Related Respiratory Symptoms Research Articles

An outbreak of swimming-pool related respiratory symptoms: An elusive source of trichloramine in a municipal indoor swimming pool.

Several members of a swimming club complained of respiratory symptoms associated with attending a municipal indoor swimming pool. Trichloramine, a volatile chlorination by-product and a potent respiratory irritant, was the most probable culprit, but the exact cause for its presence in excessive concentrations remained elusive. Twenty-two competitive swimmers and six coaches were evaluated during the outbreak and nine swimmers and four coaches were re-evaluated one year later. Symptoms were recorded by non-standardized history taking; pulmonary function testing included spirometry, measurement of fraction of exhaled nitric oxide (FENO) and histamine provocation. Concentrations of trichloramine in air were measured repeatedly by the method of Héry. The most commonly reported symptoms consisted of cough (n=16), dyspnoea (n=13), tearing eyes (n=10) and blocked or runny nose (n=6). Mean FEV1% predicted was 109.1%. Mean FENO level was 19.7 ppb (higher than 25 ppb in 3 subjects). Airway hyperreactivity to histamine (PC20 ≤ 8 mg/ml) was detected in 22/26 subjects. Measured trichloramine concentrations in air exceeded the maximal concentration (WHO) of 0.5mg/m(3) four times between May and October 2011 and four times between January and March 2012. Polyamine compounds, present in glue used for repairing pipework, were identified as a probable external source of nitrogen resulting in increasing trichloramine concentrations. After the removal of the presumed cause of the excessive trichloramine concentrations, most subjects improved clinically, but several subjects remained symptomatic and had bronchial hyperreactivity. A high prevalence of airway hyperreactivity, accompanied by symptoms of upper and lower airways, was detected in swimmers who had been repeatedly exposed to high trichloramine concentrations. A glue containing polyamines, used to repair a pipework, was suspected to be the source of this excessive production of trichloramine.

NUT midline carcinomas in the thymic region

NUT midline carcinomas (NMCs) are rare tumors described predominantly in the pediatric age group. We recently reported two cases of these tumors occurring in the thymic region. In order to establish the true incidence of these tumors, we examined a large series of thymic carcinomas for morphological features of NUT tumor and further assessed the expression of NUTM1 (also known as NUT) protein by immunohistochemistry. The histological review of slides from 110 cases of thymic carcinoma was undertaken to identify carcinomas with mixed undifferentiated and squamous features that are typically associated with NUT carcinomas. The presenting symptoms, morphological spectrum of tumors and outcome data of patients with these histologies are presented. Immunohistochemistry for NUTM1 was performed on 35 cases of thymic carcinoma with available blocks (3 with these histological features and 32 without these features) to exclude the possibility of midline carcinoma. Tumors from 10 patients had features of mixed small cell undifferentiated squamous cell carcinoma (M:F, 1.5:1; age range, 22–79). These patients predominantly presented with advanced disease and had respiratory-related symptoms or chest pain; four had paraneoplastic syndromes. The squamous component in all cases was well differentiated with little or no atypia. The undifferentiated component varied in cell size and lacked characteristic features of small cell carcinoma. All but one patients developed metastases or died within 3 years of diagnosis. NUTM1 expression was seen in two of three tumors with these histological features and in none of the 32 cases without. Mixed small cell undifferentiated carcinomas share histological and immunohistochemical similarity with NMCs and have aggressive clinical course. These tumors are not uncommon and should be considered in the differential diagnosis of carcinomas in the thymic region as novel therapies might be available.

S5 Prevalence Of Ige Sensitisation To 'improver Mix' Enzymes Among Symptomatic Bakers Working In Uk Scratch Bakeries

