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Kleinbeck S, Wolkoff P. Exposure limits for indoor volatile substances concerning the general population: The role of population-based differences in sensory irritation of the eyes and airways for assessment factors. Arch Toxicol 2024; 98:617-662. [PMID: 38243103 PMCID: PMC10861400 DOI: 10.1007/s00204-023-03642-w] [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: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 01/21/2024]
Abstract
Assessment factors (AFs) are essential in the derivation of occupational exposure limits (OELs) and indoor air quality guidelines. The factors shall accommodate differences in sensitivity between subgroups, i.e., workers, healthy and sick people, and occupational exposure versus life-long exposure for the general population. Derivation of AFs itself is based on empirical knowledge from human and animal exposure studies with immanent uncertainty in the empirical evidence due to knowledge gaps and experimental reliability. Sensory irritation in the eyes and airways constitute about 30-40% of OELs and is an abundant symptom in non-industrial buildings characterizing the indoor air quality and general health. Intraspecies differences between subgroups of the general population should be quantified for the proposal of more 'empirical' based AFs. In this review, we focus on sensitivity differences in sensory irritation about gender, age, health status, and vulnerability in people, based solely on human exposure studies. Females are more sensitive to sensory irritation than males for few volatile substances. Older people appear less sensitive than younger ones. However, impaired defense mechanisms may increase vulnerability in the long term. Empirical evidence of sensory irritation in children is rare and limited to children down to the age of six years. Studies of the nervous system in children compared to adults suggest a higher sensitivity in children; however, some defense mechanisms are more efficient in children than in adults. Usually, exposure studies are performed with healthy subjects. Exposure studies with sick people are not representative due to the deselection of subjects with moderate or severe eye or airway diseases, which likely underestimates the sensitivity of the group of people with diseases. Psychological characterization like personality factors shows that concentrations of volatile substances far below their sensory irritation thresholds may influence the sensitivity, in part biased by odor perception. Thus, the protection of people with extreme personality traits is not feasible by an AF and other mitigation strategies are required. The available empirical evidence comprising age, lifestyle, and health supports an AF of not greater than up to 2 for sensory irritation. Further, general AFs are discouraged for derivation, rather substance-specific derivation of AFs is recommended based on the risk assessment of empirical data, deposition in the airways depending on the substance's water solubility and compensating for knowledge and experimental gaps. Modeling of sensory irritation would be a better 'empirical' starting point for derivation of AFs for children, older, and sick people, as human exposure studies are not possible (due to ethical reasons) or not generalizable (due to self-selection). Dedicated AFs may be derived for environments where dry air, high room temperature, and visually demanding tasks aggravate the eyes or airways than for places in which the workload is balanced, while indoor playgrounds might need other AFs due to physical workload and affected groups of the general population.
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Affiliation(s)
- Stefan Kleinbeck
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Peder Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Beigoli S, Amin F, Kazemi Rad H, Rezaee R, Boskabady MH. Occupational respiratory disorders in Iran: a review of prevalence and inducers. Front Med (Lausanne) 2024; 11:1310040. [PMID: 38390570 PMCID: PMC10881831 DOI: 10.3389/fmed.2024.1310040] [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: 10/09/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
The link between occupational respiratory diseases (ORD) and exposure to harmful factors that are present in the workplace has been well shown. Factors such as physical activity, age and duration of occupational exposure playing important roles in ORD severity, should be identified in the workplace, their effects on workers health should be studied, and ultimately, exposure to them must be minimized. We carried out a literature review by searching PubMed, Scopus, and Web of Science databases to retrieve studies published from 1999 until the end of April 2023 reporting the prevalence and inducers of ORD in Iran. In Iranian workers, several ORD such as interstitial lung disease, silicosis, occupational asthma, pulmonary inflammatory diseases, chronic obstructive pulmonary diseases, and lung cancers have been reported. It was indicated that ORD mainly occur due to repeated and prolonged exposure to noxious agents in the workplace. We also extracted the prevalence of ORD in different regions of Iran from the retrieved reports. Based on our literature review, the prevalence of ORD among Iranian workers highlights the importance of regular assessment of the risk of exposure to noxious agents in the workplace to develop measures for preventing potential adverse effects.
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Affiliation(s)
- Sima Beigoli
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Amin
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hamideh Kazemi Rad
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein 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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Holtjer JCS, Bloemsma LD, Beijers RJHCG, Cornelissen MEB, Hilvering B, Houweling L, Vermeulen RCH, Downward GS, Maitland-Van der Zee AH. Identifying risk factors for COPD and adult-onset asthma: an umbrella review. Eur Respir Rev 2023; 32:32/168/230009. [PMID: 37137510 PMCID: PMC10155046 DOI: 10.1183/16000617.0009-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/27/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND COPD and adult-onset asthma (AOA) are the most common noncommunicable respiratory diseases. To improve early identification and prevention, an overview of risk factors is needed. We therefore aimed to systematically summarise the nongenetic (exposome) risk factors for AOA and COPD. Additionally, we aimed to compare the risk factors for COPD and AOA. METHODS In this umbrella review, we searched PubMed for articles from inception until 1 February 2023 and screened the references of relevant articles. We included systematic reviews and meta-analyses of observational epidemiological studies in humans that assessed a minimum of one lifestyle or environmental risk factor for AOA or COPD. RESULTS In total, 75 reviews were included, of which 45 focused on risk factors for COPD, 28 on AOA and two examined both. For asthma, 43 different risk factors were identified while 45 were identified for COPD. For AOA, smoking, a high body mass index (BMI), wood dust exposure and residential chemical exposures, such as formaldehyde exposure or exposure to volatile organic compounds, were amongst the risk factors found. For COPD, smoking, ambient air pollution including nitrogen dioxide, a low BMI, indoor biomass burning, childhood asthma, occupational dust exposure and diet were amongst the risk factors found. CONCLUSIONS Many different factors for COPD and asthma have been found, highlighting the differences and similarities. The results of this systematic review can be used to target and identify people at high risk for COPD or AOA.
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Affiliation(s)
- Judith C S Holtjer
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Lizan D Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Merel E B Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Bart Hilvering
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Laura Houweling
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Roel C H Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George S Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anke-Hilse Maitland-Van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
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Dodd KE, Blackley DJ, Mazurek JM. Cardiovascular Disease Among Adults With Work-Related Asthma, 2012-2017. Am J Prev Med 2023; 64:194-203. [PMID: 36371324 DOI: 10.1016/j.amepre.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Asthma is associated with an increased risk for cardiovascular disease, and adults with persistent, severe asthma have a significantly higher risk of cardiovascular disease than adults with intermittent or no asthma. METHODS The objective of this cross-sectional study was to assess the association between work-related asthma status and cardiovascular disease among ever-employed adults (aged 18-64 years) with current asthma using data from the 2012-2017 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia. Weighted prevalence ratios and 95% CIs, adjusted for age, sex, race/ethnicity, education, household income, smoking status, chronic obstructive pulmonary disease, diabetes, and BMI, were calculated. In addition, the associations of cardiovascular disease with adverse asthma outcomes and asthma control among adults with work-related asthma were examined. Analyses were conducted in 2021. RESULTS Among an estimated annualized 14.8 million ever-employed adults aged 18-64 years with current asthma, adults with work-related asthma (prevalence ratio=1.5; 95% CI=1.2, 1.8) and possible work-related asthma (prevalence ratio=1.2; 95% CI=1.0, 1.5) were significantly more likely to have cardiovascular disease than adults with non-work-related asthma. Among adults with work-related asthma, those with very poorly controlled asthma (prevalence ratio=1.8; 95% CI=1.3, 2.5) and an asthma-related emergency room visit (prevalence ratio=1.5; 95% CI=1.1, 2.0) were significantly more likely to have cardiovascular disease. CONCLUSIONS Adults with work-related asthma were more likely to have cardiovascular disease than those with non-work-related asthma. Primary prevention, early diagnosis, and implementation of optimal work-related asthma management are essential for workers' health. Cardiovascular disease should be considered where appropriate when diagnosing and recommending treatment and interventions for adults with work-related asthma.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia.
| | - David J Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia
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Ramkissoon C, Gaskin S, Hall T, Pisaniello D, Zosky G. Engineered Stone Fabrication Work Releases Volatile Organic Compounds Classified as Lung Irritants. Ann Work Expo Health 2022; 67:288-293. [PMID: 36239208 PMCID: PMC9923029 DOI: 10.1093/annweh/wxac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/11/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Engineered stones are often characterized for their crystalline silica content. Their organic composition, particularly that of the emissions generated during fabrication work using hand-held power tools, is relatively unexplored. We forensically screened the emissions from dry-cutting 12 engineered stone products in a test chamber for their organic composition by pyrolysis-gas chromatography-mass spectrometry (GC-MS) plus selected traditional capture and analysis techniques. Phthalic anhydride, which has a Respiratory Sensitization (RSEN) Notation by the American Conference of Governmental Industrial Hygienists (ACGIH), was the most common and abundant compound, at 26-85% of the total organic composition of engineered stone emissions. Benzaldehyde and styrene were also present in all twelve samples. During active cutting, the predominant volatile organic compound (VOC) emitted was styrene, with phthalic anhydride, benzene, ethylbenzene, and toluene also detected. These results have important health implications as styrene and phthalic anhydride are irritants to the respiratory tract. This study suggests a risk of concurrent exposure to high levels of respirable crystalline silica and organic lung irritants during engineered stone fabrication work.
