Occupational Lung Disease Research Articles

Occupational impact of increased dust duration on pulmonary capacities of workers.

Occupational lung diseases are usually caused due to chronic exposure to dust or irritating toxic substance. In India, morbidity due to occupational lung diseases has been reported to be high. Therefore present study was carried out to determine the impact of long term occupational barites dust exposure on pulmonary capacities of workers. Methods: The present cross-sectional study was conducted on 322 participants within age group of 22-60 years in 2013. Data regarding demographic, behavioural & occupational characteristics were collected by pre-designed questionnaire. Spirometry is an important tool for detection of pulmonary diseases in its earlier stages. Pulmonary functions were assessed by Schiller spirometry in 240 surface mine exposed workers who engaged in direct mining activities & 92 age matched healthy administrative staff workers as non exposed workers. Results: It was observed that 15.8% of exposed workers had restrictive pulmonary impairment as compared to 6.5% among non-exposed workers and the difference was statistically significant (p

P1751 Right ventricular dysfunction in heart failure patients with reduced ejection fraction with and without chronic respiratory diseases: A treacherous combination for the ominous outcome?

Abstract Background Right ventricular (RV) dysfunction is common in heart failure patients. In the present study, we determined the impact of echocardiography defined RV dysfunction on outcomes in heart failure patients with reduced ejection fraction (<40%, HFrEF) with and without chronic respiratory diseases (CRDs: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome). Methods A total of 1264 HFrEF patients (Mean age: 68 ± 13 years; male: 76.3%) referred to our department between 2009 and 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (12-40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed by multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results The proportion of NYHA functional class III-IV was 42.2%. Mean LVEF was 29.4 ± 7.0%. CRDs was identified in 276 (21.8%) patients, 399 (30.5%, without CRDs n = 290, with CRDs n = 109) patients died (n = 386) or underwent HTx (n = 13). All-cause mortality/HTx was significantly higher in HFrEF patients with CRDs than without CRDs (39.5% vs. 29.4%, P = 0.001). Cox regression analysis showed that age, BMI, and other cardiac risk factors and comorbidities including diabetes, atrial fibrillation, coronary artery disease, kidney dysfunction, and anemia were associated with all-cause mortality/HTx (all P < 0.05) besides CRDs. Multivariable Cox regression models showed that sPAP (HR 1.016, P < 0.001), TAPSE (HR 0.964, P = 0.003), RAA (HR 1.030, P < 0.001), and RVD (HR 1.029, P < 0.001) were independent determinants of all-cause mortality/HTx in HFrEF patients without CRDs, but not in HFrEF patients with CRDs after adjusted for above mentioned confounders. With the cut-off values (sPAP > 40mmHg, TAPSE < 12mm, RAA > 25cm², and RVD > 36mm) derived from the 3rd quartiles, patients without CRDs were further grouped as normal RV function (all 4 parameters normal, n = 427); mild to moderate RV dysfunction (1 or 2 parameters abnormal, n = 467) and severe RV dysfunction (≥3 parameters abnormal, n = 94). Risk of all-cause mortality/HTx was significantly higher in HFrEF patients with severe (51.1%) and mild to moderate RV dysfunction (34.7%) as compared to patients with normal RV function (18.7%, severe vs. normal: HR 1.616 , 95% CI 1.232-2.119, P = 0.001; mild to moderate vs. normal HR: 2.657, 95% CI 1.845-3.824, P < 0.001). Conclusions RV dysfunction is significantly associated with increased all-cause mortality in HFrEF patients without CRDs. Increased sPAP, RAA, RVD and decreased TAPSE are independent determinants of worse outcomes in HFrEF patients without CRDs, but not in HFrEF patients with CRDs.

Risk factors associated with respiratory morbidity among puffed rice workers in an urban area of Davanagere city

Introduction: Occupational respiratory disease can be defined as an acute or chronic disorder that arises from the inhalation of air-borne agents in the work place. Puffed rice is a famous food item in Karnataka, which is produced in a cluster of small units. Materials and Methods: A Cross sectional study was conducted among puffed rice workers in Bashanagar, urban field practice area of SSIMS & RC, Davanagere. From January to December 2017. The study population included 550 puffed rice unit workers. Results: The prevalence of respiratory morbidity among the puffed rice workers in the present study was found to be 41.0%. Among them 51(9.2%) puffed rice workers reported Obstructive lung diseases and majority of the workers 175(31.8%) reported Restrictive pattern of lung diseases.Conclusion: The risk of Respiratory morbidity was significantly associated with Age, gender, Education, duration of the work and type of work.