Introduction and objectives Bakers working in supermarket scratch bakeries in the UK are exposed not only to flour and fungal alpha amylase but also other enzymes, incorporated in a pre-mixed bag of ‘dough improvers’. Bakers and their employers are usually unaware of which enzymes are being used within the ‘improver mix’. We have examined the question of whether supermarket bakers develop sensitisation to ‘improver mix’ enzymes other than fungal alpha amylase. Methods We assayed specific IgE sensitisation in 300 bakers employed by one of two large UK supermarkets who, at routine health surveillance, had declared work related upper or lower respiratory symptoms. Sensitisation was determined using radioallergosorbent assay to enzymes contained within the specific ‘improver’ mix used by the employing supermarket; each mix contained eight individual enzymes which were not necessarily common to both supermarkets. Results Bakers were sensitised to each of the individual ‘improver’ enzymes with a prevalence ranging from 1.8% to 23.9%; the frequency did not appear to be associated with the quantity of enzyme incorporated in the mix. Sensitisation was far more likely if a baker was sensitised also to either flour or fungal alpha amylase; but a small proportion (5%) of bakers who were sensitised to neither flour nor fungal alpha amylase had specific IgE to one or more of the ‘improver mix’ enzymes. Conclusions Bakers working in UK supermarket bakeries can become sensitised to improver enzymes other than fungal alpha amylase. The clinical significance of this remains unclear but the message is important both in the diagnosis of bakers with work-related respiratory symptoms and in any programme of immunological surveillance.

Modelling the Prevalence of Respiratory Symptoms in Relation to Two Point Sources in a Northern Chilean Community

Modelling the Prevalence of Respiratory Symptoms in Relation to Two Point Sources in a Northern Chilean Community

Bronchial Hyperresponsiveness in Farmers: Severity and Work-Relatedness

OBJECTIVE: To evaluate the prevalence of respiratory symptoms, lung function and bronchial hyperresponsiveness in farmers, with emphasize to their severity and work-relatedness due occupational risk factors and farming characteristics.METHODS: A cross-sectional survey was performed including 60 cow breeders aged 21 to 65 years, compared to an equal number of agricultural farmers matched by age, job exposure duration, and smoking status. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed, and smoking history. Evaluation of examined subjects also included lung function spirometry tests, and bronchial hyperresponsiveness testing.RESULTS: We found higher prevalence of work related respiratory symptoms in the last 12 months in cow breeders with significant difference for phlegm (P = 0.039), and wheezing (P = 0.026). Mean values of all spirometric parameters were lower in cow breeders, reaching significance for MEF50 (P = 0.001) and MEF75 (P = 0.000). Significant difference was found for mild bronchial hyperresponsiveness among cow breeders with job exposure of more than 15 years. The risk of developing work-related respiratory symptoms increased significantly with full-time farming, exposure to gases and vapors, and keeping more than 10 cows.CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact.

Factors associated with high prevalence of coughs, colds and fever among urban slum dwellers in Dhaka, Bangladesh

While adverse housing is commonly associated with high respiratory morbidity in urban slum areas, data on prevalence of common respiratory symptoms among adults in urban slums in Bangladesh is limited. We compared the frequency of common respiratory symptoms among men and women in relation to individual socio-demographic and household characteristics using methods of descriptive and analytic epidemiology. Cross-sectional data from 1892 adult respondents collected in the baseline study in 2009 in nine urban slum areas of Dhaka were used. Three month prevalence of coughs and colds was 21.5% (n=1,893). Women were more vulnerable to respiratory symptoms in relation to the frequent exposure to stagnant water bodies near the house (OR: 4.44; 95% CI: 2.49-7.93) and waste disposal (OR: 3.57; 95% CI: 1.37-9.31). Practice of smoking inside dwelling increased the likelihood of having respiratory symptoms for both sexes. Recurrent contact or exposure to stagnant water and unhygienic waste management appeared to be the strongest factors associated with respiratory symptoms, particularly among women. This finding underlines the significance of the improvement of housing quality in slum areas affected by stagnation of water and improper waste management as well as the need for public health intervention to minimize the risk of diseases associated with these factors. DOI: http://dx.doi.org/10.3329/seajph.v3i2.20042 South East Asian Journal of Public Health Vol.3(2) 2013: 58-65

Bronchial Hyperresponsiveness in Farmers: Severity and Work-Relatedness

OBJECTIVE: To evaluate the prevalence of respiratory symptoms, lung function and bronchial hyperresponsiveness in farmers, with emphasize to their severity and work-relatedness due occupational risk factors and farming characteristics. METHODS: A cross-sectional survey was performed including 60 cow breeders aged 21 to 65 years, compared to an equal number of agricultural farmers matched by age, job exposure duration, and smoking status. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed, and smoking history. Evaluation of examined subjects also included lung function spirometry tests, and bronchial hyperresponsiveness testing. RESULTS: We found higher prevalence of work related respiratory symptoms in the last 12 months in cow breeders with significant difference for phlegm (P = 0.039), and wheezing (P = 0.026). Mean values of all spirometric parameters were lower in cow breeders, reaching significance for MEF50 (P = 0.001) and MEF75 (P = 0.000). Significant difference was found for mild bronchial hyperresponsiveness among cow breeders with job exposure of more than 15 years. The risk of developing work-related respiratory symptoms increased significantly with full-time farming, exposure to gases and vapors, and keeping more than 10 cows. CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact.

