Health, University of Peradeniya, Kandy, Sri Lanka; National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Marco Gnesi
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Benedicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807 Villejuif, France
| | | | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | | | - Hans Orru
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Isabelle Pin
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France; CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, Grenoble, France
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Andrea Ranzi
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy
| | | | - Valerie Siroux
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - David Soussan
- Paris Diderot University, Faculty of Medicine, Paris, France; Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Feary J, Quintero-Santofimio V, Potts J, Vermeulen R, Kromhout H, Knox-Brown B, Amaral AF. Occupational exposures and small airway obstruction in the UK Biobank Cohort. ERJ Open Res 2023; 9:00650-2022. [PMID: 37228277 PMCID: PMC10204826 DOI: 10.1183/23120541.00650-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/08/2023] [Indexed: 05/27/2023] Open
Abstract
Background Small airways obstruction (SAO) is a key feature of both COPD and asthma, which have been associated with workplace exposures. Whether SAO, which may occur early in the development of obstructive lung disease and without symptoms, also associates with occupational exposures is unknown. Methods Using UK Biobank data, we derived measurements of SAO from the 65 145 participants with high-quality spirometry and lifetime occupational histories. The ALOHA+ Job Exposure Matrix was used to assign lifetime occupational exposures to each participant. The association between SAO and lifetime occupational exposures was evaluated using a logistic regression model adjusted for potential confounders. A second logistic regression model was also run to account for potential co-exposures. Results SAO was present in varying proportions of the population depending on definition used: 5.6% (forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75) < lower limit of normal (LLN)) and 21.4% (forced expiratory volume in 3 s (FEV3)/forced expiratory volume in 6 s (FEV6) <LLN). After adjustment for confounders and co-exposures, people in the highest category of exposure to pesticides were significantly more likely to have SAO (FEV3/FEV6 <LLN: OR 1.24, 95% CI 1.06-1.44). The association between pesticides and SAO showed an exposure-response pattern. SAO was also less likely among people in the highest exposure categories of aromatic solvents (FEV3/FEV6 <LLN: OR 0.85, 95% CI 0.73-0.99) and metals (FEV3/FEV6 <LLN: OR 0.77, 95% CI 0.62-0.94). Conclusion Our findings suggest that occupational exposure to pesticides play a role in the SAO. However, further work is needed to determine causality, and identify the specific component(s) responsible and the underlying mechanisms involved.
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Affiliation(s)
- Johanna Feary
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andre F.S. Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Rabbani G, Nimmi N, Benke GP, Dharmage SC, Bui D, Sim MR, Abramson MJ, Alif SM. Ever and cumulative occupational exposure and lung function decline in longitudinal population-based studies: a systematic review and meta-analysis. Occup Environ Med 2023; 80:51-60. [PMID: 36280382 DOI: 10.1136/oemed-2022-108237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Adverse occupational exposures can accelerate age-related lung function decline. Some longitudinal population-based studies have investigated this association. This study aims to examine this association using findings reported by longitudinal population-based studies. METHODS Ovid Medline, PubMed, Embase, and Web of Science were searched using keywords and text words related to occupational exposures and lung function and 12 longitudinal population-based studies were identified using predefined inclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Lung function decline was defined as annual loss of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) or the ratio (FEV1/FVC). Fixed and random-effects meta-analyses were conducted to calculate pooled estimates for ever and cumulative exposures. Heterogeneity was assessed using the I2 test, and publication bias was evaluated using funnel plots. RESULTS Ever exposures to gases/fumes, vapours, gases, dusts, fumes (VGDF) and aromatic solvents were significantly associated with FEV1 decline in meta-analyses. Cumulative exposures for these three occupational agents observed a similar trend of FEV1 decline. Ever exposures to fungicides and cumulative exposures to biological dust, fungicides and insecticides were associated with FEV1 decline in fixed-effect models only. No statistically significant association was observed between mineral dust, herbicides and metals and FEV1 decline in meta-analyses. CONCLUSION Pooled estimates from the longitudinal population-based studies have provided evidence that occupational exposures are associated with FEV1 decline. Specific exposure control and respiratory health surveillance are required to protect the lung health of the workers.
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Affiliation(s)
| | - Naima Nimmi
- Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria, Australia
| | - Geza P Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh Bui
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheikh M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Occupational factors affecting the decline in pulmonary function among male farmers using occupational pesticide in Gyeonggi-do, South Korea. Ann Occup Environ Med 2022; 34:e42. [PMID: 36704539 PMCID: PMC9836821 DOI: 10.35371/aoem.2022.34.e42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/07/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background Occupational pesticide exposure is a potential risk for respiratory health effects. Most clinical studies on pesticide exposure were related to acute exposure, and only a few studies on chronic exposure have been conducted. This study investigated the chronic respiratory health status and the chronic effects of occupational pesticide exposures of farmers in Gyeonggi-do. Methods Surveys and pulmonary function tests were conducted on 1,697 farmers in 16 regions of Gyeonggi-do. The structured questionnaire included demographic characteristics, medical history, recent respiratory symptoms and diseases, and work-related conditions, and was conducted through one-on-one interviews. The prevalence of respiratory diseases was compared by the odds ratios (ORs) at 95% confidence intervals (CIs) estimated by logistic regression analysis. Additional multivariate logistic regression analysis was also conducted. Results Pesticide work groups showed significant association with an obstructive pattern in the lung function test (unadjusted OR, 2.38; 95% CI, 1.17-5.52). Selected work-related variables of pesticide exposure were 'start age,' 'cumulative duration,' 'mixing pesticides,' and 'protection(goggle).' The obstructive pattern of lung function test showed significant associations with mixing pesticides (OR, 2.30; 95% CI,1.07-5.46), and protection (goggle) use (OR, 0.34; 95% CI, 0.12-0.79). Conclusions Mixing two or more pesticides showed a significant association. Wearing goggles can be seen as an indicator of awareness of the protective equipment and proper wearing of protective equipment, and loss of pulmonary function can be prevented when appropriate protection is worn.
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Fishwick D, Harding AH, Chen Y, Pearce N, Frost G. Asthma in pesticide users: an update from the Great Britain Prospective Investigation of Pesticide Applicators' Health (PIPAH) cohort study. Occup Environ Med 2022; 79:380-387. [PMID: 35121651 PMCID: PMC9120395 DOI: 10.1136/oemed-2021-107486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To define the prevalence and incidence of asthma in a large working population of pesticide workers and to assess which exposures are potentially of relevance to causing or aggravating this condition. METHODS A baseline cross-sectional study at recruitment (2013-2017, n=5817), with follow-up in 2018 (n=2578), was carried out in predominantly Great Britain based pesticide workers. At baseline, participants completed a health and work questionnaire which included questions on demographic, lifestyle, socioeconomic and work-related factors, pesticide use and doctor diagnosed health conditions. In January 2018, a follow-up questionnaire focused on respiratory ill health, with questions covering self-reported respiratory symptoms and doctor diagnosed respiratory conditions. The associations of various exposures with asthma were estimated using logistic regression adjusting for age as a continuous variable, and for sex where possible. An estimate of hours worked with pesticides in the previous year was calculated for each participant. RESULTS At baseline, 608 (10.4%) had doctor diagnosed asthma. In 2018 the figure was 297 (11.5% of the follow-up population); the incidence of new asthma cases between surveys was 1.7 cases per 1000 participants per year. At follow-up, 18.1% reported wheeze in the last 12 months, 73.2% of those with self-reported asthma noted it to be persistent and using a more specific definition of asthma (doctor diagnosed asthma with at least one asthma-related symptom in the last year); 6.8% (95% CI 5.9% to 7.9%) fulfilled this definition. At follow-up, 127 participants felt that their asthma was caused or made worse by their work, with 77 (63.6%) nominating organic dust, 13 (10.7%) unspecified dust, 12 (9.9%) chemicals, 9 (7.4%) mixed exposures, 7 (5.8%) physical agents and 3 (2.5%) fumes or other irritants. There was little or no association between high pesticide exposure and doctor diagnosed asthma or self-reported recent wheeze, although there was an elevated risk for work-related wheeze (OR for high exposure=2.67; 95% CI 1.16 to 6.18). High pesticide exposure (high vs low exposure category OR 2.68, 95% CI 1.28 to 5.60) was also associated with work-related chest tightness. Exposure to organic dusts was associated (significantly, p=0.026) with persistent asthma when adjusted for the effects of age and smoking. CONCLUSIONS This large study of pesticide workers has identified expected levels of doctor diagnosed asthma, and high levels of self-reported respiratory symptoms. Pesticide exposure was associated with an increased risk of self-reported work-related wheeze, but not with asthma or wheeze in general. Further work is needed to identify more clearly which exposures within a complex mixed exposure profile are likely causative in order to best focus interventions to reduce work-related asthma and related conditions.
