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Yatera K, Nishida C. Contemporary Concise Review 2023: Environmental and occupational lung diseases. Respirology 2024; 29:574-587. [PMID: 38826078 DOI: 10.1111/resp.14761] [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: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.
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Affiliation(s)
- Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Chinatsu Nishida
- Department of Environmental Health Engineering, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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Suojalehto H, Charles-Poucel S, Suuronen K, Ronsmans S, Vanoirbeek J, Nemery B, Cullinan P. Presenting clinical data for the hazard classification of chemical respiratory sensitisers. Eur Respir J 2024; 63:2400338. [PMID: 38901888 DOI: 10.1183/13993003.00338-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/08/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Sandrine Charles-Poucel
- Agence Nationale de Sécurité Sanitaire de l'alimentation, de l'environnement et du travail, Maisons-Alfort, France
| | - Katri Suuronen
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Doyen V, Gautrin D, Vandenplas O, Malo JL. Comparison of high- and low-molecular-weight sensitizing agents causing occupational asthma: an evidence-based insight. Expert Rev Clin Immunol 2024; 20:635-653. [PMID: 38235552 DOI: 10.1080/1744666x.2024.2306885] [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: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms. AREAS COVERED The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents. EXPERT OPINION Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents.
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Affiliation(s)
- Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Denyse Gautrin
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-Luc Malo
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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Doyen V, Migueres N, Frère A, Walusiak-Skorupa J, Wiszniewska M, Suojalehto H, Munoz X, Romero-Mesones C, van Kampen V, Sastre J, Quirce S, Barranco P, Rifflart C, de Blay F, Vandenplas O. Diagnostic Accuracy of Specific IgE Against Wheat and Rye in Flour-Induced Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00528-2. [PMID: 38768897 DOI: 10.1016/j.jaip.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Assessment of IgE-mediated sensitization to flour allergens is widely used to investigate flour-induced occupational asthma. The diagnostic efficiency of detecting specific IgE antibodies (sIgEs) against wheat and rye flour, however, has not been thoroughly compared with other diagnostic procedures. OBJECTIVE We sought to evaluate the diagnostic accuracy of sIgE against wheat and rye compared with specific inhalation challenge (SIC) with flour as the reference standard. METHODS This retrospective multicenter study included 264 subjects who completed an SIC with flour in eight tertiary centers, of whom 205 subjects showed a positive SIC result. RESULTS Compared with SIC, sIgE levels of 0.35 kUA/L or greater against wheat and rye provided similar sensitivities (84% to 85%, respectively), specificities (71% to 78%), positive predictive values (91% to 93%), and negative predictive values (56% to 61%). Increasing the threshold sIgE value to 5.10 kUA/L for wheat and to 6.20 kUA/L for rye provided a specificity of 95% or greater and further enhanced the positive predictive value to 98%. Among subjects with a positive SIC, those who failed to demonstrate sIgE against wheat and rye (n = 26) had significantly lower total serum IgE level and blood and sputum eosinophil counts and a lesser increase in postchallenge FeNO compared with subjects with a detectable sIgE. CONCLUSION High levels of sIgE against wheat and/or rye flour strongly support a diagnosis of flour-induced occupational asthma without the need to perform an SIC. The absence of detectable sIgE against wheat and rye in subjects with a positive SIC seems to be associated with lower levels of TH2 biomarkers.
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Affiliation(s)
- Virginie Doyen
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Nicolas Migueres
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; UMR 7357 Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie ICUBE, Strasbourg University, Strasbourg, France
| | - Alexandra Frère
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Marta Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Hille Suojalehto
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Christian Romero-Mesones
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Joaquin Sastre
- Department of Allergy, Fundacion Jimenez Dıaz, Universidad Autonoma de Madrid and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Pilar Barranco
- Department of Allergy, La Paz University Hospital, IdiPAZ and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Catherine Rifflart
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Frédéric de Blay
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; EA 3072 Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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Pinedo Sierra C, Curto Sánchez E, Diaz Campos R, Hermida Valverde T, Sánchez-Cuellar S, Fernández Tena A. [Asthma]. OPEN RESPIRATORY ARCHIVES 2024; 6:100324. [PMID: 38707659 PMCID: PMC11067451 DOI: 10.1016/j.opresp.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024] Open
Abstract
Asthma is a chronic inflammatory disease that affects about 5% of the world's population and generates high health and social costs. Proper management of the disease requires a correct diagnosis, based on objective measures of functional impairment, as well as symptom control and assessment of the future risk of exacerbations.It has been estimated that 18% of asthma patients in Western Europe have severe asthma and approximately 50% of them have poor control. The severity of asthma is established based on the minimum maintenance treatment needs to achieve control. Asthma clinical practice guidelines recommend classifying severe patients into allergic asthma (T2); eosinophilic asthma (T2) and non-T2 asthma in order to establish the most appropriate treatment.In recent decades, new biological therapies have been developed that can be applied according to the phenotype and endotype of asthma, allowing for selective and personalized treatment. These phenotypes and endotypes can change over time and therefore, the identification of biomarkers capable of predicting the severity, the course of the disease and the response to a given treatment seems essential. A large number of biomarkers have been studied in asthma, but so far only a few can be readily used in routine clinical practice. The application of omics technologies (epigenomics, genomics, transcriptomics, proteomics, metabolomics, lipidomics, etc.) for this purpose is still in the research phase.
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Affiliation(s)
- Celia Pinedo Sierra
- Servicio de Neumología. Hospital Universitario Clínico San Carlos. Universidad Complutense, Madrid, España
| | - Elena Curto Sánchez
- Servicio de Neumología. Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Rocio Diaz Campos
- U. de Asma Grave de Alta Complejidad. Servicio de Neumología. Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - Ana Fernández Tena
- Servicio de Neumología Ocupacional. Instituto Nacional de Silicosis, Oviedo, España
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Suojalehto H, Lindström I. Long-term outcome of occupational asthma with different etiology. Curr Opin Allergy Clin Immunol 2024; 24:64-68. [PMID: 38126800 DOI: 10.1097/aci.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the recent literature on the long-term outcome of sensitizer-induced and irritant-induced occupational asthma. RECENT FINDINGS Recent studies of sensitizer-induced occupational asthma show that after the offending exposure has ceased, most patients report at least partial relief of symptoms. However, in the long term, the diagnosis may negatively impact their careers, incomes, and quality of life. The studies also offer new insights into diisocyanate-induced occupational asthma phenotypes and asthma remission rates. One third of these cases were in remission in long-term after reduction or cessation of exposure. The long-term prognosis of irritant-induced occupational asthma was demonstrated to be poorer than sensitizer-induced occupational asthma. Older age, low fractional exhaled nitric oxide levels and uncontrolled asthma at the time of diagnosis predicted uncontrolled asthma in the long term in patients with irritant and low-molecular-weight sensitizer induced occupational asthma. SUMMARY Recent studies provide further evidence of the long-term outcome of different occupational asthma phenotypes and the factors that affect them. These findings help us identify patients at risk of poor asthma outcomes, who need close monitoring and support. It should also be borne in mind that occupational asthma diagnosis may have wider-ranging negative impacts on patients' lives.
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Affiliation(s)
- Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Finland
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Chuang YC, Tsai HH, Lin MC, Wu CC, Lin YC, Wang TN. Cluster analysis of phenotypes, job exposure, and inflammatory patterns in elderly and nonelderly asthma patients. Allergol Int 2024; 73:214-223. [PMID: 38290901 DOI: 10.1016/j.alit.2024.01.001] [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: 05/24/2023] [Revised: 12/03/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Asthma has been identified as different phenotypes due to various risk factors. Age differences may have potential effects on asthma phenotypes. Our study aimed to identify potential asthma phenotypes among adults divided by age as either younger or older than 65 years. We also compared differences in blood granulocyte patterns, occupational asthmagens, and asthma control-related outcomes among patient phenotype clusters. METHODS We recruited nonelderly (<65 years old) (n = 726) and elderly adults (≥65 years old) (n = 201) with mild-to-severe asthma. We conducted a factor analysis to select 17 variables. A two-step cluster analysis was used to classify subjects with asthma phenotypes, and a discriminant analysis was used to verify the classification of cluster results. RESULTS There were three clusters with different characteristics identified in both the nonelderly and elderly asthmatic adults. In the nonelderly patient group, cluster 2 (obese, neutrophilic phenotypes) had a 1.85-fold significantly increased risk of asthma exacerbations. Cluster 3 (early-onset, atopy, and smoker with an eosinophil-predominant pattern) had a 2.37-fold risk of asthma exacerbations and higher oral corticosteroid (OCS) use than cluster 1 (late-onset and LMW exposure with paucigranulocytic blood pattern). Among elderly patients, cluster 2 had poor lung function and more ex-smokers. Cluster 3 (early-onset, long asthma duration) had the lowest paucigranulocytic blood pattern percentages in the elderly group. CONCLUSIONS The novelty of the clusters was found in age-dependent clusters. We identified three distinct phenotypes with heterogeneous characteristics, asthma exacerbations and medicine use in nonelderly and elderly asthmatic patients, respectively. Classification of age-stratified asthma phenotypes may lead to precise identification of patients, which provides personalized disease management.
