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Bhattacharya A, Syamlal G, Dodd KE. Medical costs and incremental medical costs of asthma among workers in the United States. Am J Ind Med 2024; 67:834-843. [PMID: 38961618 DOI: 10.1002/ajim.23633] [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: 02/28/2024] [Revised: 05/23/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years. METHODS We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values. RESULTS An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35-44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion. CONCLUSION Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.
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Affiliation(s)
- Anasua Bhattacharya
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Girija Syamlal
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
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Bernstein DI, Pacheco K, Lemiere C. How Allergists Can Perform an Occupational History in Every Patient. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1951-1958. [PMID: 38761860 DOI: 10.1016/j.jaip.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
The occupational history is often neglected in the routine evaluation of new patients with asthma, chronic rhinitis, or dermatologic complaints. Such omissions are inadvertent because work-related conditions are often not prioritized. There also may be lack of awareness of the scope of respiratory or cutaneous allergens capable of inducing occupational asthma (OA) or work-related contact dermatitis. Evidence exists suggesting that the occupational history is often neglected among primary care physicians and specialists. Failure to diagnose OA in a timely fashion by identifying occupational sources of exposure, for example, may result in unnecessary morbidity in workers whose exposure is not modified. In this commentary, we propose a brief intake survey to be administered to all patients coming to an allergy practice to quickly screen for possible work-related respiratory symptoms and another for occupational dermatitis. This would require minimal physician time and could be self-administered at the initial encounter and incorporated into the medical record. A positive response to either survey should trigger a more detailed evaluation by the allergy specialist. More detailed approaches for stepwise clinical evaluation of the worker suspected of OA and contact dermatitis are discussed.
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Affiliation(s)
- David I Bernstein
- Division of Immunology, Rheumatology and Allergy, University of Cincinnati, Cincinnati, Ohio.
| | - Karin Pacheco
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colo
| | - Catherine Lemiere
- Department of Environmental and Occupational Health, Université de Montréal, Montreal, QC, Canada
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Doyen V, Migueres N, Frère A, Walusiak-Skorupa J, Wiszniewska M, Suojalehto H, Munoz X, Romero-Mesones C, van Kampen V, Sastre J, Quirce S, Barranco P, Rifflart C, de Blay F, Vandenplas O. Diagnostic Accuracy of Specific IgE Against Wheat and Rye in Flour-Induced Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2017-2025.e5. [PMID: 38768897 DOI: 10.1016/j.jaip.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Assessment of IgE-mediated sensitization to flour allergens is widely used to investigate flour-induced occupational asthma. The diagnostic efficiency of detecting specific IgE antibodies (sIgEs) against wheat and rye flour, however, has not been thoroughly compared with other diagnostic procedures. OBJECTIVE We sought to evaluate the diagnostic accuracy of sIgE against wheat and rye compared with specific inhalation challenge (SIC) with flour as the reference standard. METHODS This retrospective multicenter study included 264 subjects who completed an SIC with flour in eight tertiary centers, of whom 205 subjects showed a positive SIC result. RESULTS Compared with SIC, sIgE levels of 0.35 kUA/L or greater against wheat and rye provided similar sensitivities (84% to 85%, respectively), specificities (71% to 78%), positive predictive values (91% to 93%), and negative predictive values (56% to 61%). Increasing the threshold sIgE value to 5.10 kUA/L for wheat and to 6.20 kUA/L for rye provided a specificity of 95% or greater and further enhanced the positive predictive value to 98%. Among subjects with a positive SIC, those who failed to demonstrate sIgE against wheat and rye (n = 26) had significantly lower total serum IgE level and blood and sputum eosinophil counts and a lesser increase in postchallenge FeNO compared with subjects with a detectable sIgE. CONCLUSION High levels of sIgE against wheat and/or rye flour strongly support a diagnosis of flour-induced occupational asthma without the need to perform an SIC. The absence of detectable sIgE against wheat and rye in subjects with a positive SIC seems to be associated with lower levels of TH2 biomarkers.
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Affiliation(s)
- Virginie Doyen
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Nicolas Migueres
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; UMR 7357 Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie ICUBE, Strasbourg University, Strasbourg, France
| | - Alexandra Frère
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Marta Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Hille Suojalehto
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Christian Romero-Mesones
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Joaquin Sastre
- Department of Allergy, Fundacion Jimenez Dıaz, Universidad Autonoma de Madrid and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Pilar Barranco
- Department of Allergy, La Paz University Hospital, IdiPAZ and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Catherine Rifflart
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Frédéric de Blay
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; EA 3072 Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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Lavoie G, Lemière C. Impact of Ongoing Treatment With Inhaled Corticosteroids During Specific Inhalation Challenges for Diagnosing Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00771-2. [PMID: 39094943 DOI: 10.1016/j.jaip.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Specific inhalation challenge (SIC) tests are still the reference test for diagnosing sensitizer-induced occupational asthma (SIOA). The European Respiratory Society recommends the cessation of inhaled corticosteroids (ICS) 72 hours before SIC. OBJECTIVE To assess the effect of an ongoing ICS treatment during SIC on the maximum fall in forced expiratory volume in 1 second (FEV1), the change in methacholine provocative concentration of methacholine inducing a 20% fall in FEV1 (PC20), and sputum eosinophil counts after exposure to the suspected agent. METHODS We performed a retrospective analysis using a database of cases referred to our center for suspected SIOA from 1999 to 2022. The results of the SIC were compared between subjects treated with ICS during SIC and steroid-naïve subjects. RESULTS Six hundred and seventy-one individuals underwent SIC in the laboratory. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The proportion of subjects with a positive SIC was greater among ICS-treated subjects (39. 6%) compared with steroid-naïve subjects (27.5%, P < .001). A treatment with ICS did not influence the outcome of the SIC. There was no difference in the change in PC20 or the percentage of sputum eosinophils after SIC between steroid-treated and steroid-naïve subjects. CONCLUSIONS An ongoing ICS treatment during an SIC did not affect the occurrence of an asthmatic reaction, the change in airway responsiveness, or eosinophilic inflammation after exposure to the suspected agent in subjects who have been treated with ICS for a long period of time.
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Affiliation(s)
- Gabriel Lavoie
- Chest Department, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada; Chest Department, Université de Montréal, Montréal, QC, Canada
| | - Catherine Lemière
- Chest Department, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada; Chest Department, Université de Montréal, Montréal, QC, Canada.
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Hargitai R, Parráková L, Szatmári T, Monfort-Lanzas P, Galbiati V, Audouze K, Jornod F, Staal YCM, Burla S, Chary A, Gutleb AC, Lumniczky K, Vandebriel RJ, Gostner JM. Chemical respiratory sensitization-Current status of mechanistic understanding, knowledge gaps and possible identification methods of sensitizers. FRONTIERS IN TOXICOLOGY 2024; 6:1331803. [PMID: 39135743 PMCID: PMC11317441 DOI: 10.3389/ftox.2024.1331803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/27/2024] [Indexed: 08/15/2024] Open
Abstract
Respiratory sensitization is a complex immunological process eventually leading to hypersensitivity following re-exposure to the chemical. A frequent consequence is occupational asthma, which may occur after long latency periods. Although chemical-induced respiratory hypersensitivity has been known for decades, there are currently no comprehensive and validated approaches available for the prospective identification of chemicals that induce respiratory sensitization, while the expectations of new approach methodologies (NAMs) are high. A great hope is that due to a better understanding of the molecular key events, new methods can be developed now. However, this is a big challenge due to the different chemical classes to which respiratory sensitizers belong, as well as because of the complexity of the response and the late manifestation of symptoms. In this review article, the current information on respiratory sensitization related processes is summarized by introducing it in the available adverse outcome pathway (AOP) concept. Potentially useful models for prediction are discussed. Knowledge gaps and gaps of regulatory concern are identified.