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Affiliation(s)
- David Fishwick
- Centre for Workplace Health, Science Division, Health and Safety Executive, Buxton, UK
| | | | - Y Chen
- Science Division, Health and Safety Executive, Buxton, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gillian Frost
- Science Division, Health and Safety Executive, Buxton, UK
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9
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Dhansoia V, Majumdar V, Manjunath NK, Singh Gaharwar U, Singh D. Breathing-Focused Yoga Intervention on Respiratory Decline in Chronically Pesticide-Exposed Farmers: A Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:807612. [PMID: 35372380 PMCID: PMC8965718 DOI: 10.3389/fmed.2022.807612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Occupational exposure to pesticides has been associated with lung and cognitive function exacerbations. In the present study, we tested the effectiveness of breathing focused yoga intervention on alleviation of adverse respiratory and cognitive effects associated with chronic pesticide exposure in farmers. Methods We undertook a parallel, two-armed randomized controlled trial with blinded outcome assessors on a chronically pesticide-exposed farming population. The study was conducted at district Panipat, State Haryana located in the Northern part of India from November 2019 to August 2020. A total of 634 farmers were screened, and 140 farmers were randomized to breathing-focused yoga intervention (BFY, n = 70) and waitlist control arms (n = 65). BFY was delivered weekly in 45-min group sessions over 12 weeks followed by home-based practice. The primary outcome was the change in spirometry-based markers of pulmonary function from baseline expressed as raw values, Global Lung Initiative (GLI) percent predicted (pp), and GLI z-scores after 24 weeks of intervention. Secondary variables were Trail making tests (TMT A and B), Digit symbol substitution (DSST), and WHO Quality of life-BREF (WHOQOL-Bref). Analysis was by intention-to-treat. Mediation analysis was done considering oxidative stress markers as potential mediators. Results At the end of 6 months of intervention, the overall follow-up in the participants was 87.85% (n = 123); 90% (n = 63) in the control group, and 85.71% in the yoga group (n = 60). The mean age of the study cohort (n = 140) was 38.75 (SD = 7.50) years. Compared with the control group, at 24 weeks post-intervention, the BFY group had significantly improved status of the raw sand z scores markers of airway obstruction, after adjusting for confounders, FEV1, FVC, FEF25-75 [z score-adjusted mean differences (95% CI); 1.66 (1.10-2.21) 1.88 (1.21-2.55), and 6.85 (5.12-8.57), respectively. A fraction of FEF25-75 change (mediation percentage 23.95%) was explained by glutathione augmentation. There were also significant improvements in cognitive scores of DSST, TMT-A and TMT-B, and WHOQOL-Bref. Conclusion In conclusion, regular practice of BFY could improve the exacerbations in the markers of airway obstruction in chronically pesticide-exposed farmers and cognitive variables. A significant mediating effect of glutathione augmentation was also observed concerning the effect of the intervention on FEF25-75. These findings provide an important piece of beneficial evidence of the breathing-based yoga intervention that needs validation across different farming ethnicities.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: CTRI/2019/11/021989.
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Affiliation(s)
- Vipin Dhansoia
- Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - Vijaya Majumdar
- Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - N. K. Manjunath
- Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - Usha Singh Gaharwar
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
- Swami Shraddhanand College, University of Delhi, Alipur, Delhi
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10
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Wadani ZH, Azam I, Irfan M, Fatmi Z. Pesticides Use and Impaired Lung Function Among Male Agricultural Farmers in Rural Sindh, Pakistan. Asia Pac J Public Health 2021; 34:230-235. [PMID: 34911377 DOI: 10.1177/10105395211065647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Use of pesticides implicated in decrement in lung function, manifested as restrictive or obstructive dysfunction or both. Using comparative cross-sectional study design, authors conducted the study to determine an association of pesticide use with impairment in lung function (restrictive/obstructive pattern of lung function) among agricultural farmers. The data were collected using modified American Thoracic Society Division of Lung Disease (ATS-DLD-78A) questionnaire and spirometer measurements. Using multinomial logistic regression, the risk of both restrictive and obstructive lung dysfunction was found to be almost twice among pesticides users with each increasing year of exposure to pesticides (1.92 and 1.95, respectively) after adjusting for other covariates. There is a need for reliable monitoring and reporting procedures along with appropriate environmental policies and regulations for handling of pesticides. Interventional studies are needed where farmers could be trained on the proper use of personal protective equipment (PPE) to limit the exposure to pesticides.
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Affiliation(s)
- Zahid Hyder Wadani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Muhammad Irfan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Zafar Fatmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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11
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Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts. Ann Am Thorac Soc 2021; 18:238-246. [PMID: 33090904 DOI: 10.1513/annalsats.202002-113oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up.Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults).Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking.Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
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12
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Airborne Occupational Exposures and Lung Function in the Lifelines Cohort Study. Ann Am Thorac Soc 2021; 18:60-67. [PMID: 32795190 DOI: 10.1513/annalsats.201909-678oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale: The association between airborne occupational exposures and lung function level is inconsistent in the general population. Moreover, little is known about the association between occupational exposures and annual lung function decline.Objectives: We investigated the association between occupational exposures and lung function level and annual lung function decline in the population-based Lifelines cohort study.Methods: We included 55,631 adults with baseline spirometry and reliable job code-13,759 of these subjects were aged ≥30 years and underwent spirometry again after 4.5 years of follow-up. Occupational exposures in the current or last-held job at baseline were estimated with the ALOHA+ job-exposure matrix. Linear regression analyses adjusted for covariates were used to test the association between each occupational exposure-biological dust, mineral dust, gases and fumes, pesticides, solvents, and metals-and lung function level and annual lung function decline. Interactions were used to test effect modification by sex or smoking.Results: Exposures to biological dust, mineral dust, gases and fumes, insecticides, fungicides, and aromatic solvents were associated with a lower lung function level at baseline. The effects were larger in males and smokers compared with females and nonsmokers, respectively. However, no association between occupational exposures and the rate of annual lung function decline was found between baseline and follow-up.Conclusions: In this study, airborne occupational exposures are associated with lower lung function level but not with a faster lung function decline. These negative effects are more pronounced among males and smokers.
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13
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Dement JM, Cloeren M, Ringen K, Quinn P, Chen A, Cranford K, Haas S, Hines S. COPD risk among older construction workers-Updated analyses 2020. Am J Ind Med 2021; 64:462-475. [PMID: 33728649 DOI: 10.1002/ajim.23244] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/05/2021] [Accepted: 03/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND A 2010 study of construction workers participating in medical screening programs at the Department of Energy (DOE) nuclear facilities demonstrated increased chronic obstructive pulmonary disease (COPD) risk. The current study of a larger worker cohort allowed for a more nuanced analysis of COPD risk, including for employment beginning after the mid-1990s. METHODS Study participants included 17,941 workers with demographic and smoking data and spirometry with a minimum of three recorded expiratory efforts and reproducibility of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1 ) of 0.2 L or less. COPD was defined as a FEV1 /FVC ratio below the lower limit of normal using established prediction equations without use of bronchodilation. Stratified analyses explored COPD prevalence by demographic variables and trade. Logistic regression analyses assessed risks by trade and time periods of trade and DOE site work, controlling for age, gender, race/ethnicity, body mass index, and smoking. RESULTS Overall COPD prevalence was 13.4% and 67.4% of cases were classified as moderate to severe. Compared to nonconstruction workers, construction trade workers were at significantly increased risk of all COPD (OR = 1.34, 95% CI = 1.29-1.79) and even more so for severe COPD (OR = 1.61, 95% CI = 1.32-1.96). The highest risk trades were cement masons/bricklayers (OR = 2.36; 95% CI = 1.71-3.26) and roofers (OR = 2.22; 95% CI = 1.48-3.32). Risk among workers employed after 1995 was elevated but not statistically significant. CONCLUSIONS Construction workers are at increased COPD risk. Results support the prevention of both smoking and occupational exposures to reduce these risks. While the number of participants employed after 1995 was small, patterns of risk were consistent with findings in the overall cohort.