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Affiliation(s)
- Yung-Chi Chuang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Tsai
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Chien Wu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Sit G, Orsi L, Iwatsubo Y, Dananché B, Orsi F, Goldberg M, Leynaert B, Nadif R, Ribet C, Roche N, Roquelaure Y, Varraso R, Zins M, Pilorget C, Le Moual N, Dumas O. Chronic occupational exposures to irritants and asthma in the CONSTANCES cohort. Occup Environ Med 2024; 81:129-135. [PMID: 38418224 DOI: 10.1136/oemed-2023-109100] [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: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The impact of chronic occupational exposures to irritants on asthma remains discussed. We studied the associations between occupational exposures and asthma, with specific interest for chronic exposure to irritants, including disinfectants and cleaning products (DCPs) and solvents. METHODS Cross-sectional analyses included 115 540 adults (55% women, mean age 43 years, 10% current asthma) working at inclusion in the French population-based CONSTANCES cohort (2012-2020). Current asthma was defined by ever asthma with symptoms, medication or asthma attacks (past 12 months), and the asthma symptom score by the sum of 5 respiratory symptoms (past 12 months). Both lifetime and current occupational exposures were assessed by the Occupational Asthma-specific Job-Exposure Matrix. Associations were evaluated by gender using logistic and binomial negative regressions adjusted for age, smoking status and body mass index. RESULTS In women, associations were observed between current asthma and lifetime exposure to irritants (OR 1.05, 95% CI 1.00 to 1.11), DCPs (1.06, 95% CI 1.00 to 1.12) and solvents (1.06, 95% CI 0.98 to 1.14). In men, only lifetime exposure to DCPs (1.10, 95% CI 1.01 to 1.20) was associated with current asthma. Lifetime exposure to irritants was associated with higher asthma symptom score both in women (mean score ratio: 1.08, 95% CI 1.05 to 1.11) and men (1.11, 95% CI 1.07 to 1.15), especially for DCPs (women: 1.09, 95% CI 1.06 to 1.13, men: 1.21, 95% CI 1.15 to 1.27) and solvents (women 1.14, 95% CI 1.10 to 1.19, men: 1.10, 95% CI 1.05 to 1.15). For current exposures, no consistent associations were observed with current asthma and asthma symptom score. CONCLUSIONS Lifetime occupational exposures to irritants were associated with current asthma and higher asthma symptom score. These exposures should be carefully considered in asthma management.
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Affiliation(s)
- Guillaume Sit
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Yuriko Iwatsubo
- Santé Publique France, Direction Santé Environnement Travail, Saint-Maurice, France
| | - Brigitte Dananché
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Florence Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Marcel Goldberg
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Céline Ribet
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Nicolas Roche
- APHP Centre-Université de Paris, Hôpital et Institut Cochin, Service de Pneumologie, Paris, France
| | - Yves Roquelaure
- Université d'Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S1085, Angers, France
| | - Raphäelle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Marie Zins
- Université Paris Cité, Université Paris-Saclay, UVSQ, Inserm, UMS 11, Cohortes Epidémiologiques en population, Villejuif, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Corinne Pilorget
- Santé Publique France, Direction Santé Environnement Travail, Saint-Maurice, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
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Delgado J, Navarro A, Álvarez-Gutiérrez FJ, Cisneros C, Domínguez-Ortega J. [Unmet Needs in Severe Allergic Asthma]. OPEN RESPIRATORY ARCHIVES 2023; 5:100282. [PMID: 38053757 PMCID: PMC10694599 DOI: 10.1016/j.opresp.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Severe asthma affects 3%-10% of the world's population, according to estimates by the Global Initiative for ASTHMA (GINA). Allergic asthma is one of the most common phenotypes of severe asthma and it is characterized by allergen-induced type 2 inflammation in which immunoglobulin E (IgE) is a key mediator, making it an important therapeutic target. The introduction of targeted biological therapies or treatments has entered the management for severe asthma in the era of precision medicine, and the goal of treatment is clinical remission of the disease. There is a significant percentage of patients with severe allergic asthma who do not respond to treatments and whose symptoms are not controlled. In this paper, a group of experts in the management of severe allergic asthma reviewed and evaluated the most relevant evidence regarding the pathophysiology and phenotypes of severe allergic asthma, the role of IgE in allergic inflammation, allergen identification, techniques, biomarkers and diagnostic challenges, available treatments and strategies for disease management, with a special focus on biological treatments. From this review, recommendations were developed and validated through a Delphi consensus process with the aim of offering improvements in the management of severe allergic asthma to the professionals involved and identifying the unmet needs in the management of this pathology.
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Affiliation(s)
- Julio Delgado
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | - Ana Navarro
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | | | - Carolina Cisneros
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
| | - Javier Domínguez-Ortega
- Servicio de Alergia, Hospital Universitario La Paz, Instituto de Investigación IDiPAZ, Madrid, España
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Espuela-Ortiz A, Martin-Gonzalez E, Poza-Guedes P, González-Pérez R, Herrera-Luis E. Genomics of Treatable Traits in Asthma. Genes (Basel) 2023; 14:1824. [PMID: 37761964 PMCID: PMC10531302 DOI: 10.3390/genes14091824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
The astounding number of genetic variants revealed in the 15 years of genome-wide association studies of asthma has not kept pace with the goals of translational genomics. Moving asthma diagnosis from a nonspecific umbrella term to specific phenotypes/endotypes and related traits may provide insights into features that may be prevented or alleviated by therapeutical intervention. This review provides an overview of the different asthma endotypes and phenotypes and the genomic findings from asthma studies using patient stratification strategies and asthma-related traits. Asthma genomic research for treatable traits has uncovered novel and previously reported asthma loci, primarily through studies in Europeans. Novel genomic findings for asthma phenotypes and related traits may arise from multi-trait and specific phenotyping strategies in diverse populations.
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Affiliation(s)
- Antonio Espuela-Ortiz
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 San Cristóbal de La Laguna, Tenerife, Spain; (A.E.-O.); (E.M.-G.)
| | - Elena Martin-Gonzalez
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), 38200 San Cristóbal de La Laguna, Tenerife, Spain; (A.E.-O.); (E.M.-G.)
| | - Paloma Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Tenerife, Spain; (P.P.-G.); (R.G.-P.)
- Severe Asthma Unit, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Tenerife, Spain
| | - Ruperto González-Pérez
- Allergy Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Tenerife, Spain; (P.P.-G.); (R.G.-P.)
- Severe Asthma Unit, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Tenerife, Spain
| | - Esther Herrera-Luis
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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12
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van Kampen V, Migueres N, Doyen V, Deckert A, de Blay F, Vandenplas O, Merget R. Phenotyping occupational asthma caused by platinum salts compared with other low-molecular weight agents. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2929-2932.e2. [PMID: 37328060 DOI: 10.1016/j.jaip.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Nicolas Migueres
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; UMR 7357 Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie ICUBE, Strasbourg University, Strasbourg, France
| | - Virginie Doyen
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Anja Deckert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Frédéric de Blay
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; EA 3072 Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
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13
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Schwab AD, Poole JA. Mechanistic and Therapeutic Approaches to Occupational Exposure-Associated Allergic and Non-Allergic Asthmatic Disease. Curr Allergy Asthma Rep 2023; 23:313-324. [PMID: 37154874 PMCID: PMC10896074 DOI: 10.1007/s11882-023-01079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE OF REVIEW Occupational lung disease, including asthma, is a significant cause of disability worldwide. The dose, exposure frequency, and nature of the causal agent influence the inflammatory pathomechanisms that inform asthma disease phenotype and progression. While surveillance, systems engineering, and exposure mitigation strategies are essential preventative considerations, no targeted medical therapies are currently available to ameliorate lung injury post-exposure and prevent chronic airway disease development. RECENT FINDINGS This article reviews contemporary understanding of allergic and non-allergic occupational asthma mechanisms. In addition, we discuss the available therapeutic options, patient-specific susceptibility and prevention measures, and recent scientific advances in post-exposure treatment conception. The course of occupational lung disease that follows exposure is informed by individual predisposition, immunobiologic response, agent identity, overall environmental risk, and preventative workplace practices. When protective strategies fail, knowledge of underlying disease mechanisms is necessary to inform targeted therapy development to lessen occupational asthma disease severity and occurrence.
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Affiliation(s)
- Aaron D Schwab
- Division of Allergy and Immunology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Jill A Poole
- Division of Allergy and Immunology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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14
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Pemberton MA, Kreuzer K, Kimber I. Challenges in the classification of chemical respiratory allergens based on human data: Case studies of 2-hydroxyethylmethacrylate (HEMA) and 2-hydroxypropylmethacrylate (HPMA). Regul Toxicol Pharmacol 2023; 141:105404. [PMID: 37105297 DOI: 10.1016/j.yrtph.2023.105404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
Occupational asthma resulting from workplace exposure to chemical respiratory allergens is an important disease. No widely accepted or formally validated tests for the identification of chemical respiratory sensitizers. Consequently, there is a heavy reliance on human data from clinical examinations. Unfortunately, however, although such investigations are critical for the diagnosis of occupational asthma, and in guiding remedial actions, they do not reliably identify specific chemicals within the workplace that are the causative agents. There are several reasons for this, including the fact that specific inhalation tests conducted as part of clinical investigations are frequently performed with complex mixtures rather than single substances, that sometimes inhalation challenges are conducted at concentrations above the OEL and STEL, where effects may be confounded by irritation, and that involvement of immune mechanisms cannot be assumed from the observation of late asthmatic reactions. Further, caution should be taken when implicating substances on lists of "recognised" asthmagens unless they have undergone a formal weight of evidence assessment. Here the limitations of clinical investigations as currently performed for the purposes of regulatory classification and decision making are explored by reference to previously published case studies that implicate 2-hydroxyethylmethacrylate (HEMA) and/or 2-hydroxypropylmethacrylate (HPMA) as respiratory allergens.
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Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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15
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van Kampen V, Eisenhawer C, Brüning T, Merget R. Serial fractional exhaled nitric oxide measurements at and off work may help to identify immunologic occupational asthma in cases with complex exposures. Respir Physiol Neurobiol 2023; 313:104068. [PMID: 37100218 DOI: 10.1016/j.resp.2023.104068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 04/28/2023]
Abstract
Serial measurements of fractional exhaled nitric oxide (FeNO) at home and at work have been described to provide complementary information for the diagnosis of occupational asthma (OA) when specific inhalation challenge (SIC) is missing or doubtful. We describe two cases in which serial FeNO measurements enabled the detection of probable OA after complex exposures. A 25-year-old industrial painter with exposure to a variety of paints suffered from work-related airway symptoms for five years. Lung function was normal, and he was not atopic. SIC with hexamethylene diisocyanate was negative. A 47-year-old sign maker (screen printing, foils) suffering from work-related dyspnoea for seven years. Moderate airway obstruction, but no atopy was detectable. Due to the complex exposures SIC was not performed. Both patients performed FeNO measurements once daily during a 2-week-holiday and a subsequent 2-week-work period. In both cases elevated baseline FeNO decreased to normal (25 ppb) during holidays and increased after resuming work (case 1: 125 ppb, case 2: 45 ppb).