Safety and immunogenicity in man of a cell culture derived trivalent live attenuated seasonal influenza vaccine: A Phase I dose escalating study in healthy volunteers

Live attenuated influenza vaccine (LAIV) offers the promise of inducing a variety of immune responses thereby conferring protection to circulating field strains. LAIVs are based on cold adapted and temperature sensitive phenotypes of master donor viruses (MDVs) containing the surface glycoprotein genes of seasonal influenza strains. Two types of MDV lineages have been described, the Ann Arbor lineages and the A/Leningrad/17 and B/USSR/60 lineages. Here the safety and immunogenicity of a Madin Darby Canine Kidney – cell culture based, intranasal LAIV derived from A/Leningrad/17 and B/USSR, was evaluated in healthy influenza non-naive volunteers 18–50 years of age. In a double-blind, randomized, placebo-controlled design, single escalating doses of 1×105, 1×106, or 1×107 tissue culture infectious dose 50% (TCID50) of vaccine containing each of the three influenza virus re-assortants recommended by the World Health Organization for the 2008–2009 season were administered intranasally. A statistically significant geometric mean increase in hemagglutination inhibition titer was reached for influenza strain A/H3N2 after immunization with all doses of LAIV. For the A/H1N1 and B strains, the GMI in HI titer did not increase for any of the doses. Virus neutralization antibody titers showed a similar response pattern. A dose–response effect could not be demonstrated for any of the strains, neither for the HI antibody nor for the VN antibody responses. No influenza like symptoms, no nasal congestions, no rhinorrhea, or other influenza related upper respiratory tract symptoms were observed. In addition, no difference in the incidence or nature of adverse events was found between vaccine and placebo treated subjects. Overall, the results indicated that the LAIV for nasal administration is immunogenic (i.e. able to provoke an immune response) and safe both from the perspective of the attenuated virus and the MDCK cell line from which it was derived, and it warrants further development.

Transient paradoxical bronchospasm associated with inhalation of the LAMA AZD9164: analysis of two Phase I, randomised, double-blind, placebo-controlled studies

BackgroundAZD9164 has demonstrated potential as an inhaled, long-acting, muscarinic antagonist (LAMA) bronchodilator. However, in patients with COPD, but not in healthy subjects, a transient initial drop in FEV1 was observed following inhalation of nebulised doses of AZD9164 in citrate buffer.Two additional studies were conducted to further assess the safety and tolerability of multiple ascending doses of AZD9164 in 27 white and 18 Japanese healthy subjects and in 4 patients with COPD. In these studies, AZD9164 was inhaled via Turbuhaler™.MethodsThese were Phase I, randomised, double-blind, placebo-controlled, multiple ascending dose (MAD) studies conducted in Sweden and UK. Healthy subjects (mean age 25.9 yrs) and patients with COPD (mean age 66 yrs, mean post-bronchodilator FEV1 60.1% predicted normal value) were randomised 2:1 to active treatment (400, 1000 or 2800 μg delivered doses of AZD9164) or placebo.ResultsNo safety or tolerability concerns were identified in the healthy subjects at doses up to and including 2800 μg and both studies confirmed the bronchodilator effect of AZD9164. However, the first 3 patients in the COPD cohort who received AZD9164 (1000 μg) experienced a transient fall in FEV1 5 to 15 minutes after inhalation of AZD9164 while the patient receiving placebo did not. The study safety review process then resulted in cessation of further activities on AZD9164. Retrospective analysis showed that two healthy subjects had also had transient falls in FEV1 shortly after inhalation of AZD9164 400 and 2800 μg respectively, although neither reported any related respiratory symptoms or other AEs.ConclusionsThese results show that transient paradoxical bronchoconstriction can occur in some healthy subjects, in addition to patients with COPD, following inhalation of AZD9164 and that the citrate buffer used in the nebulised formulation cannot have been the only cause of the drop in FEV1 in previous studies. As preclinical data do not provide an explanation, the reasons for this brief post-dose drop in FEV1 remain unclear. However, these results highlight the importance of monitoring lung function immediately post-dose when investigating novel inhaled treatments, even when a rapid onset of effect is not expected.Trial registrationClinicaltrials.gov NCT01016951 and NCT01096563.

