Occupational Chronic Obstructive Pulmonary Disease Research Articles

The role of nanoparticles of industrial aerosols in the formation of occupational bronchopulmonary pathology

The significant prevalence of industrial aerosols with unintentional nanoparticles and the increasing use of engineering nanoparticles in modern production determine the relevance of research on the patterns of interaction with the human bronchopulmonary system. Unintentional nanoparticles are formed during various production processes: melting and welding of metals, combustion, crushing, grinding of minerals, plasma processing of materials. Engineering nanoparticles are released into the air of the work area during their production or use in any technological processes.
 The respiratory system, as a barrier organ, is most vulnerable to the effects of adverse environmental factors. At the same time, nanoparticles are the least studied component of industrial aerosols. In order to systematize data on the role of nanoparticles in the development of occupational bronchopulmonary pathology, the authors conducted a literature review.
 The size determines the features of the physical, chemical and biological properties of nanoparticles. They have high values of the ratio of surface area to volume, total surface area, which leads to an increase in reactogenicity and penetrating power. The pathogenic properties of nanoparticles depend on the chemical composition, shape, curvature of the surface, structure, charge, mass concentration, total surface area of the particles, and exposure time.
 The multidimensionality of hygienic characteristics determines the complexity of hygienic rationing and monitoring of nanoparticles. To date, safe exposure levels have not been established. When interacting with cells of the respiratory tract, nanoparticles induce the following cellular and molecular mechanisms: oxidative stress, inflammation, violation of the epithelial barrier, autophagy and dysfunction of lysosomes, stress of the endoplasmic reticulum, apoptosis, senescence, fibrosis, endothelial dysfunction, DNA damage. This leads to the development of interstitial pneumonitis, pulmonary fibrosis and obstructive disorders, and an increase in the activity of allergic inflammation. All these mechanisms are present in the pathogenesis of occupational lung diseases. Under the influence of nanoparticles of various chemical compositions, separate phenotypes of occupational chronic obstructive pulmonary disease are formed. There is a lack of epidemiological studies of the possible etiological role of nanoparticles. Nanoparticles of industrial aerosols are a significant factor in the development of occupational diseases of the bronchopulmonary system and have a significant impact on the formation 
 of phenotypes.

Phenotypic variants of occupational bronchial asthma (immune profile, cytokines, diagnosis and prognosis)

Currently, occupational bronchial asthma is considered as a phenotypically and genotypically heterogeneous disease. The assessment of immunological characteristics opens up new opportunities in assessing the disease development, predicting the characteristics of the course, and establishing a personalized approach to pharmacotherapy of occupational asthma, as well as in developing an individual strategy for its prevention. The purpose of the study is to determine immunological markers of the risk of developing occupational bronchial asthma under conditions of exposure to sensitizing substances for various phenotypes of this disease. Materials and methods. The study included 170 patients with various phenotypes of occupational asthma and 50 participants in the control group. The levels of immunoglobulins A, M, and G in serum were determined by the Mancini technique (radial immunodiffusion). The determination of the levels of cytokines IL-1β, IL-4, IL-6, IL-8, IL-10, IL-17, TNF-α, MCP- 1, and IFN-γ, total IgE, C-reactive protein, and fibronectin in blood serum was carried out by enzyme-linked immunosorbent assay using kits and reagents (OOO Proteinovy Kontur, Vektor-Best, Diateks-E, DIA-plus, Pharmacia diagnostika). To study the content of vascular endothelial growth factor (VEGF) in blood serum, we used a sandwich-type enzyme-linked immunosorbent assay with a set of reagents from eBioscience. Genotyping was performed by real-time polymerase chain reaction using primers and probes developed with the PrimerQuest program (Integrated DNA Technologies, Inc.). Results. For the first time, the study has established the features of immunological manifestations in allergic and non-allergic phenotypes of occupational bronchial asthma, as well as the phenotypes of the combination of occupational asthma with occupational chronic obstructive pulmonary disease and metabolic syndrome. The features of the formation, pathogenesis, and prognosis of various phenotypes of occupational bronchial asthma have been identified. This allows recommending the determination of these immunological parameters during in-depth periodic medical examinations of workers exposed to sensitizing and irritating substances for differential diagnosis of various occupational asthma phenotypes in a specialized inpatient examination. Limitations of the study. The study has regional (Samara Region) and professional (in terms of detailing working conditions in the studied comparison groups) limitations. Conclusion. The identified immunological features in various phenotypes of occupational bronchial asthma and the established profiles of occupational asthma genotypes can optimize the approach to early diagnosis, prognosis, prevention, and pharmacotherapy of this disease, as well as expand the list of immunological research indicators used during preliminary and periodic medical examinations, in-depth examination of patients with occupational asthma in occupational disease clinics and occupational pathology centers, and the use of new reliable criteria for predicting the course of the disease.