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Affiliation(s)
- Rita Hargitai
- Unit of Radiation Medicine, Department of Radiobiology and Radiohygiene, National Centre for Public Health and Pharmacy (NCPHP), Budapest, Hungary
| | - Lucia Parráková
- Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Tünde Szatmári
- Unit of Radiation Medicine, Department of Radiobiology and Radiohygiene, National Centre for Public Health and Pharmacy (NCPHP), Budapest, Hungary
| | - Pablo Monfort-Lanzas
- Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University of Innsbruck (MUI), Innsbruck, Austria
- Institute of Bioinformatics, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Valentina Galbiati
- Laboratory of Toxicology, Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università Degli Studi di Milano (UNIMI), Milano, Italy
| | | | | | - Yvonne C. M. Staal
- Centre for Health Protection, National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sabina Burla
- Luxembourg Institute of Science and Technology (LIST), Belvaux, Luxembourg
| | - Aline Chary
- Luxembourg Institute of Science and Technology (LIST), Belvaux, Luxembourg
| | - Arno C. Gutleb
- Luxembourg Institute of Science and Technology (LIST), Belvaux, Luxembourg
| | - Katalin Lumniczky
- Unit of Radiation Medicine, Department of Radiobiology and Radiohygiene, National Centre for Public Health and Pharmacy (NCPHP), Budapest, Hungary
| | - Rob J. Vandebriel
- Centre for Health Protection, National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Johanna M. Gostner
- Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University of Innsbruck (MUI), Innsbruck, Austria
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Klaut GM, Karrasch S, Kutzora S, Nowak D, Quartucci C. The impact of years of training and possible technical, procedural, and individual risk factors for the development of atopic symptoms among bakery and confectionery trainees. Int Arch Occup Environ Health 2024:10.1007/s00420-024-02079-7. [PMID: 38951216 DOI: 10.1007/s00420-024-02079-7] [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: 01/18/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Occupational asthma is commonly observed in bakers and confectioners. Endogenous and exogenous risk factors contribute to bakers' asthma. A heightened awareness of this and early diagnosis can be helpful in terms of prevention. The aim of the study was to identify a temporal relationship between the years of training, as well as possible technical, procedural, and individual risk factors for the development of flour-exposure related atopic symptoms such as rhinitis, cough, and rash in young professionals. METHODS 127 bakers and confectioner trainees were observed over a one-year period. Two questionnaires served as test instruments. It was investigated whether the rates of atopic symptoms change over the course of a school year and which conditions in the workplace could be responsible for this. Descriptive statistics were used to answer the research questions concerning flour exposure and symptom rates. The Pearson-Chi-Square test was used for testing statistical differences between different groups (e.g. year of training, working conditions). RESULTS An increase in rates of self-reported rhinitis, coughing, and rashes throughout the duration of traineeship was shown (e.g. rhinitis of bakers at work: 0% in the first year of training, 20% in the second and 33% in the third year of training). The installation of vapour extraction systems and low-dust transfer of baking agents led to fewer symptoms in the workplace (30% of participants with rhinitis symptoms worked with no installed vapour extraction systems). A medical history of atopy was positively correlated with the occurrence of symptoms. CONCLUSION To prevent the development of asthma in bakers, methods to improve occupational health and safety should be developed. Creating low dust working conditions e.g., due to the use of vapour extraction systems should be considered.
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Affiliation(s)
- Gina-Maria Klaut
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Centre for Environment and Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Susanne Kutzora
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany.
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
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7
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Doyen V, Gautrin D, Vandenplas O, Malo JL. Comparison of high- and low-molecular-weight sensitizing agents causing occupational asthma: an evidence-based insight. Expert Rev Clin Immunol 2024; 20:635-653. [PMID: 38235552 DOI: 10.1080/1744666x.2024.2306885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms. AREAS COVERED The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents. EXPERT OPINION Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents.
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Affiliation(s)
- Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Denyse Gautrin
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-Luc Malo
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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Pinedo Sierra C, Curto Sánchez E, Diaz Campos R, Hermida Valverde T, Sánchez-Cuellar S, Fernández Tena A. [Asthma]. OPEN RESPIRATORY ARCHIVES 2024; 6:100324. [PMID: 38707659 PMCID: PMC11067451 DOI: 10.1016/j.opresp.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024] Open
Abstract
Asthma is a chronic inflammatory disease that affects about 5% of the world's population and generates high health and social costs. Proper management of the disease requires a correct diagnosis, based on objective measures of functional impairment, as well as symptom control and assessment of the future risk of exacerbations.It has been estimated that 18% of asthma patients in Western Europe have severe asthma and approximately 50% of them have poor control. The severity of asthma is established based on the minimum maintenance treatment needs to achieve control. Asthma clinical practice guidelines recommend classifying severe patients into allergic asthma (T2); eosinophilic asthma (T2) and non-T2 asthma in order to establish the most appropriate treatment.In recent decades, new biological therapies have been developed that can be applied according to the phenotype and endotype of asthma, allowing for selective and personalized treatment. These phenotypes and endotypes can change over time and therefore, the identification of biomarkers capable of predicting the severity, the course of the disease and the response to a given treatment seems essential. A large number of biomarkers have been studied in asthma, but so far only a few can be readily used in routine clinical practice. The application of omics technologies (epigenomics, genomics, transcriptomics, proteomics, metabolomics, lipidomics, etc.) for this purpose is still in the research phase.
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Affiliation(s)
- Celia Pinedo Sierra
- Servicio de Neumología. Hospital Universitario Clínico San Carlos. Universidad Complutense, Madrid, España
| | - Elena Curto Sánchez
- Servicio de Neumología. Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Rocio Diaz Campos
- U. de Asma Grave de Alta Complejidad. Servicio de Neumología. Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | - Ana Fernández Tena
- Servicio de Neumología Ocupacional. Instituto Nacional de Silicosis, Oviedo, España
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Frei-Stuber L, Wächter A, Benthaus T, Ochmann U, Nowak D. [Prevention of progression of allergic bronchial asthma as an occupational disease]. Pneumologie 2024; 78:269-275. [PMID: 37857319 DOI: 10.1055/a-2185-0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Since January 1st, 2021, termination of a harmful activity as a requirement for its recognition as an occupational disease (OD) has been abolished in Germany. This also includes the OD No. 4301 in accordance with Appendix 1 of the Occupational Diseases Ordinance (ODO) (obstructive respiratory diseases caused by allergenic substances). There has already been a significant increase in the number of diseases recognized under this OD. In this article, we present two patients with allergic (in the second case report mixed-form) bronchial asthma, in whom a medically easily preventable disease progression occurred as a result of continued occupational exposure to allergens as a farmer. According to § 3 (1) ODO, if there is a "risk that an occupational disease will develop, recur or worsen", the statutory accident insurance institutions are obliged to "counteract this danger with all suitable means". These individual preventive measures are compulsory by law and medically sensible, even under circumstances where only the risk of the genesis of an OD is given. Nonetheless, they are likely to be indicated and offered more frequently in the future due to an increased recognition of ODs. Unfavorable clinical courses such as those described in the two case reports presented here should therefore occur less frequently in the future.
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Affiliation(s)
- Ludwig Frei-Stuber
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Annabelle Wächter
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Tobias Benthaus
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
- Betriebsärztlicher Dienst, Bayerischer Rundfunk, München, Deutschland
| | - Uta Ochmann
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Deutschland
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10
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Suarthana E, Le Moual N, Henneberger PK, Kigloo HN, Vandenplas O. Reply to "Both quality of life and exacerbation are important outcomes of work-related asthma". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:804-805. [PMID: 38458711 DOI: 10.1016/j.jaip.2023.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 03/10/2024]
Affiliation(s)
- Eva Suarthana
- Research Institute of the McGill University Health Center, Montréal, QC, Canada.
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WVa
| | - Hormoz Nassiri Kigloo
- Research Institute of the McGill University Health Center, Montréal, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec City, QC, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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Weaver VM, Hua JT, Fitzsimmons KM, Laing JR, Farah W, Hart A, Braegger TJ, Reid M, Weissman DN. Fatal Occupational Asthma in Cannabis Production - Massachusetts, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1257-1261. [PMID: 37971937 PMCID: PMC10684356 DOI: 10.15585/mmwr.mm7246a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Multiple respiratory hazards have been identified in the cannabis cultivation and production industry, in which occupational asthma and work-related exacerbation of preexisting asthma have been reported. An employee working in a Massachusetts cannabis cultivation and processing facility experienced progressively worsening work-associated respiratory symptoms, which culminated in a fatal asthma attack in January 2022. This report represents findings of an Occupational Safety and Health Administration inspection, which included a worksite exposure assessment, coworker and next-of-kin interviews, medical record reviews, and collaboration with the Massachusetts Department of Public Health. Respiratory tract or skin symptoms were reported by four of 10 coworkers with similar job duties. Prevention is best achieved through a multifaceted approach, including controlling asthmagen exposures, such as cannabis dust, providing worker training, and conducting medical monitoring for occupational allergy. Evaluation of workers with new-onset or worsening asthma is essential, along with prompt diagnosis and medical management, which might include cessation of work and workers' compensation when relation to work exposures is identified. It is important to recognize that work in cannabis production is potentially causative.