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Affiliation(s)
- V van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | - C Eisenhawer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - R Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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16
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Meek B, Bridges JW, Fasey A, Sauer UG. Evidential requirements for the regulatory hazard and risk assessment of respiratory sensitisers: methyl methacrylate as an example. Arch Toxicol 2023; 97:931-946. [PMID: 36797432 PMCID: PMC10025211 DOI: 10.1007/s00204-023-03448-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
This review addresses the need for a framework to increase the consistency, objectivity and transparency in the regulatory assessment of respiratory sensitisers and associated uncertainties. Principal issues are considered and illustrated through a case study (with methyl methacrylate). In the absence of test methods validated for regulatory use, formal documentation of the weight-of-evidence for hazard classification both at the level of integration of individual studies within lines of evidence and across a broad range of data streams was agreed to be critical for such a framework. An integrated approach is proposed to include not only occupational studies and clinical evidence for the regulatory assessment of respiratory sensitisers, but also information on structure and physical and chemical factors, predictive approaches such as structure activity analysis and in vitro and in vivo mechanistic and toxicokinetic findings. A weight-of-evidence protocol, incorporating integration of these sources of data based on predefined considerations, would contribute to transparency and consistency in the outcome of the assessment. In those cases where a decision may need to be taken on the basis of occupational findings alone, conclusions should be based on transparent weighting of relevant data on the observed prevalence of occupational asthma in various studies taking into account all relevant information including the range and nature of workplace exposures to the substance of interest, co-exposure to other chemicals and study quality.
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Affiliation(s)
| | - James W Bridges
- Emeritus Professor, University of Surrey, Guildford, Surrey, UK
| | | | - Ursula G Sauer
- Scientific Consultancy-Animal Welfare, Hallstattfeld 16, 85579, Neubiberg, Germany.
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17
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Muñoz X, Clofent D, Cruz MJ. Occupational respiratory allergy to reactive dyes. Curr Opin Allergy Clin Immunol 2023; 23:70-75. [PMID: 36473025 DOI: 10.1097/aci.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Reactive dyes have been shown to cause respiratory sensitization in workers with occupational exposure. The present review analyzes the current knowledge of the role of reactive dyes in promoting occupational respiratory allergy. We discuss the current classification of reactive dyes as well as the potential development of occupational respiratory diseases after exposure to these substances. RECENT FINDINGS Few descriptions of the role of reactive dyes in the development of occupational allergy have been published in recent years. Several reactive dyes are considered causes of occupational asthma (OA), mainly in workers in textile industries. Positive skin tests and the presence of specific serum IgE antibodies to reactive dyes suggest that respiratory symptoms provoked by reactive dyes may be immunoglobulin E (IgE)-mediated reactions. It was suggested that airborne dye molecules may act as haptens and induce IgE-mediated hypersensitivity reactions. SUMMARY Reactive dyes are widely used in the textile industry, owing to their ability to produce strong covalent bonds to textile fibers. These substances have been identified as potential respiratory sensitizers causing OA and occupational rhinitis. The clinical presentation and phenotype of patients with OA due to reactive dyes is very similar to those presented by patients with OA to high molecular weight agents. The extensive use of reactive dyes in industry means that it is particularly important to describe their implications for health, which in fact are probably underestimated.
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Affiliation(s)
- Xavier Muñoz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona
- CIBER de Enfermedades Respiratorias (CIBERES)
- Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain
| | - David Clofent
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona
- CIBER de Enfermedades Respiratorias (CIBERES)
| | - María-Jesús Cruz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona
- CIBER de Enfermedades Respiratorias (CIBERES)
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18
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Baatjies R, Chamba P, Jeebhay MF. Wood dust and asthma. Curr Opin Allergy Clin Immunol 2023; 23:76-84. [PMID: 36821481 PMCID: PMC9977320 DOI: 10.1097/aci.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE OF THE REVIEW Review recent developments on asthma associated with wood dust, given the increasing scale of wood handling and processing activities globally. RECENT FINDINGS Work in wood industries is associated with a significantly increased risk of respiratory symptoms, rhinitis and asthma. This can be attributed to traditional processing techniques and newer technologies producing complex bioaerosol exposures, which may include chemicals. Meta-analysis studies indicate strong evidence for wood dusts as occupational sensitizers for asthma, but the underlying mechanisms remain poorly understood. The global prevalence of asthma in wood workers ranges between 6-18% and for rhinitis 16-33%. Exposure estimates show wide variation. Risk factors include atopy and exposure to certain wood species, elevated current and cumulative particulate exposures. SUMMARY Future studies should focus on better characterization of wood dust allergens and other bioaerosol components, specific immunoglobulin E responses to different wood species, pathophysiological mechanisms underlying asthma, and modelling dose-response relationships using refined exposure metrics for dust particulate and other bioaerosol components. There is a need for improved health-based international exposure standards and effective workplace control measures to reduce exposures to wood dust particulate (hard and soft woods), endotoxin and β-glucan, to reduce the risks of asthma in wood workers.
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Affiliation(s)
- Roslynn Baatjies
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology (CPUT), Cape Town, South Africa
| | - Paulino Chamba
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mohamed F Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town
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19
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Lucas D, Robin C, Vongmany N, Dewitte JD, Loddé B, Pougnet R, Larabi L. Main Causal Agents of Occupational Asthma in France, Reported to the National Network for Occupational Disease Vigilance and Prevention (RNV3P) 2001-2018. Ann Work Expo Health 2023; 67:297-302. [PMID: 36477519 DOI: 10.1093/annweh/wxac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The definition of work-related Asthma (WRA) has changed in recent years and new etiologies and agents have been identified. The aim of this study is to describe the main causal agents of WRA in France in the period 2001-2018 in the main work sectors. METHODS Data were collected from the French national network of occupational health surveillance and prevention [Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)], Data between 2001 and 2018 with at least a probable or certain association with one occupational agent, were included. RESULTS Work sectors with more cases OF WRA included personal service activities (10.6%), food industry (10.2%) and healthcare activities (7.6%). WRA cases were most frequently related to flour (10%), quaternary ammoniums compounds (5.3%), isocyanates (5.1%) and cleaning products (4.8%). CONCLUSION Occupational exposure to specific agents capable of causing WRA is still present, and four agents represent more than 25% of the cases. Actions to prevent respiratory exposure are still relevant.
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Affiliation(s)
- D Lucas
- Occupational Diseases Centre, CHRU Morvan, 2 Avenue Foch, 29609 Brest Cedex 2, France.,ORPHY Laboratory, 6 Av V Le Gorgeu 29238 Brest Cedex, Occidental Brittany University Brest, France
| | - C Robin
- Occupational Diseases Centre, CHRU Morvan, 2 Avenue Foch, 29609 Brest Cedex 2, France
| | - N Vongmany
- Direction des alertes et des vigilances sanitaires, National Agency for Security of Food, Environment and Work Agence Nationale de sécurité de l'alimentation, de l'environnement et du travail (ANSES), 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
| | - J D Dewitte
- Occupational Diseases Centre, CHRU Morvan, 2 Avenue Foch, 29609 Brest Cedex 2, France.,Laboratory of Research on Sociology (EA 3149), Université de Bretagne Occidentale Brest, 22 Avenue Camille Desmoulins, 29238 Brest Cedex 3, France
| | - B Loddé
- Occupational Diseases Centre, CHRU Morvan, 2 Avenue Foch, 29609 Brest Cedex 2, France.,ORPHY Laboratory, 6 Av V Le Gorgeu 29238 Brest Cedex, Occidental Brittany University Brest, France
| | - R Pougnet
- Occupational Diseases Centre, CHRU Morvan, 2 Avenue Foch, 29609 Brest Cedex 2, France.,Laboratory of Research on Sociology (EA 3149), Université de Bretagne Occidentale Brest, 22 Avenue Camille Desmoulins, 29238 Brest Cedex 3, France
| | - L Larabi
- Direction des alertes et des vigilances sanitaires, National Agency for Security of Food, Environment and Work Agence Nationale de sécurité de l'alimentation, de l'environnement et du travail (ANSES), 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
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20
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Mason P, Liviero F, Paccagnella ER, Biasioli M, Maestrelli P, Frigo AC. Impact of occupational asthma on health and employment status: a long-term follow-up study. Occup Environ Med 2023; 80:70-76. [PMID: 36581454 DOI: 10.1136/oemed-2022-108504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/03/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the predictors of a favourable prognosis of occupational asthma (OA) and the employment status of patients with OA at least 2 years after diagnosis. METHODS We collected data from 204 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. We defined OA remission as meeting the following three criteria: no asthma symptoms, no antiasthma therapy for the last year and having normal lung function at the end of follow-up. A logistic regression analysis was performed to estimate the effects of the covariates. RESULTS At 10.6±7.8-year follow-up, 60 of 204 possible patients participated in the study, and among them 17 showed OA remission. When compared with the 43 patients with persistent OA, these patients exhibited at diagnosis younger age (p=0.0039), shorter duration of symptomatic exposure (p=0.0512), better lung function expressed by higher forced vital capacity (FVC%) predicted (p=0.0164), forced expiratory volume in 1 s (FEV1) % predicted (p=0.0066) and FEV1/FVC% (p=0.0132), and less bronchial hyper-responsiveness (p=0.0118). Nevertheless, in the multivariable model, no variables were significantly associated with OA remission. At follow-up, three individuals have retired; among the remaining 57 workers, 91.2% were still employed and 43.8% of them had continued working in the same factory after ceasing exposure to the causative agent. CONCLUSIONS This monocentric study did not identify a strong predictor of OA remission, but documented a high employment rate and a good job preservation over a long timeframe after diagnosis of OA mainly induced by low molecular weight agents.