Individual approach in the treatment of occupational chronic obstructive pulmonary disease

Introduction. Occupational COPD (PCODD) is characterized by partially irreversible airflow limitation, the phenomenon of "air traps" and the formation of emphysema, has a steadily progressive character. In the work of a practitioner, an individual approach to the patient with targeted pharmacotherapy using new combinations in the treatment of occupational COPD is important, taking into account the evaluation of the effectiveness of previous therapy.
 The study aims to evaluate the effectiveness of therapy with combined bronchodilators in PCOPD with an analysis of the dynamics of functional parameters, exercise tolerance, using additional criteria for differential diagnosis.
 Material and methods. The effectiveness of bronchodilator therapy was analyzed in 45 men, diagnosed with occupational COPD (PCODD). Additional differential diagnostics included the following informative indicators: instantaneous volumetric velocity after exhalation 75 FVC (MOS75); cough intensity according to the CAT questionnaire (1 point); ratio of forced vital capacity to forced expiratory volume in 1 minute (FVC/FEV1); 6MWT data, % predicted; 6MWT, m; overall score on the mMRС questionnaire; the severity of shortness of breath according to the CAT questionnaire (point 4); instantaneous volumetric velocity after exhalation 25 FVC (MOS25). The discriminant equation is represented by the formula: F=–9,76+0,75×a1–2,00×a2–0,19×a3+0,27×a4–0,11×a5+1,22×a6+3,62×a7+2,22×a8.
 Results. Two clinical trials were retrospectively analyzed using combined bronchodilator therapy with long-acting muscarinic receptor antagonists (LAA) and β2-agonists (LAA) in patients with PCOD. A group of patients was identified where a statistically significant improvement in clinical and functional parameters was not achieved against the background of the therapy. When to the group of occupational bronchial asthma (OBA). When conducting an individual analysis of indicators, it was found that for patients with PCOD during bronchodilator therapy, an improvement in spirometric parameters is characteristic, in particular, an increase in FEV1 and FVC; Significant reduction in symptoms of shortness of breath, cough, sputum. Whereas, the PBA group was characterized only by an improvement in the distance traveled in 6MWT.
 Conclusion. Our earlier clinical studies on the effectiveness of treatment of patients with PCOD with combined bronchodilator therapy showed the effectiveness of this therapy in 70–75% of the patients examined. An individual analysis of the clinical and functional parameters of the examined patients made it possible to identify the features of the course of occupational bronchopulmonary pathology, with the identification of individuals who need the use of a triple combination of LABA, LAAA with the addition of topical glucocorticosteroids. In this regard, all patients, as part of diagnostic measures, in addition to the standard examination, it is necessary to include 6MWT, BPG, questionnaires using mMRС and CAT questionnaires. Calculation of discriminant equations using data from spirometry, questionnaires, 6MWT and BPG will allow at the first stage of differential diagnosis to identify a group of patients for whom "triple" therapy is the means of choice.
 Ethics. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was reviewed at a meeting of the local Ethics Committee East-Siberian Institute of Medical and Ecological Research.

Administrative Burden of the Compensation Claim System - Physicians and Union Compensation Representatives’ Views

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. Cigarettes are the leading cause of this disease. However, workplace exposures, including those in the mining industry, may also lead to COPD. These exposures include dust and fumes that can be higher for mineral industry workers who work in confined areas. As a result, workers in the minerals industry may submit compensation claims. Sadly, work-related COPD is not well compensated or recognized by the Ontario Workplace Safety and Insurance Board (WSIB). Physicians and union representatives struggle to complete forms and have claims approved, and because of this, workers can struggle with money, family, and mental health problems. This qualitative narrative study used in-depth telephone interviews (eight) to collect information. The information collected from physicians (four) and union representatives (four) was analyzed to understand their perspectives and experiences when assisting workers with compensation claims. This is the first study to examine how COPD could affect underground mineral workers in Northeastern Ontario. Themes identified in this study include 1) additional administrative and human support resources are required, 2) smoking cessation is essential, 3) COPD is a crippling disease, 4) education is required to support documenting an occupational illness, 5) the compensation claim process is challenging; 6) occupational diseases are challenging to prove, 7) occupational COPD is costly. This study may help with compensation services and provide support for physicians and union representatives involved with an underground mineral worker diagnosed with occupational COPD.

