Postapprenticeship isocyanate exposure and risk of work-related respiratory symptoms using an asthma-specific job exposure matrix, self-reported and expert-rated exposure estimates

A prognostic model of excessive lung function decline among Québec apprentices: a cohort exposed to occupational sensitizing agents

BACKGROUND Forced expiratory volume in 1 second (FEV1) decline as a predictor of lung-related health problems is widely observed, but not fully investigated. This study aimed to develop models to predict FEV1 decline among apprentices exposed to sensitizing agents. METHODS Of 692 apprentices recruited and followed in 3.6–17.3 years, 292 were exposed to low-molecular weight agents. The analysis was restricted to 357 apprentices with complete lung function assessment at the end of their training with a minimum of 5-year follow-up. According to the American Thoracic Society guideline, a mean FEV₁ decline >60 ml/year was defined as “accelerated.” Descriptive statistics and Cox regression analysis were utilized to determine its predictors. To develop the prognostic models, we used a logistic regression analysis adjusted for the follow-up duration. The accuracy of the models was quantified using calibration and discrimination measures. RESULTS Of 357 subjects, 62 (17.4%) had an excessive FEV1 decline post-apprenticeship. The questionnaire model (model 1), which included male sex, wheezing, and exposure to isocyanate or animal allergens during the apprenticeship, showed a reasonable discriminative ability (area under the receiver operating characteristics curve [AUC] of 0.67, 95% CI = 0.59–0.75). Adding the percent-predicted FEV₁ value at the end of apprenticeship significantly increased the discriminative ability of the model (model 4) (AUC = 0.762, 95% CI = 0.694–0.829) with a good calibration and reasonable internal validity. CONCLUSIONS We developed a model for accelerated lung function decline with a good accuracy and internal validity. However, external validation of the model is necessary.

Career Advice for Young Allergy Patients

BACKGROUND

One-third of all young persons entering the work force have a history of atopic disease. Occupationally induced allergy and asthma generally arise in the first few months on the job, while pre-existing symptoms tend to worsen. Young persons with a history of an atopic disease should receive evidence-based advice before choosing a career.

METHODS

We systematically searched PubMed for cohort studies investigating the new onset of asthma, rhinitis, or hand eczema among job trainees from before the start of training and onward into the first few years on the job. The search revealed 514 articles; we read their abstracts and selected 85 full-text articles for further analysis. 24 of these met the inclusion criteria.

RESULTS

According to present evidence, atopy and a history of allergic disease (allergic rhinitis, atopic dermatitis) are the main risk factors for occupationally induced disease. The predictive value of a personal history of allergic diseases for the later development of an occupationally induced disease varies from 9% to 64% in the studies we analyzed. It follows that only young people with severe asthma or severe atopic eczema should be advised against choosing a job that is associated with a high risk of allergy, e.g., hairdressing or working with laboratory animals. Young people with a history of other atopic diseases should be counseled about their individual risk profile.

CONCLUSION

In view of the relatively poor predictive value of pre-existing atopic disease, secondary prevention is particularly important. This includes frequent medical follow-up of the course of symptoms over the first few years on the job. If sensitization or allergic symptoms arise, it should be carefully considered whether exposure reduction will enable the apprentice to stay on the job.