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Affiliation(s)
- John M. Dement
- Division of Occupational and Environmental Medicine, Department of Family Medicine and Community Health Duke University Medical Center Durham North Carolina USA
| | - Marianne Cloeren
- Division of Occupational and Environmental Medicine, School of Medicine University of Maryland Baltimore Maryland USA
| | - Knut Ringen
- Energy Workers Department CPWR—The Center for Construction Research and Training Silver Spring Maryland USA
| | - Patricia Quinn
- Energy Workers Department CPWR—The Center for Construction Research and Training Silver Spring Maryland USA
| | - Anna Chen
- Government Services Department Zenith American Solutions Seattle Washington USA
| | - Kim Cranford
- Government Services Department Zenith American Solutions Seattle Washington USA
| | - Scott Haas
- Government Services Department Zenith American Solutions Seattle Washington USA
| | - Stella Hines
- Division of Occupational and Environmental Medicine, School of Medicine University of Maryland Baltimore Maryland USA
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14
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Skaaby S, Flachs EM, Lange P, Schlünssen V, Marott JL, Brauer C, Çolak Y, Afzal S, Nordestgaard BG, Sadhra S, Kurmi O, Bonde JPE. Occupational inhalant exposures and longitudinal lung function decline. Eur Respir J 2021; 58:13993003.04341-2020. [PMID: 33958430 DOI: 10.1183/13993003.04341-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/11/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Stinna Skaaby
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Lange
- Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark.,Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jacob Louis Marott
- Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yunus Çolak
- Department of Respiratory Medicine, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Shoaib Afzal
- Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Børge G Nordestgaard
- Copenhagen City Heart Study, Copenhagen University Hospital Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Om Kurmi
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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15
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Faruque MO, Boezen HM, Kromhout H, Vermeulen R, Bültmann U, Vonk JM. Airborne occupational exposures and the risk of developing respiratory symptoms and airway obstruction in the Lifelines Cohort Study. Thorax 2021; 76:thoraxjnl-2020-216721. [PMID: 33653936 PMCID: PMC8311115 DOI: 10.1136/thoraxjnl-2020-216721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To date, only a few studies have investigated the associations between occupational exposures and respiratory outcomes longitudinally in the general population. We investigated the associations between occupational exposures and the development of respiratory symptoms and airway obstruction in the Lifelines Cohort Study. METHODS We included 35 739 occupationally active subjects with data on chronic cough, chronic phlegm, chronic bronchitis or airway obstruction at baseline and approximately 4.5 years follow-up. Exposures to biological dust, mineral dust, gases/fumes, pesticides, solvents and metals in the current job at baseline were estimated with the ALOHA+job-exposure matrix (JEM). Airway obstruction was defined as FEV1/FVC below the lower limit of normal. Logistic regression analysis adjusted for baseline covariates was used to investigate the associations. RESULTS At follow-up, 1888 (6.0%), 1495 (4.7%), 710 (2.5%) and 508 (4.5%) subjects had developed chronic cough, chronic phlegm, chronic bronchitis and airway obstruction, respectively. High exposure to biological dust was associated with a higher odds to develop chronic cough and chronic bronchitis. High exposure to pesticides was associated with a higher odds for the development of all respiratory symptoms and airway obstruction. In the multiple exposures analyses, only the association between pesticides exposure and respiratory symptoms remained. CONCLUSIONS Subjects exposed to high pesticides had a higher odds to develop respiratory symptoms on average 4.5 years later. Control measures should be taken to reduce pesticides exposure among the working population to prevent respiratory symptoms and airway obstruction.
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Affiliation(s)
- Md Omar Faruque
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, Netherlands
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - H Marike Boezen
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, Netherlands
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Utrecht, Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Utrecht, Netherlands
| | - Ute Bültmann
- University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, University of Groningen, Groningen, Netherlands
| | - Judith M Vonk
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, Netherlands
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, Netherlands
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16
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Pagán-Santana M, Amaya C, Rivera-Gutiérrez R, Caporali S. Chronic Diseases among Agricultural Workers in a Rural Area of Puerto Rico. J Agromedicine 2020; 26:211-219. [PMID: 33143555 DOI: 10.1080/1059924x.2020.1824829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Occupational and environmental exposures in the agricultural industry have been associated with several illnesses and poor health outcomes. Information regarding the characteristics and health status of the labor force working in the agricultural sector in Puerto Rico is limited. The overall objective of this study was to increase the available information on agricultural workers health and needs by ascertaining the potential differences in characteristics and health status of farmworkers when compared to the general population in rural Puerto Rico This cross-sectional study used the collection and analysis of medical records of agricultural workers and non-agricultural workers in Hospital General Castañer, located in Lares, Puerto Rico. The research period was five years, from 2012 to 2016. This research described agricultural workers' demographic and socioeconomic profile and evaluated relationships between one or more demographic variables and farmer's health. Agricultural workers presented alower prevalence of hypertensive disease (69.4%) and ahigher prevalence of cerebrovascular disease (3.4%) when compared to non-agricultural workers. In other words, agricultural workers were 21% less likely to have hypertensive disease as compared to non-agricultural workers. Results for agricultural workers showed that 4.0% of the workers were diagnosed with arthritis, and 48.8% had suffered at least one type of dorsopathy. The results from this research provide useful information for developing an appropriate framework to address Puerto Rican agricultural worker's health while promoting the agricultural industry development on the island. Finally, this study provided insight into the prevalence and demographic characteristics of agriculture workers in acentral region of Puerto Rico. Further efforts are needed to better define the agricultural workers and farming communities in Puerto Rico that may be exposed to related hazards.
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Affiliation(s)
- Marysel Pagán-Santana
- Environmental Health Department, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - C Amaya
- Epidemiology and Biostatistics Department, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - R Rivera-Gutiérrez
- Health Services Administration Department, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - S Caporali
- Environmental Health Department, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
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17
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McHugh J, Duong M, Ma J, Dales RE, Bassim CW, Verschoor CP. A comprehensive analysis of factors related to lung function in older adults: Cross-sectional findings from the Canadian Longitudinal Study on Aging. Respir Med 2020; 173:106157. [PMID: 33010732 DOI: 10.1016/j.rmed.2020.106157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
Maintenance of lung function is an often underappreciated, yet critical component of healthy aging. Given the unprecedented shift in the average age of Canadians over the next half century, it will be important to investigate the determinants of lung function in the elderly. In the following study, we estimated the association between lung function and a broad array of factors related to sociodemographics, lifestyle, chronic medical conditions and psychosocial factors in older adults aged 45-86 years old using cross-sectional data from the Canadian Longitudinal Study of Aging (n = 21,338). In addition to examining the entire cohort, we also performed stratified analyses within men/women, adults aged 45-64/65+, and healthy/comorbid. In multivariable regression, our explanatory factors (excluding age, sex, height and ethnicity) were able to explain 17% and 11% of the total variance in FEV1 and FEV1/FVC, respectively. Notable and significant contributions were observed for respiratory disease, smoking, obesity, income, and physical activity, while psychosocial factors mainly exhibited non-significant associations. Generally, these associations were stronger for males than females, and adults 65 and older as compared to those aged 45-64. Our findings indicate that there are pervasive and generally under-recognized sociodemographic and lifestyle factors that exhibit significant associations with FEV1 and FEV1/FVC in older adults. While implication of causality in these relationships is not possible due to the cross-sectional nature of the study, future work aiming to investigate determinants of lung health in older adults may choose to target these factors, given that many are modifiable.
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Affiliation(s)
- Jenna McHugh
- Health Sciences North Research Institute, Sudbury, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Robert E Dales
- Population Studies Division, Health Canada, Ottawa, Canada, University of Ottawa, ON, Canada
| | - Carol W Bassim
- Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada
| | - Chris P Verschoor
- Health Sciences North Research Institute, Sudbury, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, ON, Canada; Northern Ontario School of Medicine, Sudbury, ON, Canada.
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18
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Buralli RJ, Dultra AF, Ribeiro H. Respiratory and Allergic Effects in Children Exposed to Pesticides-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082740. [PMID: 32316194 PMCID: PMC7254369 DOI: 10.3390/ijerph17082740] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/26/2022]
Abstract
Pesticide exposure may affect children’s respiratory and allergic health, although results from epidemiological studies have not reached consensus. This review aims to analyze the scientific evidence on respiratory and allergic effects of exposure to agricultural pesticides in children aged up to 12 years old. The databases PubMed, Web of Science, Scielo, and Lilacs were screened to select articles published in English, Spanish, or Portuguese, and 21 articles were included in this review. Most investigations were conducted in North America (mostly in the United States), while no studies conducted in Latin America or Africa were found, despite their intensive use of pesticides. Children are exposed to pesticides through multiple pathways from the prenatal period throughout later developmental stages and may experience several respiratory effects. Most studies (79%) found positive associations with pesticide exposure and children’s respiratory and allergic effects such as asthma, wheezing, coughs, acute respiratory infections, hay fever, rhinitis, eczema, chronic phlegm, and lung function impairments. Contrastingly, 21% of the studies found no associations between pesticide exposure and children’s respiratory health. The vast differences among the characteristics of the studies hamper any comparison of the results. Exposure to pesticides may have several impacts on childhood respiratory health. More studies must be conducted, especially in low- and middle-income countries, preferably with comparable research protocols adapted to local realities. Efforts should be made to develop comprehensive risk mitigation strategies and behavioral interventions to reduce children’s exposure to pesticides used in agriculture and respiratory health effects, and to ensure healthy childhood growth.
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Affiliation(s)
- Rafael Junqueira Buralli
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo-SP 01246-904, Brazil; (A.F.D.); (H.R.)
- Department of Environmental and Occupational Health and Public Health Emergency Surveillance, Brazilian Ministry of Health (DSASTE/SVS/MS), Brasília-DF 70723-040, Brazil
- Correspondence: ; Tel.: +55-11-3061-7894
| | - Amana Freitas Dultra
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo-SP 01246-904, Brazil; (A.F.D.); (H.R.)
| | - Helena Ribeiro
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo-SP 01246-904, Brazil; (A.F.D.); (H.R.)