Features of the frequency distribution of alleles and genotypes of the IL5 gene polymorphism rs2069812 in various phenotypes of bronchial asthma of professional genesis

Despite the fact that occupational bronchial asthma has long been considered as a separate, independent disease, in recent years, more and more attention has been paid to its heterogeneity. Phenotyping of occupational asthma was initially based on identifying combinations of clinical characteristics of the disease, but now an increasing amount of data is emerging making it possible to understand the cause of clinical differences at the molecular genetic level. Thus, molecular genotyping opens up new opportunities in the search for a more targeted and personalized approach to the treatment of occupational bronchial asthma, as well as in the development of an individual strategy for its prevention. The purpose of the study is to determine genetic markers of the risk of developing occupational asthma under conditions of exposure to sensitizing substances by assessing the IL5 rs2069812 polymorphism. Materials and methods. The study was conducted on the basis of the Department of Occu pational Diseases and Clinical Pharmacology named after honored scientist of the Russian Federation professor V. V. Kosarev, FSBEI HE Samara State Medical University of the Ministry of Health of Russia, and the Department of Occupational Pathology, Regional Center of Occupational Pathology, SBHI SR Samara Medical and Sanitary Unit No. 5 of the Kirov District. The study was carried out on 170 patients with various phenotypes of occupational bronchial asth ma and 50 participants in the control group: group 1 (42 patients) — phenotype «occupational asthma, allergic form», group 2 (36 patients) — phenotype «occupational asthma, non-allergic form», group 3 (58 patients) — phenotype «occupational asthma — occupational chronic obstructive pulmonary disease», group 4 (34 patients) — phenotype «occupational asthma — metabolic syndrome», group 5 — control group (healthy), 50 participants. As part of the study of genetic predisposition to occupational bronchial asthma, IL5 rs2069812 polymorphism was determined. DNA samples were isolated from peripheral venous blood lymphocytes using phenol-chloroform extraction. Genotyping was performed by real-time polymerase chain reaction using primers and probes designed using PrimerQuest (Integrated DNA Technologies, Inc.). Results. Thus, for the first time, the genetic markers of the risk of occupational asthma under exposure to sensitizing substances, i.e. IL5 rs2069812 polymorphism, have been identified, which makes it possible to recommend the determination of this genetic marker during indepth periodic medical examinations of individuals working under conditions of exposure to sensitizing and irritating substances in the presence of clinical, functional, and immunological changes. Conclusion. The identified marker profiles of genotypes of occupational bronchial asthma can optimize the approach to diagnosis, treatment, and prevention of this pathology, as well as expand the range of criteria for predicting the course of the disease. When IL-5 polymorphism is detected during molecular genetic studies, patients need to be linked to care and undergo repeated pulmonary function tests once every 6 months and in-depth periodic medical exami nations in a specialized occupational pathology center with the mandatory participation of a pulmonologist, allergist/immunologist, and occupational pathologist, as well as with conducting extended functional and immunological studies once every 2 years.

Assessment of lung hyperinflation in occupational chronic obstructive pulmonary disease: a multicentric cross-sectional study

Occupational exposure is associated with elevated morbidity and lower quality of life in patients with chronic obstructive pulmonary disease (COPD). Static hyperinflation is an independent risk factor for all-cause mortality...

Features of the immune status in occupational chronic obstructive pulmonary disease of varying severity in coal mine workers

Introduction. The peculiarities of the clinical course of bronchopulmonary diseases, which occupy a large place in the structure of occupational diseases in coal mine workers, are largely due to a violation of immune reactivity, which is important to take into account for the development of effective preventive and therapeutic measures.
 The study aims to explore the features of the immune status in occupational chronic obstructive pulmonary disease of varying severity in coal mine workers.
 Materials and methods. The scientists have conducted a survey of 110 miners, who worked in underground conditions with an average concentration of aerosols of predominantly fibrogenic action at the workplace up to ten or more times higher than the maximum permissible concentrations, with an established diagnosis of occupational chronic obstructive pulmonary disease. The control group consisted of 89 trained miners who also worked in dust conditions above the maximum permissible concentrations, without bronchopulmonary pathology. The above groups had no statistical differences among themselves in age and work experience in dusty conditions. The authors also conducted an immunological examination.
 Results. Researchers have identified the features of the immune status in occupational chronic obstructive pulmonary disease — the development of combined immune insufficiency with damage to the humoral link of immunity (decrease in serum immunoglobulin G) and phagocytic activity of neutrophils. At the same time, we have an increased level of proteins of the acute phase of inflammation (C-reactive protein and haptoglobin) and an increased level of circulating immune complexes as an indicator of a high antigenic load. In patients with severe occupational chronic obstructive pulmonary disease, the suppression of the humoral link of immunity increases (a decrease in the relative and absolute amount of CD20+ and the level of serum immunoglobulin G), as well as the phagocytic activity of neutrophils compared with patients with chronic obstructive pulmonary disease of moderate severity and a comparison group that can contribute to the development and recurrence of the infectious and inflammatory process not only in the lungs, but also in other organs.
 Conclusion. The authors revealed the development of combined immune insufficiency with damage to the humoral link of immunity (decrease in serum immunoglobulin G) and phagocytic activity of neutrophils in miners with chronic obstructive pulmonary disease. With a severe degree of the disease, there are more pronounced violations of the humoral link of immunity and phagocytic activity of neutrophils.
 Ethics. This medical study with the participation of a person as a subject was carried out in compliance with the Ethical principles presented in the latest version of the Helsinki Declaration, developed by the World Medical Association.