Study of Clinico-Radiological Profiles of Patients with Occupational Interstitial Lung Disease in a Tertiary Care Center.

Study of Clinico-Radiological Profiles of Patients with Occupational Interstitial Lung Disease in a Tertiary Care Center.

Symptomatic pulmonary siderosis in scissors/knife sharpening worker: A case report

Pulmonary siderosis is a rare occupational lung disease. Traditionally, it has been considered a “benign pneumoconiosis” because of the absence of associated clinical symptoms or pulmonary fibrosis. However, few authors have reported the evidence of pulmonary symptoms with lung fibrosis on high-resolution computed tomography and lung biopsy. Symptomatic pulmonary siderosis in scissors/knife sharpening worker has not been described in past literature. We report a case of biopsy proven symptomatic pulmonary siderosis in scissors/knife sharpening worker, who was unnecessarily treated with antitubercular therapy for 3 months.

Airborne Levels of Lung Carcinogens at an Ascon Manufacturing Site

ABSTRACT We assessed the airborne concentrations of the dust (both total and respirable), quartz, polycyclic aromatic hydrocarbons, and elemental carbon in an ascon manufacturing environment to determine the exposure to operators and the likelihood of developing occupational respiratory disease. The Ascon production process is divided into four stages, namely, feeding, drying, mixing, and loading. During the feeding stage, the aggregate is transferred via hoppers to underground conveyors. The drying process removes moisture from the aggregate and maintains the required temperature for combining the aggregate, asphalt, and additives into ascon during the mixing stage. Finally, the ascon is disgorged from an outlet on the mixing machine and loaded onto dump trucks. The airborne concentrations of the total dust, respirable dust, and quartz measured at Hopper 1 and Hopper 6 were 8.540, 1.536, and 0.125 mg m–3, and 10.092, 3.989, and 0.331 mg m–3, respectively. The amounts of respirable dust and quartz by the vibrating screen totaled 12.362 and 1.645 mg m–3, respectively, and that of elemental carbon near a dryer burner equaled 0.001 mg m–3. The levels of the total dust, respirable dust, and quartz at the mixer outlet and in the dump truck zone were observed to be 0.685, 0.265, and 0.011 mg m–3, and 0.419, 0.036, and 0.011 mg m–3, respectively. Of the measured substances, only naphthalene was found at concentrations significantly lower than the permissible exposure limit (10 ppm), reaching only 0.274, 0.138, 0.192, and 0.237 ppm for the dryer burner, dump truck zone, dump truck waiting zone, and operational room, respectively. The conveyors on the ground, vibratory sieve, Bunker C oil tank, and mixer also exhibited very low concentrations of naphthalene—0.074, 0.088, 0.080, and 0.074 ppm, respectively. Relatively low levels of personal exposure to the total and the respirable dust (0.027 and 0.013 mg m–3) were measured during the operational tasks. However, operators were exposed to higher levels of respirable dust and quartz, 4.260 and 0.548 mg m–3, while cleaning the underground conveyors. Based our results, we conclude that whereas PAHs are emitted at very low concentrations during ascon production, quartz-containing aggregate dust is released in large quantities. This study presents the first environmental evaluation at an ascon production facility in terms of substances that cause lung cancer.

A thermogravimetric analysis application to determine coal, carbonate, and non-carbonate minerals mass fractions in respirable mine dust

Occupational lung diseases such as coal worker’s pneumoconiosis, often called black lung, are caused by exposures to respirable coal mine dust. Dust composition is increasingly understood as an important disease factor, and it can vary significantly depending on dust source materials and generation processes. For regulatory compliance purposes, the mass concentration and quartz percentage of respirable dust are monitored in U.S. coal mines, but the whole composition is not typically determined. Previous work has indicated that thermogravimetric analysis (TGA) can be used to apportion the respirable dust mass to three important component fractions (i.e., coal, non-carbonate minerals, and carbonate), which should generally correlate with three different dust sources (i.e., coal strata, rock strata, and limestone rock dusting products being applied in the mine). However, a primary shortcoming of that previous work was use of fibrous sampling filters, which limited dust recovery and thus analytical accuracy. Here, an improved TGA application is presented using smooth polycarbonate filters. Based on experiments with laboratory-generated dust samples (masses ranging between 95–1,319 µg), the TGA-derived mass fractions (reported as percentage values) for all three components were found to generally be within ±10% of expected values.