Adherence to reduced-polluting biomass fuel stoves improves respiratory and sleep symptoms in children

BackgroundSymptoms of sleep apnea are markedly increased in children exposed to smoke from biomass fuels and are reduced by kitchen stoves that improve indoor biomass pollution. However, the impact of adherence to the use of improved stoves has not been critically examined.MethodsSleep-related symptom questionnaires were obtained from children <15 years of age in 56 families residing in the communities of Lliupapuquio, Andahuaylas province in Peru before and 2 years after installation of less-polluting Inkawasi cooking stoves.Results82 children with lifetime exposures to indoor fuel pollution were included. When compared to those alternating between both types of stoves or those using traditional stoves only, those children who exclusively used Inkawasi cooking stoves showed significant improvements in sleep and respiratory related symptoms, but some minor albeit significant improvements occurred when both stoves were concomitantly used.ConclusionsImprovements in respiratory and sleep-related symptoms associated with elevated indoor biomass pollution occur only following implementation and exclusive utilization of improved kitchen stoves.

Respiratory Symptoms and Associated Factors among Cement Factory Workers and Civil Servants in North Shoa, Oromia Regional State, North West Ethiopia: Comparative Cross Sectional Study

Background: In Ethiopia, workers are not well informed about the health effects of their work environment and occupational related respiratory symptoms are extensively high especially, in cement factories. Objective: This study was designed to determine prevalence of respiratory symptoms and associated factors among Cement Factories Workers and Civil Servants. Methods: An organization based comparative cross sectional study were done on 266 cement factories and 269 civil servant workers, using pre-tested questionnaire. Simple random sampling method was used to select participants from Civil Servants, while working section stratification with simple random was applied to select participant Cement Factories Workers. The data were entered to Epi-info version 7 and exported to SPSS version 20 for analysis. In the bivariate logistic regression variables with p≤0.2 were fitted to multivariate logistic regression and finally, variables with p<0.05 was considered as significantlly associated. Result: The prevalence of respiratory symptoms was 66.2% in cement factories workers and 31.2% in Civil Servants with a significant difference (p<0.001). The odds of developing respiratory symptoms were higher among exposed groups (AOR=7.60, 95% CI: 4.93-11.89). Respiratory symptoms were higher in ≥45years old workers (AOR=4.67, 95% CI: 1.16-18.74) than <25years old workers. Night shift workers were more likely to develop respiratory symptoms (AOR=2.07, 95% CI: 1.02-4.18) than their counterpart. Having trained in occupational health and safety (AOR=0.18, 95% CI: 0.09- 0.36) and education above secondary school (AOR= 0.15, 95% CI: 0.03-0.78) were protective for respiratory symptoms in the exposed groups. Smoking was positively associated with respiratory symptoms in both cement factories workers (AOR=11.7, 95% CI: 1.6- 85.76) and unexposed groups (AOR=3.4, 95% CI: 1.19-9.05). Conclusion: Respiratory symptoms were higher among cement factories workers than civil servants, so engineering and administrative control measures are needed to reduce the exposure of workers to cement dust.

Are Former Athletes More Prone to Asthma?

Objective. We have designed the present study to compare prevalent lifetime cases of diagnosed asthma or exercise-induced asthma, as well as current related respiratory symptoms, across two different levels of former athletes and non-athletes. Methods. Demographic, behavioral, and asthma history information, as well as current related respiratory symptoms, were obtained through a questionnaire from 627 subjects (290 former elite and 201 non-elite athletes that competed between 1969 and 2005, and 136 control subjects that had never been athletes). Results. Non-athletes presented a higher percentage of subjects reporting the existence of symptoms associated with exercise or vigorous activities. Former athletes who reported having practiced mostly in indoor facilities presented significant lower risk for asthma than outdoor athletes (Odds Ratio = 0.48, 95% CI = 0.25-0.94). Multiple regression analysis (where “B” refers to unstandardized coefficients) showed that former elite (B = –0.85, p < .001) and non-elite athletes (B = –0.70, p < .001) were less prone to be affected by asthma-related symptoms than non-athletes. Athletes with careers that lasted more than 20 years were more likely to possess asthma-related symptoms than the ones with shorter careers (3–7 years, B = –0.47, p < .001; 8–14 years, B = –0.42, p < .01; 15–20, B = –0.32, p < .05). Conclusions. Non-athletes seem to have a higher prevalence of respiratory symptoms. Among former athletes, career characteristics seem to play a crucial role, with special emphasis to its duration, where the most lengthy seem to be more associated with respiratory symptoms.