Occupational Risks and Chronic Obstructive Pulmonary Disease in the Indian Subcontinent: A Critical Review.

Chronic obstructive pulmonary disease (COPD) is a significant public health concern in the Indian subcontinent, with high prevalence rates observed in countries like India, Pakistan, Bangladesh, and neighboring nations. This review article critically examines the occupational risks associated with COPD in the region and emphasizes the need for comprehensive preventive strategies. The review begins by providing background on COPD and highlighting its impact on individuals and the economy. It then explores the different occupational hazards that contribute to the development and progression of COPD, including exposure to airborne pollutants and chemicals, occupational dust, and smoking and secondhand smoke in the workplace. The existing occupational health and safety regulations in the Indian subcontinent are assessed, along with an evaluation of their effectiveness in addressing occupational risks for COPD. The review also highlights gaps and challenges in implementing and enforcing these regulations. The impact of COPD on occupational health and the economy is examined, emphasizing the burden it places on affected individuals and their ability to work. The economic implications of COPD-related productivity losses are evaluated, underscoring the importance of addressing occupational risks to improve workforce health and productivity. Prevention and mitigation strategies are explored, including an overview of preventive measures to reduce occupational risks for COPD, the significance of early detection and diagnosis of COPD in the workplace, and the implementation of engineering controls, personal protective equipment, and ventilation systems. The role of education and training programs for workers and employers is also discussed. The review identifies research gaps in the current understanding of occupational risks and COPD in the Indian subcontinent and suggests future research directions to address these gaps. It emphasizes the importance of collaborative efforts between researchers, policymakers, and industry stakeholders to generate evidence, inform policy decisions, and implement effective interventions.

Глутатион как прогностический фактор риска нарушения здоровья работающих лиц

Redox balance plays the key role in maintaining health. Optimizing glutathione levels has been proposed as a strategy for health promotion and disease prevention, although cause-effect relationships between glutathione status and disease risk or treatment have not been fully clarified. This study aims to estimate glutathione as a non-specific prognostic risk factor of health disorders in people exposed to industrial aerosols at their workplaces. Our observation covered the following occupational groups: workers employed at a metallurgic plant who contacted industrial aerosols (welding and silicon-containing aerosols with predominantly fibrogenic effects); patients with non-obstructive chronic industrial bronchitis (NCIB) without exacerbation; patients suffering from occupational chronic obstructive pulmonary disease (oCOPD) who were in a post-exposure period; workers who were not exposed to industrial aerosols at their workplaces. Total glutathione (TG), reduced glutathione (GSH) and oxidized glutathione (GSSG) were identified in whole blood by the Ellman method. Elevated GSSG levels (higher than 100 µmol/l) and low values of the GSH/GSSG ratio (less than 10 units) were identified in more than 50 % of the workers exposed to industrial aerosols. These markers were established to have diagnostic sensitivity of more than 50 %, diagnostic specificity of more than 85 % and prognostic significance of more than 80 % for the examined groups. The GSSG level and GSH/GSSG ratio can be used as a prognostic indicator of health disorders in workers exposed to industrial aerosols and a possibility of chronic bronchopulmonary pathology developing in future.

Glutathione as a prognostic factor of health risk in working population

Redox balance plays the key role in maintaining health. Optimizing glutathione levels has been proposed as a strategy for health promotion and disease prevention, although cause-effect relationships between glutathione status and disease risk or treatment have not been fully clarified. This study aims to estimate glutathione as a non-specific prognostic risk factor of health disorders in people exposed to industrial aerosols at their workplaces. Our observation covered the following occupational groups: workers employed at a metallurgic plant who contacted industrial aerosols (welding and silicon-containing aerosols with predominantly fibrogenic effects); patients with non-obstructive chronic industrial bronchitis (NCIB) without exacerbation; patients suffering from occupational chronic obstructive pulmonary disease (oCOPD) who were in a post-exposure period; workers who were not exposed to industrial aerosols at their workplaces. Total glutathione (TG), reduced glutathione (GSH) and oxidized glutathione (GSSG) were identified in whole blood by the Ellman method. Elevated GSSG levels (higher than 100 µmol/l) and low values of the GSH/GSSG ratio (less than 10 units) were identified in more than 50 % of the workers exposed to industrial aerosols. These markers were established to have diagnostic sensitivity of more than 50 %, diagnostic specificity of more than 85 % and prognostic significance of more than 80 % for the examined groups. The GSSG level and GSH/GSSG ratio can be used as a prognostic indicator of health disorders in workers exposed to industrial aerosols and a possibility of chronic bronchopulmonary pathology developing in future.