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Affiliation(s)
- Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Filippo Liviero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Rachele Paccagnella
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Marco Biasioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Piero Maestrelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
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21
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Sit G, Varraso R, Fezeu LK, Galan P, Orsi F, Pacheco Da Silva E, Touvier M, Hercberg S, Paris C, Le Moual N, Dumas O. Occupational Exposures to Irritants and Sensitizers, Asthma and Asthma Control in the Nutrinet-Santé Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3220-3227.e7. [PMID: 36108925 DOI: 10.1016/j.jaip.2022.08.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of chronic occupational exposures to irritants in asthma remains not well-defined. Few studies have examined their associations with asthma and its control. OBJECTIVE To study the associations of occupational exposures with asthma and its control, with specific interest for irritants, including disinfectants and cleaning products (DCPs) and solvents. METHODS Analyses included 4,469 adults (3,792 with neither asthma nor respiratory symptoms, 677 with current asthma; 75.9% women, mean age 54 years) of a case-control study (2018) from the French NutriNet-Santé cohort. Current asthma was defined by ever asthma with symptoms, medication or asthma attacks in the past 12 months, adult-onset asthma by age at first asthma attack older than 16 years, and uncontrolled asthma was defined by an Asthma Control Test score less than 20. Ever/current exposures were assessed with the Occupational Asthma-specific Job Exposure Matrix. Associations were evaluated by multinomial logistic regressions adjusted for sex, age, smoking status, and body mass index. RESULTS Ever exposures to sensitizers (high molecular weight [HMW]: OR 1.53, 95% CI 1.18-2.00; and low molecular weight [LMW]: OR 1.42; 95% CI 1.09-1.87), irritants (OR 1.32; 95% CI 1.03-1.68), and DCPs (OR 1.43; 95% CI 1.10-1.85) were associated with current adult-onset asthma. Significant associations between ever exposures and uncontrolled adult-onset asthma were observed for high molecular weight (OR 2.69; 95% CI 1.52-4.78) and low molecular weight (OR 2.27; 95% CI 1.24-4.37) sensitizers, irritants (OR 2.32; 95% CI 1.36-3.95), and DCPs (OR 2.59; 95% CI 1.48-4.54). Results were similar for current exposures, with higher ORs. No association was observed with solvents. CONCLUSIONS Occupational exposures to both sensitizers and irritants were associated with current adult-onset asthma and uncontrolled asthma. Irritant and sensitizing agents should be carefully considered in asthma management.
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Affiliation(s)
- Guillaume Sit
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Léopold K Fezeu
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Florence Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Emilie Pacheco Da Silva
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Mathilde Touvier
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France
| | - Christophe Paris
- Équipe d'Épidémiologie en santé au travail et ergonomie (ESTER), Université Rennes 1, Institut de recherche en santé, environnement et travail (IRSET), Inserm (U1085), École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France.
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
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22
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Influence of the environment on the characteristics of asthma. Sci Rep 2022; 12:20522. [PMID: 36443644 PMCID: PMC9705565 DOI: 10.1038/s41598-022-25028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Few studies have compared the prevalence of asthma in urban and rural settings or explored the issue of whether these two manifestations of the disease may represent different phenotypes. The aim of this study was: (a) to establish whether the prevalence of asthma differs between rural and urban settings, and b) to identify differences in the clinical presentation of asthma in these two environments. Descriptive epidemiological study involving individuals aged 18 or over from a rural (n = 516) and an urban population (n = 522). In the first phase, individuals were contacted by letter in order to organize the administration of a first validated questionnaire (Q1) designed to establish the possible prevalence of bronchial asthma. In the second phase, patients who had presented association patterns in the set of variables related to asthma in Q1 completed a second validated questionnaire (Q2), designed to identify the characteristics of asthma. According to Q1, the prevalence of asthma was 15% (n = 78) and 11% (n = 59) in rural and urban populations respectively. Sixty-five individuals with asthma from the rural population and all 59 individuals from the urban population were contacted and administered the Q2. Thirty-seven per cent of the individuals surveyed had previously been diagnosed with bronchial asthma (35% in the rural population and 40% in the urban setting). In the urban asthmatic population there was a predominance of women, a greater personal history of allergic rhinitis and a family history of allergic rhinitis and/or eczema. Asthma was diagnosed in adulthood in 74.8% of the patients, with no significant differences between the two populations. Regarding symptoms, cough (morning, daytime and night) and expectoration were more frequent in the urban population. The prevalence of asthma does not differ between urban and rural settings. The differences in exposure that characterize each environment may lead to different manifestations of the disease and may also affect its severity.
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Effect of Different Molecular Weights of Polyacrylic Acid on Rat Lung Following Intratracheal Instillation. Int J Mol Sci 2022; 23:ijms231810345. [PMID: 36142256 PMCID: PMC9499135 DOI: 10.3390/ijms231810345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background: We conducted intratracheal instillations of different molecular weights of polyacrylic acid (PAA) into rats in order to examine what kinds of physicochemical characteristics of acrylic acid-based polymer affect responses in the lung. Methods: F344 rats were intratracheally exposed to a high molecular weight (HMW) of 598 thousand g/mol or a low molecular weight (LMW) of 30.9 thousand g/mol PAA at low and high doses. Rats were sacrificed at 3 days, 1 week, 1 month, 3 months and 6 months post exposure. Results: HMW PAA caused persistent increases in neutrophil influx, cytokine-induced neutrophil chemoattractants (CINC) in the bronchoalveolar lavage fluid (BALF), and heme oxygenase-1 (HO-1) in the lung tissue from 3 days to 3 months and 6 months following instillation. On the other hand, LMW PAA caused only transient increases in neutrophil influx, CINC in BALF, and HO-1 in the lung tissue from 3 days to up to 1 week or 1 month following instillation. Histopathological findings of the lungs demonstrated that the extensive inflammation and fibrotic changes caused by the HMW PAA was greater than that in exposure to the LMW PAA during the observation period. Conclusion: HMW PAA induced persistence of lung disorder, suggesting that molecular weight is a physicochemical characteristic of PAA-induced lung disorder.
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Tsui HC, Ronsmans S, Hoet PHM, Nemery B, Vanoirbeek JAJ. Occupational Asthma Caused by Low-Molecular-Weight Chemicals Associated With Contact Dermatitis: A Retrospective Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2346-2354.e4. [PMID: 35643279 DOI: 10.1016/j.jaip.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Occupational asthma (OA) may have different etiologies, but it is not clear whether the etiologic agents influence the clinical presentation, especially the co-occurrence of skin lesions. OBJECTIVE To determine the impact of different asthmagens on the characteristics of OA, with a focus on the occurrence of prior or concomitant skin disorders. METHODS In a retrospective analysis of patients who visited the Occupational and Environmental Disease Clinic of a tertiary referral hospital from 2009 to 2019, we classified patients into definite, probable, or possible OA according to prespecified diagnostic guidelines. In multivariate logistic regression with sensitivity analysis, we examined the relation of high- and low-molecular-weight (HMW and LMW) agents with the clinical presentation. RESULTS Of 209 cases of OA, 66 were caused by HMW agents and 143 by LMW agents. Patients with OA exposed to LMW agents had higher odds of having (had) allergic contact dermatitis (odds ratio, 5.45 [1.80-23.70]; P < .01), compared with patients exposed to HMW agents. Conversely, HMW agents were associated with higher odds of rhinitis symptoms (odds ratio of LMW/HMW, 0.33 [0.17-0.63]; P < .001) and high total IgE (odds ratio of LMW/HMW, 0.35 [0.17-0.70]; P < .01). Risk factors for having coexisting contact dermatitis included construction work, hairdressing, and exposure to metals or epoxy resins. CONCLUSIONS Among patients with OA, exposure to specific LMW agents was associated with a high frequency of contact dermatitis. Different types of asthmagens within HMW or LMW agents appear to determine the phenotype and comorbidity of OA.
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Affiliation(s)
- Hung-Chang Tsui
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Peter H M Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | - Jeroen A J Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
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Khazdair MR, Ghorani V, Boskabady MH. Experimental and clinical evidence on the effect of carvacrol on respiratory, allergic, and immunologic disorders: A comprehensive review. Biofactors 2022; 48:779-794. [PMID: 35555834 DOI: 10.1002/biof.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022]
Abstract
Carvacrol (CAR) showed various pharmacological and therapeutic effects in different disorders. In the current article, the experimental and clinical effects of CAR on respiratory, allergic, and immunologic disorders are described. Various databases, including PubMed, Science Direct, and Scopus, were searched regarding the effects of CAR on respiratory and allergic disorders until the end of October 2021. CAR showed the relaxant effect, with various possible mechanisms suggesting the bronchodilatory effect in obstructive pulmonary diseases. The preventive effects of CAR on experimental animal models of respiratory diseases were shown through mechanisms such as antioxidant, immunomodulatory, and anti-inflammatory. CAR also showed therapeutic potential on lung cancer, lung infections, and allergic and immunologic disorders. Clinical studies also revealed therapeutic effects of CAR on asthma, sulfur-mustard-induced lug disorders, and some other allergic and immunologic diseases. Pharmacological and therapeutic effects of CAR indicate possible remedy effects of this agent in the treatment of respiratory, allergic, and immunologic diseases.
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Affiliation(s)
- Mahammad R Khazdair
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Vahideh Ghorani
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad H Boskabady
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Lantto J, Suojalehto H, Karvala K, Remes J, Soini S, Suuronen K, Lindström I. Clinical Characteristics of Irritant-Induced Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1554-1561.e7. [PMID: 35259533 DOI: 10.1016/j.jaip.2022.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete. OBJECTIVES To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. METHODS This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. RESULTS Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting β-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). CONCLUSIONS Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
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Affiliation(s)
- Jussi Lantto
- Doctoral Program in Clinical Research, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland.
| | - Hille Suojalehto
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland; Varma Mutual Pension Insurance Company, Consultant Physicians, Helsinki, Finland
| | - Jouko Remes
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Satu Soini
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Katri Suuronen
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Irmeli Lindström
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
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Hiller J, Greiner A, Drexler H. Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series. J Occup Med Toxicol 2022; 17:10. [PMID: 35606825 PMCID: PMC9125837 DOI: 10.1186/s12995-022-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/12/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Respiratory symptoms at work are common among hairdressers. Various working materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. The objective of this study is to achieve a better understanding of work-related respiratory symptoms of hairdressers by describing common features in a large affected collective. METHODS One hundred forty-eight hairdressers with respiratory symptoms at work presenting between 2012 and 2019 were consecutively included in a case series. Anamnestic and diagnostic data including pulmonary function and allergy testing were retrospectively compiled from records and analysed. Additionally, cases were categorised in five groups with respect to occupational causation certainty. RESULTS 30% of the predominantly female collective had changed jobs or were on longer sick-leave. Besides respiratory symptoms, 10% also reported contact urticaria to blonde dyes. In 60% an obstructive airway disease was confirmed. A specific hypersensitivity reaction to ammonium persulfate was found in 15%. Group 1 with a proven immunological occupational causation showed significantly lower age (p < 0.001) and tenure time (p = 0.001), higher sensitization rates against environmental allergens as well as a higher total IgE (p = 0.015), compared to group 4 (obstructive airway disease, specific occupational causation unlikely). CONCLUSIONS This case series contributes to a better characterization of work-related respiratory symptoms in hairdressing as one of the largest examined collectives of symptomatic hairdressers. Ammonium persulfate as the most common specific cause showed signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy. Prick testing is recommended in all symptomatic cases. However, a specific occupational causation often cannot be proved.