Sentinel approach to detect emerging causes of work-related respiratory diseases.

The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD). To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK. Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD. A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses). Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs.

Rare occupational respiratory diseases

This paper reviews rare occupational respiratory diseases with uncommon causes. Among others, it refers to the Ardystil syndrome characterized by the occurrence of organizing pneumonia in the textile printing sprayers, as a result of inhalation of substances used in aerographic textile printing. Furthermore, secondary pulmonary alveolar proteinosis due to exposure to chemical and organic dusts was described, and so was the occurrence of the "vineyard sprayer's lung" in farm workers in Portugal. Eosinophilic bronchitis, showing a strong resemblance to bronchial asthma, was found to occur, among others, in a baker, a nurse and workers exposed to acrylates, α-amylase or welding gases. Occupational exposure to diacetyl in popcorn production workers might also create a threat to their respiratory system. A newly recognized factor that may cause bronchitis and lung diseases is the fiberglass used by workers building small boats and ships. An increased risk for respiratory ailments is observed in people employed in the textile industry, exposed to commodities or cotton dust. Even the resources used to protect different surfaces against moisture have been recognized as the causative agents of lung diseases. The rare occurrence of some occupational respiratory diseases enables a detailed analysis of the epidemiology and evaluation of the relationship between the etiologic agents and the development of the disease. This literature review highlights the fact that most respiratory diseases require a special analysis of occupational and environmental exposure. Med Pr. 2020;71(1):89-104.

P.051 Improvements in workplace productivity in working patients with major depressive disorder: results from the AtWoRC study

Work-related asthma (WRA) is the most common chronic occupational lung disease in the developed world. Several factors including sociodemographic status and occupation/industry increase the risks of developing WRA. In this study, we sought to identify changes in patterns and characteristics among patients with WRA over a 15-year period in an occupational lung disease clinic.We performed a retrospective analysis of patients with WRA charts at the Occupational Lung Disease Clinic of a University Hospital in Toronto, Canada. Patients were divided into two periods classified by first attendance at the clinic 2000 through 2007 and 2008 through 2015. Comparisons between the two periods included: sociodemographic characteristics, smoking status, occupations, exposures, and submitted workers’ compensation claims.Fewer occupational asthma cases were seen in the more recent period vs the earlier period (40 vs 74 cases), with a smaller reduction in work-exacerbated asthma cases (40 vs 58). The recent period included a significantly smaller proportion employed in the manufacturing industry and isocyanate-induced cases compared with the earlier period. An increased proportion were employed in health-care and education industries (primarily cleaners and teachers) in the recent period, consistent with a corresponding increased frequency of cleaning agents and dust exposures.The changes observed in work sectors in the patients with WRA in this clinic in Toronto are consistent with reductions reported in Ontario workers’ compensation claims for occupational asthma and may relate to preventive measures. Cleaners and teachers should be a focus of further intervention measures for work-related asthma.

Evidence-based occupational health and safety interventions: a comprehensive overview of reviews

ObjectivesOccupational injuries and diseases are a huge public health problem and cause extensive suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS) guidelines are still not based...