Acute and Chronic Respiratory Symptoms among Primary Care Patients Who Smoke Crack Cocaine

Among inner-city populations in Canada, the use of crack cocaine by inhalation is prevalent. Crack smoking is associated with acute respiratory symptoms and complications, but less is known about chronic respiratory problems related to crack smoking. There is also a gap in the literature addressing the management of respiratory disease in primary health care among people who smoke crack. The purpose of our study was to assess the prevalence of acute and chronic respiratory symptoms among patients who smoke crack and access primary care. We conducted a pilot study among 20 patients who currently smoke crack (used within the past 30days) and who access the "drop-in clinic" at an inner-city primary health care center. Participants completed a 20- to 30-min interviewer-administered survey and provided consent for a chart review. We collected information on respiratory-related symptoms, diagnoses, tests, medications, and specialist visits. Data were analyzed using frequency tabulations in SPSS (version 19.0). In the survey, 95% (19/20) of the participants reported having at least one respiratory symptom in the past week. Thirteen (13/19, 68.4%) reported these symptoms as bothersome. Chart review indicated that 12/20 (60%) had a diagnosis of either asthma or chronic obstructive pulmonary disease (COPD), and four participants (4/20, 20%) had a diagnosis of both asthma and COPD. Majority of the participants had been prescribed an inhaled medication (survey 16/20, 80%; chart 12/20, 60%). We found that 100% (20/20) of the participants currently smoked tobacco, and 16/20 (80%) had smoked both tobacco and marijuana prior to smoking crack. Our study suggests that respiratory symptoms and diagnoses of asthma and COPD are prevalent among a group of patients attending an inner-city clinic in Toronto and who also smoke crack. The high prevalence of smoking tobacco and marijuana among our participants is a major confounder for attributing respiratory symptoms to crack smoking alone. This novel pilot study can inform future research evaluating the primary health care management of respiratory disease among crack smokers, with the aim of improving health and health care delivery.

A Preliminary Investigation of Laparoscopic Fundoplication Treatment on Gastroesophageal Reflux Disease-related Respiratory Symptoms

Extraesophageal syndromes are more difficult to identify and treat than the usual esophageal symptoms. The current study explores the efficacy of laparoscopic Nissen fundoplication (LNF) on gastroesophageal reflux disease (GERD)-related respiratory symptoms (RSs) during a 12-month follow-up observation. From April 2008 to September 2009, LNF was performed on 198 patients (107 men and 91 women) with GERD-related RSs according to underlying esophageal motility. A questionnaire form ranging from 0 to 5 was the basic requirement for recording pretreatment and posttreatment and for making detailed evaluation of the symptoms. All scores of GERD-related RSs, such as heartburn, regurgitation, coughing, breathe holding, wheezing, shortness of breath, and choking, significantly decreased at the 12th month. All the patients who participated in the current study were adults and elders aged 22 to 84 years with a mean age of 49 ± 12.89. The median length of stay was 4.3 days with a range of 2 to 8 days. The median score of heartburn, regurgitation, coughing, wheezing, shortness of breath, choking, and chest pain decreased from 4.92 ± 1.99, 4.98 ± 1.81, 7.23 ± 1.87, 7.50 ± 1.88, 5.83 ± 2.13, 5.94 ± 2.22, and 4.92 ± 1.88 to 1.62 ± 2.33, 0.64 ± 1.43, 2.79 ± 2.82, 2.53 ± 2.96, 1.37 ± 2.10, 1.28 ± 2.09, and 1.57 ± 2.55 (P<0.01), respectively. A total of 173 patients had various relieved symptom scores, 16 patients (8.1%) had different scale recurrence of symptoms after laparoscopic fundoplication treatment, and 13 patients had to retreat to omeprazole as an auxiliary medical therapy. Three other patients rejected any therapy, and no deaths occurred. A single patient converted from laparoscopic surgery to open surgery. Several short-term symptoms included retrosternal uneasiness or pain (n = 63; 31.8%), dysphagia (n = 45; 22.7%), abdominal distension (n = 87; 43.9%), and diarrhea (n = 23; 11.6%). Early dysphagia lasting <6 weeks was common, and 45 patients (22.7%) underwent an early esophagogastroduodenoscopy or contrast swallow. Five patients (2.5%) who had prolonged dysphagia during the 6-month clinical review required esophageal dilatation, and the outcomes were successful. LNF can be an effective means for treating RSs in patients with GERD.