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Romero-Mesones C, Cruz MJ, Alobid I, Barroso B, Arismendi E, Barranco P, Betancor D, Bobolea I, Cárdaba B, Curto E, Domenech G, Domínguez-Ortega J, Espejo D, González-Barcala FJ, Luna-Porta JA, Martínez-Rivera C, Méndez-Brea P, Mullol J, Olaguibel JM, Picado C, Plaza V, Del Pozo V, Quirce S, Rial MJ, Rodrigo-Muñoz JM, Sastre J, Serrano S, Soto-Retes L, Valero A, Valverde-Monge M, Munoz X. Disposition of Work-Related Asthma in a Spanish Asthma Cohort: Comparison of Asthma Severity Between Employed and Retired Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3407-3413.e1. [PMID: 37391017 DOI: 10.1016/j.jaip.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Exposure to certain agents in the workplace can trigger occupational asthma or work-exacerbated asthma, both of which come under the heading of work-related asthma (WRA). Understanding the burden that WRA represents can help in the management of these patients. OBJECTIVE To assess the influence of occupation on asthma in real life and analyze the characteristics of patients with WRA included in an asthma cohort. METHODS This was a prospective multicenter study of a cohort of consecutive patients with asthma. A standardized clinical history was completed. Patients were classified as having WRA or non-WRA. All patients underwent respiratory function tests, FeNO test, and methacholine challenge (methacholine concentration that causes a 20% drop in FEV1) at the beginning of the study. They were classified into two groups, depending on their employment status: employed (group 1) or unemployed (group 2). RESULTS Of the 480 patients included in the cohort, 82 (17%) received the diagnosis of WRA. Fifty-seven patients (70%) were still working. Mean age (SD) was 46 (10.69) years in group 1 and 57 (9.91) years in group 2 (P < .0001). Significant differences were observed in adherence to treatment (64.9% in group 1 vs 88% in group 2; P = .0354) and in severe asthma exacerbations (35.7% in group 1 vs 0% in group 2; P = .0172). No significant differences were observed in the rest of the variables analyzed. CONCLUSIONS The burden of WRA in specialized asthma units is not negligible. The absence of differences in the severity of asthma, the treatment administered, alterations in lung function, and the number of exacerbations in those working versus not working may support the idea that advice regarding changing jobs should be customized for individual patients.
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Affiliation(s)
- Christian Romero-Mesones
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Maria-Jesus Cruz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
| | - Isam Alobid
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
| | - Blanca Barroso
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Diana Betancor
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Cárdaba
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Curto
- CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Gemma Domenech
- Medical Statistics Core Facility, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain
| | - Javier Domínguez-Ortega
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - David Espejo
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Juan-Alberto Luna-Porta
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Pulmonology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona Badalona, Barcelona, Spain
| | - Paula Méndez-Brea
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Rhinology Unit and Smell Clinic, ENT Department, Clinical and Experimental Respiratory Immunoallergy (Instituto de Investigaciones Biomédicas August Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | | | - Cesar Picado
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victoria Del Pozo
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Manuel-Jorge Rial
- Allergy Department, Complexo Hospitalario Universitario, A Coruña, Spain
| | - José-María Rodrigo-Muñoz
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Sandra Serrano
- Medical Statistics Core Facility, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain
| | - Lorena Soto-Retes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marcela Valverde-Monge
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Xavier Munoz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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van Kampen V, Migueres N, Doyen V, Deckert A, de Blay F, Vandenplas O, Merget R. Phenotyping occupational asthma caused by platinum salts compared with other low-molecular weight agents. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2929-2932.e2. [PMID: 37328060 DOI: 10.1016/j.jaip.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Nicolas Migueres
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; UMR 7357 Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie ICUBE, Strasbourg University, Strasbourg, France
| | - Virginie Doyen
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Anja Deckert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Frédéric de Blay
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; EA 3072 Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
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Gandhi SA, Heinzerling A, Flattery J, Cummings KJ. Occupational Contributions to Respiratory Health Disparities. Clin Chest Med 2023; 44:635-649. [PMID: 37517841 PMCID: PMC10861114 DOI: 10.1016/j.ccm.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.
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Affiliation(s)
- Sheiphali A Gandhi
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, 2330 Post St Ste 460, San Francisco, CA 94115, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA.
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Lee KM, Lee S, Kim YJ, Lee SE, Kim Y, Kang D, Kim SY. Occupational asthma related to indoor air pollution in a worker at an indoor air gun shooting range: a case report. Ann Occup Environ Med 2023; 35:e13. [PMID: 37614335 PMCID: PMC10442578 DOI: 10.35371/aoem.2023.35.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 08/25/2023] Open
Abstract
Background Indoor air pollution can cause and exacerbate asthma. We report a previously undescribed case of occupational asthma related to indoor air pollution in a worker at an indoor air gun shooting range and highlight the potential risk of developing occupational asthma in this environment. Case presentation A 31-year-old man presented with dyspnea, cough, and sputum and was diagnosed with asthma complicated by pneumonia. Objective evidence of asthma was obtained by performing a methacholine bronchial provocation test. It was suspected that the patient had occupational asthma, which began one month after changing jobs to work within the indoor air gun shooting range. The highest peak expiratory flow (PEF) diurnal variability on working days was 15%, but the highest variation was 24%, with 4 days out of 4 weeks having a variation of over 20% related to workplace exposure. Conversely, the diurnal variability on the rest days was 7%, and no day showed a variation exceeding 20%. The difference in the average PEF between working and rest days was 52 L/min. PEF deterioration during working days and improvement on rest days were noted. Conclusions The results obtained from the in-depth analysis of the PEF were adequate to diagnose the patient with occupational asthma. Exposure to indoor air pollution and lead and the patient's atopy and allergic rhinitis may have contributed to the development of occupational asthma.
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Affiliation(s)
- Kwang Min Lee
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seungho Lee
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yoon-Ji Kim
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Seung-eun Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Youngki Kim
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Dongmug Kang
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Se-Yeong Kim
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Sack C, Simpson C, Pacheco K. The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry. Semin Respir Crit Care Med 2023; 44:405-414. [PMID: 37015286 PMCID: PMC10449032 DOI: 10.1055/s-0043-1766116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
While the cannabis industry is one of the fastest growing job markets in the United States and globally, relatively little is known about the occupational hazards that cannabis production workers face. Based on the closely related hemp industry and preliminary studies from recreational cannabis grow facilities, there is concern for significant respiratory exposures to bioaerosols containing microbial and plant allergens, chemicals such as pesticides, volatile organic compounds, and other irritant gases. Components of the cannabis plant have also recently been identified as allergenic and capable of inducing an immunoglobulin E-mediated response. Accumulating evidence indicates a spectrum of work-related respiratory diseases, particularly asthma and other allergic diseases. Disentangling causal relationships is difficult given the heterogeneity of mixed exposures, diagnostic challenges, and confounding by personal cannabis use. Despite and because of these uncertainties, better regulatory guidance and exposure controls need to be defined in order to reduce the risk of work-related disease.
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Affiliation(s)
- Coralynn Sack
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Christopher Simpson
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Karin Pacheco
- Department of Environmental and Occupational Health Sciences, National Jewish Hospital, Denver, CO
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González-Iglesias V, Martínez-Pérez I, Rodríguez Suárez V, Fernández-Somoano A. Spatial distribution of hospital admissions for asthma in the central area of Asturias, Northern Spain. BMC Public Health 2023; 23:787. [PMID: 37118792 PMCID: PMC10141842 DOI: 10.1186/s12889-023-15731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Asturias is one of the communities with the highest rates of hospital admission for asthma in Spain. The environmental pollution or people lifestyle are some of the factors that contribute to the appearance or aggravation of this illness. The aim of this study was to show the spatial distribution of asthma admissions risks in the central municipalities of Asturias and to analyze the observed spatial patterns. METHODS Urgent hospital admissions for asthma and status asthmaticus occurred between 2016 to 2018 on the public hospitals of the central area of Asturias were used. Population data were assigned in 5 age groups. Standardised admission ratio (SAR), smoothed relative risk (SRR) and posterior risk probability (PP) were calculated for each census tract (CT). A spatial trend analysis was run, a spatial autocorrelation index (Morans I) was calculated and a cluster and outlier analysis (Anselin Local Morans I) was finally performed in order to analyze spatial clusters. RESULTS The total number of hospital urgent asthma admissions during the study period was 2324, 1475 (63.46%) men and 849 (36.56%) women. The municipalities with the highest values of SRR and PP were located on the northwest area: Avilés, Gozón, Carreño, Corvera de Asturias, Castrillón and Illas. A high risk cluster was found for the municipalities of Avilés, Gozón y Corvera de Asturias. CONCLUSIONS The spatial analysis showed high risk of hospitalization for asthma on the municipalities of the northwest area of the study, which highlight the existence of spatial inequalities on the distribution of urgent hospital admissions.