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Affiliation(s)
- Julia Hiller
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestr. 9-11, 91054, Erlangen, Germany.
| | - Annette Greiner
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestr. 9-11, 91054, Erlangen, Germany
| | - Hans Drexler
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestr. 9-11, 91054, Erlangen, Germany
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Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:963-971.e3. [PMID: 35150902 DOI: 10.1016/j.jaip.2022.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
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Affiliation(s)
| | | | - Kim L Lavoie
- Department of Psychology, University of Québec at Montreal and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Chantal Raherison-Semjen
- Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France; INSERM U1219, EpiCene Team, University of Bordeaux, Bordeaux, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Barber CM, Cullinan P, Feary J, Fishwick D, Hoyle J, Mainman H, Walters GI. British Thoracic Society Clinical Statement on occupational asthma. Thorax 2022; 77:433-442. [DOI: 10.1136/thoraxjnl-2021-218597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The Impact of Ambient Environmental and Occupational Pollution on Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052788. [PMID: 35270479 PMCID: PMC8910713 DOI: 10.3390/ijerph19052788] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
Ambient pollutants and occupational pollutants may cause and exacerbate various lung and respiratory diseases. This review describes lung and respiratory diseases in relation to ambient pollutants, particularly particulate matter (PM2.5), and occupational air pollutants, excluding communicable diseases and indoor pollutants, including tobacco smoke exposure. PM2.5 produced by combustion is an important ambient pollutant. PM2.5 can cause asthma attacks and exacerbations of chronic obstructive pulmonary disease in the short term. Further, it not only carries a risk of lung cancer and death, but also hinders the development of lung function in children in the long term. It has recently been suggested that air pollution, such as PM2.5, is a risk factor for severe coronavirus disease (COVID-19). Asbestos, which causes asbestosis, lung cancer, and malignant mesothelioma, and crystalline silica, which cause silicosis, are well-known traditional occupational pollutants leading to pneumoconiosis. While work-related asthma (WRA) is the most common occupational lung disease in recent years, many different agents cause WRA, including natural and synthetic chemicals and irritant gases. Primary preventive interventions that increase awareness of pollutants and reduce the development and exacerbation of diseases caused by air pollutants are paramount to addressing ambient and occupational pollution.
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Rui F, Otelea MR, Fell AKM, Stoleski S, Mijakoski D, Holm M, Schlünssen V, Larese Filon F. Occupational Asthma: The Knowledge Needs for a Better Management. Ann Work Expo Health 2022; 66:287-290. [PMID: 34984434 PMCID: PMC9006971 DOI: 10.1093/annweh/wxab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/12/2022] Open
Abstract
The management of occupational asthma (OA) may be influenced by several factors and removal from exposure is the main tertiary prevention approach, but it is not always feasible without personal and socioeconomic consequences. Reducing the delay between the onset of suggestive symptoms of OA and the diagnosis of OA is associated with a better prognosis. Workers' education to increase awareness to trigger agents and a medical surveillance program directed especially at at-risk workers could be helpful in reducing this latency time. An early identification of workers who develop rhinitis and conjunctivitis which often precede the onset of asthma symptoms could be important for an early identification of OA. This is particularly important for cases of asthma caused by high-molecular-weight sensitizers and in the early years of employment. The availability of financial support and compensation measures for workers with OA may influence the latency time before diagnosis and, consequently, may influence the OA outcomes. In conclusion, there is a need for high-quality cohort studies that will increase knowledge about risk factor that may influence the timing of diagnosis of OA. This knowledge will be useful for implementation of future surveillance and screening programs in workplaces.
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Affiliation(s)
- Francesca Rui
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Clinical Department 5, Dionisie Lupu St, 37, Bucharest, Romania
| | - Anne Kristin Møller Fell
- Department of Occupational and Environmental Medicine, Telemark hospital, Skien, Norway.,Department of Global Health and Community Medicine, Institute of Health and Community, University of Oslo, Oslo, Norway
| | - Sasho Stoleski
- Department of Occupational Diseases, Institute of Occupational Health of R.N. Macedonia, WHO CC, GA2LEN CC, II Makedonska Brigada 43, Skopje, R.N. Macedonia.,Department of Occupational Medicine, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, 50 Divizija 6, Skopje, R.N. Macedonia
| | - Dragan Mijakoski
- Department of Occupational Diseases, Institute of Occupational Health of R.N. Macedonia, WHO CC, GA2LEN CC, II Makedonska Brigada 43, Skopje, R.N. Macedonia.,Department of Occupational Medicine, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, 50 Divizija 6, Skopje, R.N. Macedonia
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE 40530 Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Barholins Allé 2, bg 1260, 8000 Aarhus, Denmark.,National Research Center for Working Environment, Lersø Parallé 105, 2100 Copenhagen, Denmark
| | - Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
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Minov J. Occupational chronic obstructive pulmonary disorder: prevalence and prevention. Expert Rev Respir Med 2021; 16:429-436. [PMID: 34822743 DOI: 10.1080/17476348.2021.2011722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Occupational chronic obstructive pulmonary disorder, i.e. work-related asthma (WRA) and occupational chronic obstructive pulmonary disease (COPD), are the most common occupational lung diseases in the last decades worldwide. As in the case of the other occupational disorders, these diseases may be prevented. AREAS COVERED WRA is a heterogeneous entity that includes three subtypes, immunologic occupational asthma (OA), irritant-induced asthma (IIA), and work-exacerbated asthma (WEA), depending on the role of occupational exposures as a causing or aggravating factor of the disease. In addition, there is consistent evidence that a substantial proportion of COPD cases can be explained by exposure to noxious particles and gases other than tobacco smoke, such as workplace dusts, gases, fumes, and vapors. The articles cited in this paper were searched by keywords in several databases in the period up to May-July 2021. EXPERT OPINION The development of occupational chronic obstructive disorder is a matter of prevention. WRA and occupational COPD contribute significantly to the overall burden of asthma and COPD. Activities and measures targeted to elimination or reduction of harmful workplace exposures, as well as to early detection and early intervention in the course of the lung damage, can significantly reduce the burden caused by these diseases.
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Affiliation(s)
- Jordan Minov
- Department for Physiology of Work, Institute for Occupational Health of R. North Macedonia, Skopje, R. Macedonia
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Singh T, Bello B, Jeebhay MF. Characterizing Inflammatory Cell Asthma Associated Phenotypes in Dental Health Workers Using Cytokine Profiling. FRONTIERS IN ALLERGY 2021; 2:747591. [PMID: 35387066 PMCID: PMC8974759 DOI: 10.3389/falgy.2021.747591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Cytokines elicit a pro-inflammatory response by modifying the airway microenvironment in patients with acute or chronic asthma. The expression pattern of several distinct cytokines could be a useful discriminator in asthma. This study aimed to identify asthma subject groupings based on common inflammatory patterns and to determine the relationship between these identified patterns and asthma-associated clinical indices. A sub-group of 76 dental healthcare workers (HCWs) identified from a larger cross-sectional study of 454 dental HCWs in five dental institutions were evaluated further. A self-administered questionnaire elicited the health and employment history of subjects. Sera were analyzed for atopic status, latex sensitization, and 12 cytokines (IL-1β, 3, 4, 5, 6, 7, 8, 10, 12p70, eotaxin, GM-CSF, TNF-α). Pre and post-bronchodilator spirometry was performed on all HCWs. Data clustering and factor analysis were used to identify inflammatory cluster patterns of cytokines. Associations between the cytokine cluster groupings and relevant asthma-associated clinical indices were determined using multivariate logistic regression. The classification of asthma subtype based on cytokine patterns demonstrated both eosinophilic and neutrophilic inflammatory responses. Four phenotypically distinct subgroups relating to the severity of inflammation (acute or chronic) of the cell types were identified. Cytokine determinants for the neutrophilic subtype included IL-1β, 6, 8, 10, 12p70, and TNF-α whereas for the eosinophilic subtype these included IL-3, 4, 5, 7, eotaxin, and GM-CSF. The multivariate models showed a significant association between work-related chest symptoms and all four inflammatory patterns. However, stronger associations were observed for the acute neutrophilic (OR = 6.00, p < 0.05) compared to acute and chronic eosinophilic responses (OR = 4.30, p < 0.05; OR = 4.93, p < 0.05), respectively. Subjects with airway obstruction were more likely to have a mixed cellular infiltrate. The odds of work-exacerbated asthma were increased in acute or chronic eosinophilia (OR = 7.75 and 8.12; p < 0.05), respectively as well as with acute neutrophilia (OR = 6) sub-type. This study demonstrated that neutrophilic inflammatory cell asthma phenotypes coexist with eosinophilic inflammatory phenotypes suggesting a possible dual pathway for asthma in dental health workers, probably due to mixed exposures to high molecular weight (e.g., latex) and low molecular weight (e.g., acrylates) agents.