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Affiliation(s)
- Chandnee Ramkissoon
- Author to whom correspondence should be addressed. Tel: +610883134957; e-mail:
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5031, Australia
| | - Tony Hall
- Mawson Analytical Spectrometry Services, School of Physical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
| | - Dino Pisaniello
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5031, Australia
| | - Graeme Zosky
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
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Stoleski S, Minov J, Mijakoski D, Atanasovska A, Bislimovska D, Karadzinska-Bislimovska J. Prevalence and Characteristics of Chronic Obstructive Pulmonary Disease in Dairy Farmers. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To assess the prevalence and characteristics of chronic obstructive pulmonary disease (COPD) in dairy farmers, and evaluate the role of job exposure and smoking as predictors for respiratory health impairment. Methods: A cross-sectional study was performed, including 83 dairy farmers (mean age: 52.6±8.7 years; mean exposure duration: 23.7±7.6 years) and 80 office workers as a control group (mean age: 52.7±8.2 years) matched for age, smoking habits, and socioeconomic status. Methods for evaluation of study participants included a questionnaire on respiratory symptoms in the last 12 months, baseline spirometry and bronchodilator reversibility testing, and diagnostic criteria for COPD. Results: The mean post-bronchodilator values of spirometric parameters are significantly lower in subjects among EG with negative bronchodilator test compared to those in CG, while the mean post-bronchodilator values of spirometric parameters are lower in dairy farmers with negative BD tests exposed more than 20 years compared to those with exposure less than 20 years, being statistically significant for FEV1/FVC%, MEF25, MEF50 and MEF75. The COPD prevalence is non-significantly higher in dairy farmers compared to controls, and is significantly associated with age over 40 years in dairy farmers (P=0.035). The risk for COPD development in dairy farmers is about 36 fold higher in subjects exposed more than 20 years (OR = 36.00 (1.21-37.77) CI 95%) compared to those with exposure duration less than 20 years, and is about 6 fold higher in dairy farmers who are current smokers (OR = 6.12 (0.95-37.77) CI 95%). COPD is significantly associated with smoking duration among smokers in both groups, while combined effect of smoking, smoking duration, and number of cigarettes smoked daily has a significant impact on COPD development in dairy farmers. According to the GOLD classification, depending on the degree of airflow limitation, mild and moderate types of COPD are detected in dairy farmers, and only mild type in controls, showing no significant difference between the two groups. Conclusion: The study findings recognized the role of farming exposure, and smoking as well, as predictors for respiratory health impairment, and furthermore confirmed their potential to be a predictive factor in the COPD development. These facts should be helpful in detection of critical points for action, indicate the need of adverse occupational exposures reduction through adequate preventive measures and regular health examinations, implementation of relevant engineering controls, smoking cessation programs, and complete and efficient respiratory health assessment.
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Lenander-Ramirez A, Bryngelsson IL, Vihlborg P, Westberg H, Andersson L. Respirable Dust and Silica: Respiratory Diseases Among Swedish Iron Foundry Workers. J Occup Environ Med 2022; 64:593-598. [PMID: 35275887 PMCID: PMC9301988 DOI: 10.1097/jom.0000000000002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The mortality and morbidity pattern for respiratory diseases was determined in a cohort of 1752 Swedish foundry workers, particularly for respirable silica dust exposure. METHODS The morbidity follow-up in the Swedish National Non-primary Outpatient Register covered 2001 to 2017 (NPR; specialist not in care patients), the mortality from the National Causes of Death Register covered 2001 to 2017. Cumulative exposures to silica and dust were determined. RESULTS The morbidity in COPD showed significantly increased risk for all exposure groups, as did silicosis in the high exposure group, these cases corresponded to silica exposure levels below 0.05 mg/m3. The mortality of all causes and respiratory diseases was significantly increased by cumulative silica exposure in the high exposure group. CONCLUSIONS Significantly increased morbidity for respiratory diseases and COPD was determined at silica exposure levels below the current Swedish OEL.
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Affiliation(s)
- Alexander Lenander-Ramirez
- From the Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Lenander-Ramirez, Bryngelsson, Westberg, and Dr Andersson); Geriatic Clinic, Faculty of Medicine and Health, Örebro University, Örebro Sweden (Dr Vihlborg); School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Westberg and Dr Andersson)
| | - Ing-Liss Bryngelsson
- From the Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Lenander-Ramirez, Bryngelsson, Westberg, and Dr Andersson); Geriatic Clinic, Faculty of Medicine and Health, Örebro University, Örebro Sweden (Dr Vihlborg); School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Westberg and Dr Andersson)
| | - Per Vihlborg
- From the Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Lenander-Ramirez, Bryngelsson, Westberg, and Dr Andersson); Geriatic Clinic, Faculty of Medicine and Health, Örebro University, Örebro Sweden (Dr Vihlborg); School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Westberg and Dr Andersson)
| | - Håkan Westberg
- From the Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Lenander-Ramirez, Bryngelsson, Westberg, and Dr Andersson); Geriatic Clinic, Faculty of Medicine and Health, Örebro University, Örebro Sweden (Dr Vihlborg); School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Westberg and Dr Andersson)
| | - Lena Andersson
- From the Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Lenander-Ramirez, Bryngelsson, Westberg, and Dr Andersson); Geriatic Clinic, Faculty of Medicine and Health, Örebro University, Örebro Sweden (Dr Vihlborg); School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Westberg and Dr Andersson)
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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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Environmental Substances Associated with Chronic Obstructive Pulmonary Disease-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073945. [PMID: 35409627 PMCID: PMC8997594 DOI: 10.3390/ijerph19073945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a slowly developing non-communicable disease (NCD), causing non-reversible obstruction and leading to marked morbidity and mortality. Besides traditional risk factors such as smoking, some environmental substances can augment the risk of COPD. The European Human Biomonitoring Initiative (HBM4EU) is a program evaluating citizens’ exposure to various environmental substances and their possible health impacts. Within the HBM4EU, eighteen priority substances or substance groups were chosen. In this scoping review, seven of these substances or substance groups are reported to have an association or a possible association with COPD. Main exposure routes, vulnerable and high-exposure risk groups, and matrices where these substances are measured are described. Pesticides in general and especially organophosphate and carbamate insecticides, and some herbicides, lead (Pb), and polycyclic aromatic hydrocarbons (PAHs) showed an association, and cadmium (Cd), chromium (Cr and CrVI), arsenic (As), and diisocyanates, a possible association with COPD and/or decreased lung function. Due to long latency in COPD’s disease process, the role of chemical exposure as a risk factor for COPD is probably underestimated. More research is needed to support evidence-based conclusions. Generally, chemical exposure is a growing issue of concern, and prompt action is needed to safeguard public health.
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Nishida C, Yatera K. The Impact of Ambient Environmental and Occupational Pollution on Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2788. [PMID: 35270479 PMCID: PMC8910713 DOI: 10.3390/ijerph19052788] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Affiliation(s)
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka 807-8555, Japan;
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Ojha UC, Spalgais S, Ranjan A, Choudhari OK. Respiratory health evaluation of construction workers using questionnaire. RUDN JOURNAL OF MEDICINE 2021. [DOI: 10.22363/2313-0245-2021-25-4-313-320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Relevance . With growing economy and flourishing construction industries the comorbidities among construction workers are also raised. They are exposed to various dust, fumes, noxious gases and vapours making them susceptible to chronic airway diseases like Chronic Obstructive Lung Disease. The aim of the study was to evaluate the respiratory health status of construction workers in an unorganised sector. Materials and Methods . The data collected from National Capital of Delhi region in an unorganised sector of construction workers by using a Saint George Respiratory Questionnaire by the Institute of Occupational Health and Environmental research, Basaidarapur, Delhi, India. All the participant response was noted and the answers were evaluated to see respiratory health status of workers. Total 200 workers were evaluated. Total 182 males and 18 female participated in the study. Results and Discussion . 25% of workers reported poor health at the time of the survey, while only 4% of workers considered their health to be very good. Among the main complaints were indicated: cough, sputum production, shortness of breath, chest infections, attacks of wheezing. The overall mean of Saint George Respiratory Questionnaire core was 33.55. It increases with the working period in the construction field with 21.6% for 10years and 49.1 for 30years experienced workers, while workers with 11 to 20 years of experience, the score was 28.4. The Saint George Respiratory Questionnaire score was 35.1 in 21-30 years of experienced construction workers. Conclusion . As a result of the study, construction workers are found to be at high risk of various respiratory diseases and related disabilities. Participants in this study did not receive any treatment for respiratory problems at any clinic. This means the importance of occupational health education and the use of personal protective equipment and safe working conditions for construction workers.
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12
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Coureau E, Fontana L, Lamouroux C, Pélissier C, Charbotel B. Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413181. [PMID: 34948791 PMCID: PMC8706635 DOI: 10.3390/ijerph182413181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
Isocyanate, whose disease-inducing mechanism is poorly understood, with poor prognosis, is widely used. Asthma is the most frequent manifestation of prolonged exposure. We assessed the evolution of the incidence of isocyanate-induced occupational asthma over time. PubMed and Cochrane databases were systematically searched for studies published since 1990 that assessed the relationship between occupational exposure to isocyanates and asthma. We identified 39 studies: five retrospective cohort studies, seven prospective cohort studies, three of which were inception cohorts), seven observational cross-sectional studies, five literature reviews, two case series, and 13 registry studies. The incidence of occupational asthma secondary to isocyanate exposure has decreased from more than 5% in the early 1990s to 0.9% in 2017 in the United States. Despite the wide use of optimal collective and individual protection measures, the risk of occupational asthma has stabilized. Occupational asthma risk can be assessed with good sensitivity using self-questionnaires and pulmonary function tests. Occupational avoidance should be implemented as soon as possible after the first symptoms appear because the prognosis becomes increasingly poor with the persistence of exposure. It is now necessary to study specifically cutaneous sensitization to isocyanates and to define what protective equipment is effective against this mode of exposure.
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Affiliation(s)
- Elie Coureau
- UMRESTTE, UMR T 9405, Université Lyon 1, Université Gustave Eiffel—IFSTTAR, Domaine Rockefeller, 8 Avenue Rockefeller, 69008 Lyon, France; (E.C.); (C.L.)
- CRPPE-Lyon, Centre Régional de Pathologies Professionnelles et Environnementales de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France
| | - Luc Fontana
- Hospital University Center of Saint-Etienne, Université Lyon 1, Université de St Etienne, IFSTTAR, UMRESTTE, UMR T 9405, 42005 Saint-Etienne, France; (L.F.); (C.P.)
- Service de Santé au Travail, Centre Hospitalier Universitaire de Saint-Etienne, 42005 Saint-Etienne, France
| | - Céline Lamouroux
- UMRESTTE, UMR T 9405, Université Lyon 1, Université Gustave Eiffel—IFSTTAR, Domaine Rockefeller, 8 Avenue Rockefeller, 69008 Lyon, France; (E.C.); (C.L.)
- CRPPE-Lyon, Centre Régional de Pathologies Professionnelles et Environnementales de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France
| | - Carole Pélissier
- Hospital University Center of Saint-Etienne, Université Lyon 1, Université de St Etienne, IFSTTAR, UMRESTTE, UMR T 9405, 42005 Saint-Etienne, France; (L.F.); (C.P.)