Chronic Obstructive Pulmonary Disease and Work: The Continuing Narrative

It has long been recognized that harmful inhaled workplace exposures can contribute to the development of chronic obstructive pulmonary disease (COPD). This article, intended for the clinician, summarizes some of this evidence and some areas of controversy. Current estimates based on pooled epidemiological analyses of population-based studies identify that approximately 14% of the burden of COPD (and 13% of the burden of chronic bronchitis) is attributable to such exposures. In addition to these approaches, various studies implicate specific exposures as contributing. Certain of these relating to cadmium, coal, and respirable crystalline silica are discussed in more detail. Despite this amassed evidence to date supporting associations between COPD and workplace exposures, there have been surprisingly few studies that have attempted to assess the attribution by experts of an occupational cause in cases of COPD. One study, using hypothetical cases of COPD, noted that while expert physicians were willing to make such an occupational link, this was only likely in cases with light smoking histories and a priori defined heavy occupational exposures. Relatively recent data relating to computed tomography (CT) scan appearances may give the clinician a further guide. Several studies from populations have now linked potentially harmful occupational exposures specifically with the presence of emphysema on CT scanning. It will be of interest to see if this finding, along with other clinical attributes of cases such as smoking and family histories, exclusion of asthma, genetic data, and the nature of workplace exposures, will increase the future diagnosis by clinicians of occupational COPD. In the interim, while better diagnostic approaches are developed, we suggest that consideration of an occupational cause is an important part of the clinical investigation of cases of COPD. Finally, we suggest that evidence-based workplace preventive strategies for occupational COPD should be informed by knowledge of which exposures are most important to reduce, and whether and when intervention to reduce exposure at an individual worker level is warranted.

Genotypes and frequencies of the TSLP gene variant rs1837253 in different occupational asthma phenotypes

Introduction. Currently, despite the fact that occupational asthma has long been considered as a separate, independent disease, recent studies pay more and more attention to its heterogeneity. Occupational asthma phenotyping was originally based on the identification of combinations of clinical characteristics of the disease, but now more and more data that allow understanding the cause of clinical differences at the molecular genetic level are emerging. Thus, molecular genotyping opens up new opportunities in the search for a more targeted and personalized approach to the treatment of occupational asthma, as well as in the development of an individual strategy for its prevention. The aim of the study was to determine the genetic risk markers for the development of oc cupational asthma under the influence of sensitizers by assessing the TSLP gene polymor phism rs1837253. Materials and methods. The study was conducted on the basis of the Department of Occupational Diseases and Clinical Pharmacology named after honored scientist of the Russian Federation professor V. V. Kosarev, FSBEI HE Samara State Medical University of the Ministry of Health of the Russian Federation, and the Department of Occupational Pathology, SBHI SR Samara Medical and Sanitary Unit No. 5 of the Kirovsky District. The study involved 170 patients with various phenotypes of occupational bronchial asthma (OBA) and 50 people in the control group: group 1 (42 people) — the phenotype «allergic occupational bronchial asthma», group 2 (36 people) — the phenotype «non-allergic occupational bronchial asthma», group 3 (58 people) — the phenotype «occupational bronchial asthma — occupational chronic obstructive pulmonary disease», group 4 (34 people) — the phenotype «occupational bronchial asthma — metabolic syndrome», group 5 (50 people) — the control group (healthy). As part of the study of genetic predisposition to occupational bronchial asthma,genetic polymorphisms of the rs1837253 TSLP gene were determined. DNA samples were isolated from peripheral venous blood lymphocytes by phenol-chloroform extraction. Genotyping was performed by real-time polymerase chain reaction using primers and probes developed with the PrimerQuest tool (Integrated DNA Technologies, Inc.). Results. Thus, for the first time, genetic risk markers for the development of occupational asthma under the influence of sensitizers have been identified: the TSLP gene polymorphisms rs1837253, which makes it possible to recommend determining these genetic markers during in-depth periodic medical examinations in persons working under exposure to sensitizing and irritating substances in the presence of clinical, functional, and immunological changes. Conclusion. The identified marker profiles of OBA genotypes can optimize the approach to the diagnosis, treatment and prevention of this pathology, as well as expand the range of criteria for predicting the course of the disease. If polymorphisms of the TSLP gene are detected during molecular genetic studies, patients need to be registered with a dispensary and require repeated examinations of the function of external respiration once every 6 months and in-depth periodic medical examinations in a specialized center of occupational pathology with the obligatory participation of a pulmonologist, an allergist-immunologist, an occupational pathologist, as well as conducting extended functional and immunological studies once every 2 years.