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Affiliation(s)
- Tanusha Singh
- Immunology & Microbiology, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- *Correspondence: Tanusha Singh
| | - Braimoh Bello
- Immunology & Microbiology Department, Centre for Statistical Analysis and Research, Johannesburg, South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Gautier C, Lecam MT, Basses S, Pairon JC, Andujar P. [A definition of work-related asthma and its social and occupational consequences in adults and teenagers]. Rev Mal Respir 2021; 38:914-935. [PMID: 34711451 DOI: 10.1016/j.rmr.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Work-related asthma (WRA) accounts for 10-25% of all adult asthma. It therefore seems important to raise questions regarding an asthmatic's approach to occupational or job training activities. WRA takes on two forms: work-exacerbated asthma (WEA) and occupational asthma (OA), which encompasses different subtypes of heterogeneous mechanisms. It currently represents a major challenge for occupational medicine in terms of detailed diagnosis, social care, the economic repercussions for workers and employers and, last but not least, social insurance. This review aims to sensitize health care practitioners to the peculiarities of WRA management in routine practice. More specifically, prognosis depends on early diagnosis, medical care and work adjustment measures. WEA and OA are explained in detail in view of identifying causative agents and at-risk occupations and defining adapted medical strategy. Relevant lines of questioning and complementary exams are presented. In addition, the key role of the occupational physician, especially as regards recognition and identification of occupational disease, is underlined, the objective being to facilitate optimal professional and social management. In future studies, the key role of counseling and orientation mechanisms should be highlighted as means of preventing WRA occurrence.
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Affiliation(s)
- C Gautier
- Centre hospitalier intercommunal de Créteil, service de pathologies professionnelles et de l'environnement, 94000 Créteil, France
| | - M T Lecam
- Centre hospitalier intercommunal de Créteil, service de pathologies professionnelles et de l'environnement, 94000 Créteil, France
| | - S Basses
- Centre hospitalier intercommunal de Créteil, service de pathologies professionnelles et de l'environnement, 94000 Créteil, France
| | - J C Pairon
- Centre hospitalier intercommunal de Créteil, service de pathologies professionnelles et de l'environnement, 94000 Créteil, France; INSERM, unité 955, équipe 4, 94000 Créteil, France; Université Paris-Est Créteil, faculté de santé, 94000 Créteil, France
| | - P Andujar
- Centre hospitalier intercommunal de Créteil, service de pathologies professionnelles et de l'environnement, 94000 Créteil, France; INSERM, unité 955, équipe 4, 94000 Créteil, France; Université Paris-Est Créteil, faculté de santé, 94000 Créteil, France.
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Mwanga HH, Baatjies R, Singh T, Jeebhay MF. Asthma Phenotypes and Host Risk Factors Associated With Various Asthma-Related Outcomes in Health Workers. FRONTIERS IN ALLERGY 2021; 2:747566. [PMID: 35386991 PMCID: PMC8974710 DOI: 10.3389/falgy.2021.747566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Work-related asthma phenotypes in health workers (HWs) exposed to cleaning agents have not been investigated extensively as other occupational exposures. This study aimed to describe asthma phenotypes and to identify important host risk factors associated with various asthma-related outcomes. Methods: A cross-sectional study of 699 HWs was conducted in two large tertiary hospitals. A total of 697 HWs completed questionnaire interviews. Sera collected from 682 HWs were analyzed for atopy (Phadiatop) and IgE to occupational allergens (NRL—Hev b5, Hev b6.02; chlorhexidine and ortho-phthalaldehyde—OPA). Methacholine (MCT), bronchodilator challenge (BDR) and fractional exhaled nitric oxide (FeNO) were performed. An asthma symptom score (ASS) used five asthma-related symptoms reported in the past 12 months. Current asthma was based on use of asthma medication or an asthma attack or being woken up by an attack of shortness of breath in the past 12 months. Nonspecific bronchial hyperresponsiveness (NSBH) was defined as having either a positive MCT or a significant bronchodilator response. Two continuous indices of NSBH [continuous index of responsiveness (CIR) and dose-response slope (DRS)] were calculated. Results: The prevalence of current asthma was 10%, atopic asthma (6%) and non-atopic asthma (4%). Overall, 2% of subjects had work-related asthma. There was a weak positive association between NSBH and FeNO [CIR: Beta coefficient (β) = 0.12; CI: 0.03–0.22 and DRS: β = 0.07; CI: 0.03–0.12]. Combining FeNO ≥ 50 ppb with a BDR [mean ratio (MR) = 5.89; CI: 1.02–34.14] or with NSBH (MR = 4.62; CI: 1.16–18.46) correlated better with ASS than FeNO alone (MR = 2.23; CI: 1.30–3.85). HWs with current asthma were twice as likely to be atopic. FeNO was positively associated with atopy (OR = 3.19; CI: 1.59–6.39) but negatively associated with smoking status (GMR = 0.76; CI: 0.62–0.94). Most HWs sensitized to occupational allergens were atopic. Conclusion: Atopic asthma was more prevalent than non-atopic asthma in HWs. Most asthma-related outcomes were positively associated with allergic predictors suggesting a dominant role for IgE mechanisms for work-related symptoms and asthma associated with sensitization to OPA or chlorhexidine.
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Affiliation(s)
- Hussein H. Mwanga
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roslynn Baatjies
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Tanusha Singh
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Mohamed F. Jeebhay
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Preisser AM, Koschel D, Merget R, Nowak D, Raulf M, Heidrich J. Workplace-related inhalation test - Specific inhalation challenge: S2k Guideline of the German Society for Occupational and Environmental Medicine e.V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e.V. (DGP) and the German Society for Allergology and Clinical Immunology e.V. (DGAKI). Allergol Select 2021; 5:315-334. [PMID: 34646977 PMCID: PMC8507414 DOI: 10.5414/alx02280e] [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: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022] Open
Abstract
Not available.
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Affiliation(s)
- Alexandra M. Preisser
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg
- Mandated representative of the German Society for Occupational and Environmental Medicine e. V. (DGAUM)
- Coordinator of the guideline
| | - Dirk Koschel
- Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Lung Center, Coswig, Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden
- Mandated representative of the German Society for Allergology and Clinical Immunology (DGAKI)
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and
- Mandated representative of the German Society for Occupational and Environmental Medicine e. V. (DGAUM)
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, CPC Comprehensive Pneumology Center Munich, DZL, Deutsches Zentrum für Lungenforschung Munich, Germany
- Mandated representative of the German Society for Pneumology and Respiratory Medicine e. V. (DGP) , and
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and
- Mandated representative of the German Society for Allergology and Clinical Immunology (DGAKI)
| | - Jan Heidrich
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg
- Coordinator of the guideline
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Andrianjafimasy MV, Febrissy M, Zerimech F, Dananché B, Kromhout H, Matran R, Nadif M, Oberson-Geneste D, Quinot C, Schlünssen V, Siroux V, Zock JP, Le Moual N, Nadif R, Dumas O. Association between occupational exposure to irritant agents and a distinct asthma endotype in adults. Occup Environ Med 2021; 79:155-161. [PMID: 34413158 DOI: 10.1136/oemed-2020-107065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 07/22/2021] [Indexed: 11/04/2022]
Abstract
AIM The biological mechanisms of work-related asthma induced by irritants remain unclear. We investigated the associations between occupational exposure to irritants and respiratory endotypes previously identified among never asthmatics (NA) and current asthmatics (CA) integrating clinical characteristics and biomarkers related to oxidative stress and inflammation. METHODS We used cross-sectional data from 999 adults (mean 45 years old, 46% men) from the case-control and familial Epidemiological study on the Genetics and Environments of Asthma (EGEA) study. Five respiratory endotypes have been identified using a cluster-based approach: NA1 (n=463) asymptomatic, NA2 (n=169) with respiratory symptoms, CA1 (n=50) with active treated adult-onset asthma, poor lung function, high blood neutrophil counts and high fluorescent oxidation products level, CA2 (n=203) with mild middle-age asthma, rhinitis and low immunoglobulin E level, and CA3 (n=114) with inactive/mild untreated allergic childhood-onset asthma. Occupational exposure to irritants during the current or last held job was assessed by the updated occupational asthma-specific job-exposure matrix (levels of exposure: no/medium/high). Associations between irritants and each respiratory endotype (NA1 asymptomatic as reference) were studied using logistic regressions adjusted for age, sex and smoking status. RESULTS Prevalence of high occupational exposure to irritants was 7% in NA1, 6% in NA2, 16% in CA1, 7% in CA2 and 10% in CA3. High exposure to irritants was associated with CA1 (adjusted OR aOR, (95% CI) 2.7 (1.0 to 7.3)). Exposure to irritants was not significantly associated with other endotypes (aOR range: 0.8 to 1.5). CONCLUSION Occupational exposure to irritants was associated with a distinct respiratory endotype suggesting oxidative stress and neutrophilic inflammation as potential associated biological mechanisms.
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Affiliation(s)
- Miora Valérie Andrianjafimasy
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Mickaël Febrissy
- LIPADE, Université Paris 5 Descartes, Paris, Île-de-France, France
| | - Farid Zerimech
- Univ. Lille, ULR 4483 - IMPECS, CHU Lille, F-59000 Lille, Lille, France.,Institut Pasteur de Lille, F-59000, Lille, France
| | | | - Hans Kromhout
- Utrecht University, Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht, Netherlands
| | - Régis Matran
- Univ. Lille, ULR 4483 - IMPECS, CHU Lille, F-59000 Lille, Lille, France.,Institut Pasteur de Lille, F-59000, Lille, France
| | - Mohamed Nadif
- LIPADE, Université Paris 5 Descartes, Paris, Île-de-France, France
| | | | - Catherine Quinot
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Vivi Schlünssen
- Aarhus University, Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus, Denmark.,National Research Centre for the Working Environment, Kobenhavn, Denmark
| | - Valérie Siroux
- Universite Grenoble Alpes, Inserm, CNRS, Team of environmental epidemiology applied to Reproduction and Respiratory health, IAB, Grenoble, France
| | - Jan-Paul Zock
- Institute for Global Health (ISGlobal) and Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, 94807, Villejuif, Île-de-France, France
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Roio LCD, Mizutani RF, Pinto RC, Terra-Filho M, Santos UP. Work-related asthma. ACTA ACUST UNITED AC 2021; 47:e20200577. [PMID: 34406224 PMCID: PMC8352763 DOI: 10.36416/1806-3756/e20200577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.