- Service de Santé au Travail, Centre Hospitalier Universitaire de Saint-Etienne, 42005 Saint-Etienne, France
| | - Barbara Charbotel
- UMRESTTE, UMR T 9405, Université Lyon 1, Université Gustave Eiffel—IFSTTAR, Domaine Rockefeller, 8 Avenue Rockefeller, 69008 Lyon, France; (E.C.); (C.L.)
- CRPPE-Lyon, Centre Régional de Pathologies Professionnelles et Environnementales de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France
- Correspondence: ; Tel.: +33-4-78-77-28-09
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13
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Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease. MEDICINA-LITHUANIA 2021; 57:medicina57090911. [PMID: 34577834 PMCID: PMC8469547 DOI: 10.3390/medicina57090911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.
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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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15
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Jaakkola MS, Lajunen TK, Heibati B, Wang YC, Lai CH, Jaakkola JJK. Occupation and subcategories of asthma: a population-based incident case-control study. Occup Environ Med 2021; 78:661-668. [PMID: 34282040 PMCID: PMC8380874 DOI: 10.1136/oemed-2020-106953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022]
Abstract
Background We hypothesised that occupational exposures differently affect subtypes of adult-onset asthma. Objective We investigated potential relations between occupation and three subtypes of adult asthma, namely atopic asthma, non-atopic asthma and asthma–COPD overlap syndrome (ACOS). Methods This is a population-based case–control study of incident asthma among working-age adults living in Pirkanmaa Hospital District in Southern Finland. The determinant of interest was occupation at the time of diagnosis of asthma or the job that the subject had quit due to respiratory symptoms. Asthma was divided into three mutually exclusive subtypes on the basis of any positive IgE antibody (atopic and non-atopic asthma) and presence of persistent airways obstruction in spirometry (ACOS). We applied unconditional logistic regression analysis to estimate adjusted OR (aOR), taking into account gender, age and smoking. Results The following occupational groups showed significantly increased risk of atopic asthma: chemical industry workers (aOR 15.76, 95% CI 2.64 to 94.12), bakers and food processors (aOR 4.69, 95% CI 1.18 to 18.69), waiters (aOR 4.67, 95% CI 1.40 to 15.56) and those unemployed (aOR 3.06, 95% CI 1.52 to 6.17). The following occupations showed clearly increased risk of non-atopic asthma: metal workers (aOR 8.37, 95% CI 3.77 to 18.59) and farmers and other agricultural workers (aOR 2.36, 95% CI 1.10 to 5.06). Some occupational groups showed statistically significantly increased OR of ACOS: electrical and electronic production workers (aOR 30.6, 95% CI 6.10 to 153.35), fur and leather workers (aOR 16.41, 95% CI 1.25 to 215.85) and those retired (aOR 5.55, 95% CI 1.63 to 18.97). Conclusions Our results show that different occupations are associated with different subtypes of adult-onset asthma.
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Affiliation(s)
- Maritta S Jaakkola
- Center for Environmental and Respiratory Health Research, Oulun yliopisto, Oulu, Finland .,Biocenter, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland
| | - Taina K Lajunen
- Center for Environmental and Respiratory Health Research, Oulun yliopisto, Oulu, Finland.,Biocenter, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland
| | - Behzad Heibati
- Center for Environmental and Respiratory Health Research, Oulun yliopisto, Oulu, Finland.,Biocenter, University of Oulu, Oulu, Finland
| | - Ying-Chuan Wang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Huang Lai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research, Oulun yliopisto, Oulu, Finland.,Biocenter, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland.,Finnish Meteorological Institute, Oulu, Finland
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16
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Hadrup N, Frederiksen M, Wedebye EB, Nikolov NG, Carøe TK, Sørli JB, Frydendall KB, Liguori B, Sejbaek CS, Wolkoff P, Flachs EM, Schlünssen V, Meyer HW, Clausen PA, Hougaard KS. Asthma-inducing potential of 28 substances in spray cleaning products-Assessed by quantitative structure activity relationship (QSAR) testing and literature review. J Appl Toxicol 2021; 42:130-153. [PMID: 34247391 PMCID: PMC9291953 DOI: 10.1002/jat.4215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 12/27/2022]
Abstract
Exposure to spray cleaning products constitutes a potential risk for asthma induction. We set out to review whether substances in such products are potential inducers of asthma. We identified 101 spray cleaning products for professional use. Twenty‐eight of their chemical substances were selected. We based the selection on (a) positive prediction for respiratory sensitisation in humans based on quantitative structure activity relationship (QSAR) in the Danish (Q)SAR Database, (b) positive QSAR prediction for severe skin irritation in rabbits and (c) knowledge on the substances' physico‐chemical characteristics and toxicity. Combining the findings in the literature and QSAR predictions, we could group substances into four classes: (1) some indication in humans for asthma induction: chloramine, benzalkonium chloride; (2) some indication in animals for asthma induction: ethylenediaminetetraacetic acid (EDTA), citric acid; (3) equivocal data: hypochlorite; (4) few or lacking data: nitriloacetic acid, monoethanolamine, 2‐(2‐aminoethoxy)ethanol, 2‐diethylaminoethanol, alkyldimethylamin oxide, 1‐aminopropan‐2‐ol, methylisothiazolinone, benzisothiazolinone and chlormethylisothiazolinone; three specific sulphonates and sulfamic acid, salicylic acid and its analogue sodium benzoate, propane‐1,2‐diol, glycerol, propylidynetrimethanol, lactic acid, disodium malate, morpholine, bronopol and benzyl alcohol. In conclusion, we identified an asthma induction potential for some of the substances. In addition, we identified major knowledge gaps for most substances. Thus, more data are needed to feed into a strategy of safe‐by‐design, where substances with potential for induction of asthma are avoided in future (spray) cleaning products. Moreover, we suggest that QSAR predictions can serve to prioritise substances that need further testing in various areas of toxicology. We reviewed whether substances in spray cleaning products constitute a potential risk for asthma induction. For this, we identified 101 spray cleaning products for professional use and prioritised their ingredient substances by use of quantitative structure activity relationship (QSAR). We provide a review of 28 selected substances: we give conclusions on their asthma induction potential, as well as a discussion on the use of QSAR for prioritisation of substances, and the major knowledge gaps we encountered.
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Affiliation(s)
- Niels Hadrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Marie Frederiksen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Eva B Wedebye
- DTU QSAR Team, Division for Diet, Disease Prevention and Toxicology, Group for Chemical Risk Assessment and GMO, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nikolai G Nikolov
- DTU QSAR Team, Division for Diet, Disease Prevention and Toxicology, Group for Chemical Risk Assessment and GMO, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Tanja K Carøe
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jorid B Sørli
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Karen B Frydendall
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Camilla S Sejbaek
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Peder Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Esben M Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Harald W Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per A Clausen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Karin S Hougaard
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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17
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Sutton P, Chartres N, Rayasam SDG, Daniels N, Lam J, Maghrbi E, Woodruff TJ. Reviews in environmental health: How systematic are they? ENVIRONMENT INTERNATIONAL 2021; 152:106473. [PMID: 33798823 PMCID: PMC8118386 DOI: 10.1016/j.envint.2021.106473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Synthesizing environmental health science is crucial to taking action to protect public health. Procedures for evidence evaluation and integration are transitioning from "expert-based narrative" to "systematic" review methods. However, little is known about the methodology being utilized for either type of review. OBJECTIVES To appraise the methodological strengths and weaknesses of a sample of "expert-based narrative" and "systematic" reviews in environmental health. METHODS We conducted a comprehensive search of multiple databases and identified relevant reviews using pre-specified eligibility criteria. We applied a modified version of the Literature Review Appraisal Toolkit (LRAT) to three environmental health topics that assessed the utility, validity and transparency of reviews. RESULTS We identified 29 reviews published between 2003 and 2019, of which 13 (45%) were self-identified as systematic reviews. Across every LRAT domain, systematic reviews received a higher percentage of "satisfactory" ratings compared to non-systematic reviews. In eight of these domains, there was a statistically significant difference observed between the two types of reviews and "satisfactory" ratings. Non-systematic reviews performed poorly with the majority receiving an "unsatisfactory" or "unclear" rating in 11 of the 12 domains. Systematic reviews performed poorly in six of the 12 domains; 10 (77%) did not state the reviews objectives or develop a protocol; eight (62%) did not state the roles and contribution of the authors, or evaluate the internal validity of the included evidence consistently using a valid method; and only seven (54%) stated a pre-defined definition of the evidence bar on which their conclusions were based, or had an author disclosure of interest statement. DISCUSSION Systematic reviews produced more useful, valid, and transparent conclusions compared to non-systematic reviews, but poorly conducted systematic reviews were prevalent. Ongoing development and implementation of empirically based systematic review methods are required in environmental health to ensure transparent and timely decision making to protect the public's health.
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Affiliation(s)
- Patrice Sutton
- UCSF Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA 94143, United States.
| | - Nicholas Chartres
- UCSF Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA 94143, United States.
| | - Swati D G Rayasam
- UCSF Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA 94143, United States.
| | - Natalyn Daniels
- UCSF Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA 94143, United States
| | - Juleen Lam
- Department of Health Sciences, California State University East Bay, SF 533, 25800 Carlos Bee Blvd, Hayward, CA 94542, United States.
| | - Eman Maghrbi
- Department of Health Sciences, California State University East Bay, SF 533, 25800 Carlos Bee Blvd, Hayward, CA 94542, United States.
| | - Tracey J Woodruff
- UCSF Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology & Reproductive Sciences, Box 0132, 490 Illinois Street, Floor 10, San Francisco, CA 94143, United States.
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18
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Lindström I, Lantto J, Karvala K, Soini S, Ylinen K, Suojalehto H, Suuronen K. Occupations and exposure events in acute and subacute irritant-induced asthma. Occup Environ Med 2021; 78:793-800. [PMID: 33790028 PMCID: PMC8526874 DOI: 10.1136/oemed-2020-107323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
Background Exposures leading to irritant-induced asthma (IIA) are poorly documented. Methods We retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000–2018. We classified the cases into acute (onset after single exposure) and subacute (onset after multiple exposures) IIA. We analysed in detail, occupations, causative agents and their air levels in the workplace, exposure events and the root causes of high exposure. Results Altogether 69 patients were diagnosed with IIA, 30 with acute and 39 with subacute IIA. The most common occupational groups were industrial operators (n=23, 33%), metal and machinery workers (n=16, 11%) and construction workers (n=12, 8%). Among industrial operators significantly more cases had subacute IIA than acute IIA (p=0.002). Forty cases (57%) were attributable to some type of corrosive acidic or alkaline chemical. Acute IIA followed accidents at work in different types of occupation, while subacute IIA was typical among industrial operators performing their normal work tasks under poor work hygiene conditions. The most common root cause was lack of information or false guidance in acute IIA (n=11, 36%) and neglect of workplace hygiene measures in subacute IIA (n=29, 74%). Conclusions Accidents are the main causes of acute IIA, whereas subacute IIA can develop in normal work in risk trades with poor work hygiene. Airborne strong acids or bases seem to be the most important causative agents of acute and subacute IIA. The different risk profiles of acute and subacute IIA should be considered in the prevention and identification of the cases.