Dynamics of the occupational respiratory diseases in Bulgaria in the period 2009-2016

Abstract Background The number of occupational respiratory diseases has declined in recent years in Bulgaria. This is the result of technological advance, mechanization and automation of the processes generating high levels of dust in the work environment; adequate ventilation; personal protective equipment and, last but not least, the training of workers on preventive approaches. Methods The aim of the study is to find out the trends of registered occupational respiratory diseases in Bulgaria in 2009-2016, according to official statistics. Analytical and statistical methods were used. Results In 2016, the number of occupational diseases (n = 33), registered in Bulgaria decreased by 71.55% compared to 2009 (n = 116). In 2009, the relative share of silicosis from respiratory occupational diseases was 47.54% (n = 29), while in 2016 it grew to 64.29% (n = 9). Its share is also increasing as part of all occupational diseases in Bulgaria from 25% in 2009 to 27,27% in 2016. The registered cases of chronic rhinitis, nasopharyngitis and pharyngitis for the whole period are only 2, of professional asthma - 3; of chronic bronchitis - 5, less than cases of asbestosis - 9. In 2009, there were five reported cases of talcosis and the total number of cases of siderosis was 23 for the period of eight years. There are 4 cases of other pneumoconiosis and 2 of pneumoconiosis associated with tuberculosis, as well as 10 cases of toxic pulmonary fibrosis during the whole period. Conclusions It is worth noting the small number of occupational respiratory diseases that could be caused by other factors not necessarily related to the work environment, such as chronic bronchitis and asthma, although they are significantly more frequent than those mandatory caused by occupational hazards such as silicosis, asbestosis and toxic pulmonary fibrosis. This means that a significant proportion of these cases are counted as common chronic non-communicable diseases with significant negative social consequences. Key messages The registered occupational respiratory diseases decrease, but the relative share of those with strictly professional etiology, such as silicosis, is growing. A significant proportion of occupational respiratory diseases are reported as chronic non-communicable diseases.

THE ROLE OF INDUSTRIAL AEROSOLS IN THE DEVELOPMENT OF ALLERGIC RESPIRATORY DISEASES AND MEASURES TO REDUCE THEM

Introduction. Industrial aerosols remain one of the main sources of development of occupational respiratory diseases of allergic etiology, leading to the early and permanent disability of qualified industrial workers. Material and methods. A retrospective analysis of the prevalence of occupational diseases of the respiratory tract from exposure to industrial aerosols according to statistical records and the first time established occupational diseases registration logs in the clinic for the period from 2008 to 2017 was carried out. Results. According to the analysis of occupational respiratory diseases in the Republic of Bashkortostan and the sanitary and hygienic characteristics of working conditions, the development of occupational allergic diseases of the respiratory organs was established in 54% of cases to be associated with exposure to aerosols of complex chemical composition exceeding the maximum permissible concentrations. Discussion. The working conditions of employees in a number of industries are characterized by the predominant effect of industrial aerosols of complex composition influenced the formation of occupational allergic diseases of the respiratory system. Adverse microclimatic conditions at the workplace in combination with a chemical factor are aggravating factors. The largest number of cases of occupational respiratory diseases is registered in the manufacturing sectors of the economy, mining companies, and the construction industry. Conclusion. Based on the studies conducted, measures have been developed to reduce the levels of exposure to industrial aerosols and to maintain workers’ health.

An impact of pneumococcal vaccination on exacerbations of occupational lung diseases

Dust-related diseases are the most common occupational diseases with significant economic burden. The purpose of this study was to assess an impact of pneumococcal vaccination on exacerbation rate of occupational lung diseases. Methods. Patients with occupational lung diseases were vaccinated with pneumococcal polysaccharide 23-valent vaccine (PPV23) or pneumococcal conjugate vaccine (PCV13) and then were followed-up for long time. We analyzed the rate of exacerbations of occupational lung diseases at baseline and during 5 years after the vaccination. The immune status, anti-IgG antibodies and antibodies against PPV23 polysaccharides were measured in blood; lactoferrin and IgA were measured in saliva. Exacerbations were determined retrospectively based on outpatient medical records. Results. A rate of exacerbations significantly decreased over two years after the vaccination with PPV-23 followed by an increase to the end of the third year and a significant increase to the end the fourth year; the latter exceeded the pre-vaccination exacerbation rate. After re-vaccination with PPV23, the exacerbation rate decreased and reached the lowest rate two years after the revaccination. This result was maintained over five years with a slight transient decrease during the fourth year. This could be explained by lack of immune memory cells after the re-vaccination compared to primary vaccination and to the risk of B-cell pool depletion. When PCV13 vaccine was used for re-vaccination a year after primary vaccination with PPV23, the exacerbation rate sharply decreased a year after the re-vaccination with maintenance of the effect during three subsequent years and a significant decrease to the end of the fourth year. In a subgroup of patients with pneumoconiosis who were primarily vaccinates with PCV13 without further re-vaccination, the exacerbation rate significantly reduced a year after the vaccination with further reduction during five years. The exacerbation rates were similar in this subgroup and in patients vaccinated sequentially with PCV13 and PPV23. Conclusion. The long-term immune response could be provided by conjugation caused the memory cell formation compared to PPV23 vaccine.