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Affiliation(s)
- Lavinia Clara Del Roio
- . Programa de Pós-Graduação em Pneumologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Rafael Futoshi Mizutani
- . Grupo de Doenças Respiratórias Ocupacionais, Ambientais e de Cessação de Tabagismo, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Regina Carvalho Pinto
- . Grupo de Doenças Obstrutivas, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Mário Terra-Filho
- . Disciplina de Pneumologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Ubiratan Paula Santos
- . Grupo de Doenças Respiratórias Ocupacionais, Ambientais e de Cessação de Tabagismo, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
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Endotyping asthma related to three different work exposures. J Allergy Clin Immunol 2021; 148:1072-1080. [PMID: 34331994 DOI: 10.1016/j.jaci.2021.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Work exposures play a significant role in adult-onset asthma, but mechanisms of work-related asthma are not fully elucidated. OBJECTIVE We aimed to reveal the molecular mechanisms of work-related asthma associated with flour (FA), isocyanate (IA) or welding fume (WA) exposures and identify potential biomarkers that distinguish these groups from each other. METHODS We used a combination of clinical tests, transcriptomic analysis and associated pathway analyses to investigate underlying disease mechanisms of the blood immune cells and the airway epithelium of 61 men. RESULTS Compared to the healthy controls, the WA patients had more differentially expressed genes than the FA and IA patients both in the airway epithelia and in the blood immune cells. In the airway epithelia, active inflammation was detected only in WA patients. In contrast, large number of differentially expressed genes were detected in all asthma groups in blood cells. Disease-related immune functions in blood cells were suppressed in all the asthma groups including leukocyte migration and inflammatory responses and decreased expression of upstream cytokines such as TNF and IFNγ. In transcriptome-phenotype correlations, hyperresponsiveness (R∼|0.6|) had the highest clinical relevance and associated with a set of exposure-group specific genes. Finally, biomarker subsets of only 5 genes specifically distinguished each of the asthma exposure group. CONCLUSIONS This study provides novel data on the molecular mechanisms underlying work-related asthma. We identified set of 5 promising biomarkers in asthma related to flour, isocyanate and welding exposure to be tested and clinically validated in future studies.
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Abstract
PURPOSE OF REVIEW To describe the recent findings of the last 2 years on the epidemiology and phenotypes of occupational asthma, as well as new developments in its diagnosis and management. RECENT FINDINGS Data from nine longitudinal studies showed a population attributable fraction for the occupational contribution to incident asthma of 16%. The main phenotypes of occupational asthma are: occupational asthma caused by high-molecular-weight (HMW) or low-molecular-weight (LMW) agents, irritant-induced asthma and occupational asthma-chronic obstructive pulmonary disease overlap. Among the variety of causative agents of occupational asthma, food-derived components are increasingly being reported, accounting for up to 25% cases of occupational asthma and/or occupational rhinitis. Recently, a specific inhalation challenge (SIC)-independent model has been developed to calculate the probability of occupational asthma diagnosis in workers exposed to HMW agents. In this model, work-specific sensitization, bronchial hyperresponsiveness, inhaled corticosteroid use, rhinoconjunctivitis and age 40 years or less were the most relevant predictive factors. Specific IgE measurements showed a pooled sensitivity of 0.74 and a specificity of 0.71 in the diagnosis of occupational asthma for HMW agents, while a lower sensitivity (0.28) and a higher specificity (0.89) was shown for LMW agents. Cessation of exposure to workplace sensitizers is the cornerstone of management of work-related conditions. SUMMARY An early and precise diagnosis of occupational asthma is crucial, allowing appropriate management and implementation of preventive strategies.
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Tiotiu A, Novakova P, Guillermo G, Correira de Sousa J, Braido F. Management of adult asthma and chronic rhinitis as one airway disease. Expert Rev Respir Med 2021; 15:1135-1147. [PMID: 34030569 DOI: 10.1080/17476348.2021.1932470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Chronic rhinitis is defined as nasal inflammation with the presence of minimum two symptoms such as nasal obstruction, rhinorrhea, sneezing and/or itching one hour daily for a minimum of 12 weeks/year. According their etiology, four groups of rhinitis are described: allergic, infectious, non-allergic non-infectious and mixed.Chronic rhinitis is frequently associated with asthma, shares similar mechanisms of the pathogenesis and has a negative impact of its outcomes sustaining the concept of unified airways disease.Areas covered: The present review summarizes the complex relationship between chronic rhinitis and asthma on the basis of recent epidemiological data, clinical characteristics, diagnosis and therapeutic management. All four groups are discussed with the impact of their specific treatment on asthma outcomes. Some medications are common for chronic rhinitis and asthma while others are more specific but able to treat the associated comorbidity.Expert opinion: The systematic assessment of chronic rhinitis in patients with asthma and its specific treatment improves both disease outcomes. Conversely, several therapies of asthma demonstrated beneficial effects on chronic rhinitis. Treating both diseases at the same time by only one medication is an interesting option to explore in the future in order to limit drugs administration, related costs and side effects.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, France; 9 Rue Du Morvan, Vandoeuvre-lès-Nancy, France.,Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, - Vandoeuvre-lès-Nancy, France
| | - Plamena Novakova
- ;department of Allergology, Medical University of Sofia, University Hospital "Alexandrovska"; 1, Sofia, Bulgaria
| | - Guidos Guillermo
- Department of Immunology, School of Medicine, Instituto Politecnico Nacional, Gustavo A. Madero, Ciudad De México, CDMX, Mexico
| | - Jaime Correira de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Campus De, Braga, Portugal
| | - Fulvio Braido
- Allergy and Respiratory Diseases Department, University of Genoa, Genova GE, Italy
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Cullinan P, Vandenplas O, Bernstein D. Assessment and Management of Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3264-3275. [PMID: 33161958 DOI: 10.1016/j.jaip.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
Exposures at work can give rise to different phenotypes of "work-related asthma." The focus of this review is on the diagnosis and management of sensitizer-induced occupational asthma (OA) caused by either a high- or low-molecular-weight agent encountered in the workplace. The diagnosis of OA remains a challenge for the clinician because there is no simple test with a sufficiently high level of accuracy. Instead, the diagnostic process combines different procedures in a stepwise manner. These procedures include a detailed clinical history, immunologic testing, measurement of lung function parameters and airway inflammatory markers, as well as various methods that relate changes in these functional and inflammatory indices to workplace exposure. Their diagnostic performances, alone and in combination, are critically reviewed and summarized into evidence-based key messages. A working diagnostic algorithm is proposed that can be adapted to the suspected agent, purpose of diagnosis, and available resources. Current information on the management options of OA is summarized to provide pragmatic guidance to clinicians who have to advise their patients with OA.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, United Kingdom
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - David Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Mason P, Liviero F, Maestrelli P, Frigo AC. Long-Term Follow-Up of Cluster-Based Diisocyanate Asthma Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3380-3386. [PMID: 33940214 DOI: 10.1016/j.jaip.2021.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on the outcome of occupational asthma (OA) are heterogeneous. OBJECTIVE To assess the impact of being part of a specific cluster at diagnosis on the long-term outcome of diisocyanate-induced OA. METHODS We collected data from 56 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. Patients sensitized to toluene diisocyanate were allocated to cluster 1 or 2 based on a tree analysis, using the 3 variables relevant for cluster segregation identified in a previous study: age, body mass index, and forced expiratory volume in 1 second/forced vital capacity at diagnosis. Patients sensitized to methylene diisocyanate were allocated to cluster 3, as in previous study. We defined OA remission when a patient had met a total of 3 criteria: no asthma symptoms and no antiasthma therapy for the last year, as well as having normal lung function. RESULTS At follow-up, 16 patients showed OA remission. They exhibited better lung function, less bronchial hyperreactivity, as well as younger age at diagnosis. Twenty-eight patients were allocated to cluster 1, 10 to cluster 2, and 18 to cluster 3. The percentage of patients with OA remission was higher in cluster 2 (50% vs 25% in cluster 1 and 22.5% in cluster 3), although the difference was not statistically significant (P = .2789). CONCLUSIONS Age at diagnosis was a strong predictor of OA remission. The outcome of diisocyanate OA tended to be more favorable for patients with toluene diisocyanate OA allocated in cluster 2, but this finding needs to be validated by further data.
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Affiliation(s)
- Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Filippo Liviero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Piero Maestrelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Migueres N, Debaille C, Walusiak-Skorupa J, Lipińska-Ojrzanowska A, Munoz X, van Kampen V, Suojalehto H, Suuronen K, Seed M, Lee S, Rifflart C, Godet J, de Blay F, Vandenplas O. Occupational Asthma Caused by Quaternary Ammonium Compounds: A Multicenter Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3387-3395. [PMID: 33940212 DOI: 10.1016/j.jaip.2021.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPTs). OBJECTIVE To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared with OA caused by other low-molecular weight (LMW) agents. METHODS The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n = 22) were identified based on a positive BPT to QACs after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers. They were compared with 289 subjects with OA caused by other LMW agents. RESULTS Most subjects with QAC-induced OA were working in the health care sector (n = 14). A twofold or greater increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in eight of 11 subjects with QAC-induced OA (72.7%) and in 49.7% of those with OA caused by other LMW agents. Although sputum assessment was available in only eight subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [range, 12.1% to 21.1%]) compared with those with OA caused by other LMW agents (2.0% [range, 0% to 5.2%]; P < .001). CONCLUSIONS This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiologic pathways involved in OA caused by LMW agents.
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Affiliation(s)
- Nicolas Migueres
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France; Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Charlotte Debaille
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | | | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University, Bochum, Germany
| | - Hille Suojalehto
- Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Katri Suuronen
- Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Martin Seed
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, United Kingdom
| | - Sewon Lee
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, United Kingdom
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Julien Godet
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
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Classification of chemicals as respiratory allergens based on human data: Requirements and practical considerations. Regul Toxicol Pharmacol 2021; 123:104925. [PMID: 33831493 DOI: 10.1016/j.yrtph.2021.104925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 02/01/2023]
Abstract
Occupational asthma is an important health problem that can include exacerbation of existing asthma, or induce new asthma either through allergic sensitisation, or non-immunological mechanisms. While allergic sensitisation of the respiratory tract can be acquired to proteins, or to low molecular weight chemicals (chemical respiratory allergens) this article is on the latter exclusively. Chemical respiratory allergy resulting in occupational asthma is associated with high levels of morbidity and there is a need, therefore, that chemicals which can cause sensitisation of the respiratory tract are identified accurately. However, there are available no validated, or even widely accepted, predictive test methods (in vivo, in vitro or in silico) that have achieved regulatory acceptance for identifying respiratory sensitising hazards. For this reason there is an important reliance on human data for the identification of chemical respiratory allergens, and for distinguishing these from chemicals that cause occupational asthma through non-immunological mechanisms. In this article the reasons why it is important that care is taken in designating chemicals as respiratory allergens are reviewed. The value and limitations of human data that can aid the accurate identification of chemical respiratory allergens are explored, including exposure conditions, response characteristics in specific inhalation challenge tests, and immunological investigations.