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Affiliation(s)
- Irmeli Lindström
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Lantto
- Pulmonary Medicine, Helsinki University Hospital Heart and Lung Center, Helsinki, Finland.,University of Helsinki Faculty of Medicine, Helsinki, Finland
| | - Kirsi Karvala
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland.,Varma Mutual Pension Insurance Company, Helsinki, Finland
| | - Satu Soini
- Occupational Health, Finnish Institute of Occupational Health, Oulu, Finland
| | - Katriina Ylinen
- Work Environmental Laboratories, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Katri Suuronen
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
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19
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Lam J, Koustas E, Sutton P, Padula AM, Cabana MD, Vesterinen H, Griffiths C, Dickie M, Daniels N, Whitaker E, Woodruff TJ. Exposure to formaldehyde and asthma outcomes: A systematic review, meta-analysis, and economic assessment. PLoS One 2021; 16:e0248258. [PMID: 33788856 PMCID: PMC8011796 DOI: 10.1371/journal.pone.0248258] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/23/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Every major federal regulation in the United States requires an economic analysis estimating its benefits and costs. Benefit-cost analyses related to regulations on formaldehyde exposure have not included asthma in part due to lack of clarity in the strength of the evidence. OBJECTIVES 1) To conduct a systematic review of evidence regarding human exposure to formaldehyde and diagnosis, signs, symptoms, exacerbations, or other measures of asthma in humans; and 2) quantify the annual economic benefit for decreases in formaldehyde exposure. METHODS We developed and registered a protocol in PROSPERO (Record ID #38766, CRD 42016038766). We conducted a comprehensive search of articles published up to April 1, 2020. We evaluated potential risk of bias for included studies, identified a subset of studies to combine in a meta-analysis, and rated the overall quality and strength of the evidence. We quantified economics benefit to children from a decrease in formaldehyde exposure using assumptions consistent with EPA's proposed formaldehyde rule. RESULTS We screened 4,821 total references and identified 150 human studies that met inclusion criteria; of these, we focused on 90 studies reporting asthma status of all participants with quantified measures of formaldehyde directly relevant to our study question. Ten studies were combinable in a meta-analysis for childhood asthma diagnosis and five combinable for exacerbation of childhood asthma (wheezing and shortness of breath). Studies had low to probably-low risk of bias across most domains. A 10-μg/m3 increase in formaldehyde exposure was associated with increased childhood asthma diagnosis (OR = 1.20, 95% CI: [1.02, 1.41]). We also found a positive association with exacerbation of childhood asthma (OR = 1.08, 95% CI: [0.92, 1.28]). The overall quality and strength of the evidence was rated as "moderate" quality and "sufficient" for asthma diagnosis and asthma symptom exacerbation in both children and adults. We estimated that EPA's proposed rule on pressed wood products would result in 2,805 fewer asthma cases and total economic benefit of $210 million annually. CONCLUSION We concluded there was "sufficient evidence of toxicity" for associations between exposure to formaldehyde and asthma diagnosis and asthma symptoms in both children and adults. Our research documented that when exposures are ubiquitous, excluding health outcomes from benefit-cost analysis can underestimate the true benefits to health from environmental regulations.
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Affiliation(s)
- Juleen Lam
- University of California San Francisco, Program on Reproductive Health and the Environment, San Francisco, California, United States of America
- Department of Health Sciences, California State University, East Bay, Hayward, California, United States of America
| | - Erica Koustas
- Scientific Consultant to the University of California, San Francisco, California, United States of America
| | - Patrice Sutton
- University of California San Francisco, Program on Reproductive Health and the Environment, San Francisco, California, United States of America
| | - Amy M. Padula
- University of California San Francisco, Program on Reproductive Health and the Environment, San Francisco, California, United States of America
| | - Michael D. Cabana
- University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, San Francisco, California, United States of America
- University of California San Francisco, Schools of Medicine and Pharmacy, San Francisco, California, United States of America
| | - Hanna Vesterinen
- Scientific Consultant to the University of California, San Francisco, California, United States of America
| | - Charles Griffiths
- U.S. Environmental Protection Agency, National Center for Environmental Economics, Washington, DC, United States of America
| | - Mark Dickie
- Department of Economics, University of Central Florida, Orlando, Florida, United States of America
| | - Natalyn Daniels
- University of California San Francisco, Program on Reproductive Health and the Environment, San Francisco, California, United States of America
| | - Evans Whitaker
- University of California San Francisco, Schools of Medicine and Pharmacy, San Francisco, California, United States of America
| | - Tracey J. Woodruff
- University of California San Francisco, Program on Reproductive Health and the Environment, San Francisco, California, United States of America
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20
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Akgündüz Üzmezoğlu B. Inhalation Challenge Tests in Occupational Asthma: Why Are Multiple Tests Needed? Turk Thorac J 2021; 22:154-162. [PMID: 33871340 DOI: 10.5152/turkthoracj.2021.20007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/16/2020] [Indexed: 11/22/2022]
Abstract
Occupational and environmental lung diseases are on the rise because of the widespread use of various toxic agents in industry. Asthma etiopathogenesis is unclear because of exposure to high and low molecular agents in workplaces. Approximately 15-25% of asthma in adults is reported to be related to occupational exposure. The prevalence of occupational asthma (OA) is predicted to be high. The difficulties in diagnosing OA results in inadequate treatment, permanent airway damage, and medicolegal and social problems. As with other occupational diseases, it is necessary to demonstrate a direct causal relationship between the suspected agent and OA. Spirometry, peak expiratory flow rate, and/or non-specific bronchial hyperresponsiveness are frequently used to show airway hyperresponsiveness at the workplace and away from work. However, there are some controversies about the specificity and sensitivity of these test methods. Furthermore, these tests do not identify the exposure agent, which could be the causative agent. Specific inhalation challenge (SIC) tests that demonstrate the direct causal relationship are currently the gold standard. However, their positive and negative predictive values have not yet been established; therefore, many low molecular weight agents could cause late or atypical reactions. Therefore, a negative SIC test cannot exclude the disease. This review describes the procedures for the SIC test and discusses the importance of using the combined test methods with the SIC test.
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Affiliation(s)
- Bilge Akgündüz Üzmezoğlu
- Department of Occupational Diseases, Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
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21
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Lux H, Baur X, Budnik LT, Heutelbeck A, Teixeira JP, Neumann E, Adliene D, Puišo J, Lucas D, Löndahl J, Damialis A, Goksel O, Orru H. Outdoor air pollution from industrial chemicals causing new onset of asthma or COPD: a systematic review protocol. J Occup Med Toxicol 2020; 15:38. [PMID: 33371904 PMCID: PMC7768640 DOI: 10.1186/s12995-020-00289-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Until today, industrial sources contribute to the multifaceted contamination of environmental air. Exposure to air pollutants has the potential to initiate and promote asthma and chronic obstructive pulmonary disease (COPD). At global scale, both entities cause the majority of about 4 million annual deaths by respiratory disease. However, we identified industrial contamination as a subgroup of air pollution that may be associated with this burden and is underinvestigated in research. Therefore, the aim of this study is to investigate associations between substances industrially released into environmental air and the occurrence of asthma and COPD in the human population. Here we present the protocol for our systematic review of the current evidence. METHODS The following determinations will be applied during the systematic review process and are specified in the protocol that complies with the PRISMA-P statement. Populations of children and adults, as well as outdoor workers, exposed to industrially released air pollutants are of interest. Eligible studies may include subjects as controls who are non- or less exposed to the investigated air pollutants. The outcomes new-onset asthma and/or COPD investigated with risk ratio, odds ratio, hazard ratio, incidence rate ratio, cumulative incidence, and incidence rate are eligible. We will search the electronic literature databases EMBASE, MEDLINE, and Web of Science for peer-reviewed reports of incidence studies and incidence case-control studies. After systematic sorting of initial records, included studies will be subjected to quality assessment. Data will be synthesized qualitatively and, if appropriate, quantitatively for risk ratio and odds ratio. We will maintain and provide a PRISMA report. DISCUSSION Results of this systematic review may indicate alterations of incidence and risk of asthma and/or COPD in populations within industrial exposure radiuses including outdoor workplaces. Specific causal substances and compositions will be identified, but results will depend on the exposure assessment of the eligible studies. Our approach covers effects of industrial contributions to overall air pollution if studies reportedly attribute investigated emissions to industry. Results of this study may raise the question wether the available higher-level evidence sufficiently covers the current scale of industrial exposure scenarios and their potential harm to respiratory health. TRIAL REGISTRATION This protocol was registered in PROSPERO, registration number CRD42020151573 .
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Affiliation(s)
- Harald Lux
- Occupational, Social and Environmental Medicine, University Hospital Jena - Friedrich Schiller University Jena, Erlanger Allee 103, 07747, Jena, Germany.