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Affiliation(s)
- Verónica González-Iglesias
- Departamento de Medicina, IUOPA-Área de Medicina Preventiva Y Salud Pública, Universidad de Oviedo. C/Julián Clavería S/N, 33006, Oviedo (Asturias), Spain
| | - Isabel Martínez-Pérez
- Departamento de Medicina, IUOPA-Área de Medicina Preventiva Y Salud Pública, Universidad de Oviedo. C/Julián Clavería S/N, 33006, Oviedo (Asturias), Spain.
| | - Valentín Rodríguez Suárez
- Dirección General de Salud Pública, Consejería de Salud, Principado de Asturias, C/ Ciriaco Miguel Vigil, 9, 33006, Oviedo, Spain
| | - Ana Fernández-Somoano
- Departamento de Medicina, IUOPA-Área de Medicina Preventiva Y Salud Pública, Universidad de Oviedo. C/Julián Clavería S/N, 33006, Oviedo (Asturias), Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Avenida Roma, S/N, 33001, Oviedo, Spain
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Pemberton MA, Kreuzer K, Kimber I. Challenges in the classification of chemical respiratory allergens based on human data: Case studies of 2-hydroxyethylmethacrylate (HEMA) and 2-hydroxypropylmethacrylate (HPMA). Regul Toxicol Pharmacol 2023; 141:105404. [PMID: 37105297 DOI: 10.1016/j.yrtph.2023.105404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
Occupational asthma resulting from workplace exposure to chemical respiratory allergens is an important disease. No widely accepted or formally validated tests for the identification of chemical respiratory sensitizers. Consequently, there is a heavy reliance on human data from clinical examinations. Unfortunately, however, although such investigations are critical for the diagnosis of occupational asthma, and in guiding remedial actions, they do not reliably identify specific chemicals within the workplace that are the causative agents. There are several reasons for this, including the fact that specific inhalation tests conducted as part of clinical investigations are frequently performed with complex mixtures rather than single substances, that sometimes inhalation challenges are conducted at concentrations above the OEL and STEL, where effects may be confounded by irritation, and that involvement of immune mechanisms cannot be assumed from the observation of late asthmatic reactions. Further, caution should be taken when implicating substances on lists of "recognised" asthmagens unless they have undergone a formal weight of evidence assessment. Here the limitations of clinical investigations as currently performed for the purposes of regulatory classification and decision making are explored by reference to previously published case studies that implicate 2-hydroxyethylmethacrylate (HEMA) and/or 2-hydroxypropylmethacrylate (HPMA) as respiratory allergens.
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Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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20
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Martins RS, Hussain H, Chaudry M, Rizvi NA, Mustafa MA, Ayub B, Aamdani SS, Rehman AA, Pervez A, Nadeem S, Khalid R, Ali AS, Shahid S, Zubairi ABS, Haider AH, Irfan M. GRADE-ADOLOPMENT of clinical practice guidelines and creation of clinical pathways for the primary care management of chronic respiratory conditions in Pakistan. BMC Pulm Med 2023; 23:123. [PMID: 37069600 PMCID: PMC10111762 DOI: 10.1186/s12890-023-02409-4] [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: 11/20/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION In Pakistan, chronic respiratory conditions contribute a large burden of morbidity and mortality. A major reason for this is the lack of availability of local evidence-based clinical practice guidelines (EBCPGs) in Pakistan, particularly at the primary care level. Thus, we developed EBCPGs and created clinical diagnosis and referral pathways for the primary care management of chronic respiratory conditions in Pakistan. METHODS The source guidelines were selected by two local expert pulmonologists after a thorough literature review on PubMed and Google Scholar from 2010 to December 2021. The source guidelines covered idiopathic pulmonary fibrosis, asthma, chronic obstructive pulmonary disorders, and bronchiectasis. The GRADE-ADOLOPMENT process consists of three key elements: adoption (using recommendations as is or with minor changes), adaptation (effective context-specific changes to recommendations) or additions (including new recommendations to fill a gap in the EBCPG). We employed the GRADE-ADOLOPMENT process to adopt, adapt, adopt with minor changes, or exclude recommendations from a source guideline. Additional recommendations were added to the clinical pathways based on a best-evidence review process. RESULTS 46 recommendations were excluded mainly due to the unavailability of recommended management in Pakistan and scope beyond the practice of general physicians. Clinical diagnosis and referral pathways were designed for the four chronic respiratory conditions, explicitly delineating the role of primary care practitioners in the diagnosis, basic management, and timely referral of patients. Across the four conditions, 18 recommendations were added (seven for IPF, three for bronchiectasis, four for COPD, and four for asthma). CONCLUSION The widespread use of the newly created EBCPGs and clinical pathways in the primary healthcare system of Pakistan can help alleviate the morbidity and mortality related to chronic respiratory conditions disease in the country.
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Affiliation(s)
- Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Hawra Hussain
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Maryam Chaudry
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Nashia Ali Rizvi
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Mohsin Ali Mustafa
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Bushra Ayub
- Learning Research Centre, Patel Hospital, Karachi, 75300, Pakistan
| | | | - Alina Abdul Rehman
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Alina Pervez
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
| | - Sarah Nadeem
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Rameesha Khalid
- Section of Pulmonology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Akbar Shoukat Ali
- Section of Pulmonology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Shayan Shahid
- Section of Pulmonology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Ali Bin Sarwar Zubairi
- Center for Clinical Best Practices, Clinical and Translational Research Incubator (CITRIC), Aga Khan University, Karachi, 74800, Pakistan
- Section of Pulmonology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Adil H Haider
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Muhammad Irfan
- Section of Pulmonology, Department of Medicine, Aga Khan University, Karachi, 74800, Pakistan.
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Meek B, Bridges JW, Fasey A, Sauer UG. Evidential requirements for the regulatory hazard and risk assessment of respiratory sensitisers: methyl methacrylate as an example. Arch Toxicol 2023; 97:931-946. [PMID: 36797432 PMCID: PMC10025211 DOI: 10.1007/s00204-023-03448-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
This review addresses the need for a framework to increase the consistency, objectivity and transparency in the regulatory assessment of respiratory sensitisers and associated uncertainties. Principal issues are considered and illustrated through a case study (with methyl methacrylate). In the absence of test methods validated for regulatory use, formal documentation of the weight-of-evidence for hazard classification both at the level of integration of individual studies within lines of evidence and across a broad range of data streams was agreed to be critical for such a framework. An integrated approach is proposed to include not only occupational studies and clinical evidence for the regulatory assessment of respiratory sensitisers, but also information on structure and physical and chemical factors, predictive approaches such as structure activity analysis and in vitro and in vivo mechanistic and toxicokinetic findings. A weight-of-evidence protocol, incorporating integration of these sources of data based on predefined considerations, would contribute to transparency and consistency in the outcome of the assessment. In those cases where a decision may need to be taken on the basis of occupational findings alone, conclusions should be based on transparent weighting of relevant data on the observed prevalence of occupational asthma in various studies taking into account all relevant information including the range and nature of workplace exposures to the substance of interest, co-exposure to other chemicals and study quality.
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Affiliation(s)
| | - James W Bridges
- Emeritus Professor, University of Surrey, Guildford, Surrey, UK
| | | | - Ursula G Sauer
- Scientific Consultancy-Animal Welfare, Hallstattfeld 16, 85579, Neubiberg, Germany.
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Roio LCD, Stelmach R, Mizutani RF, Terra-Filho M, Santos UDP. Work-related asthma consequences on socioeconomic, asthma control, quality of life, and psychological status compared with non-work-related asthma: A cross-sectional study in an upper-middle-income country. Am J Ind Med 2023; 66:529-539. [PMID: 36906884 DOI: 10.1002/ajim.23472] [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: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Work-related asthma (WRA) is the most prevalent occupational respiratory disease, and it has negative effects on socioeconomic standing, asthma control, quality of life, and mental health status. Most of the studies on WRA consequences are from high-income countries; there is a lack of information on these effects in Latin America and in middle-income countries. METHODS This study compared socioeconomic, asthma control, quality of life, and psychological outcomes among individuals diagnosed with WRA and non-work-related asthma (NWRA) in a middle-income country. Patients with asthma, related and not related to work, were interviewed using a structured questionnaire to assess their occupational history and socioeconomic conditions, and with questionnaires to assess asthma control (Asthma Control Test and Asthma Control Questionnaire-6), quality of life (Juniper's Asthma Quality of Life Questionnaire), and presence of anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Each patient's medical record was reviewed for exams and use of medication, and comparisons were made between individuals with WRA and NWRA. RESULTS The study included 132 patients with WRA and 130 with NWRA. Individuals with WRA had worse socioeconomic outcomes, worse asthma control, more quality-of-life impairment, and a higher prevalence of anxiety and depression than individuals with NWRA. Among individuals with WRA, those who had been removed from occupational exposure had a worse socioeconomic impact. CONCLUSIONS Consequences on socioeconomic, asthma control, quality of life, and psychological status are worse for WRA individuals when compared with NWRA.
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Affiliation(s)
- Lavinia Clara Del Roio
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael F Mizutani
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mario Terra-Filho
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ubiratan D P Santos
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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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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MacKinnon M, Barrick K, Lévesque LE, Liss G, Tarlo SM, Lougheed MD. Linkage of administrative and compensation databases for work-related asthma surveillance in Ontario: A proof of concept study. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023. [DOI: 10.1080/24745332.2022.2161025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Kendra Barrick
- Department of Family Medicine, University of Calgary, Calgary, Alberta
| | - Linda E. Lévesque
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Gary Liss
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Susan M. Tarlo
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto
- Respiratory Division, University Health Network, Toronto, Ontario, Canada
| | - M. Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW The study of microRNA in asthma has revealed a vibrant new level of gene regulation underlying asthma pathology. Several miRNAs have been shown to be important in asthma, influencing various biological mechanisms which lead to asthma pathology and symptoms. In addition, miRNAs have been proposed as biomarkers of asthma affection status, asthma severity, and asthma treatment response. We review all recent asthma-miRNA work, while also presenting comprehensive tables of all miRNA results related to asthma. RECENT FINDINGS We here reviewed 63 recent studies published reporting asthma and miRNA research, and an additional 14 reviews of the same. We summarized the information for both adult and childhood asthma, as well as research on miRNAs in asthma-COPD overlap syndrome (ACOs), and virus-induced asthma exacerbations. We attempted to present a comprehensive collection of recently published asthma-associated miRNAs as well as tables of all published asthma-related miRNA results.