EPIDEMIOLOGICAL STUDY OF SILICOSIS WITH BILATERAL SPONTANEOUS PNEUMOTHORAX IN RAJASTHAN

Background: Silicosis is reported to be an occupational lung disease, which is caused by the inhalation of silica dust. Workers in occupations related to silica dust exposure are characterized by increased foci of fibrogenesis which result in radiological and pathological findings in the lungs. In most circumstances silicosis only develops subsequent to substantial occupational exposures.
 Material & Methods: The present prospective study was conducted at department of respiratory medicine of our tertiary care hospital. The study was an observational study conducted during a period of one year. The study done at 95% confidence interval at 10% of maximum allowable error. All patients who were diagnosed with silicosis were enrolled into the study.
 Results: In the present study, all patient had cough at presentation out which 7 (70%) patients had dry cough and 3 patients with productive coughs, four patients experienced loss of appetite. Eight (80%) patients had a history of smoking. Chest X-rays of all patients revealed bilateral, widespread, reticulonodular, and nodular appearances. Six patients had work on crusher machine and four patients as manual stone cutter. Pneumothorax was located bilaterally in all cases.
 Conclusion: We concluded from the present study that inhalation of quartz dust or silica dusts was commonly associated with adverse health effects and it can cause serious morbidity like secondary spontaneous pneumothorax and mortalities.
 Keywords: Silicosis, occupational lung disease, secondary spontaneous pneumothorax.

Recent Trend of Occupational Respiratory Disease

Recent Trend of Occupational Respiratory Disease

P3551Right ventricular dysfunction in heart failure patients with reduced ejection fraction with and without chronic respiratory diseases: A treacherous combination for the ominous outcome?

Abstract Background Right ventricular (RV) dysfunction is common in heart failure patients. In the present study, we determined the impact of echocardiography defined RV dysfunction on outcomes in heart failure patients with reduced ejection fraction (<40%, HFrEF) with and without chronic respiratory diseases (CRDs: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome). Methods A total of 1264 HFrEF patients (Mean age: 68±13 years; male: 76.3%) referred to our department between 2009 and 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (12–40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed by multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results The proportion of NYHA functional class III-IV was 42.2%. Mean LVEF was 29.4±7.0%. CRDs was identified in 276 (21.8%) patients, 399 (30.5%, without CRDs n=290, with CRDs n=109) patients died (n=386) or underwent HTx (n=13). All-cause mortality/HTx was significantly higher in HFrEF patients with CRDs than without CRDs (39.5% vs. 29.4%, P=0.001). Cox regression analysis showed that age, BMI, and other cardiac risk factors and comorbidities including diabetes, atrial fibrillation, coronary artery disease, kidney dysfunction, and anemia were associated with all-cause mortality/HTx (all P<0.05) besides CRDs. Multivariable Cox regression models showed that sPAP (HR 1.016, P<0.001), TAPSE (HR 0.964, P=0.003), RAA (HR 1.030, P<0.001), and RVD (HR 1.029, P<0.001) were independent determinants of all-cause mortality/HTx in HFrEF patients without CRDs, but not in HFrEF patients with CRDs after adjusted for above mentioned confounders. With the cut-off values (sPAP>40mmHg, TAPSE<12mm, RAA>25cm2, and RVD>36mm) derived from the 3rd quartiles, patients without CRDs were further grouped as normal RV function (all 4 parameters normal, n=427); mild to moderate RV dysfunction (1 or 2 parameters abnormal, n=467) and severe RV dysfunction (≥3 parameters abnormal, n=94). Risk of all-cause mortality/HTx was significantly higher in HFrEF patients with severe (51.1%) and mild to moderate RV dysfunction (34.7%) as compared to patients with normal RV function (18.7%, severe vs. normal: HR 1.616, 95% CI 1.232–2.119, P=0.001; mild to moderate vs. normal HR: 2.657, 95% CI 1.845–3.824, P<0.001). Conclusions RV dysfunction is significantly associated with increased all-cause mortality in HFrEF patients without CRDs. Increased sPAP, RAA, RVD and decreased TAPSE are independent determinants of worse outcomes in HFrEF patients without CRDs, but not in HFrEF patients with CRDs.