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19
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Lung Function Decline in Farm and Nonfarm Rural Residents of Saskatchewan. J Occup Environ Med 2020; 62:e250-e259. [PMID: 32168000 DOI: 10.1097/jom.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to assess the annual changes in lung function among farm and nonfarm adult residences in rural Saskatchewan, Canada. METHODS Data from the Saskatchewan Rural Health Study survey (2010 to 2014) among 724 adults were used. RESULTS For forced expiratory volume in 1 second (FEV1) measurements, estimates of annual decline (in milliliters) were highest in older age male (65+ years) (Mean, SD) (-42.63, 21.16); and among old heavy smokers (-57.79, 24.30). Estimates of annual decline in forced vital capacity (FVC) were highest in current smokers without the use of natural gas (-25.78, 14.78) and among old heavy smokers (-33.88, 20.28). Living on a farm is associated with decreased FEV1 and FVC, but not statistically significant by sex and age. CONCLUSIONS A complex mix of personal and contextual factors may affect these estimates.
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20
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Ohlander J, Fuhrimann S, Basinas I, Cherrie JW, Galea KS, Povey AC, van Tongeren M, Harding AH, Jones K, Vermeulen R, Kromhout H. Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993-2017. Occup Environ Med 2020; 77:357-367. [PMID: 32098789 PMCID: PMC7279185 DOI: 10.1136/oemed-2019-105880] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 12/28/2022]
Abstract
Objective Numerous exposure assessment methods (EAM) exist for investigating health effects of occupational exposure to pesticides. Direct (eg, biomonitoring) and indirect methods (eg, self-reported exposures) are however associated with degrees of exposure misclassification. We systematically reviewed EAM in studies of occupational pesticide exposure. Methods We searched for articles reporting observational epidemiological studies in MEDLINE and Embase published 1993 to 2017. The relative frequency of EAM was analysed according to EAM type (direct and indirect methods), health outcome, study design, study location (country) and specificity of assessment. Temporal trends in EAM were analysed. Results In 1298 included articles 1521 EAM occurrences were documented. Indirect EAM (78.3%), primarily self-reported exposures (39.3%) and job titles assessments (9.5%), were mainly applied in case-control studies (95.0%), in high-income countries (85.0%) and in studies of doctor-diagnosed health outcomes (>85%). Direct EAM (20.8%), primarily biomonitoring of blood (15.6%) or urine (4.7%), were predominantly applied in cross-sectional studies (29.8%), in lower middle-income countries (40.9%) and in studies of neurological (50.0%) outcomes. Between 1993 to 2017 no distinct time trends regarding the ratio indirect to direct methods was seen. Within the category of indirect methods use of self-reported exposures and job exposure matrices increased while assessments by job titles and registers decreased. The use of algorithms showed no trend. The specificity of pesticide assessment increased since studies assessing exposure by using job title as a proxy declined. Assessments of type of pesticide increased. Conclusion Over the last 25 years, the ratio (5:1) of indirect to direct EAM applied in articles on occupational pesticide epidemiology stayed relatively constant; changes were mainly attributable to increasing use of self-reported exposures and job exposure matrices. This review, combined with studies assessing EAM validity, will inform on magnitudes of exposure misclassification and help improve the quality of studies on occupational pesticides exposure.
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Affiliation(s)
- Johan Ohlander
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Samuel Fuhrimann
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ioannis Basinas
- Institute of Occupational Medicine (IOM), Edinburgh, United Kingdom
| | - John W Cherrie
- Institute of Occupational Medicine (IOM), Edinburgh, United Kingdom.,Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot Watt University, Edinburgh, UK
| | - Karen S Galea
- Institute of Occupational Medicine (IOM), Edinburgh, United Kingdom
| | - Andrew C Povey
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Kate Jones
- Health and Safety Executive, Harpur Hill, Buxton, UK
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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21
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de Vries M, Nedeljkovic I, van der Plaat DA, Zhernakova A, Lahousse L, Brusselle GG, Amin N, van Duijn CM, Vonk JM, Boezen HM. DNA methylation is associated with lung function in never smokers. Respir Res 2019; 20:268. [PMID: 31791327 PMCID: PMC6889726 DOI: 10.1186/s12931-019-1222-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Active smoking is the main risk factor for COPD. Here, epigenetic mechanisms may play a role, since cigarette smoking is associated with differential DNA methylation in whole blood. So far, it is unclear whether epigenetics also play a role in subjects with COPD who never smoked. Therefore, we aimed to identify differential DNA methylation associated with lung function in never smokers. METHODS We determined epigenome-wide DNA methylation levels of 396,243 CpG-sites (Illumina 450 K) in blood of never smokers in four independent cohorts, LifeLines COPD&C (N = 903), LifeLines DEEP (N = 166), Rotterdam Study (RS)-III (N = 150) and RS-BIOS (N = 206). We meta-analyzed the cohort-specific methylation results to identify differentially methylated CpG-sites with FEV1/FVC. Expression Quantitative Trait Methylation (eQTM) analysis was performed in the Biobank-based Integrative Omics Studies (BIOS). RESULTS A total of 36 CpG-sites were associated with FEV1/FVC in never smokers at p-value< 0.0001, but the meta-analysis did not reveal any epigenome-wide significant CpG-sites. Of interest, 35 of these 36 CpG-sites have not been associated with lung function before in studies including subjects irrespective of smoking history. Among the top hits were cg10012512, cg02885771, annotated to the gene LTV1 Ribosome Biogenesis factor (LTV1), and cg25105536, annotated to Kelch Like Family Member 32 (KLHL32). Moreover, a total of 11 eQTMS were identified. CONCLUSIONS With the identification of 35 CpG-sites that are unique for never smokers, our study shows that DNA methylation is also associated with FEV1/FVC in subjects that never smoked and therefore not merely related to smoking.
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Affiliation(s)
- Maaike de Vries
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
| | - Ivana Nedeljkovic
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Diana A van der Plaat
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Alexandra Zhernakova
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Bioanalysis, FFW, Ghent University, Ghent, Belgium
| | - Guy G Brusselle
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Judith M Vonk
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - H Marike Boezen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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22
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Feary J. Aromatic solvents: the not so sweet side. Thorax 2019; 74:e1. [DOI: 10.1136/thoraxjnl-2019-213489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/03/2022]
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23
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Alif SM, Dharmage S, Benke G, Dennekamp M, Burgess J, Perret JL, Lodge C, Morrison S, Johns DP, Giles G, Gurrin L, Thomas PS, Hopper JL, Wood-Baker R, Thompson B, Feather I, Vermeulen R, Kromhout H, Jarvis D, Garcia Aymerich J, Walters EH, Abramson MJ, Matheson MC. Occupational exposure to solvents and lung function decline: A population based study. Thorax 2019; 74:650-658. [PMID: 31028237 DOI: 10.1136/thoraxjnl-2018-212267] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/19/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
RATIONALE While cross-sectional studies have shown associations between certain occupational exposures and lower levels of lung function, there was little evidence from population-based studies with repeated lung function measurements. OBJECTIVES We aimed to investigate the associations between occupational exposures and longitudinal lung function decline in the population-based Tasmanian Longitudinal Health Study. METHODS Lung function decline between ages 45 years and 50 years was assessed using data from 767 participants. Using lifetime work history calendars completed at age 45 years, exposures were assigned according to the ALOHA plus Job Exposure Matrix. Occupational exposures were defined as ever exposed and cumulative exposure -unit- years. We investigated effect modification by sex, smoking and asthma status. RESULTS Compared with those without exposure, ever exposures to aromatic solvents and metals were associated with a greater decline in FEV1 (aromatic solvents 15.5 mL/year (95% CI -24.8 to 6.3); metals 11.3 mL/year (95% CI -21.9 to - 0.7)) and FVC (aromatic solvents 14.1 mL/year 95% CI -28.8 to - 0.7; metals 17.5 mL/year (95% CI -34.3 to - 0.8)). Cumulative exposure (unit years) to aromatic solvents was also associated with greater decline in FEV1 and FVC. Women had lower cumulative exposure years to aromatic solvents than men (mean (SD) 9.6 (15.5) vs 16.6 (14.6)), but greater lung function decline than men. We also found association between ever exposures to gases/fumes or mineral dust and greater decline in lung function. CONCLUSIONS Exposures to aromatic solvents and metals were associated with greater lung function decline. The effect of aromatic solvents was strongest in women. Preventive strategies should be implemented to reduce these exposures in the workplace.
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Affiliation(s)
- Sheikh M Alif
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Geza Benke
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martine Dennekamp
- Environmental Public Health, Environment Protection Authority Victoria, Melbourne, Victoria, Australia
| | - John Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Morrison
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David Peter Johns
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Graham Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Lyle Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul S Thomas
- Faculty of Medicine, University of new South Wales, Sydney, New South Wales, Australia
| | - John Llewelyn Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Bruce Thompson
- Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Iain Feather
- Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Roel Vermeulen
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College, London, United Kingdom of Great Britain and Northern Ireland
| | | | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Claire Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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24
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Lytras T, Kogevinas M, Kromhout H, Carsin AE, Antó JM, Bentouhami H, Weyler J, Heinrich J, Nowak D, Urrutia I, Martínez-Moratalla J, Gullón JA, Vega AP, Raherison Semjen C, Pin I, Demoly P, Leynaert B, Villani S, Gíslason T, Svanes Ø, Holm M, Forsberg B, Norbäck D, Mehta AJ, Probst-Hensch N, Benke G, Jogi R, Torén K, Sigsgaard T, Schlünssen V, Olivieri M, Blanc PD, Watkins J, Bono R, Buist AS, Vermeulen R, Jarvis D, Zock JP. Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey. Occup Environ Med 2019; 76:222-229. [PMID: 30700596 DOI: 10.1136/oemed-2018-105274] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. METHODS Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. RESULTS 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. CONCLUSIONS Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.