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Affiliation(s)
- Rinku Sharma
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anshul Tiwari
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael J McGeachie
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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MacKinnon M, Moloney M, Bullock E, Morra A, To T, Lemiere C, Lougheed MD. Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study. JMIR Form Res 2022; 6:e37503. [PMID: 35964327 PMCID: PMC9523520 DOI: 10.2196/37503] [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: 02/23/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background A work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun. Objective This study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L). Methods This study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities. Results A total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee. Conclusions Stakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation.
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Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Max Moloney
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Emma Bullock
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Alison Morra
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine Lemiere
- Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, ON, Canada
- Faculty of Medicine, University of Montreal, Montreal, ON, Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Tsui HC, Ronsmans S, Hoet PHM, Nemery B, Vanoirbeek JAJ. Occupational Asthma Caused by Low-Molecular-Weight Chemicals Associated With Contact Dermatitis: A Retrospective Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2346-2354.e4. [PMID: 35643279 DOI: 10.1016/j.jaip.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Occupational asthma (OA) may have different etiologies, but it is not clear whether the etiologic agents influence the clinical presentation, especially the co-occurrence of skin lesions. OBJECTIVE To determine the impact of different asthmagens on the characteristics of OA, with a focus on the occurrence of prior or concomitant skin disorders. METHODS In a retrospective analysis of patients who visited the Occupational and Environmental Disease Clinic of a tertiary referral hospital from 2009 to 2019, we classified patients into definite, probable, or possible OA according to prespecified diagnostic guidelines. In multivariate logistic regression with sensitivity analysis, we examined the relation of high- and low-molecular-weight (HMW and LMW) agents with the clinical presentation. RESULTS Of 209 cases of OA, 66 were caused by HMW agents and 143 by LMW agents. Patients with OA exposed to LMW agents had higher odds of having (had) allergic contact dermatitis (odds ratio, 5.45 [1.80-23.70]; P < .01), compared with patients exposed to HMW agents. Conversely, HMW agents were associated with higher odds of rhinitis symptoms (odds ratio of LMW/HMW, 0.33 [0.17-0.63]; P < .001) and high total IgE (odds ratio of LMW/HMW, 0.35 [0.17-0.70]; P < .01). Risk factors for having coexisting contact dermatitis included construction work, hairdressing, and exposure to metals or epoxy resins. CONCLUSIONS Among patients with OA, exposure to specific LMW agents was associated with a high frequency of contact dermatitis. Different types of asthmagens within HMW or LMW agents appear to determine the phenotype and comorbidity of OA.
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Affiliation(s)
- Hung-Chang Tsui
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Peter H M Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | - Jeroen A J Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
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El-Sayed ZA, El-Ghoneimy DH, Ortega-Martell JA, Radwan N, Aldave JC, Al-Herz W, Al-Nesf MA, Condino-Neto A, Cole T, Eley B, Erwa NH, Espinosa-Padilla S, Faria E, Rosario Filho NA, Fuleihan R, Galal N, Garabedian E, Hintermeyer M, Imai K, Irani C, Kamal E, Kechout N, Klocperk A, Levin M, Milota T, Ouederni M, Paganelli R, Pignata C, Qamar FN, Quinti I, Qureshi S, Radhakrishnan N, Rezaei N, Routes J, Singh S, Siniah S, Abdel-Hakam Taha I, Tanno LK, Van Dort B, Volokha A, Sullivan K. Allergic manifestations of inborn errors of immunity and their impact on the diagnosis: A worldwide study. World Allergy Organ J 2022; 15:100657. [PMID: 35783543 PMCID: PMC9218584 DOI: 10.1016/j.waojou.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Allergies have long been observed in Inborn Errors of Immunity (IEI) and might even be the first presentation resulting in delayed diagnosis or misdiagnosis in some cases. However, data on the prevalence of allergic diseases among IEI patients are limited and contradictory. Objective To provide a worldwide view of allergic diseases, across a broad spectrum of IEI, and their impact on the timely diagnosis of IEI. Methods This is a worldwide study, conceived by the World Allergy Organization (WAO) Inborn Errors of Immunity Committee. A questionnaire was developed and pilot-tested and was sent via email to collect data from 61 immunology centers known to treat pediatric and/or adult IEI patients in 41 countries. In addition, a query was submitted to The United States Immunodeficiency Network (USIDNET) at its website. Results Thirty centers in 23 countries caring for a total 8450 IEI patients responded. The USIDNET dataset included 2332 patients. Data from responders showed that a median (IQR) of 16.3% (10-28.8%) of patients experienced allergic diseases during the course of their IEI as follows: 3.6% (1.3-11.3%) had bronchial asthma, 3.6% (1.9-9.1%) atopic dermatitis, 3.0% (1.0-7.8%) allergic rhinitis, and 1.3% (0.5-3.3%) food allergy. As per the USIDNET data, the frequency of allergy among IEI patients was 68.8% (bronchial asthma in 46.9%). The percentage of IEI patients who presented initially with allergic disorders was 8% (5-25%) and diagnosis delay was reported in 7.5% (0.9-20.6%). Predominantly antibody deficiencies had the highest frequency of allergic disease followed by combined immunodeficiency with a frequency of 40.3% (19.2-62.5%) and 20.0% (10-32%) respectively. As per the data of centers, anaphylaxis occurred in 25/8450 patients (0.3%) whereas per USIDNET dataset, it occurred in 249/2332 (10.6%); drugs and food allergy were the main causes in both datasets. Conclusions This multinational study brings to focus the relation between allergic diseases and IEI. Major allergies do occur in IEI patients but were less frequent than the general population. Initial presentation with allergy could adversely affect the timely diagnosis of IEI. There is a need for policies to raise awareness and educate primary care and other referring specialties on the association of allergic diseases with IEI. This study provides a network among centers for future prospective studies in the field.