P4513Impact of right ventricular dysfunction on outcome in heart failure patients with mid-range ejection fraction with and without chronic respiratory diseases

Abstract Background The impact of right ventricular (RV) dysfunction on outcome of heart failure patients with mid-range left ventricular ejection fraction (HFmrEF, 40–49%) is not well characterized yet. In this study, we observed the association between echocardiography defined RV dysfunction with outcomes and if the outcome was jointly affected by co-existed chronic respiratory diseases (CRD: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome) in HFmrEF patients Methods 1090 HFmrEF patients referred to our department between 2009 and 2017 were included in this study. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (15–38) months. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed with the use of multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results Mean age was 69±13 years and 73.4% were male. The proportion of NYHA functional class III or IV was 24.8%. CRD was identified in 209 (19.2%) patients. 280 patients (25.7%, without CRD: 204, with CRD: 76) died and 2 patients (without CRD) underwent HTx. All-cause mortality/HTx was significantly higher in HFmrEF patients with CRD than without CRD (36.4% vs. 23.4%, P<0.001). Besides CRD, Cox regression analysis showed that age, body mass index, and cardiac risk factors and comorbidities including diabetes, atrial fibrillation, dyslipidemia, coronary artery disease, kidney dysfunction (eGFR <60ml/min/1.73qm), anemia were associated with increased all-cause mortality/HTx (all P<0.05). Multivariable Cox regression models showed that sPAP (HR 1.015, P=0.002) and TAPSE (HR 0.962, P=0.004) were independent determinants of all-cause mortality/HTx in patients without CRD, while sPAP served as independent determinant of all-cause mortality/HTx In patients with CRD (HR 1.018, P=0.026) after adjusted for above mentioned confounders. Patients without CRDs were further grouped into those with normal (sPAP≤40mmHg and TAPSE≥14mm, n=513); mild to moderate (sPAP>40mmHg or TAPSE<14mm, n=387) and severe RV dysfunction (sPAP>40mmHg and TAPSE<14mm, n=88). Severe RV dysfunction was independently associated with a 2-fold increased all-cause mortality/HTx as compared to normal RV function (HR 2.209, 95% CI 1.455–3.355, P<0.001). Conclusions Increased sPAP and reduced TAPSE are independent determinants of all-cause mortality in HFmrEF patients without CRD, and sPAP is an independent determinant of all-cause mortality in HFmrEF patients with CRD. Moreover, HFmrEF patients with severe RV dysfunction face a 2-fold increased all-cause mortality, as compared to patients with normal RV function and no CRD.

Harmonization of classifications of occupational interstitial lung diseases, solutions from pulmonologist’s point of view

Introduction. Modern international and domestic classifications of occupational interstitial lung diseases in comparison with pulmonology are presented. The necessity of revision of the List of occupational diseases is substantiated. The ways to optimize the classification of occupational interstitial lung diseases are proposed.

Coffee Roasters and Their Occupational Lung Disease: A Literature Review

Because of its characteristic sensory properties and physiological properties, coffee is one of the most popular beverages in the world. Roasted coffee beans are broadly consumed in nearly all classes of the population. The literature search used a lot of sites, including PubMed, Google Scholar, and ScienceDirect, and was further refined by reviewing titles, abstracts, and references in the bibliography to confirm additional missing reports. In this review, I collected the references for not only coffee intake and its related diseases, but also its beneficial effects on health, and investigated the toxic effects on workers, focusing on occupational lung diseases in the coffee roasting process, such as obstructive bronchiolitis. With respect to respiratory health for diacetyl and 2,3-pentanedione, air exposure was assessed in coffee packaging and roasting processes, and alpha-diketones were the most exposed during bean processing in the production process. OSHA recommended regular monitoring of diacetyl in related processes, providing respiratory protection to workers, and active medical surveillance, including health screening for all workers.