- Department of Psychiatry and Psychotherapy, Ruppiner Kliniken, Neuruppin, Germany.
| | - Xaver Baur
- European Society for Environmental and Occupational Medicine, Berlin, Germany
- Emeritus University of Hamburg, Hamburg, Germany
| | - Lygia Therese Budnik
- Translational Toxicology and Immunology Unit, Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Astrid Heutelbeck
- Occupational, Social and Environmental Medicine, University Hospital Jena - Friedrich Schiller University Jena, Erlanger Allee 103, 07747, Jena, Germany
| | - João Paulo Teixeira
- Environmental Health Department, National Institute of Health, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Emeri Neumann
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Diana Adliene
- Department of Physics, Kaunas University of Technology, Kaunas, Lithuania
| | - Judita Puišo
- Department of Physics, Kaunas University of Technology, Kaunas, Lithuania
| | - David Lucas
- EA4324 ORPHY Laboratory, Occidental Brittany University Brest, Brest, France
| | - Jakob Löndahl
- Ergonomics and Aerosol Technology, Lund University, Lund, Sweden
| | - Athanasios Damialis
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
| | - Ozlem Goksel
- Laboratory of Occupational & Environmental Respiratory Diseases, Division of Immunology, Allergy and Asthma, Department of Pulmonary Medicine, Faculty of Medicine, EGE University, Izmir, Turkey
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
- Section of Sustainable Health, Umea University, Umea, Sweden
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Dodd KE, Mazurek JM. Prevalence of COPD among workers with work-related asthma. J Asthma 2020; 57:1179-1187. [PMID: 31303076 PMCID: PMC6962561 DOI: 10.1080/02770903.2019.1640733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 01/03/2023]
Abstract
Objective: Concurrent asthma and chronic obstructive pulmonary disease (COPD) diagnoses occur in 15%-20% of patients, and have been associated with worse health outcomes than asthma or COPD alone. Work-related asthma (WRA), asthma that is caused or made worse by exposures in the workplace, is characterized by poorly controlled asthma. The objective of this study was to assess the proportion of ever-employed adults (≥18 years) with current asthma who have been diagnosed with COPD, by WRA status.Methods: Data from 23 137 respondents to the 2012-2014 Behavioral Risk Factor Surveillance System Asthma Call-back Survey from 31 states and the District of Columbia were examined. Logistic regression was used to calculate adjusted prevalence ratios (PRs), examining six disjoint categories of WRA-COPD overlap with non-WRA/no COPD as the referent category.Results: An estimated 51.9% of adults with WRA and 25.6% of adults with non-WRA had ever been diagnosed with COPD. Adults with WRA/COPD were more likely than those with non-WRA/no COPD to have an asthma attack (PR = 1.77), urgent treatment for worsening asthma (PR = 2.85), an asthma-related emergency room visit (PR = 4.21), overnight stay in a hospital because of asthma (PR = 6.57), an activity limitation on 1-13 days (PR = 2.01) or ≥14 days (PR = 5.02), and very poorly controlled asthma (PR = 3.22).Conclusions: COPD was more frequently diagnosed among adults with WRA than those with non-WRA, and adults diagnosed with both WRA and COPD appear to have more severe adverse asthma outcomes than those with non-WRA and no COPD.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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Hoy R, Burdon J, Chen L, Miles S, Perret JL, Prasad S, Radhakrishna N, Rimmer J, Sim MR, Yates D, Zosky G. Work-related asthma: A position paper from the Thoracic Society of Australia and New Zealand and the National Asthma Council Australia. Respirology 2020; 25:1183-1192. [PMID: 33020986 PMCID: PMC7702173 DOI: 10.1111/resp.13951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Work-related asthma (WRA) is one of the most common occupational respiratory conditions, and includes asthma specifically caused by occupational exposures (OA) and asthma that is worsened by conditions at work (WEA). WRA should be considered in all adults with asthma, but especially those with new-onset or difficult to control asthma. Improvement in asthma symptoms when away from work is suggestive of WRA. Clinical history alone is insufficient to diagnose WRA; therefore, objective investigations are required to confirm the presence of asthma and the association of asthma with work activities. Management of WRA requires pharmacotherapy similar to that of non-WRA, however, also needs to take into account control of the causative workplace exposure. Ongoing exposure will likely lead to decline in lung function and worsening asthma control. WRA is a preventable condition but this does rely on increased awareness of WRA and thorough identification and control of all potential occupational respiratory hazards.
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Affiliation(s)
- Ryan Hoy
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ling Chen
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Susan Miles
- Department of Medicine, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Shivonne Prasad
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Deborah Yates
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Graeme Zosky
- Menzies Institute for Medical Research, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Chemicals inhaled from spray cleaning and disinfection products and their respiratory effects. A comprehensive review. Int J Hyg Environ Health 2020; 229:113592. [PMID: 32810683 DOI: 10.1016/j.ijheh.2020.113592] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
Spray cleaning and disinfection products have been associated with adverse respiratory effects in professional cleaners and among residents doing domestic cleaning. This review combines information about use of spray products from epidemiological and clinical studies, in vivo and in vitro toxicological studies of cleaning chemicals, as well as human and field exposure studies. The most frequent chemicals in spray cleaning and disinfection products were compiled, based on registrations in the Danish Product Registry. The chemicals were divided into acids, bases, disinfectants, fragrances, organic solvents, propellants, and tensides. In addition, an assessment of selected cleaning and disinfectant chemicals in spray products was carried out. Chemicals of concern regarding respiratory effects (e.g. asthma) are corrosive chemicals such as strong acids and bases (including ammonia and hypochlorite) and quaternary ammonium compounds (QACs). However, the evidence for respiratory effects after inhalation of QACs is ambiguous. Common fragrances are generally not considered to be of concern following inhalation. Solvents including glycols and glycol ethers as well as propellants are generally weak airway irritants and not expected to induce sensitization in the airways. Mixing of certain cleaning products can produce corrosive airborne chemicals. We discuss different hypotheses for the mechanisms behind the development of respiratory effects of inhalation of chemicals in cleaning agents. An integrative assessment is needed to understand how these chemicals can cause the various respiratory effects.
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Dodd KE, Wood J, Mazurek JM. Mortality Among Persons with Both Asthma and Chronic Obstructive Pulmonary Disease Aged ≥25 Years, by Industry and Occupation - United States, 1999-2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:670-679. [PMID: 32497026 PMCID: PMC7272111 DOI: 10.15585/mmwr.mm6922a3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Patients with asthma typically have chronic airway inflammation, variable airflow limitation, and intermittent respiratory symptoms; patients with chronic obstructive pulmonary disease (COPD) often have fixed airflow limitation and persistent respiratory symptoms. Some patients exhibit features suggesting that they have both conditions, which is termed asthma-COPD overlap. These patients have been reported to have worse health outcomes than do those with asthma or COPD alone (1). To describe mortality among persons aged ≥25 years with asthma-COPD overlap, CDC analyzed 1999-2016 National Vital Statistics multiple-cause-of-death mortality data* extracted from the National Occupational Mortality System (NOMS), which included industry and occupation† information collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2014. Age-adjusted death rates per one million persons¶ and proportionate mortality ratios (PMRs)** were calculated. During 1999-2016, 6,738 male decedents (age-adjusted rate per million = 4.30) and 12,028 female decedents (5.59) had both asthma and COPD assigned on their death certificate as the underlying or contributing cause of death. The annual age-adjusted death rate per million among decedents with asthma-COPD overlap declined from 6.70 in 1999 to 3.01 in 2016 (p<0.05) for men and from 7.71 in 1999 to 4.01 in 2016 (p<0.05) for women. Among adults aged 25-64 years, asthma-COPD overlap PMRs, by industry, were significantly elevated among nonpaid workers, nonworkers, and persons working at home for both men (1.72) and women (1.40) and among male food, beverage, and tobacco products workers (2.64). By occupation, asthma-COPD overlap PMRs were significantly elevated among both men (1.98) and women (1.79) who were unemployed, had never worked, or were disabled workers and among women bartenders (3.28) and homemakers (1.34). The association between asthma-COPD overlap mortality and nonworking status among adults aged 25-64 years suggests that asthma-COPD overlap might be associated with substantial morbidity. Increased risk for asthma-COPD overlap mortality among adults in certain industries and occupations suggests targets for public health interventions (e.g., elimination of or removal from exposures, engineering controls, and workplace smoke-free policies) to prevent asthma and COPD in and out of the workplace.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC
| | - John Wood
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC
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Andersson L, Bryngelsson IL, Hedbrant A, Persson A, Johansson A, Ericsson A, Lindell I, Stockfelt L, Särndahl E, Westberg H. Respiratory health and inflammatory markers - Exposure to respirable dust and quartz and chemical binders in Swedish iron foundries. PLoS One 2019; 14:e0224668. [PMID: 31675355 PMCID: PMC6824619 DOI: 10.1371/journal.pone.0224668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/19/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose To study the relationship between respirable dust, quartz and chemical binders in Swedish iron foundries and respiratory symptoms, lung function (as forced expiratory volume FEV1 and vital capacity FVC), fraction of exhaled nitric oxide (FENO) and levels of club cell secretory protein 16 (CC16) and CRP. Methods Personal sampling of respirable dust and quartz was performed for 85 subjects in three Swedish iron foundries. Full shift sampling and examination were performed on the second or third day of a working week after a work free weekend, with additional sampling on the fourth or fifth day. Logistic, linear and mixed model analyses were performed including, gender, age, smoking, infections, sampling day, body mass index (BMI) and chemical binders as covariates. Results The adjusted average respirable quartz and dust concentrations were 0.038 and 0.66 mg/m3, respectively. Statistically significant increases in levels of CC16 were associated with exposure to chemical binders (p = 0.05; p = 0.01) in the regression analysis of quartz and respirable dust, respectively. Non-significant exposure-responses were identified for cumulative quartz and the symptoms asthma and breathlessness. For cumulative chemical years, non-significant exposure–response were observed for all but two symptoms. FENO also exhibited a non significant exposure-response for both quartz and respirable dust. No exposure-response was determined for FEV1 or FVC, CRP and respirable dust and quartz. Conclusions Our findings suggest that early markers of pulmonary effect, such as increased levels of CC16 and FENO, are more strongly associated with chemical binder exposure than respirable quartz and dust in foundry environments.
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Affiliation(s)
- Lena Andersson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, School of Medicine and Health, Örebro University, Örebro, Sweden
- * E-mail:
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alexander Hedbrant
- Department of Medical Sciences, School of Medicine and Health, Örebro University, Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Örebro University, Örebro, Sweden
| | - Alexander Persson
- Department of Medical Sciences, School of Medicine and Health, Örebro University, Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Örebro University, Örebro, Sweden
| | - Anders Johansson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Annette Ericsson
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ina Lindell
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Leo Stockfelt
- Unit of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Särndahl
- Department of Medical Sciences, School of Medicine and Health, Örebro University, Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Örebro University, Örebro, Sweden
| | - Håkan Westberg
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, School of Medicine and Health, Örebro University, Örebro, Sweden
- Inflammatory Response and Infection Susceptibility Centre (iRiSC), Örebro University, Örebro, Sweden
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Kreis K, Aumann-Suslin I, Lüdeke A, Wegewitz U, Zeidler J, Graf von der Schulenburg JM. Costs of isocyanate-related occupational diseases: A systematic review. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:446-466. [PMID: 31100044 DOI: 10.1080/15459624.2019.1609005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although isocyanates are increasingly used in manufacturing and workplace exposure to isocyanates is widely recognized as one of the most frequent causes for occupational lung and skin diseases, little is known about the economic burden on the affected individual and the society. This study provides an overview on costs of occupational diseases related to isocyanates. We performed a systematic literature search of studies in the electronic databases of the German Institute of Medical Documentation and Information, and the Canadian Centre for Occupational Health and Safety. We extracted the key characteristics of the studies and performed a study quality assessment. We identified eight studies on the costs of illness, of which five focused on occupational lung diseases and three on occupational skin diseases. Further, eight studies calculated loss of income/compensation payments. Out of the 16 identified articles, only two reported costs directly attributable to isocyanate-induced diseases (asthma). Studies were hardly comparable because they differed substantially in their methodological approaches. Moreover, the quality assessment of the studies revealed substantial limitations. While a wide range of isocyanate-related costs was identified, consequences of isocyanate-related occupational diseases were considerable in terms of societal costs and loss of income. In most studies, indirect costs were the main cost driver. There is a need for high-quality cost of illness studies on isocyanate-induced diseases stratified by degree of severity and sex. Such studies provide valuable information to develop preventive strategies and set priorities for measures to lower the burden of professional health risks.