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Affiliation(s)
- Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Dalia H. El-Ghoneimy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Nesrine Radwan
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Juan C. Aldave
- Allergy and Clinical Immunology, Hospital Nacional Edgardo Rebagliati Martins, Peru
| | - Waleed Al-Herz
- Allergy and Clinical Immunology Unit, Pediatric Department, AlSabah Hospital, Faculty of Medicine, Kuwait University, Kuwait
| | - Maryam A. Al-Nesf
- Department of Pediatrics, Pulmonary Division- Allergy and Immunology Section, Qatar
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Theresa Cole
- Department of Allergy and Immunology- Royal Children's Hospital, Australia
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Nahla H.H. Erwa
- Allergy and Immunology Unit- Soba University Hospital and Faculty of Medicine, University of Khartoum, Sudan
| | | | - Emilia Faria
- Immunoallergy Department, Coimbra Hospital and University Centre (CHUC), Portugal
| | | | - Ramsay Fuleihan
- Pediatric Allergy, Immunology and Rheumatology, Columbia University Medical Center, New York, USA
| | - Nermeen Galal
- Department of Pediatrics- Division of Immunology, Cairo University, Egypt
| | | | - Mary Hintermeyer
- Department of Allergy and Clinical Immunology- Children's Hospital of Wisconsin, Medical College of Wisconsin, USA
| | - Kohsuke Imai
- Department of Pediatrics-Tokyo Medical and Dental University, Japan
| | - Carla Irani
- Department of Internal Medicine and Clinical Immunology, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Ebtihal Kamal
- Allergy and Immunology Unit- Soba University Hospital and Faculty of Medicine, University of Khartoum, Sudan
| | - Nadia Kechout
- Department of Immunology, Pasteur Institute of Algeria, Algeria
| | - Adam Klocperk
- Department of Immunology, University Hospital Motol and the 2nd Faculty of Medicine, Charles University, Czech Republic
| | - Michael Levin
- Division of Pediatric Allergy, University of Cape Town, South Africa
| | - Tomas Milota
- Department of Immunology, University Hospital Motol and the 2nd Faculty of Medicine, Charles University, Czech Republic
| | - Monia Ouederni
- Department of Pediatrics, Immuno-hematology and Stem Cell Transplantation- Bone Marrow Transplantation Center Tunisia
| | - Roberto Paganelli
- Department of Medicine and Sciences of Aging, University “G. D’Annunzio”, Chieti-Pescara – and YDA, Institute of Clinical Immunotherapy and Advanced Biological Treatments, Pescara, Italy
| | | | - Farah N. Qamar
- Department of Pediatrics and Child Health- Aga Khan University Hospital, Karachi, Pakistan
| | - Isabella Quinti
- Department of Molecular Medicine, PID Reference Centre, Sapienza University of Rome, Italy
| | - Sonia Qureshi
- Department of Pediatrics and Child Health- Aga Khan University Hospital, Karachi, Pakistan
| | - Nita Radhakrishnan
- Department of Pediatric Hematology Oncology, Super Specialty Pediatric Hospital and Post Graduate Teaching Institute Noida, Delhi NCR 201303, India
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - John Routes
- Department of Allergy and Clinical Immunology- Children's Hospital of Wisconsin, Medical College of Wisconsin, USA
| | - Surjit Singh
- Department of Pediatrics and Chief, Allergy Immunology Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sangeetha Siniah
- Hospital Tunku Azizah, Women and Children Hospital Kuala Lumpur, Malaysia
| | | | - Luciana K. Tanno
- Department of Pulmonology, Division of Allergy, University Hospital of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA11, INSERM, University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Classification Scientific Support, Montpellier, France
| | - Ben Van Dort
- Department of Allergy and Immunology- Royal Children's Hospital, Australia
| | - Alla Volokha
- Department of Pediatric Infectious Diseases and Immunology- Shupyk National Medical Academy of Postgraduate Education, Ukraine
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Effects Of Chronic Exposure to Paint Fumes Among Artisans in Lagos State, Nigeria. Toxicol Rep 2022; 9:663-669. [PMID: 35399220 PMCID: PMC8990164 DOI: 10.1016/j.toxrep.2022.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
The chronic effects of automobile paint fumes and their volatile organic constituents form detrimental air pollution with hazardous consequences especially to paint industrial workers and the population within the vicinity. This study investigated the chronic effects of exposure to paint fumes in Mushin area of Lagos, Nigeria. Fifty artisans employed in automobile painting industries were compared with 50 control group whose work does not expose them to paint fumes. Five milliliters blood was collected and used for assessment of hematological and biochemical parameters. This was compared in artisan and unexposed control group and p value of < 0.05 indicates significant difference. In artisans, kidney function analysis showed a significant decrease in potassium (3.63 ± 0.1012 mEq/L) compared to healthy control (4.26 ± 0.1699 mEq/L, p = 0.0049), as well as bicarbonate ion concentration (23.89 ± 0.3795 vs 26.40 ± 0.3578 mmol/L respectively, p = 0.0011), however, a significant increase in creatinine level was recorded in artisans than control group (1.140 ± 0.1075 vs 0.76 ± 0.03578 mg/dL, p = 0.03); which is an indicator of renal function impairment. AST and ALT levels were significantly higher in artisans (11.44 ± 0.8190 and 8.78 ± 0.7558 U/L) compared to control group (6.83 ± 0.3086 and 6.67 ± 0.3354 U/L), respectively (p < 0.05), while ALP levels were similar. For oxidative stress parameters - CAT, MDA and protein, there was a significant increase in artisans while the corresponding GSH and SOD activities decreased significantly (p < 0.05). The results showed similar Zinc and Chromium levels in both groups but Lead was not detected in any participant. The findings of this study indicate that chronic exposure to paint fumes among automobile painting artisans may impair renal function, liver function and induce oxidative damages. Creating awareness of potential dangers and recommending use of personal protective equipment among automobile painting artisans can further decrease their exposure.ga1![]() Prolonged exposure to hazardous components of paint like heavy metals used as solvents in the paints have health implications. Chronic exposure to paint fumes in automobile artisans may impair renal, liver function, induce oxidative stress and toxicity. Implementing use of protective equipment in artisans will reduce occupational hazard and toxicity due to heavy metal exposure.
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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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31
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Association of GSTM1 and GSTT1 Null Genotypes with Toluene Diisocyanate-Induced Asthma. Can Respir J 2022; 2022:7977937. [PMID: 35186174 PMCID: PMC8856815 DOI: 10.1155/2022/7977937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/15/2022] [Indexed: 12/11/2022] Open
Abstract
Background. Toluene diisocyanate (TDI) causes occupational asthma by generating oxidative stress, leading to tissue injury and inflammation. Glutathione transferases (GSTs) are detoxifying enzymes that eliminate oxidative stress. We examined whether the genotypes of the GSTM1 and GSTT1 genes are associated with TDI-induced occupational asthma (TDI-OA). Methods. The study population consisted of 26 asthmatics with a positive response to the TDI challenge (TDI-PA) and 27 asthmatics with negative responses (TDI-NA). GSTM1 and GSTT1 null and wild-type genotypes were determined using multiplex PCR. The plasma GSTM1 and GSTT1 protein concentrations were determined using ELISA. Results. The GSTM1 null genotype was more frequent in the TDI-PA than in the TDI-NA (77.8 vs. 50.0%, OR = 3.5,
), while the frequency of the GSTT1 null genotype tended to be higher in the TDI-PA than in the TDI-NA (59.3 vs. 42.3%, OR = 1.98,
). When analyzed together, the GSTM1/GSTT1 null genotype was more frequent in the TDI-PA than in the TDI-NA (48.2 vs. 15.3%, OR = 6.5,
). The decline in the FEV in 1 s after TDI challenge was higher with the GSTM1/GSTT1 null than the GSTM1 wild-type/GSTT1 null genotypes (24.29% vs. 7.47%,
). The plasma GSTM1 level was lower with the GSTM1 null than with the GSTM1 wild-type genotypes both before (13.7 vs. 16.6 ng/mg,
) and after (12.9 vs. 17.1 ng/mg,
) the TDI challenge, while the GSTT1 level was not changed with either the GSTT1 null or wild-type genotype. Conclusions. The GSTM1 null genotype, but not GSTT1 alone, may confer susceptibility to TDI-OA. However, the genetic effect of the GSTM1 null genotype may be enhanced synergistically by the GSTT1 null genotype. The genetic effect of GSTM1 was validated in the plasma as the GSTM1 protein level. Therefore, the GSTM1 and GSTT1 genotypes may be useful diagnostic markers for TDI-OA.
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Rui F, Otelea MR, Fell AKM, Stoleski S, Mijakoski D, Holm M, Schlünssen V, Larese Filon F. Occupational Asthma: The Knowledge Needs for a Better Management. Ann Work Expo Health 2022; 66:287-290. [PMID: 34984434 PMCID: PMC9006971 DOI: 10.1093/annweh/wxab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/12/2022] Open
Abstract
The management of occupational asthma (OA) may be influenced by several factors and removal from exposure is the main tertiary prevention approach, but it is not always feasible without personal and socioeconomic consequences. Reducing the delay between the onset of suggestive symptoms of OA and the diagnosis of OA is associated with a better prognosis. Workers' education to increase awareness to trigger agents and a medical surveillance program directed especially at at-risk workers could be helpful in reducing this latency time. An early identification of workers who develop rhinitis and conjunctivitis which often precede the onset of asthma symptoms could be important for an early identification of OA. This is particularly important for cases of asthma caused by high-molecular-weight sensitizers and in the early years of employment. The availability of financial support and compensation measures for workers with OA may influence the latency time before diagnosis and, consequently, may influence the OA outcomes. In conclusion, there is a need for high-quality cohort studies that will increase knowledge about risk factor that may influence the timing of diagnosis of OA. This knowledge will be useful for implementation of future surveillance and screening programs in workplaces.
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Affiliation(s)
- Francesca Rui
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Clinical Department 5, Dionisie Lupu St, 37, Bucharest, Romania
| | - Anne Kristin Møller Fell
- Department of Occupational and Environmental Medicine, Telemark hospital, Skien, Norway.,Department of Global Health and Community Medicine, Institute of Health and Community, University of Oslo, Oslo, Norway
| | - Sasho Stoleski
- Department of Occupational Diseases, Institute of Occupational Health of R.N. Macedonia, WHO CC, GA2LEN CC, II Makedonska Brigada 43, Skopje, R.N. Macedonia.,Department of Occupational Medicine, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, 50 Divizija 6, Skopje, R.N. Macedonia
| | - Dragan Mijakoski
- Department of Occupational Diseases, Institute of Occupational Health of R.N. Macedonia, WHO CC, GA2LEN CC, II Makedonska Brigada 43, Skopje, R.N. Macedonia.,Department of Occupational Medicine, Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, 50 Divizija 6, Skopje, R.N. Macedonia
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, SE 40530 Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Barholins Allé 2, bg 1260, 8000 Aarhus, Denmark.,National Research Center for Working Environment, Lersø Parallé 105, 2100 Copenhagen, Denmark
| | - Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
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33
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Berufsasthma. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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34
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The Cotton Dust-Related Allergic Asthma: Prevalence and Associated Factors among Textile Workers in Nam Dinh Province, Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189813. [PMID: 34574732 PMCID: PMC8467793 DOI: 10.3390/ijerph18189813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Objective: To determine the prevalence of cotton dust-related allergic asthma and associated factors among textile workers in Nam Dinh province, Vietnam. Methods: A cross-sectional study was performed with 1082 workers in two textile garment companies using the asthma diagnostic criteria of the GINA (Global Initiative for Asthma) 2016 guidelines. Results: Among study participants, 11.9% had suspected asthma symptoms, 7.4% were diagnosed with asthma, and 4.3% (3.6% in men and 4.5% in women) were diagnosed with cotton dust-related allergic asthma. Overweight, seniority more than 10 years, history of asthma, allergic rhinitis, family history of allergy, and exposure to cotton dust from more than one hour per day in the working environment were found to be important predictors of cotton dust-related allergic asthma among textile workers. Conclusions: Textile workers in two companies in Nam Dinh, Vietnam had a high prevalence of dust-related allergic asthma compared to estimates from the general population. There is a need to design appropriate measures of prevention, screening, and care for dust-related asthma in the textile industry. Further evaluation with better exposure assessment is necessary.