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46
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Tiotiu A, Novakova P, Baiardini I, Bikov A, Chong-Neto H, de-Sousa JC, Emelyanov A, Heffler E, Fogelbach GG, Kowal K, Labor M, Mihaicuta S, Nedeva D, Novakova S, Steiropoulos P, Ansotegui IJ, Bernstein JA, Boulet LP, Canonica GW, Dubuske L, Nunes C, Ivancevich JC, Santus P, Rosario N, Perazzo T, Braido F. Manifesto on united airways diseases (UAD): an Interasma (global asthma association - GAA) document. J Asthma 2021; 59:639-654. [PMID: 33492196 DOI: 10.1080/02770903.2021.1879130] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). METHODS Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. RESULTS The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. CONCLUSIONS Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France.,EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Jaime Correia- de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University named after I.I.Mechnikov, St-Petersburg, Russia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Guillermo Guidos Fogelbach
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria.,Instituto Politécnico Nacional, Escuela Nacional de Medicina y Homeopatía, Laboratorio de Bioquímica Estructural, Ciudad de México, México
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | - Stefan Mihaicuta
- Pulmonology Department, Cardio Prevent Foundation, University of Medicine and Pharmacy "Dr Victor Babes", Timisoara, Romania
| | - Denislava Nedeva
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Sylvia Novakova
- Allergy Unit of Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section University of Cincinnati, Cincinnati, OH, USA
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Lawrence Dubuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Carlos Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - Juan Carlos Ivancevich
- Immunology Department, Faculty of Medicine, del Salvador University, Buenos Aires, Argentina
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences, University of Milan, Division of Respiratory Diseases "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Tommaso Perazzo
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Respiratory Unit for Continuity of Care IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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47
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Wiszniewska M, Dellis P, van Kampen V, Suojalehto H, Munoz X, Walusiak-Skorupa J, Lindström I, Merget R, Romero-Mesones C, Sastre J, Quirce S, Mason P, Rifflart C, Godet J, de Blay F, Vandenplas O. Characterization of Occupational Eosinophilic Bronchitis in a Multicenter Cohort of Subjects with Work-Related Asthma Symptoms. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:937-944.e4. [PMID: 32920064 DOI: 10.1016/j.jaip.2020.08.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/31/2020] [Accepted: 08/15/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Occupational eosinophilic bronchitis (OEB) has been described only as anecdotal case reports. OBJECTIVE We investigated the clinical and inflammatory characteristics of subjects with OEB identified in a cohort of subjects who completed a specific inhalation challenge (SIC) with occupational agents. METHODS In this retrospective multicenter study, OEB was defined by (1) a fall in FEV1 less than 15% during the SIC and the absence of nonspecific bronchial hyperresponsiveness both before and after the SIC and (2) a postchallenge increase of 3% or more in sputum eosinophils. The subjects who fulfilled these criteria were compared with 226 subjects with a negative SIC and 30 subjects with a positive SIC who failed to show baseline nonspecific bronchial hyperresponsiveness. RESULTS An isolated increase in postchallenge sputum eosinophils was documented in 33 of 259 subjects (13%) with a negative SIC. These subjects reported significantly more often an isolated cough at work compared with the negative and positive SIC controls. When compared with positive SIC controls, the subjects with OEB experienced less frequently work-related wheezing and reported a shorter duration of symptoms at work. The sensitivity of the post-SIC increase in fractional exhaled nitric oxide in identifying OEB among subjects with a negative SIC was low, ranging from 43% to 24% using cutoff values of 8 ppb to 17.5 ppb, whereas the specificity was high (90%-97%). CONCLUSIONS This study highlights the relevance of induced sputum analysis in the investigation of work-related asthma symptoms to identify isolated increases in sputum eosinophils that are consistent with a diagnosis of OEB.
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Affiliation(s)
- Marta Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Perrine Dellis
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - Hille Suojalehto
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Irmeli Lindström
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Rolph Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - Christian Romero-Mesones
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joaquin Sastre
- Department of Allergy, Fundacion Jimenez Dıaz, Universidad Autonoma de Madrid and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Paola Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Julien Godet
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
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48
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Morimoto Y, Nishida C, Tomonaga T, Izumi H, Yatera K, Sakurai K, Kim Y. Lung disorders induced by respirable organic chemicals. J Occup Health 2021; 63:e12240. [PMID: 34128301 PMCID: PMC8204092 DOI: 10.1002/1348-9585.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023] Open
Abstract
Respirable organic chemicals were originally thought to cause allergic respiratory diseases, such as bronchial asthma and hypersensitivity pneumonitis, and believed not to cause lung disorders derived from inflammatory or fibrotic processes such as pulmonary fibrosis and interstitial pneumonitis. It has recently been reported, however, that exposure to organic chemicals can cause interstitial lung diseases. In this review, we discuss the clinical features of occupational asthma and hypersensitivity pneumonitis, as well as other lung disorders, including interstitial pneumonitis, caused by humidifier disinfectants in Korea and by a cross-linked acrylic acid-based polymer (CL-PAA) in Japan.
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Affiliation(s)
- Yasuo Morimoto
- Department of Occupational PneumologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Chinatsu Nishida
- Department of Respiratory MedicineSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Taisuke Tomonaga
- Department of Occupational PneumologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Hiroto Izumi
- Department of Occupational PneumologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kazuhiro Yatera
- Department of Respiratory MedicineSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kazuo Sakurai
- Department of Life and Environmental EngineeringThe University of KitakyushuKitakyushuJapan
| | - Yangho Kim
- Department of Occupational and Environmental MedicineUlsan University HospitalUniversity of Ulsan College of MedicineUlsanKorea
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49
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Pignatti P, Visca D, Loukides S, Märtson AG, Alffenaar JWC, Migliori GB, Spanevello A. A snapshot of exhaled nitric oxide and asthma characteristics: experience from high to low income countries. Pulmonology 2020; 28:44-58. [PMID: 33358001 DOI: 10.1016/j.pulmoe.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022] Open
Abstract
Nitric oxide is a gas produced in the airways of asthmatic subjects and related to T2 inflammation. It can be measured as fractional nitric oxide (FeNO) in the exhaled air and used as a non-invasive, easy to evaluate, rapid marker. It is now widely used in many settings to determine airway inflammation. The aim of this narrative review is to report relationship between FeNO and the physiopathologic characteristics of asthmatic patients. Factors affecting FeNO levels have also been analysed as well as the impact of corticosteroid, target therapies and rehabilitation programs. Considering the availability of the test, spreading this methodology to low income countries has also been considered as a possibility for evaluating airway inflammation and monitoring adherence to inhaled corticosteroid therapy. PubMed data search has been performed restricted to English language papers. Research was limited to studies in adults unless studies in children were the only ones reported for a particular issue. This revision could be useful to summarize the role of FeNO in relation to asthma characteristics and help in the use of FeNO in different clinical settings particularly in low income countries.
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Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia; Westmead Hospital, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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50
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Cevhertas L, Ogulur I, Maurer DJ, Burla D, Ding M, Jansen K, Koch J, Liu C, Ma S, Mitamura Y, Peng Y, Radzikowska U, Rinaldi AO, Satitsuksanoa P, Globinska A, Veen W, Sokolowska M, Baerenfaller K, Gao Y, Agache I, Akdis M, Akdis CA. Advances and recent developments in asthma in 2020. Allergy 2020; 75:3124-3146. [PMID: 32997808 DOI: 10.1111/all.14607] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022]
Abstract
In this review, we discuss recent publications on asthma and review the studies that have reported on the different aspects of the prevalence, risk factors and prevention, mechanisms, diagnosis, and treatment of asthma. Many risk and protective factors and molecular mechanisms are involved in the development of asthma. Emerging concepts and challenges in implementing the exposome paradigm and its application in allergic diseases and asthma are reviewed, including genetic and epigenetic factors, microbial dysbiosis, and environmental exposure, particularly to indoor and outdoor substances. The most relevant experimental studies further advancing the understanding of molecular and immune mechanisms with potential new targets for the development of therapeutics are discussed. A reliable diagnosis of asthma, disease endotyping, and monitoring its severity are of great importance in the management of asthma. Correct evaluation and management of asthma comorbidity/multimorbidity, including interaction with asthma phenotypes and its value for the precision medicine approach and validation of predictive biomarkers, are further detailed. Novel approaches and strategies in asthma treatment linked to mechanisms and endotypes of asthma, particularly biologicals, are critically appraised. Finally, due to the recent pandemics and its impact on patient management, we discuss the challenges, relationships, and molecular mechanisms between asthma, allergies, SARS-CoV-2, and COVID-19.
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Affiliation(s)
- Lacin Cevhertas
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Department of Medical Immunology Institute of Health Sciences, Bursa Uludag University Bursa Turkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Faculty of Medicine, Division of Pediatric Allergy and Immunology Marmara University Istanbul Turkey
| | - Debbie J. Maurer
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Daniel Burla
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Mei Ding
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan Hubei China
| | - Kirstin Jansen
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Jana Koch
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Institute for Bioinformatics (SIB) Davos Switzerland
| | - Chengyao Liu
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen HospitalCapital Medical University Beijing China
| | - Siyuan Ma
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen HospitalCapital Medical University Beijing China
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Yaqi Peng
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Otorhinolaryngology HospitalThe First Affiliated HospitalSun Yat‐sen University Guangzhou China
| | - Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Department of Regenerative Medicine and Immune Regulation Medical University of Bialystok Bialystok Poland
| | - Arturo O. Rinaldi
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Pattraporn Satitsuksanoa
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - Anna Globinska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Willem Veen
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Katja Baerenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Institute for Bioinformatics (SIB) Davos Switzerland
| | - Ya‐dong Gao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan Hubei China
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
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