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Affiliation(s)
- Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Manolis Kogevinas
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Hans Kromhout
- IRAS, University of Utrecht, Utrecht, The Netherlands
| | - Anne-Elie Carsin
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josep Maria Antó
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Hayat Bentouhami
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joost Weyler
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Galdakao, Spain
| | - Jesús Martínez-Moratalla
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | - Antonio Pereira Vega
- Pulmonology and Allergy Clinical Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Chantal Raherison Semjen
- Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Université de Bordeaux, Bordeaux, France
| | - Isabelle Pin
- Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.,U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, Paris, France
| | - Bénédicte Leynaert
- Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
| | - Simona Villani
- Section of Epidemiology and Medical Statistics, Department of Health Sciences, University of Pavia, Pavia, Italy
| | - Thorarinn Gíslason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Øistein Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amar J Mehta
- Office of Research and Evaluation, Boston Public Health Commission, Boston, Massachusetts, USA
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Europe
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torben Sigsgaard
- Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Vivi Schlünssen
- Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Paul D Blanc
- San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA
| | - John Watkins
- School of Medicine, Cardiff University, Cardiff, Wales, UK.,Public Health Wales, Cardiff, Wales, UK
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Sonia Buist
- Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Deborah Jarvis
- School of Medicine, Cardiff University, Cardiff, Wales, UK.,Public Health Wales, Cardiff, Wales, UK.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy.,Population Health and Occupational Disease, National Heart and Lung Institute, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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25
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Zeng X, Vonk JM, van der Plaat DA, Faiz A, Paré PD, Joubert P, Nickle D, Brandsma CA, Kromhout H, Vermeulen R, Xu X, Huo X, de Jong K, Boezen HM. Genome-wide interaction study of gene-by-occupational exposures on respiratory symptoms. ENVIRONMENT INTERNATIONAL 2019; 122:263-269. [PMID: 30449631 DOI: 10.1016/j.envint.2018.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 02/05/2023]
Abstract
Respiratory symptoms are important indicators of respiratory diseases. Both genetic and environmental factors contribute to respiratory symptoms development but less is known about gene-environment interactions. We aimed to assess interactions between single nucleotide polymorphisms (SNPs) and occupational exposures on respiratory symptoms cough, dyspnea and phlegm. As identification cohort LifeLines I (n = 7976 subjects) was used. Job-specific exposure was estimated using the ALOHA + job exposure matrix. SNP-by-occupational exposure interactions on respiratory symptoms were tested using logistic regression adjusted for gender, age, and current smoking. SNP-by-exposure interactions with a p-value <10-4 were tested for replication in two independent cohorts: LifeLines II (n = 5260) and the Vlagtwedde-Vlaardingen cohort (n = 1529). The interaction estimates of the replication cohorts were meta-analyzed using PLINK. Replication was achieved when the meta-analysis p-value was <0.05 and the interaction effect had the same direction as in the identification cohort. Additionally, we assessed whether replicated SNPs associated with gene expression by analyzing if they were cis-acting expression quantitative trait loci (eQTL) in lung tissue. In the replication meta-analysis, sixteen out of 477 identified SNP-by-occupational exposure interactions had a p-value <0.05 and 9 of these interactions had the same direction as in the identification cohort. Several identified loci were plausible candidates for respiratory symptoms, such as TMPRSS9, SERPINH1, TOX3, and ARHGAP18. Three replicated SNPs were cis-eQTLs for FCER1A, CHN1, and TIMM13 in lung tissue. Taken together, this genome-wide SNP-by-occupational exposure interaction study in relation to cough, dyspnea, and phlegm identified several suggestive susceptibility genes. Further research should determine if these genes are true susceptibility loci for respiratory symptoms in relation to occupational exposures.
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Affiliation(s)
- Xiang Zeng
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands; Shantou University Medical College, Laboratory of Environmental Medicine and Developmental Toxicology, Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, China; Xinxiang Medical University, School of Public Health, Department of Epidemiology and Health Statistics, Xinxiang, China
| | - Judith M Vonk
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands
| | - Diana A van der Plaat
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands
| | - Alen Faiz
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
| | - Peter D Paré
- University of British Columbia, Department of Medicine, Center for Heart Lung Innovation and Institute for Heart and Lung Health, St. Paul's Hospital, Vancouver, BC, Canada
| | - Philippe Joubert
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Québec, QC, Canada
| | | | - Corry-Anke Brandsma
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands
| | - Hans Kromhout
- University of Utrecht, Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht, the Netherlands
| | - Roel Vermeulen
- University of Utrecht, Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht, the Netherlands
| | - Xijin Xu
- Shantou University Medical College, Laboratory of Environmental Medicine and Developmental Toxicology, Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, China
| | - Xia Huo
- Jinan University, School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Guangzhou Key Laboratory of Environmental Exposure and Health, Guangzhou, China
| | - Kim de Jong
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands
| | - H Marike Boezen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands.
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26
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de Vries M, van der Plaat DA, Nedeljkovic I, Verkaik-Schakel RN, Kooistra W, Amin N, van Duijn CM, Brandsma CA, van Diemen CC, Vonk JM, Marike Boezen H. From blood to lung tissue: effect of cigarette smoke on DNA methylation and lung function. Respir Res 2018; 19:212. [PMID: 30390659 PMCID: PMC6215675 DOI: 10.1186/s12931-018-0904-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/28/2018] [Indexed: 01/07/2023] Open
Abstract
Background Genetic and environmental factors play a role in the development of COPD. The epigenome, and more specifically DNA methylation, is recognized as important link between these factors. We postulate that DNA methylation is one of the routes by which cigarette smoke influences the development of COPD. In this study, we aim to identify CpG-sites that are associated with cigarette smoke exposure and lung function levels in whole blood and validate these CpG-sites in lung tissue. Methods The association between pack years and DNA methylation was studied genome-wide in 658 current smokers with >5 pack years using robust linear regression analysis. Using mediation analysis, we subsequently selected the CpG-sites that were also associated with lung function levels. Significant CpG-sites were validated in lung tissue with pyrosequencing and expression quantitative trait methylation (eQTM) analysis was performed to investigate the association between DNA methylation and gene expression. Results 15 CpG-sites were significantly associated with pack years and 10 of these were additionally associated with lung function levels. We validated 5 CpG-sites in lung tissue and found several associations between DNA methylation and gene expression. Conclusion This study is the first to validate a panel of CpG-sites that are associated with cigarette smoking and lung function levels in whole blood in the tissue of interest: lung tissue. Electronic supplementary material The online version of this article (10.1186/s12931-018-0904-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maaike de Vries
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands. .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
| | - Diana A van der Plaat
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Ivana Nedeljkovic
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rikst Nynke Verkaik-Schakel
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, The Netherlands
| | - Wierd Kooistra
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Corry-Anke Brandsma
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Cleo C van Diemen
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Judith M Vonk
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - H Marike Boezen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, Groningen, 9713, GZ, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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27
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Amaral AFS, Quint JK. Cottage by the sea or house above the trees: which is better for my lungs? Thorax 2018; 73:1103-1104. [PMID: 30166423 DOI: 10.1136/thoraxjnl-2018-212146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Andre F S Amaral
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Jennifer K Quint
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
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28
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Buralli RJ, Ribeiro H, Mauad T, Amato-Lourenço LF, Salge JM, Diaz-Quijano FA, Leão RS, Marques RC, Silva DS, Guimarães JRD. Respiratory Condition of Family Farmers Exposed to Pesticides in the State of Rio de Janeiro, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061203. [PMID: 29890615 PMCID: PMC6025513 DOI: 10.3390/ijerph15061203] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/20/2022]
Abstract
Pesticide exposure is a growing public health concern. Although Brazil is the world’s largest consumer of pesticides, only a few studies have addressed the health effects among farmers. This study aimed to evaluate whether pesticide exposure is associated with respiratory outcomes among rural workers and relatives in Brazil during the crop and off-seasons. Family farmers (82) were interviewed about occupational history and respiratory symptoms, and cholinesterase tests were conducted in the crop-season. Spirometry was performed during the crop and off-season. Respiratory outcomes were compared between seasons and multiple regressions analysis were conducted to search for associations with exposure indicators. Participants were occupationally and environmentally exposed to multiple pesticides from an early age. During the crop and off-season, respectively, they presented a prevalence of 40% and 30.7% for cough, 30.7% and 24% for nasal allergies, and 24% and 17.3% for chest tightness. Significant associations between spirometry impairments and exposure indicators were found both during the crop and off-season. These findings provide complementary evidence about the association of pesticide exposure with adverse respiratory effects among family farmers in Brazil. This situation requires special attention as it may increase the risk of pulmonary dysfunctions, and the morbidity and mortality burden associated with these diseases.