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Abstract
OBJECTIVE Workers exposed to cobalt may develop two lung conditions, asthma or lung fibrosis. There is a relative lack of awareness of the risk of lung disease from cobalt exposure. METHODS The state of Michigan requires physicians, and hospitals to report work-related asthma (WRA). A standardized telephone interview of each reported case was conducted. An industrial hygienist evaluated the reported cases's workplace, and a physician reviewed the results to confirm the diagnosis. This is a population-based case series of all workers in whom the exposure to cobalt was confirmed as likely responsible for WRA from 1988 to 2017. We also included an illustrative case report and data on the workplace evaluations. RESULTS Of the 35 cases identified, 77% were males, 97.1% were white, and 62.9% had a history of smoking cigarettes. Fifteen (44%) cases were involved in manufacturing cutting tools and machine tool accessories. Symptoms improved in 28 cases (80%) when away from work. Fourteen cases (40%) had emergency department visits, while 10 (28.6%) had been hospitalized for breathing problems. Spirometry had been performed for 33 (94.3%) cases. Only 13 (37.1%) reported they were informed by a doctor that their asthma was work-related. Twenty-six inspections were conducted at 21 different workplaces, where 498 coworkers were interviewed, 55 (11%) of which had respiratory symptoms at work. Six workplaces were cited for cobalt air level higher than permissible limits. These inspections resulted in $29,380 in penalties. CONCLUSIONS WRA secondary to cobalt is associated with significant morbidity. Most of the cases were unaware of their medical diagnosis.
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Affiliation(s)
- A Al-Abcha
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA
| | - L Wang
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - M J Reilly
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - K D Rosenman
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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36
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Walters GI, Huntley CC. Updated review of reported cases of reactive airways dysfunction syndrome. Occup Med (Lond) 2021; 70:490-495. [PMID: 33063819 DOI: 10.1093/occmed/kqaa133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A previous systematic review of the diagnosis of reactive airways dysfunction syndrome (RADS), undertaken from 1985 to 2004, found a lack of standardization of case reporting, thus misattribution of symptoms can occur. AIMS We aimed to update the systematic review, update the list of reported causes and see whether a more structured approach to reporting has been adopted. METHODS We undertook a systematic literature review, using the databases EMBASE and Ovid MEDLINE, with search terms 'reactive airways dysfunction syndrome' or 'asthma AND acute irritant', and reported according to PRISMA guidelines. We included papers and abstracts published from January 2005 to September 2019, and articles were grouped by the presence or absence of diagnostic features: 'definite' RADS (met Brooks' criteria) or 'possible' RADS (Brooks' criteria not met or insufficient data). We collected demographic and diagnostic data for cases, where given. RESULTS Eleven papers and six conference abstracts met the inclusion criteria, 13 of which were case series or reports, and comprised 752 cases in total; seven articles met Brooks' criteria for RADS diagnosis. A variety of agents were implicated, with chlorine or chlorine-releasing molecules most frequently reported. CONCLUSIONS A lack of standardized reporting of RADS remains. The majority of published articles and conference abstracts either do not meet, or contain insufficient data to judge against, Brooks' criteria, particularly in relation to onset of symptoms and bronchial hyper-reactivity or variability of airflow obstruction. Some novel agents are described, in keeping with recognized structural taxonomies.
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Affiliation(s)
- G I Walters
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK.,Occupational and Environmental Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - C C Huntley
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
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37
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Cullinan P, Vandenplas O, Bernstein D. Assessment and Management of Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3264-3275. [PMID: 33161958 DOI: 10.1016/j.jaip.2020.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
Exposures at work can give rise to different phenotypes of "work-related asthma." The focus of this review is on the diagnosis and management of sensitizer-induced occupational asthma (OA) caused by either a high- or low-molecular-weight agent encountered in the workplace. The diagnosis of OA remains a challenge for the clinician because there is no simple test with a sufficiently high level of accuracy. Instead, the diagnostic process combines different procedures in a stepwise manner. These procedures include a detailed clinical history, immunologic testing, measurement of lung function parameters and airway inflammatory markers, as well as various methods that relate changes in these functional and inflammatory indices to workplace exposure. Their diagnostic performances, alone and in combination, are critically reviewed and summarized into evidence-based key messages. A working diagnostic algorithm is proposed that can be adapted to the suspected agent, purpose of diagnosis, and available resources. Current information on the management options of OA is summarized to provide pragmatic guidance to clinicians who have to advise their patients with OA.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, United Kingdom
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - David Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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38
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Classification of chemicals as respiratory allergens based on human data: Requirements and practical considerations. Regul Toxicol Pharmacol 2021; 123:104925. [PMID: 33831493 DOI: 10.1016/j.yrtph.2021.104925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 02/01/2023]
Abstract
Occupational asthma is an important health problem that can include exacerbation of existing asthma, or induce new asthma either through allergic sensitisation, or non-immunological mechanisms. While allergic sensitisation of the respiratory tract can be acquired to proteins, or to low molecular weight chemicals (chemical respiratory allergens) this article is on the latter exclusively. Chemical respiratory allergy resulting in occupational asthma is associated with high levels of morbidity and there is a need, therefore, that chemicals which can cause sensitisation of the respiratory tract are identified accurately. However, there are available no validated, or even widely accepted, predictive test methods (in vivo, in vitro or in silico) that have achieved regulatory acceptance for identifying respiratory sensitising hazards. For this reason there is an important reliance on human data for the identification of chemical respiratory allergens, and for distinguishing these from chemicals that cause occupational asthma through non-immunological mechanisms. In this article the reasons why it is important that care is taken in designating chemicals as respiratory allergens are reviewed. The value and limitations of human data that can aid the accurate identification of chemical respiratory allergens are explored, including exposure conditions, response characteristics in specific inhalation challenge tests, and immunological investigations.
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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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40
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Pulmonary Function Testing in Work-Related Asthma: An Overview from Spirometry to Specific Inhalation Challenge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052325. [PMID: 33652998 PMCID: PMC7967683 DOI: 10.3390/ijerph18052325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines.
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41
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James E, Linde B, Redlich CA. Master Clinician and Public Health Practitioner: Selected Occupational and Environmental Pulmonary Cases. Clin Chest Med 2021; 41:567-580. [PMID: 33153680 DOI: 10.1016/j.ccm.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contributing factors. Mastering occupational and environmental medicine clinical decision making requires specialized clinical skills. These skills include obtaining an appropriate work and exposure history; making an assessment of the magnitude and relevance of exposures and their contribution to a patient's respiratory disease; utilizing appropriate resources for evaluation and management of exposure-related disease; and considering socioeconomic and public health factors.
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Affiliation(s)
- Efia James
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, 367 Cedar Street, ESHA 2nd Floor, New Haven, CT 06510, USA.
| | - Brian Linde
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, 367 Cedar Street, ESHA 2nd Floor, New Haven, CT 06510, USA
| | - Carrie A Redlich
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, 367 Cedar Street, ESHA 2nd Floor, New Haven, CT 06510, USA
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42
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Jo W, Seo KW, Jung HS, Park CY, Kang BJ, Kang HH, Ra SW, Jegal Y, Ahn JJ, Park SE, Jung MS, Park JI, Park EJ, Sim CS, Kim TB, Lee T. Clinical Importance of Work-Exacerbated Asthma: Findings From a Prospective Asthma Cohort in a Highly Industrialized City in Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:256-270. [PMID: 33474860 PMCID: PMC7840872 DOI: 10.4168/aair.2021.13.2.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Work-related asthma (WRA) occupies about 10%-30% of all asthma cases. Among 2 subtypes of WRA (occupational asthma [OA] and work-exacerbated asthma [WEA]), the rate of WEA has been reported to increase recently. WRA is described as having worse characteristics than non-WRA (NWRA), while WEA is known to show similar severity to OA in terms of symptoms and exacerbations. However, these data were mainly based on indirect surveys. Ulsan is a highly industrialized city in Korea; therefore, it is estimated to have a high incidence of WRA. This study aimed to identify the characteristics of WRA in the city. METHODS This was a prospective asthma cohort study of individuals diagnosed with asthma and treated at Ulsan University Hospital between Jan 2015 and Dec 2016. Baseline characteristics and work-related inquiry (9 questionnaires) were investigated at enrollment. Various severity indices and job change were then investigated for the longitudinal analysis at 12 months after enrollment. RESULTS In total, 217 asthma patients completed the study. WRA accounted for 17% (36/217), with an equal number of WEA and OA (18 patients each). Before the work-related survey, only 33% (n = 12) of WRA patients (22% [4/18] of WEA and 44% [8/18] of OA) were diagnosed with WRA by the attending physicians. Compared to the NWRA group and the OA subgroup, the WEA subgroup had more outpatient visits, more oral corticosteroids prescriptions, and trends of low asthma control test scores and severe asthma. The rate of job change was markedly lower in the WEA subgroup than in the OA subgroup (20% vs. 5%). CONCLUSIONS The overall prevalence of WRA (17%) was similar to those of previous studies, but the share of WEA was high (50% of WRA). WEA was more severe than OA or NWRA. The possible reason for this severity is ongoing workplace exposure.