Exposure to occupational risk factors is associated with the severity and progression of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) results from a complex interaction between genes and the environment, and occupational exposures are an underappreciated risk factor. Until now, little research attention has been paid to the potential impact of occupational risk factor exposure on the COPD in China. The aim of this retrospective study was to analyze the role of occupational risk factor exposure on the severity and progression of COPD for exploring new prevention strategies for this disease. This study adopted a random cluster-sampling method. Five grade-A tertiary hospitals that met the inclusion criteria were selected as the survey sites, and patients with COPD hospitalized in these hospitals from January 1, 2019, to December 31, 2019, were selected as the research subjects. Data of the patients diagnosed with COPD met the Global Initiative for Chronic Obstructive Lung Disease (2019) criteria and were collected from the computerized medical record databases. Among 4082 investigated COPD patients, 1063 (26%) were found to have occupational risk factor exposure history. The top 3 industries with a large COPD case number and a history of occupational risk factor exposure ranked in the order of agriculture (including farming, forestry, animal husbandry, and fishery), manufacturing, and mining. Further multivariate logistic regression analysis indicated that when setting a low exposure level as a reference, medium and high exposure levels were correlated with the severity of COPD (odds ratio values were 2.837 and 6.201, respectively, P < .05). Linear regression analysis showed that cumulative exposure to occupational risk factors was negatively correlated with the forced expiratory volume in 1-second percentage of COPD patients, with a correlation coefficient of 0.68. Our results indicated that occupational risk factor exposure levels were related to the severity of COPD significantly. The incubation period of COPD in the exposure group was significantly shorter than that in the non-exposure group. To prevent worked-related COPD, special attention and control efforts should be taken to reduce the level of occupational risk factors such as organic dust, irritating chemicals, etc in the work environments, especially in the industries of agriculture, forestry, animal husbandry and fishery, manufacturing, and mining.

Distribution of allele and genotype frequencies for the IL5 rs2069812 polymorphism in occupational asthma according to its phenotype

Molecular genotyping opens up fresh opportunities to search for a more targeted and personalized approach to treating occupational asthma (OA) and to developing an individual strategy for its prevention. Objective. To determine genetic risk markers for OA under the influence of sensitizers, by assessing IL5 rs2069812 polymorphic variants. Subjects and methods. The investigation enrolled 170 patients with different OA phenotypes. The patients were divided into groups according to the OA phenotype: 1) 42 patients with an allergic OA phenotype; 2) 36 patients with a non-allergic OA phenotype; 3) 58 patients with an OA + occupational chronic obstructive pulmonary disease (COPD) phenotype; 4) 34 patients with an OA + metabolic syndrome (MS) phenotype. A control group included 50 healthy individuals. IL5 rs2069812 polymorphisms were determined as part of the study of genetic predisposition to OA. Phenol chloroform extraction was used to isolate DNA from peripheral lymphocyte samples. Genotyping was done by real-time polymerase chain reaction with primers and probes designed using the PrimerQuest program (Integrated DNA Technologies, Inc., USA). Results. The genetic markers for OA were found for the first time after exposure to sensitizers, IL5 rs2069812 polymorphic variants, which can recommend that this genetic marker should be identified during thorough periodic medical examinations in individuals with clinical, functional, and immunological changes upon occupational exposure to sensitizing and irritating substances. Conclusion. The identified marker profiles of the genotypes of OA can optimize an approach to diagnosing, treating, and preventing this disease, and expanding the range of criteria for predicting its course. When a polymorphism in the IL5 gene is detected using a molecular genetic study, the patient needs to be registered for follow-up, repeated respiratory function tests once every six months, thorough periodic medical examinations in a specialized center of occupational pathology, by obligatorily attracting a pulmonologist, an allergist/immunologist, and an occupational pathologist, as well as extensive functional and immunological studies once every two years.

КЛИНИКО-ЛАБОРАТОРНЫЕ ОСОБЕННОСТИ ФЕНОТИПОВ БОЛЬНЫХ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЁГКИХ ПРОФЕССИОНАЛЬНОЙ ЭТИОЛОГИИ

Introduction. The pathogenetic differences between the phenotypes of occupational chronic obstructive pulmonary disease which develop after silica-containing dust exposure are still unclear. The research aims to study the relationship of occupational chronic obstructive pulmonary disease clinical phenotypes with inflammation. Material and methods. 123 patients were included in the study. Basing on the forced expiratory volume in 1 second, clinical symptoms and the history of exacerbations, the patients were divided into 4 groups (group 1 - 30 people (24%) phenotype «B1», group 2 - 16 people phenotype «B2» (13%), group 3 - 32 people (26%) phenotype «D», group 4 - 45 people (36%) phenotype «A»). The groups of patients were comparable in age, body mass index, duration of working period in hazardous conditions, the number of cardiovascular comorbidities (p&gt;0.05), but differed in spirometry, the number of exacerbations and the number of eosinophils in the blood (p = 0.02, p = 0.0001 and p=0.006) and therapy. Results and discussion. The concentration of hyaluronic acid in the blood serum was increased in all groups of the patients, but most of all in the «D» phenotype, 204.5 ng/ml, p=0.0024. Immunoglobulin A was above the normal level in the patients with phenotypes «B2» and «D»6,32 and 9.84 mg/l, p=0.0059. Endothelial synthase in phenotypes «B2» and «D» was more than 2 times higher than in other groups (57.9 and 64.5 pg/ml, р=0.013). The groups did not differ in terms of endothelin-1. Correlation analysis revealed statistically significant (p&lt;0.05) correlations between exacerbations, eosinophils, comorbidities, forced expiratory volume in 1 second. Immunoglobulin A had a direct relationship with endothelial synthase and an inverse relationship with forced expiratory volume in 1 second. Hyaluronic acid directly correlated with the number of exacerbations and eosinophils and inversely with forced expiratory volume in 1 second. Endothelial synthase had a direct relationship with eosinophils and cardiovascular comorbidities and an inverse relationship with forced expiratory volume in 1 second. Conclusion. The concentration of hyaluronic acid, immunoglobulin A and endothelial synthase in the blood serum reflects the activity of remodelling bronchi, the risk of exacerbations and connections to cardiovascular comorbidities.