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Affiliation(s)
- Kristine Kreis
- a Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Ines Aumann-Suslin
- a Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Andreas Lüdeke
- b Federal Institute for Occupational Safety and Health (BAuA) , Dortmund , Germany
| | - Uta Wegewitz
- c Federal Institute for Occupational Safety and Health (BAuA) , Berlin , Germany
| | - Jan Zeidler
- a Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
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Abstract
Occupational exposures are a major cause of lung disease and disability worldwide. This article reviews the broad range of types of occupational lung diseases, including airways disease, pneumoconioses, and cancer. Common causes of occupational lung disease are reviewed with specific examples and clinical features. Emphasis on the importance of a detailed history to make an accurate diagnosis of an occupational lung disease is discussed.
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Affiliation(s)
- David M Perlman
- Division of Pulmonary and Critical Care Medicine, University of Minnesota, MMC # 276, 420 Delaware Street Southeast, Minneapolis, MN 55045, USA
| | - Lisa A Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, 1400 Jackson Street, G212, Denver, CO 80206, USA; Division of Pulmonary and Critical Care Sciences, Environmental Occupational Health Department, School of Medicine, Colorado School of Public Health, University of Colorado, Denver, CO, USA.
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Kim BG, Lee PH, Lee SH, Hong J, Jang AS. Claudins, VEGF, Nrf2, Keap1, and Nonspecific Airway Hyper-Reactivity Are Increased in Mice Co-Exposed to Allergen and Acrolein. Chem Res Toxicol 2019; 32:139-145. [PMID: 30608172 DOI: 10.1021/acs.chemrestox.8b00239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acrolein, an α/β-unsaturated aldehyde, is volatile at room temperature. It is a respiratory irritant found in environmental tobacco smoke, which can be generated during cooking or endogenously at sites of injury. An acute high concentration of uncontrolled irritant exposure can lead to an asthma-like syndrome known as reactive airways dysfunction syndrome (RADS). However, whether acrolein can induce RADS remains poorly understood. The aim of study is to develop a RADS model of acrolein inhalation in mice and to clarify the mechanism of RADS. Mice were treated with ovalbumin (OVA) and exposed to acrolein (5 ppm/10 min). Airway hyper-responsiveness (AHR) was measured on days 24 and 56, and samples were collected on days 25 and 57. Tight junction protein, antioxidant-associated protein, and vascular endothelial growth factor (VEGF) levels were estimated by Western blotting and immunohistochemical staining. Reactive oxygen species (ROS) was calculated using enzyme linked immunosorbent assays. Acrolein or OVA groups exhibited an increase in airway inflammatory cells and AHR compared to a sham group. These effects were further increased in mice in the OVA + acrolein exposure group than in the OVA exposure group and persisted in the acrolein exposure group for 8 weeks. CLDNs, carbonyls, VEGF, Nrf2, and Keap1 were observed in the lungs. Our data demonstrate that acrolein induces RADS and that ROS, angiogenesis, and tight junction proteins are involved in RADS in a mouse model.
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Affiliation(s)
- Byeong-Gon Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - Pureun-Haneul Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - Sun-Hye Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - Jisu Hong
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - An-Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
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van der Molen HF, de Groene GJ, Hulshof CTJ, Frings-Dresen MHW. Association between Work and Chronic Obstructive Pulmonary Disease (COPD). J Clin Med 2018; 7:E335. [PMID: 30304764 PMCID: PMC6210126 DOI: 10.3390/jcm7100335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 12/25/2022] Open
Abstract
To support occupational physicians in their assessment and notification of occupational diseases, diagnostic registration guidelines are developed with information about associations between work-related risk factors and diseases. The objective of this review of systematic reviews is to examine whether work-related risk factors are associated with chronic pulmonary obstructive disease (COPD). We searched the electronic database of Medline for systematic reviews published between 1 January 2009 and 20 June 2017. Reviews were included when COPD was assessed by data on lung function and when work-related exposures to vapors, dusts, gases, or fumes (VDGF) were described. One author selected studies and extracted data; two authors assessed study quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). In all eight systematic reviews included, various exposures to vapors, dusts, gases, and fumes (VGDF) at work are associated with COPD. Two-thirds of the included studies are cross-sectional and show a high heterogeneity in population, setting, and mostly self-reported-exposures. Two high-quality reviews (AMSTAR score ≥ 9) including meta-analyses show associations and excess risk of COPD for work-related general exposure to VDGF with a summary odds ratio of 1.4 (95% confidence interval (CI) 1.19⁻1.73) and to inorganic dust with a mean difference in predicted forced expiratory volume in one second (FEV₁) of -5.7% (95% CI: -8.62% to -2.71%). Exposure to VGDF at work is associated with a small but increased risk of COPD. More detailed workplace measurements of specific VGDF are warranted to gain an insight into dose⁻response relationships.
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Affiliation(s)
- H F van der Molen
- Amsterdam UMC, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - G J de Groene
- Amsterdam UMC, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - C T J Hulshof
- Amsterdam UMC, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - M H W Frings-Dresen
- Amsterdam UMC, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Saraei M, Masoudi H, Aminian O, Izadi N. Respiratory Health and Cross-Shift Changes of Foundry Workers in Iran. TANAFFOS 2018; 17:285-290. [PMID: 31143220 PMCID: PMC6534795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Respirable dust exposure is associated with increased respiratory impairment. As there are various airborne contaminants in the foundry industry, our aim was to thoroughly examine the acute effects of ambient respiratory dust on the respiratory system. MATERIALS AND METHODS A cross-shift study was conducted in a cast iron foundry in Iran. A total of 200 participants, including 110 workers from production department and 90 office workers were enrolled in this study. Workers were evaluated with regard to respiratory symptoms using the American Thoracic Society (ATS) questionnaire and examination of their lung function by spirometry. RESULTS The mean exposure of all studied substances was higher than occupational exposure limits. The most common respiratory symptom in exposed workers was cough (24.5%). A statistically significant post shift reduction in FEV1 and FEF25-75 was seen in exposed group. After adjusting for age, working history, smoking and Body Mass Index (BMI), there was a significant decrease based on exposure in FEV1 and FVC. CONCLUSION Dust exposure was a significant predictor of lung function. Implementing the health promotion program, periodic medical surveillance and efficient use of respiratory protection equipment could help to protect foundry workers from respiratory impairment.
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Affiliation(s)
| | | | | | - Nazanin Izadi
- Correspondence to: Izadi N, Address: Center for Research on Occupational Disease, Tehran University of Medical Sciences, Tehran, Iran, Email address:
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Patel O, Syamlal G, Wood J, Dodd KE, Mazurek JM. Asthma Mortality Among Persons Aged 15-64 Years, by Industry and Occupation - United States, 1999-2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:60-65. [PMID: 29346343 PMCID: PMC5772803 DOI: 10.15585/mmwr.mm6702a2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adult asthma deaths were reported (1). An estimated 11%-21% of asthma deaths might be attributable to occupational exposures (2). To describe asthma mortality among persons aged 15-64 years,* CDC analyzed multiple cause-of-death data† for 1999-2016 and industry and occupation information collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2012. Proportionate mortality ratios (PMRs)¶ for asthma among persons aged 15-64 years were calculated. During 1999-2016, a total of 14,296 (42.9%) asthma deaths occurred among males and 19,011 (57.1%) occurred among females. Based on an estimate that 11%-21% of asthma deaths might be related to occupational exposures, during this 18-year period, 1,573-3,002 asthma deaths in males and 2,091-3,992 deaths in females might have resulted from occupational exposures. Some of these deaths might have been averted by instituting measures to prevent potential workplace exposures. The annual age-adjusted asthma death rate** per 1 million persons aged 15-64 years declined from 13.59 in 1999 to 9.34 in 2016 (p<0.001) among females, and from 9.14 (1999) to 7.78 (2016) (p<0.05) among males. The highest significantly elevated asthma PMRs for males were for those in the food, beverage, and tobacco products manufacturing industry (1.82) and for females were for those in the social assistance industry (1.35) and those in community and social services occupations (1.46). Elevated asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures.
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Vincent MJ, Parker A, Maier A. Cleaning and asthma: A systematic review and approach for effective safety assessment. Regul Toxicol Pharmacol 2017; 90:231-243. [PMID: 28918194 DOI: 10.1016/j.yrtph.2017.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/06/2017] [Accepted: 09/10/2017] [Indexed: 12/14/2022]
Abstract
Research indicates a correlative relationship between asthma and use of consumer cleaning products. We conduct a systematic review of epidemiological literature on persons who use or are exposed to cleaning products, both in occupational and domestic settings, and risk of asthma or asthma-like symptoms to improve understanding of the causal relationship between exposure and asthma. A scoring method for assessing study reliability is presented. Although research indicates an association between asthma and the use of cleaning products, no study robustly investigates exposure to cleaning products or ingredients along with asthma risk. This limits determination of causal relationships between asthma and specific products or ingredients in chemical safety assessment. These limitations, and a lack of robust animal models for toxicological assessment of asthma, create the need for a weight-of-evidence (WoE) approach to examine an ingredient or product's asthmatic potential. This proposed WoE method organizes diverse lines of data (i.e., asthma, sensitization, and irritation information) through a systematic, hierarchical framework that provides qualitatively categorized conclusions using hazard bands to predict a specific product or ingredient's potential for asthma induction. This work provides a method for prioritizing chemicals as a first step for quantitative and scenario-specific safety assessments based on their potential for inducing asthmatic effects. Acetic acid is used as a case study to test this framework.