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Affiliation(s)
- Rafael J Buralli
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr Arnaldo, 715, São Paulo, SP 01246-904, Brazil.
| | - Helena Ribeiro
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr Arnaldo, 715, São Paulo, SP 01246-904, Brazil.
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Av. Dr Arnaldo, 455, sala 1155, São Paulo, SP 01246-903, Brazil.
| | - Luís F Amato-Lourenço
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Av. Dr Arnaldo, 455, sala 1155, São Paulo, SP 01246-903, Brazil.
| | - João M Salge
- Pneumologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr Enéas Carvalho de Aguiar, 44-Bloco II, 5 andar, São Paulo, SP 05403000, Brazil.
| | - Fredi A Diaz-Quijano
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr Arnaldo, 715, São Paulo, SP 01246-904, Brazil.
| | - Renata S Leão
- Centro de Tecnologia em Nanomateriais-CTNANO, Rua Prof. José Vieira de Mendonça, 1000, Belo Horizonte, MG 31310-260, Brazil.
| | - Rejane C Marques
- Universidade Federal do Rio de Janeiro-Campus Macaé, Av. Aloísio da Silva Gomes, 50, Macaé, RJ 27930-560, Brazil.
| | - Daniele S Silva
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373-Bloco G-CCS, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil.
| | - Jean Remy Davée Guimarães
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373-Bloco G-CCS, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil.
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29
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Lytras T, Kogevinas M, Kromhout H, Carsin AE, Antó JM, Bentouhami H, Weyler J, Heinrich J, Nowak D, Urrutia I, Martinez-Moratalla J, Gullón JA, Pereira-Vega A, Raherison-Semjen C, Pin I, Demoly P, Leynaert B, Villani S, Gislason T, Svanes C, Holm M, Forsberg B, Norbäck D, Mehta AJ, Probst-Hensch N, Benke G, Jogi R, Torén K, Sigsgaard T, Schlünssen V, Olivieri M, Blanc PD, Vermeulen R, Garcia-Aymerich J, Jarvis D, Zock JP. Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey. Thorax 2018; 73:1008-1015. [PMID: 29574416 DOI: 10.1136/thoraxjnl-2017-211158] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey. METHODS General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework. FINDINGS 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%. INTERPRETATION These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
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Affiliation(s)
- Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Manolis Kogevinas
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Hans Kromhout
- IRAS, University of Utrecht, Utrecht, The Netherlands
| | - Anne-Elie Carsin
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Josep M Antó
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Hayat Bentouhami
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joost Weyler
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Bizkaia, Spain
| | - Jesús Martinez-Moratalla
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | | - Antonio Pereira-Vega
- Respiratory and Allergy Clinical Unit, Universitary Hospitalary Complex, Huelva, Spain
| | - Chantal Raherison-Semjen
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, France
| | - Isabelle Pin
- Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.,Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, Paris, France
| | - Bénédicte Leynaert
- Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
| | - Simona Villani
- Department of Health Sciences, Experimental and Forensic Medicine - Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amar J Mehta
- Research and Evaluation Office, Boston Public Health Commission, Boston, Massachusetts, USA
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torben Sigsgaard
- Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Paul D Blanc
- University of California San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Judith Garcia-Aymerich
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Deborah Jarvis
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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30
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van der Plaat DA, de Jong K, de Vries M, van Diemen CC, Nedeljković I, Amin N, Kromhout H, Vermeulen R, Postma DS, van Duijn CM, Boezen HM, Vonk JM. Occupational exposure to pesticides is associated with differential DNA methylation. Occup Environ Med 2018; 75:427-435. [PMID: 29459480 PMCID: PMC5969365 DOI: 10.1136/oemed-2017-104787] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/01/2017] [Accepted: 12/31/2017] [Indexed: 01/07/2023]
Abstract
Objectives Occupational pesticide exposure is associated with a wide range of diseases, including lung diseases, but it is largely unknown how pesticides influence airway disease pathogenesis. A potential mechanism might be through epigenetic mechanisms, like DNA methylation. Therefore, we assessed associations between occupational exposure to pesticides and genome-wide DNA methylation sites. Methods 1561 subjects of LifeLines were included with either no (n=1392), low (n=108) or high (n=61) exposure to any type of pesticides (estimated based on current or last held job). Blood DNA methylation levels were measured using Illumina 450K arrays. Associations between pesticide exposure and 420 938 methylation sites (CpGs) were assessed using robust linear regression adjusted for appropriate confounders. In addition, we performed genome-wide stratified and interaction analyses by gender, smoking and airway obstruction status, and assessed associations between gene expression and methylation for genome-wide significant CpGs (n=2802). Results In total for all analyses, high pesticide exposure was genome-wide significantly (false discovery rate P<0.05) associated with differential DNA methylation of 31 CpGs annotated to 29 genes. Twenty of these CpGs were found in subjects with airway obstruction. Several of the identified genes, for example, RYR1, ALLC, PTPRN2, LRRC3B, PAX2 and VTRNA2-1, are genes previously linked to either pesticide exposure or lung-related diseases. Seven out of 31 CpGs were associated with gene expression levels. Conclusions We show for the first time that occupational exposure to pesticides is genome-wide associated with differential DNA methylation. Further research should reveal whether this differential methylation plays a role in the airway disease pathogenesis induced by pesticides.
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Affiliation(s)
- Diana A van der Plaat
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kim de Jong
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maaike de Vries
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cleo C van Diemen
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivana Nedeljković
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hans Kromhout
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Groningen, The Netherlands
| | | | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Groningen, The Netherlands
| | - Dirkje S Postma
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelia M van Duijn
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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31
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Alif SM, Dharmage SC, Benke G, Dennekamp M, Burgess JA, Perret JL, Lodge CJ, Morrison S, Johns DP, Giles GG, Gurrin LC, Thomas PS, Hopper JL, Wood-Baker R, Thompson BR, Feather IH, Vermeulen R, Kromhout H, Walters EH, Abramson MJ, Matheson MC. Occupational exposure to pesticides are associated with fixed airflow obstruction in middle-age. Thorax 2017; 72:990-997. [PMID: 28687678 DOI: 10.1136/thoraxjnl-2016-209665] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/24/2017] [Accepted: 05/01/2017] [Indexed: 11/04/2022]
Abstract
RATIONALE Population-based studies have found evidence of a relationship between occupational exposures and Chronic Obstructive Pulmonary Disease (COPD), but these studies are limited by the use of prebronchodilator spirometry. Establishing this link using postbronchodilator is critical, because occupational exposures are a modifiable risk factor for COPD. OBJECTIVES To investigate the associations between occupational exposures and fixed airflow obstruction using postbronchodilator spirometry. METHODS One thousand three hundred and thirty-five participants were included from 2002 to 2008 follow-up of the Tasmanian Longitudinal Health Study (TAHS). Spirometry was performed and lifetime work history calendars were used to collect occupational history. ALOHA plus Job Exposure Matrix was used to assign occupational exposure, and defined as ever exposed and cumulative exposure unit (EU)-years. Fixed airflow obstruction was defined by postbronchodilator FEV1/FVC <0.7 and the lower limit of normal (LLN). Multinomial logistic regressions were used to investigate potential associations while controlling for possible confounders. RESULTS Ever exposure to biological dust (relative risk (RR)=1.58, 95% CI 1.01 to 2.48), pesticides (RR=1.74,95% CI 1.00 to 3.07) and herbicides (RR=2.09,95% CI 1.18 to 3.70) were associated with fixed airflow obstruction. Cumulative EU-years to all pesticides (RR=1.11,95% CI 1.00 to 1.25) and herbicides (RR=1.15,95% CI 1.00 to 1.32) were also associated with fixed airflow obstruction. In addition, all pesticides exposure was consistently associated with chronic bronchitis and symptoms that are consistent with airflow obstruction. Ever exposure to mineral dust, gases/fumes and vapours, gases, dust or fumes were only associated with fixed airflow obstruction in non-asthmatics only. CONCLUSIONS Pesticides and herbicides exposures were associated with fixed airflow obstruction and chronic bronchitis. Biological dust exposure was also associated with fixed airflow obstruction in non-asthmatics. Minimising occupational exposure to these agents may help to reduce the burden of COPD.