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Affiliation(s)
- Woori Jo
- Department of Internal Medicine, Metro Silver Hospital, Changwon, Korea
| | - Kwang Won Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hwa Sik Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chui Yong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Byung Ju Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyeon Hui Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung Won Ra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Joon Ahn
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Moon Sik Jung
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ju Ik Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Ji Park
- Medical Information Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chang Sun Sim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Tae Bum Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Taehoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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43
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Morimoto Y, Nishida C, Tomonaga T, Izumi H, Yatera K, Sakurai K, Kim Y. Lung disorders induced by respirable organic chemicals. J Occup Health 2021; 63:e12240. [PMID: 34128301 PMCID: PMC8204092 DOI: 10.1002/1348-9585.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023] Open
Abstract
Respirable organic chemicals were originally thought to cause allergic respiratory diseases, such as bronchial asthma and hypersensitivity pneumonitis, and believed not to cause lung disorders derived from inflammatory or fibrotic processes such as pulmonary fibrosis and interstitial pneumonitis. It has recently been reported, however, that exposure to organic chemicals can cause interstitial lung diseases. In this review, we discuss the clinical features of occupational asthma and hypersensitivity pneumonitis, as well as other lung disorders, including interstitial pneumonitis, caused by humidifier disinfectants in Korea and by a cross-linked acrylic acid-based polymer (CL-PAA) in Japan.
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Affiliation(s)
- Yasuo Morimoto
- Department of Occupational PneumologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Chinatsu Nishida
- Department of Respiratory MedicineSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Taisuke Tomonaga
- Department of Occupational PneumologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Hiroto Izumi
- Department of Occupational PneumologyInstitute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kazuhiro Yatera
- Department of Respiratory MedicineSchool of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Kazuo Sakurai
- Department of Life and Environmental EngineeringThe University of KitakyushuKitakyushuJapan
| | - Yangho Kim
- Department of Occupational and Environmental MedicineUlsan University HospitalUniversity of Ulsan College of MedicineUlsanKorea
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44
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Abstract
PURPOSE OF REVIEW The purpose of this review was to list all new confirmed cases of immunological occupational asthma (IOA) described between mid-2014 and April 2020. RECENT FINDINGS Several new agents, both of high and low molecular weight, have been identified in the last 6 years as potential respiratory sensitizers being able to induce immunological occupational asthma. This review confirms that new causes of IOA are still identified regularly, particularly in subjects exposed to high molecular agents, in the food industry (farming, pest control, food processing), pharmaceutical industry (antibiotics, various drugs) and cosmetic environment (dyes, powders). SUMMARY It stressed the need for clinicians to stay alert and suspect occupational asthma in any adult with new onset asthma or newly uncontrolled asthma.
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45
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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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Belloumi N, Mersni M, Fenniche S, Bani M, Bachouche I, Chermiti Ben Abdallah F, Nouaigui H. [A questionnaire assessing knowledge level concerning occupational asthma]. Rev Mal Respir 2020; 37:710-721. [PMID: 33069502 DOI: 10.1016/j.rmr.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Screening for occupational asthma is should still be promoted. In order to improve the efficiency of any educational intervention we need to evaluate the patient's knowledge of the disease. OBJECTIVES The aims were to evaluate objectively the knowledge level of Tunisian asthmatic patients concerning occupational asthma using a self-questionnaire in Arabic Tunisian dialect, then to conduct a validation process of the questionnaire. METHODS We followed De Vellis's rules during all stages of redaction of the self-questionnaire. It contained 18 items allocated in 4 dimensions: knowledge about asthma; knowledge about occupational asthma; prognosis of occupational asthma; prevention of occupational asthma. A pre-test was conducted on 18 asthmatic patients to assess the clarity and comprehensibility of all the questions. The questionnaire was then applied to 107 asthmatic patients. RESULTS The statistical analysis proved the discrimination value in 14 of the 18 items. The internal consistency of the questionnaire was demonstrated by a KR20 index of 0.731. Factorial analysis of the principal components showed the reliability of the questionnaire and of its uni-dimensional structure. The statistical findings proved the positive correlation between the mean scores of all its dimensions. CONCLUSIONS Using this questionnaire in daily practice should inform health care providers about the level of knowledge of occupational asthma in the targeted population and improve the effectiveness of any further educational intervention.
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Affiliation(s)
- N Belloumi
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie.
| | - M Mersni
- Service de médecine de travail et des maladies professionnelles, institut de santé et de sécurité de travail, Tunis, Tunisie
| | - S Fenniche
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - M Bani
- Service de médecine de travail et des maladies professionnelles, institut de santé et de sécurité de travail, Tunis, Tunisie
| | - I Bachouche
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - F Chermiti Ben Abdallah
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - H Nouaigui
- Service de médecine de travail et des maladies professionnelles, institut de santé et de sécurité de travail, Tunis, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
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47
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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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48
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Abstract
Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β2-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β2-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.
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49
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Mirershadi F, Ahmadi M, Rezabakhsh A, Rajabi H, Rahbarghazi R, Keyhanmanesh R. Unraveling the therapeutic effects of mesenchymal stem cells in asthma. Stem Cell Res Ther 2020; 11:400. [PMID: 32933587 PMCID: PMC7493154 DOI: 10.1186/s13287-020-01921-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Asthma is a chronic inflammatory disease associated with airway hyper-responsiveness, chronic inflammatory response, and excessive structural remodeling. The current therapeutic strategies in asthmatic patients are based on controlling the activity of type 2 T helper lymphocytes in the pulmonary tissue. However, most of the available therapies are symptomatic and expensive and with diverse side outcomes in which the interruption of these modalities contributes to the relapse of asthmatic symptoms. Up to date, different reports highlighted the advantages and beneficial outcomes regarding the transplantation of different stem cell sources, and relevant products from for the diseases' alleviation and restoration of injured sites. However, efforts to better understand by which these cells elicit therapeutic effects are already underway. The precise understanding of these mechanisms will help us to translate stem cells into the clinical setting. In this review article, we described current knowledge and future perspectives related to the therapeutic application of stem cell-based therapy in animal models of asthma, with emphasis on the underlying therapeutic mechanisms.
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Affiliation(s)
- Fatemeh Mirershadi
- Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 51666-14766, Iran.,Department of Physiology, Ardabil Branch, Islamic Azad University, Ardabil, Iran
| | - Mahdi Ahmadi
- Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 51666-14766, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aysa Rezabakhsh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Rajabi
- Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Istanbul, Turkey.,Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Reza Rahbarghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Applied Cell Sciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 51548-53431, Iran.
| | - Rana Keyhanmanesh
- Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 51666-14766, Iran. .,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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50
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Reibman J, Caplan-Shaw C, Wu Y, Liu M, Amin MR, Berger KI, Cotrina-Vidal ML, Kazeros A, Durmus N, Fernandez-Beros ME, Goldring RM, Rosen R, Shao Y. Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186645. [PMID: 32933057 PMCID: PMC7558705 DOI: 10.3390/ijerph17186645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022]
Abstract
The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.
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Affiliation(s)
- Joan Reibman
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
- Correspondence: ; Tel.: +1-212-263-6479
| | - Caralee Caplan-Shaw
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Yinxiang Wu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Milan R. Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Kenneth I. Berger
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Maria L. Cotrina-Vidal
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Angeliki Kazeros
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Nedim Durmus
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
| | - Maria-Elena Fernandez-Beros
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Roberta M. Goldring
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA; (C.C.-S.); (K.I.B.); (A.K.); (N.D.); (M.-E.F.-B.); (R.M.G.)
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
| | - Rebecca Rosen
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA; (Y.W.); (M.L.); (Y.S.)
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- World Trade Center Environmental Health Center, NYC H+HC, New York, NY 10016, USA; (M.L.C.-V.); (R.R.)
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