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Affiliation(s)
- Melissa J Vincent
- Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ann Parker
- Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Maier
- Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA
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Fontana L, Lee SJ, Capitanelli I, Re A, Maniscalco M, Mauriello MC, Iavicoli I. Chronic Obstructive Pulmonary Disease in Farmers: A Systematic Review. J Occup Environ Med 2017; 59:775-788. [PMID: 28594705 DOI: 10.1097/jom.0000000000001072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a significant public health problem but it is unclear whether agricultural work causes an increased risk of disease. The aim of this review was to study COPD risk among farmers and analyze occupational exposures in agricultural workplaces. METHODS A systematic literature search was conducted to identify epidemiological studies investigating COPD prevalence in farmers. RESULTS In the 14 studies reviewed, COPD prevalence ranged from 3% to 68% due to different characteristics of study population, working activities, case definition/diagnosis. Livestock farmers were at higher risk and significant associations were observed for exposure to organic dusts, endotoxins, mites, ammonia, and hydrogen sulfide. CONCLUSIONS Farming work was associated with greater risk of developing COPD. However, considering the several variables that may influence the disease prevalence in farmers, we suggest the adoption of a standardized research strategy.
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Affiliation(s)
- Luca Fontana
- Section of Occupational Medicine, Institute of Public Health, Catholic University of Sacred Heart, Rome (Dr Fontana, Dr Capitanelli); Department of Community Health Systems, University of California San Francisco, San Francisco, California (Dr Lee); Unit of Pneumology, Department of Internal Medicine, Hospital of Vittorio Veneto, Vittorio Veneto (Dr Re); Laboratory of Respiratory Inflammation, IRCCS Istituti Clinici Scientifici Maugeri, Telese Terme, Benevento (Dr Maniscalco); Section of Occupational Medicine, Department of Public Health, University of Naples "Federico II", Naples (Dr Mauriello, Dr Iavicoli), Italy
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Serrano M, Gallego M, Silva M. Origin of low-molecular mass aldehydes as disinfection by-products in beverages. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2017. [DOI: 10.1080/19440049.2017.1346393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- María Serrano
- Department of Analytical Chemistry, Campus of Rabanales, University of Córdoba, Córdoba, Spain
| | - Mercedes Gallego
- Department of Analytical Chemistry, Campus of Rabanales, University of Córdoba, Córdoba, Spain
| | - Manuel Silva
- Department of Analytical Chemistry, Campus of Rabanales, University of Córdoba, Córdoba, Spain
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Abstract
PURPOSE OF REVIEW The present review summarizes the recent literature on the relation between chronic workplace irritant exposures and asthma, focusing on exposures of low to moderate levels. We discuss results from epidemiological surveys, potential biological mechanisms, and needs for further research. These aspects are largely illustrated by studies on exposure to cleaning products. RECENT FINDINGS Recent results from nine population-based and workplace-based epidemiological studies, mostly cross-sectional, found an increased risk of both new-onset and work-exacerbated asthma among participants exposed to moderate level of irritants and/or cleaning products. SUMMARY Evidence of a causal effect of chronic workplace irritant exposure in new-onset asthma remains limited, mainly because of a lack of longitudinal studies and the difficulty to evaluate irritant exposures. However, recent epidemiological studies strengthen the evidence of an effect of chronic exposure to irritants in work-related asthma. The underlying mechanism remains unknown but may be related to oxidative stress, neurogenic inflammation and dual irritant and adjuvant effects. However, disentangling chronic irritant effects from either acute irritant-induced asthma or immunological low molecular weight agent-induced asthma is difficult for some agents. Further research is needed to improve assessment of irritant exposures and identify biomarkers.
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Zendehdel R, Fazli Z, Mazinani M. Neurotoxicity effect of formaldehyde on occupational exposure and influence of individual susceptibility to some metabolism parameters. ENVIRONMENTAL MONITORING AND ASSESSMENT 2016; 188:648. [PMID: 27796833 DOI: 10.1007/s10661-016-5662-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
Over the years, neurotoxicity and cognitive dysfunction have separately been associated with endogenous formaldehyde and reduction of acetylcholine signals. However, a limited number of studies have shown a relationship between cholinergic neurotransmitter and formaldehyde exposure. Therefore, the aim of this study was to assess the neurological effect on workers from melamine-dish preparation workshop, who were exposed to formaldehyde. A total of 35 formaldehyde-exposed workers were compared with 32 control employees from the food industry. Occupational exposure to formaldehyde was conducted using the National Institute of Occupational Safety and Health 3500 methods. Using the Ellman method, acetylcholinesterase (AChE) as a biomarker for neurotoxicity was analyzed in blood erythrocyte. The effects of alcohol dehydrogenase III (ADH3) and Mn-superoxide dismutase (Mn-SOD) polymorphism were used to survey the level of AChE activity. In this study, it was found that exposure to airborne formaldehyde increased from 0.024 to 0.74 ppm and the median personnel exposure was 0.057. Induction of AChE activity was observed in formaldehyde-exposed workers as compared with the control group (p < 0.01), while AChE activity increased in 64 % of the exposed subjects. Spearman's correlation (p < 0.02) was used to evaluate the association between AChE activity and occupational exposure to formaldehyde. Exposed subjects containing ADH32-2 genotype had higher AChE than others. The findings of this study suggest that the neurotoxic effect of formaldehyde depends on the AChE activity, which is affected by metabolism. It can be concluded that cholinergic signal reduction in cases of cognitive dysfunction could be associated with endogenous formaldehyde.
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Affiliation(s)
- Rezvan Zendehdel
- Safety Promotion and Injury Preventation Research Centre, Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Occupational Hygiene, School of Public Health, Shahid Beheshti University, Tehran, Iran.
| | - Zohreh Fazli
- Department of Occupational Hygiene, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mazinani
- Department of Occupational Hygiene, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Quirce S, Campo P, Domínguez-Ortega J, Fernández-Nieto M, Gómez-Torrijos E, Martínez-Arcediano A, Mur P, Delgado J. New developments in work-related asthma. Expert Rev Clin Immunol 2016; 13:271-281. [PMID: 27653257 DOI: 10.1080/1744666x.2017.1239529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Work-related asthma includes two subtypes: occupational asthma or asthma caused by specific agents (sensitizers or irritants) in the workplace, and work-exacerbated asthma or pre-existing asthma worsened by workplace exposures. Areas covered: This review provides an update on the definitions and the clinical features of the different work-related asthma subtypes as well as new insights into their etiology and the pathophysiological mechanisms involved. The diagnosis of work-related asthma should be made on objective basis using a constellation of clinical, physiologic and allergologic tests. Specific inhalation challenge with the suspected occupational agent(s) remains as the reference standard for diagnosis. A literature search was performed using the following terms: work-related asthma, occupational asthma, work-exacerbated asthma, irritant-induced asthma and etiological agents. Expert commentary: Studies focusing on the biological effects and mechanisms of environmental exposures in the development of sensitizer-induced or irritant-induced asthma in various workplace settings are of greatest interest. An integrative approach that combines clinical parameters with component-resolved diagnosis as well as inflammatory biomarkers appears to be very promising. Occupational allergy provides a good opportunity to understand the complex relationships between exposure to allergens in the workplace, interaction with genes and the co-exposures to other factors in the working environment.
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Affiliation(s)
- Santiago Quirce
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | - Paloma Campo
- b Unidad de Gestión Clínica Allergy-IBIMA , Hospital Regional Universitario , Malaga , Spain
| | - Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | | | | | | | - Pilar Mur
- f Allergy Unit , Hospital Santa Barbara , Puertollano , Spain
| | - Julio Delgado
- g Unidad de Gestión Clínica Alergología , Hospital Virgen Macarena , Sevilla , Spain
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Alexander V, Sindhu KNC, Zechariah P, Resu AV, Nair SR, Kattula D, Mohan VR, Alex T RG. Occupational safety measures and morbidity among welders in Vellore, Southern India. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:300-306. [PMID: 27682579 DOI: 10.1080/10773525.2016.1228287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Welders in the unorganized occupational sector in the economically developing world are exposed to respiratory, skin, eye, ear, and neurological problems exacerbated by non-usage of personal protective equipment (PPE). OBJECTIVE To study the frequency of health problems and the usage of PPE among welders in unorganized welding units in Vellore, India. METHODS A cross-sectional survey was conducted among 150 welders to determine the frequency of skin, ear, eye, and respiratory morbidity and the usage of PPE. A group of 150 non-welders were chosen for comparison. RESULTS Significant differences in the frequency of skin burns, redness, hyper pigmentation, itching, eye injuries, and sensorineural deafness were observed among the welders and non-welders (P < 0.001). Hypertension was noted in 12.6% of the welders as compared to 0.7% among the non-welders. None of the welders used appropriate PPE. For welders, low educational attainment was associated with an increased risk of eye injury (P < 0.05, OR = 0.29). There was also a significant difference between sensorineural deafness and a welder having less than 10 years of welding work experience (P < 0.001, OR = 18.18) which could probably be accounted for by the healthy worker effect. CONCLUSION Welders in this sample experienced a significant skin, eye, and ear morbidity accentuated by the non-usage of PPE. All worked without formal training and were unaware of the safe working guidelines that exist, but are not implemented for the welders in India.
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Affiliation(s)
- Vijay Alexander
- a Department of Community Health , Christian Medical College , Vellore , India
| | | | - Pradeep Zechariah
- a Department of Community Health , Christian Medical College , Vellore , India
| | | | | | - Deepthi Kattula
- b Division of GI Sciences , Christian Medical College , Vellore , India
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Increased Decline in Pulmonary Function Among Employees in Norwegian Smelters Reporting Work-Related Asthma-Like Symptoms. J Occup Environ Med 2016; 57:1004-8. [PMID: 26340289 DOI: 10.1097/jom.0000000000000518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate associations between work-related asthma-like symptoms (WASTH) and annual pulmonary function decline among employees of 18 Norwegian smelters. METHODS A 5-year longitudinal study in which WASTH was defined as a combination of dyspnea and wheezing that improved on rest days and vacation. RESULTS A total of 12,966 spirometry examinations were performed in 3084 employees. Crude annual decline in forced expiratory volume in 1 second (FEV1) (dFEV1) was 32.9 mL/yr (95% confidence interval, 30.5 to 35.3), and crude annual decline in forced vital capacity (FVC) (dFVC) was 40.9 mL/yr (37.8 to 43.9). After adjustment for relevant covariates, employees reporting WASTH showed higher dFEV1 by 16.0 m:/yr (3.4 to 28.6) and higher dFVC by 20.5 mL/yr (6.0 to 35.0) compared with employees not reporting WASTH. CONCLUSION Work-related asthma-like symptom was associated with greater annual declines in FEV1 and FVC, indicating a restrictive pattern.