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Affiliation(s)
- Sheikh M Alif
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Geza Benke
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martine Dennekamp
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Morrison
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David Peter Johns
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Graham G Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Paul S Thomas
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John Llewelyn Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Bruce R Thompson
- Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Iain H Feather
- Gold Coast University Hospital, Southport, Queensland, Australia.,Bond University, Robina, Queensland, Australia
| | - Roel Vermeulen
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Claire Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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32
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Carles C, Bouvier G, Lebailly P, Baldi I. Use of job-exposure matrices to estimate occupational exposure to pesticides: A review. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:125-140. [PMID: 27189257 DOI: 10.1038/jes.2016.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
The health effects of pesticides have been extensively studied in epidemiology, mainly in agricultural populations. However, pesticide exposure assessment remains a key methodological issue for epidemiological studies. Besides self-reported information, expert assessment or metrology, job-exposure matrices still appear to be an interesting tool. We reviewed all existing matrices assessing occupational exposure to pesticides in epidemiological studies and described the exposure parameters they included. We identified two types of matrices, (i) generic ones that are generally used in case-control studies and document broad categories of pesticides in a large range of jobs, and (ii) specific matrices, developed for use in agricultural cohorts, that generally provide exposure metrics at the active ingredient level. The various applications of these matrices in epidemiological studies have proven that they are valuable tools to assess pesticide exposure. Specific matrices are particularly promising for use in agricultural cohorts. However, results obtained with matrices have rarely been compared with those obtained with other tools. In addition, the external validity of the given estimates has not been adequately discussed. Yet, matrices would help in reducing misclassification and in quantifying cumulated exposures, to improve knowledge about the chronic health effects of pesticides.
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Affiliation(s)
- Camille Carles
- Université Bordeaux, ISPED, Equipe Epicène, Bordeaux, France
- CHU de Bordeaux, Service de Médecine du Travail, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219, Bordeaux, France
| | - Ghislaine Bouvier
- Université Bordeaux, ISPED, Equipe Epicène, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219, Bordeaux, France
| | - Pierre Lebailly
- INSERM, UMR1086-Cancers et Préventions, Caen, France
- Université Caen Normandie, Caen, France
- Centre François Baclesse, Caen, France
| | - Isabelle Baldi
- Université Bordeaux, ISPED, Equipe Epicène, Bordeaux, France
- CHU de Bordeaux, Service de Médecine du Travail, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219, Bordeaux, France
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Tagiyeva N, Sadhra S, Mohammed N, Fielding S, Devereux G, Teo E, Ayres J, Graham Douglas J. Occupational airborne exposure in relation to Chronic Obstructive Pulmonary Disease (COPD) and lung function in individuals without childhood wheezing illness: A 50-year cohort study. ENVIRONMENTAL RESEARCH 2017; 153:126-134. [PMID: 27940105 DOI: 10.1016/j.envres.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Evidence from longitudinal population-based studies relating occupational exposure to the full range of different forms of airborne pollutants and lung function and airway obstruction is limited. OBJECTIVE To relate self-reported COPD and lung function impairment to occupational exposure to different forms of airborne chemical pollutants in individuals who did not have childhood wheeze. METHODS A prospective cohort study was randomly selected in 1964 at age 10-15 years and followed up in 1989, 1995, 2001 and 2014 (aged 58-64) by spirometry and respiratory questionnaire. Occupational histories were recorded in 2014 and occupational exposures assigned using an airborne chemical job exposure matrix. The risk of COPD and lung function impairment was analyzed in subjects, who did not have childhood wheeze, using logistic and linear regression and linear mixed effects models. RESULTS 237 subjects without childhood wheeze (mean age 60.6 years, 47% male) were analyzed. There was no association between any respiratory outcomes and exposure to gases, fibers, mists or mineral dusts and no consistent associations with exposure to fumes. Reduced FEV1 was associated with longer duration (years) of exposure to any of the six main pollutant forms - vapors, gases, dusts, fumes, fibers and mists (VGDFFiM) with evidence of a dose-response relationship (p-trend=0.004). Exposure to biological dusts was associated with self-reported COPD and FEV1<Lower Limit of Normal (LLN) (adjusted odds ratio [95%CI] 4.59 [1.15,18.32] and 3.54 [1.21,10.35] respectively), and reduced FEF25-75% (adjusted regression coefficients [95% CIs] -9.11 [-17.38, -0.84] respectively). Exposure to vapors was associated with self-reported COPD and FEV1<LLN (adjOR 6.46 [1.18,35.37] and 4.82 [1.32,17.63]). Longitudinal analysis demonstrated reduced FEV1 and FEF25-75% associated with exposure to biological dusts or vapors. CONCLUSIONS People with no history of childhood wheezing who have been occupationally exposed to biological dusts or vapors or had longer duration of lifetime exposure to any VGDFFiM are at a higher risk of reduced lung function at age 58-64 years. Occupational exposure to biological dusts or vapors also increased the risk of self-reported COPD.
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Affiliation(s)
- Nara Tagiyeva
- School of Dentistry, University of Central Lancashire, Preston PR1 2EH, UK.
| | - Steven Sadhra
- Occupational and Environmental Medicine, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Nuredin Mohammed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZG, UK
| | - Graham Devereux
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZG, UK
| | - Ed Teo
- Academic Clinical Programme for Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Jon Ayres
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - J Graham Douglas
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZG, UK
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Zeng X, Vonk JM, de Jong K, Xu X, Huo X, Boezen HM. No convincing association between genetic markers and respiratory symptoms: results of a GWA study. Respir Res 2017; 18:11. [PMID: 28073367 PMCID: PMC5223330 DOI: 10.1186/s12931-016-0495-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/17/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Respiratory symptoms are associated with accelerated lung function decline, and increased hospitalization and mortality rates in the general population. Although several environmental risk factors for respiratory symptoms are known, knowledge on genetic risk factors is lacking. We aim to identify genetic variants associated with respiratory symptoms by genome-wide association (GWA) analyses. METHODS We conducted the first GWA study on cough, dyspnea and phlegm among 7,976 participants in the LifeLines I cohort and used the LifeLines II cohort (n = 5,260) and the Vlagtwedde-Vlaardingen cohort (n = 1,529) for replication. RESULTS We identified 50 SNPs that were assessed for replication. Rs16918212, located in the alpha-2-macroglobulin pseudogene 1 (A2MP1), was associated with cough in both the identification (odds ratio (OR) = 0.72, p = 5.41 × 10-5) and the meta-analyzed replication cohorts (OR = 0.83, p = 0.033). No other significant replicated associations were found. CONCLUSIONS Given that only 1 out of 50 SNPs showed significant replication (i.e. 2%) we conclude that we did not find a convincing association between genetic markers and respiratory symptoms. Since, environmental exposures are important risk factors for respiratory symptoms, the next step is to perform a genome-wide interaction (GWI) study to identify genetic susceptibility loci for respiratory symptoms in interaction with known harmful environmental exposures.
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Grants
- This study was funded by the Groningen Research Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, the Netherlands. The LifeLines Cohort Study, and generation and management of GWAS genotype data for the LifeLines Cohort Study is supported by the Netherlands Organization of Scientific Research NWO (grant 175.010.2007.006), the Economic Structure Enhancing Fund (FES) of the Dutch government, the Ministry of Economic Affairs, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the Northern Netherlands Collaboration of Provinces (SNN), the Province of Groningen, University Medical Center Groningen, the University of Groningen, Dutch Kidney Foundation and Dutch Diabetes Research Foundation. The Vlagtwedde-Vlaardingen cohort study was supported by the Ministry of Health and Environmental Hygiene of the Netherlands and the Netherlands Asthma Fund (grant 187) and the Netherlands Asthma Fund grant no. 3.2.02.51, the Stichting Astma Bestrijding, BBMRI-NL (Complementiation project), and the European Respiratory Society COPD research award 2011 to H.M. Boezen.
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Affiliation(s)
- Xiang Zeng
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands
- Laboratory of Environmental Medicine and Developmental Toxicology, and Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Judith M Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands
| | - Kim de Jong
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands
| | - Xijin Xu
- Laboratory of Environmental Medicine and Developmental Toxicology, and Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, China
| | - Xia Huo
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Guangzhou Key Laboratory of Environmental Exposure and Health, Jinan University, Guangzhou, 510632, China
| | - H Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands.
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, 1 Hanzeplein, Groningen, 9700RB, The Netherlands.