Hyaluronic acid as a predictor of exacerbation of occupational chronic obstructive pulmonary disease

The frequency of exacerbations of chronic obstructive pulmonary disease (COPD) is one of the main factors determining the outcome. The search for biomarkers which reflect the risk of exacerbations is one of the urgent scientific and practical objectives. Aim. The study aimed to analyze the relationship between the serum concentration of hyaluronic acid (HA) and the frequency of exacerbations of occupational COPD caused by exposure to silica dust and to substantiate the use of HA as a predictor of exacerbations of COPD. Methods. 78 individuals with a diagnosis of occupational COPD were examined. Respiratory function was assessed based on forced vital capacity of the lungs (FVC, %), the forced expiratory volume in 1 second (FEV1, %) and the calculated ratio of these parameters (FEV1/FVC, %), i.e., modified Tiffno index. The serum concentration of hyaluronic acid (ng/ml) was determined in all individuals using solid-phase enzyme-linked immunosorbent assay (ELISA). The absolute blood level of eosinophils (cell/μl) was determined by a unified method of morphological study of hemocytes with white blood cell differential count. Results. Serum HA concentration in patients with occupational COPD with frequent exacerbations was 25% higher than in the patients with rare exacerbations (the difference was statistically significant; р = 0,004). The analysis of the obtained data showed that the most significant moderate correlation was found between the level of HA and the frequency of COPD exacerbations (direct relationship, r = 0.32; p &lt; 0.05), and FEV1 and the frequency of COPD exacerbations (feedback, r = -0.32;p &lt; 0.05). A weak relationship was found between the relative number of eosinophils and the frequency of COPD exacerbations (direct relationship, r = 0.2; p &lt; 0.05). Weak correlations were also found between the level of HA and FEV1 (feedback, r = -0.23; p &lt; 0.05), between the level of HA and the relative number of eosinophils (direct relationship, r = 0.18; p &lt; 0.05). Conclusion. Quantitative analysis of serum HA in patients with occupational COPD can be used in clinical practice as a biochemical marker for assessing the risk of exacerbations and progression of bronchopulmonary pathology.

Analysis of comorbid pathology in patients with occupational chronic obstructive pulmonary disease from exposure to industrial aerosols according to the regional register of Occupational Diseases of the Novosibirsk region

Introduction. In the course of the work the scientists have conducted an analysis of comorbid pathology was carried out in patients with occupational chronic obstructive pulmonary disease (OCOPD) who underwent inpatient examination at the Clinic of the Novosibirsk Research Institute of Hygiene of Rospotrebnadzor. The study aims to research the frequency and nature of comorbid pathology in patients with OCOPD who underwent inpatient examination at the Clinic of the Novosibirsk Research Institute of Hygiene of Rospotrebnadzor. Materials and methods. In the course of the work we have conducted a retrospective analysis of the medical histories of patients with occupational chronic obstructive pulmonary disease who were examined and treated at the Clinic of Occupational Pathology. Researchers have carried out the analysis of the histories using the regional register of occupational diseases of Novosibirsk and the Novosibirsk Region created by the staff of the Research Institute of Hygiene and the permanent regional register of Occupational Diseases. Results. The study made it possible to determine the structure of comorbid pathology of patients with occupational chronic obstructive pulmonary disease who were examined and treated at the Clinic of Occupational Pathology and School-related Diseases of the Novosibirsk Research Institute of Hygiene of Rospotrebnadzor. Conclusion. Comorbid pathology affects the severity of the patient's condition with OCOPD. We have made conclusions about the need for early diagnosis of occupational chronic obstructive pulmonary disease and its comorbid conditions, an individualized approach to each patient for effective rehabilitation. Ethics. The material of the article was approved by the Ethics Committee at the Novosibirsk Scientific Research Institute of Hygiene of Rospotrebnadzor (Protocol No. 3 of June 16, 2022).

Occupational COPD-The most under-recognized occupational lung disease?