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Lee TK, Yoo HW, Bae SH, Kim MJ, Kim GH, Jang AS. Reactive airways dysfunction syndrome after hydrofluoric acid inhalation. Allergol Int 2016; 65:343-4. [PMID: 26944828 DOI: 10.1016/j.alit.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tae-Kyu Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Hae-Won Yoo
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Seong-Hwan Bae
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Min-Jung Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Gyu-Hyung Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - An-Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
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Lopez-Campos JL, Marquez-Martin E, Soriano JB. The role of air pollution in COPD and implications for therapy. Expert Rev Respir Med 2016; 10:849-59. [DOI: 10.1080/17476348.2016.1191356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Freitas AS, Simoneti CS, Ferraz E, Bagatin E, Brandão IT, Silva CL, Borges MC, Vianna EO. Exposure to high endotoxin concentration increases wheezing prevalence among laboratory animal workers: a cross-sectional study. BMC Pulm Med 2016; 16:69. [PMID: 27153990 PMCID: PMC4859959 DOI: 10.1186/s12890-016-0233-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/27/2016] [Indexed: 12/04/2022] Open
Abstract
Background Endotoxin from Gram-negative bacteria are found in different concentrations in dust and on the ground of laboratories dealing with small animals and animal houses. Methods Cross-sectional study performed in workplaces of two universities. Dust samples were collected from laboratories and animal facilities housing rats, mice, guinea pigs, rabbits or hamsters and analyzed by the “Limulus amebocyte lysate” (LAL) method. We also sampled workplaces without animals. The concentrations of endotoxin detected in the workplaces were tested for association with wheezing in the last 12 months, asthma defined by self-reported diagnosis and asthma confirmed by bronchial hyperresponsiveness (BHR) to mannitol. Results Dust samples were obtained at 145 workplaces, 92 with exposure to animals and 53 with no exposure. Exposed group comprised 412 subjects and non-exposed group comprised 339 subjects. Animal-exposed workplaces had higher concentrations of endotoxin, median of 34.2 endotoxin units (EU) per mg of dust (interquartile range, 12.6–65.4), as compared to the non-exposed group, median of 10.2 EU/mg of dust (interquartile range, 2.6–22.2) (p < 0.001). The high concentration of endotoxin (above whole sample median, 20.4 EU/mg) was associated with increased wheezing prevalence (p < 0.001), i.e., 61 % of workers exposed to high endotoxin concentration reported wheezing in the last 12 months compared to 29 % of workers exposed to low endotoxin concentration. The concentration of endotoxin was not associated with asthma report or with BHR confirmed asthma. Conclusion Exposure to endotoxin is associated with a higher prevalence of wheezing, but not with asthma as defined by the mannitol bronchial challenge test or by self-reported asthma. Preventive measures are necessary for these workers.
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Affiliation(s)
- Amanda Souza Freitas
- Department of Social Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Christian Silva Simoneti
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Erica Ferraz
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ericson Bagatin
- Department of Preventive and Social Medicine, State University of Campinas, Campinas, Brazil
| | - Izaira Tincani Brandão
- Department of Biochemistry and Immunology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Celio Lopes Silva
- Department of Biochemistry and Immunology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcos Carvalho Borges
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Elcio Oliveira Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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Rundell KW, Anderson SD, Sue-Chu M, Bougault V, Boulet LP. Air quality and temperature effects on exercise-induced bronchoconstriction. Compr Physiol 2016; 5:579-610. [PMID: 25880506 DOI: 10.1002/cphy.c130013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is exaggerated constriction of the airways usually soon after cessation of exercise. This is most often a response to airway dehydration in the presence of airway inflammation in a person with a responsive bronchial smooth muscle. Severity is related to water content of inspired air and level of ventilation achieved and sustained. Repetitive hyperpnea of dry air during training is associated with airway inflammatory changes and remodeling. A response during exercise that is related to pollution or allergen is considered EIB. Ozone and particulate matter are the most widespread pollutants of concern for the exercising population; chronic exposure can lead to new-onset asthma and EIB. Freshly generated emissions particulate matter less than 100 nm is most harmful. Evidence for acute and long-term effects from exercise while inhaling high levels of ozone and/or particulate matter exists. Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool. Swimmers typically do not respond in the pool; however, a large percentage responds to a dry air exercise challenge. Studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic. Winter sport athletes and swimmers have a higher prevalence of EIB, asthma and airway remodeling than other athletes and the general population. Because of fossil fuel powered ice resurfacers in ice rinks, ice rink athletes have shown high rates of EIB and asthma. For the athlete training in the urban environment, training during low traffic hours and in low traffic areas is suggested.
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Affiliation(s)
- Kenneth W Rundell
- Department of The Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
| | - Sandra D Anderson
- Clinical Professor Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Malcolm Sue-Chu
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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López-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology 2015; 21:14-23. [DOI: 10.1111/resp.12660] [Citation(s) in RCA: 480] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/12/2015] [Accepted: 07/23/2015] [Indexed: 12/23/2022]
Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen del Rocío/Universidad de Sevilla; Sevilla Spain
- CIBER de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Wan Tan
- James Hogg Research Laboratories; St Paul's Hospital, University of British Columbia Providence Heart and Lung Institute; Vancouver Canada
| | - Joan B. Soriano
- Cátedra UAM-Linde; Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid; Madrid Spain
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Copeland S, Nugent K. Persistent and Unusual Respiratory Findings after Prolonged Glutaraldehyde Exposure. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2015; 6:177-83. [PMID: 26174994 PMCID: PMC6977055 DOI: 10.15171/ijoem.2015.532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/07/2015] [Indexed: 11/09/2022]
Abstract
Glutaraldehyde is commonly used in endoscopy labs to clean and disinfect instruments. It can cause direct irritation of the skin and the upper and lower airways. Health care workers are also at risk for the development of irritant-induced or sensitizer-induced occupational asthma when exposed to this chemical. Herein, we report on a patient who had frequent exposures to glutaraldehyde over one year while working in an endoscopy lab and developed chronic upper and lower respiratory tract symptoms. Multiple spirometric tests during her evaluation revealed variable results including restrictive pattern with a response to bronchodilators, obstructive pattern with a paradoxic bronchoconstrictive response to bronchodilators, and obstructive pattern with a partial response to bronchodilators. These results indicate that the distribution of inflammation and bronchial responsiveness can vary in a single patient with glutaraldehyde-induced occupational asthma. Therefore, the evaluation may be more difficult than might be expected in patients with occupational asthma, and some patients will need multiple pulmonary function tests to characterize their airway disease.
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Affiliation(s)
- S Copeland
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Khan AW, Kundi M, Moshammer H. Diminished pulmonary function in long-term workers exposed to cotton dust determined in a cross-sectional study in small Pakistani enterprises. Occup Environ Med 2015; 72:722-7. [PMID: 26265670 DOI: 10.1136/oemed-2015-102902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/10/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE While large cotton industry plants producing for the foreign market have undergone improvements of occupational hygiene lately, working conditions in power looms producing mainly for the local market are still poor. The respiratory health in workers of power looms has not been studied so far. METHODS In a cross-sectional study, 51 male cotton workers from power looms, 58 from large cotton factories and 52 controls were investigated by spirometry and a symptoms questionnaire. Spirometric measurements and respiratory symptoms were related to exposure duration in large and small factories by multivariate linear regression and logistic regression, respectively, with smoking, age and anthropometric parameters considered as confounders. RESULTS Work duration in power looms was associated with declines in forced expiratory volume in 1 s, peak flow, maximum midexpiratory flow and forced expiratory flow 75 and an increased risk of obstruction (OR 1.09/year; 95% CI: 1.002 to 1.18) by applying the Global Lung Initiative equations. Except cough that was only associated with smoking, all respiratory symptoms (chest tightness, shortness of breath, fever) increased as a function of duration of exposure in power looms but not in large factories. CONCLUSIONS Despite limitations inherent in the cross-sectional approach, there is evidence for workers in small weaving factories to face an increased risk of pulmonary function loss and respiratory symptoms. Industrial hygiene measures in these small enterprises should be encouraged. Failure to detect adverse respiratory outcomes from occupation in large factories could be due to a 'survivor' (healthy worker) effect.
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Affiliation(s)
- Abdul Wali Khan
- Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria Federal Government Polyclinic (PGMI), Islamabad, Pakistan
| | - Michael Kundi
- Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Hanns Moshammer
- Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Clinical aspects of work-related asthma: past achievements, persistent challenges, and emerging triggers. J Occup Environ Med 2015; 56 Suppl 10:S40-4. [PMID: 25285975 DOI: 10.1097/jom.0000000000000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to address common clinical questions pertaining to work-related asthma (WRA). METHODS This review is based on a presentation on WRA at the American College of Chest Physicians Course on Clinical Aspects of Occupational and Environmental Lung Disease, held in Toronto in 2013, and supplemented by a PubMed search of publications to 2013. RESULTS Seven clinical questions are addressed in relation to definitions, causes, diagnosis, management and emerging triggers, and challenges of WRA. CONCLUSIONS Although knowledge is expanding in this area, there remain challenges and uncertainties, particularly in the prevention of WRA.
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Dotson GS, Maier A, Siegel PD, Anderson SE, Green BJ, Stefaniak AB, Codispoti CD, Kimber I. Setting Occupational Exposure Limits for Chemical Allergens--Understanding the Challenges. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12 Suppl 1:S82-98. [PMID: 26583909 PMCID: PMC4685595 DOI: 10.1080/15459624.2015.1072277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established.
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Affiliation(s)
- G. S. Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
- Address correspondence to G.S. Dotson, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Education and Information Division, 1090 Tusculum Avenue, MS C-32, CincinnatiOhio45226. E-mail:
| | - A. Maier
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - P. D. Siegel
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - S. E. Anderson
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - B. J. Green
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - A. B. Stefaniak
- Respiratory Health Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - C. D. Codispoti
- Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois
| | - I. Kimber
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
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