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Tagiyeva N, Teo E, Fielding S, Devereux G, Semple S, Douglas G. Occupational exposure to asthmagens and adult onset wheeze and lung function in people who did not have childhood wheeze: A 50-year cohort study. ENVIRONMENT INTERNATIONAL 2016; 94:60-68. [PMID: 27209001 DOI: 10.1016/j.envint.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND There are few prospective studies that relate the development of adult respiratory disease with exposure to occupational asthmagens. OBJECTIVE To evaluate the risk of adult onset wheeze (AOW) and obstructive lung function associated with occupational exposures over 50years. METHODS A population-based randomly selected cohort of children who had not had asthma or wheezing illness, recruited in 1964 at age 10-15years, was followed-up in 1989, 1995, 2001 and 2014 by spirometry and respiratory questionnaire. Occupational histories were obtained in 2014 and occupational exposures determined with an asthma-specific job exposure matrix. The risk of AOW and lung function impairment was analysed in subjects without childhood wheeze using logistic regression and linear mixed effects models. RESULTS All 237 subjects (mean age: 61years, 47% male, 52% ever smoked) who took part in the 2014 follow-up had completed spirometry. Among those who did not have childhood wheeze, spirometry was measured in 93 subjects in 1989, in 312 in 1995 and in 270 subjects in 2001 follow-up. For longitudinal analysis of changes in FEV1 between 1989 and 2014 spirometry records were available on 191 subjects at three time points and on 45 subjects at two time points, with a total number of 663 records. AOW and FEV1<LLN were associated with occupational exposure to food-related asthmagens (adjusted odds ratios (adjORs) 95% CI: 2.7 [1.4, 5.1] and 2.9 [1.1, 7.7]) and biocides/fungicides (adjOR 95% CI: 1.8 [1.1, 3.1] and 3.4 [1.1, 10.8]), with evident dose-response effect (p-trends<0.05). Exposure to food-related asthmagens was also associated with reduced FEV1, FVC and FEF25-75% (adjusted regression coefficients 95% CI: -7.2 [-12.0, -2.4], -6.2 [-10.9, -1.4], and -13.3[-23.4, -3.3]). Exposure to wood dust was independently associated with AOW, obstructive lung function and reduced FEF25-75%. Excess FEV1 decline of 6-8ml/year was observed with occupational exposure to any asthmagen, biocides/fungicides and food-related asthmagens (p<0.05). CONCLUSIONS This longitudinal study confirmed previous findings of increased risks of adult onset wheezing illness with occupational exposure to specific asthmagens. A novel finding was the identification of food-related asthmagens and biocides/fungicides as potential new occupational risk factors for lung function impairment in adults without childhood wheeze.
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Affiliation(s)
- Nara Tagiyeva
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Edmund Teo
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Graham Devereux
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sean Semple
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Graham Douglas
- Respiratory Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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Fry JP, Love DC, MacDonald GK, West PC, Engstrom PM, Nachman KE, Lawrence RS. Environmental health impacts of feeding crops to farmed fish. ENVIRONMENT INTERNATIONAL 2016; 91:201-14. [PMID: 26970884 DOI: 10.1016/j.envint.2016.02.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/22/2016] [Accepted: 02/18/2016] [Indexed: 05/15/2023]
Abstract
Half of the seafood consumed globally now comes from aquaculture, or farmed seafood. Aquaculture therefore plays an increasingly important role in the global food system, the environment, and human health. Traditionally, aquaculture feed has contained high levels of wild fish, which is unsustainable for ocean ecosystems as demand grows. The aquaculture industry is shifting to crop-based feed ingredients, such as soy, to replace wild fish as a feed source and allow for continued industry growth. This shift fundamentally links seafood production to terrestrial agriculture, and multidisciplinary research is needed to understand the ecological and environmental health implications. We provide basic estimates of the agricultural resource use associated with producing the top five crops used in commercial aquaculture feed. Aquaculture's environmental footprint may now include nutrient and pesticide runoff from industrial crop production, and depending on where and how feed crops are produced, could be indirectly linked to associated negative health outcomes. We summarize key environmental health research on health effects associated with exposure to air, water, and soil contaminated by industrial crop production. Our review also finds that changes in the nutritional content of farmed seafood products due to altered feed composition could impact human nutrition. Based on our literature reviews and estimates of resource use, we present a conceptual framework describing the potential links between increasing use of crop-based ingredients in aquaculture and human health. Additional data and geographic sourcing information for crop-based ingredients are needed to fully assess the environmental health implications of this trend. This is especially critical in the context of a food system that is using both aquatic and terrestrial resources at unsustainable rates.
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Affiliation(s)
- Jillian P Fry
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, USA.
| | - David C Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Graham K MacDonald
- Department of Geography, McGill University, 805 Sherbrooke Street West, Montreal, Quebec, Canada
| | - Paul C West
- Institute on the Environment (IonE), University of Minnesota, 1954 Buford Avenue, St. Paul, MN, USA
| | - Peder M Engstrom
- Institute on the Environment (IonE), University of Minnesota, 1954 Buford Avenue, St. Paul, MN, USA
| | - Keeve E Nachman
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD, USA
| | - Robert S Lawrence
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, USA
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Nassar AMK, Salim YM, Malhat FM. Assessment of Pesticide Residues in Human Blood and Effects of Occupational Exposure on Hematological and Hormonal Qualities. Pak J Biol Sci 2016; 19:95-105. [PMID: 29023046 DOI: 10.3923/pjbs.2016.95.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pesticides are the first choice by farmers for use against plant pathogens, nevertheless their adverse effects to the environment. Current study was designed to measure pesticides residues in blood of spray farmers and to assess their possible effects. Blood indices and thyroid and reproductive hormones were evaluated in blood of adult male volunteers (20-48 years old). Volunteers were divided to three groups; spray-workers (directly-exposed), farmers who live in the country area (indirectly-exposed) and city inhabitants (not exposed). Spray workers had significantly decreased platelet number (PLT, 33%), ratio of large platelet (P-LCR%, 42%), average platelet volume (MPV, 70%), relative width of the distribution of erythrocytes (PDW, 56%), relative content of monocytes, basophils and eosinophils (MXD, 100%) compared to control group. In addition, blood samples of the exposed group showed significantly decreased PLT (30%), P-LCR (40%), MPV (65%) and PDW (50%) compared to the farmers. Furthermore, levels of testosterone, triiodothyronine and thyroxine hormones of spray workers were significantly low compared with the country residents. Then results were further subjected to canonical discriminant analysis to visualize the interrelationships among variables. Results highlighted the critical need for enforced official interventions that reduce overexposure of spray workers throughout Egypt.
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Affiliation(s)
- Atef M K Nassar
- Department of Plant Protection, Faculty of Agriculture, Damanhour University, Damanhour, Albeheira 22516, Egypt
| | - Yehia M Salim
- Department of Plant Protection, Faculty of Agriculture, Damanhour University, Damanhour, Albeheira 22516, Egypt
| | - Farag M Malhat
- Central Agricultural Pesticide Laboratory, Department of Pesticide Residues and Environmental Pollution, Agricultural Research Center, Dokki, Giza 12618, Egypt
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Dement J, Welch L, Ringen K, Quinn P, Chen A, Haas S. A case-control study of airways obstruction among construction workers. Am J Ind Med 2015; 58:1083-97. [PMID: 26123003 PMCID: PMC5034836 DOI: 10.1002/ajim.22495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. METHODS The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. RESULTS Approximately 18% (95% CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. CONCLUSIONS Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and smoking cessation should be promoted.
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Affiliation(s)
- John Dement
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina
| | - Laura Welch
- The Center for Construction Research and Training, Silver Spring, Maryland
| | - Knut Ringen
- The Center for Construction Research and Training, Silver Spring, Maryland
- Stoneturn Consultants, Seattle, Washington
| | - Patricia Quinn
- The Center for Construction Research and Training, Silver Spring, Maryland
| | - Anna Chen
- Zenith American Solutions, Seattle, Washington
| | - Scott Haas
- Zenith American Solutions, Seattle, Washington
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Bagdonas E, Raudoniute J, Bruzauskaite I, Aldonyte R. Novel aspects of pathogenesis and regeneration mechanisms in COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:995-1013. [PMID: 26082624 PMCID: PMC4459624 DOI: 10.2147/copd.s82518] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD), a major cause of death and morbidity worldwide, is characterized by expiratory airflow limitation that is not fully reversible, deregulated chronic inflammation, and emphysematous destruction of the lungs. Despite the fact that COPD is a steadily growing global healthcare problem, the conventional therapies remain palliative, and regenerative approaches for disease management are not available yet. We aim to provide an overview of key reviews, experimental, and clinical studies addressing lung emphysema development and repair mechanisms published in the past decade. Novel aspects discussed herein include integral revision of the literature focused on lung microflora changes in COPD, autoimmune component of the disease, and environmental risk factors other than cigarette smoke. The time span of studies on COPD, including emphysema, chronic bronchitis, and asthmatic bronchitis, covers almost 200 years, and several crucial mechanisms of COPD pathogenesis are described and studied. However, we still lack the holistic understanding of COPD development and the exact picture of the time-course and interplay of the events during stable, exacerbated, corticosteroid-treated COPD states, and transitions in-between. Several generally recognized mechanisms will be discussed shortly herein, ie, unregulated inflammation, proteolysis/antiproteolysis imbalance, and destroyed repair mechanisms, while novel topics such as deviated microbiota, air pollutants-related damage, and autoimmune process within the lung tissue will be discussed more extensively. Considerable influx of new data from the clinic, in vivo and in vitro studies stimulate to search for novel concise explanation and holistic understanding of COPD nowadays.
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Affiliation(s)
- Edvardas Bagdonas
- State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
| | - Jovile Raudoniute
- State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
| | - Ieva Bruzauskaite
- State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
| | - Ruta Aldonyte
- State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
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40
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Longitudinal assessment of lung function decline in the occupational setting. Curr Opin Allergy Clin Immunol 2015; 15:145-9. [DOI: 10.1097/aci.0000000000000153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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