Chronic obstructive pulmonary disease (COPD) is caused by exposure to noxious particles and gases. Smoking is the main risk factor, but other factors are also associated with COPD. Occupational exposure to vapours, gases, dusts and fumes contributes to the development and progression of COPD, accounting for a population attributable fraction of 14%. Workplace pollutants, in particular inorganic dust, can initiate airway damage and inflammation, which are the hallmarks of COPD pathogenesis. Occupational COPD is still underdiagnosed, mainly due to the challenges of assessing the occupational component of the disease in clinical settings, especially if other risk factors are present. There is a need for specific education and training for clinicians, and research with a focus on evaluating the role of occupational exposure in causing COPD. Early diagnosis and identification of occupational causes is very important to prevent further decline in lung function and to reduce the health and socio‐economic burden of COPD. Establishing details of the occupational history by general practitioners or respiratory physicians could help to define the occupational burden of COPD for individual patients, providing the first useful interventions (smoking cessation, best therapeutic management, etc.). Once patients are diagnosed with occupational COPD, there is a wide international variation in access to specialist occupational medicine and public health services, along with limitations in workplace and income support. Therefore, a strong collaboration between primary care physicians, respiratory physicians and occupational medicine specialists is desirable to help manage COPD patients' health and social issues.

Diagnostic markers of exacerbation of chronic obstructive pulmonary disease in workers exposed to industrial aerosols and tobacco

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the most common occupational diseases registered in workers exposed to dust for a long time. This disease significantly worsens the quality of life, requires constant monitoring in the centers of occupational pathology and regular preventive measures. The proportion of COPD in the structure of occupational diseases has not changed significantly for decades, high rates of disability and premature mortality characterized this disease. The study aims to research the diagnostic parameters of COPD exacerbation under the influence of industrial aerosols and tobacco in the clinic of occupational diseases. Materials and methods. Researchers examined 153 patients with occupational COPD (toxic gases and inorganic dust). The comparison group consisted of 103 patients with smoking COPD. We established the diagnosis of COPD in accordance with the criteria of GOLD 2011. The duration of the study was 5 years. The authors conducted a complex of clinical and laboratory studies in all patients with an emphasis on the diagnostic parameters of COPD exacerbation and lung function. The critical significance level is p=0.05. Results. The development of occupational COPD under the influence of industrial aerosols and tobacco affects the frequency and predominant phenotype of exacerbations. Rare but severe exacerbations, mainly with eosinophilic type of inflammation, are present in COPD from the action of toxic gases. They respond well to therapy with systemic GCS. With COPD from the action of dust, hospitalization is not necessary for short-term exacerbations with neutrophilic type of inflammation, since such exacerbations respond to therapy with bronchodilators, and a significant proportion of exacerbations require the use of antibacterial therapy. Also, in COPD from the action of toxic gases, the experience of exposure to aerosols and gases of the production environment is an independent predictor of any exacerbations. But we do not have data on the significance of the length of service and the intensity of dust exposure. Conclusion. The risks of exacerbations of occupational COPD and the predicted features of their course depend on the etiological production factor, its intensity and duration of exposure. Clinical features determine different tactics of treatment and prevention of health deterioration. With the severity of COPD exacerbation from the action of toxic gases, symptoms of emphysema and hypoxemia are characteristic, with COPD from the action of dust, symptoms of bronchial obstruction, emphysema and hypoxemia are characteristic. Obtained results can use to construct risk meters of exacerbations and the scale of effectiveness of rehabilitation measures, to revise the standards of treatment and prevention of patients with COPD of professional genesis, as well as for the differential diagnosis of occupational obstructive pulmonary disease. Limitations. The study was conducted on the basis of Novosibirsk State Medical University and on the basis of the City Clinical Hospital No. 2. The limitations of the study may be the unidirectionality of the study performed and the small sample of patients participating in the research. Ethics. All patients have signed an informed consent form. The study program, the content of the informed consent, and the materials of the article were approved by the local ethics committee of Novosibirsk State Medical University and City Clinical Hospital No. 2.

Occupational causes of chronic obstructive pulmonary disease: an update.

This brief narrative review aims to highlight relevant recent updates on occupational causes of chronic obstructive pulmonary disease (COPD). The most recent literature has been searched for any new relevant association between occupational exposures and COPD. Only large epidemiological studies of high quality have been included. Beyond the more traditional exposures, such as mineral or organic dusts, new chemicals have emerged as potential occupational causal agents for COPD. In particular, pesticides and cleaning products, including disinfectants, that have shown also positive exposure-response trends. For cleaning products, some specific chemicals have been identified, but for pesticides the identification of specific causal compounds is more challenging. The biological underlying mechanisms are still under study. In the recent literature, occupational exposure to pesticides and cleaning products has emerged as potential cause of COPD. Awareness on occupational causes of COPD should increase among all stakeholders, from health professionals to public to prevent the associated public health burden. More studies on identifying the specific causal agents and mechanisms are needed to focus preventive strategies.