The effect of exposure to chlorine on pulmonary function tests and respiratory and allergic symptoms in Iranian lifeguards

Lifeguards are frequently exposed to various irritant chemicals including chlorine during work, which can induce respiratory and allergic disorders. In this study, pulmonary function tests (PFTs) and self-reported respiratory and allergic symptoms in lifeguards were compared with matched control subjects. The frequency of respiratory and allergic symptoms was evaluated in a sample of 38 Iranian male lifeguards and 38 control subjects with similar age, having other jobs from the general population, using a questionnaire including questions on work-related respiratory and allergic symptoms in the past year, smoking habits, and duration of working as a lifeguard. PFTs were also measured in lifeguard subjects before and 15min after 200µg inhaled salbutamol and baseline PFT in controls. A total of 22 (55%) participants reported work-related respiratory symptoms. Sputum (39.4%) and cough (18.4%) were the most common symptoms and only 7.9% and 15.8% of lifeguards reported wheezing and shortness of breath, respectively. Both sputum and breathlessness were significantly higher in lifeguards than control group (p<0.05 and p<0.005, respectively). Most allergic symptoms (sneezing and runny nose) in lifeguards were also significantly greater than control group (p<0.05 for both cases). In addition, all respiratory (except sputum and wheezing) and allergic symptoms were significantly higher in lifeguards during work compared with rest period (p<0.05 to p<0.005). Most PFT values were also significantly lower in lifeguards than control subjects (p<0.05 to p<0.001). In addition, most (all) PFT values were significantly improved after 200µg inhaled salbutamol (p<0.05 to p<0.001). These results showed that lifeguards have higher frequencies of work related respiratory symptoms and allergic symptoms particularly during the work period. PFT values were also significantly reduced among lifeguards.

Impact of exercise-related respiratory symptoms in adults with asthma: Exercise-Induced Bronchospasm Landmark National Survey

An estimated 5-20% of the general population and up to 90% of people with asthma experience exercise-induced bronchospasm (EIB). The EIB Landmark Survey is the first comprehensive study on exercise-related respiratory symptoms in the United States. Two surveys were conducted: the first surveyed adults (≥18 years) in the general public and the second surveyed adults with asthma or taking medications for asthma in the prior year. Parameters assessed included exercise-related respiratory symptoms, activity levels, and short-acting beta-antagonist (SABA) use. In the general public survey (n = 1085), 8% were currently diagnosed with asthma. However, 29% reported experiencing one or more of six respiratory-related symptoms during or immediately after exercising. In the EIB in adult asthma survey (n = 1001), although >80% of adults experienced one or more of six exercise-related respiratory symptoms, only 30.6% reported a diagnosis of EIB. Almost one-half (45.6%) of adults with asthma reported that they avoid physical activities because of symptoms. Despite symptoms, only 22.2% of respondents took SABAs before exercise "always" or "most of the time"; 36.3% took rescue medications after or during exercise. Exercise-related respiratory symptoms limit physical activities and negatively impact daily lives. However, adults in the United States lack awareness of EIB. Although many subjects stated that their asthma symptoms limit their physical activity, few adhered to treatment guidelines by using SABAs appropriately before exercising. Findings from this survey support the need for better communication about the proper evaluation and management of EIB in the community and in asthma patients.

Non-allergic cutaneous reactions in airborne chemical sensitivity – A population based study

Multiple chemical sensitivity (MCS) is characterised by adverse effects due to exposure to low levels of chemical substances. The aetiology is unknown, but chemical related respiratory symptoms have been found associated with positive patch test. The purpose of this study was to investigate the relationship between cutaneous reactions from patch testing and self-reported severity of chemical sensitivity to common airborne chemicals. A total of 3460 individuals participating in a general health examination, Health 2006, were patch tested with allergens from the European standard series and screened for chemical sensitivity with a standardised questionnaire dividing the participants into four severity groups of chemical sensitivity. Both allergic and non-allergic cutaneous reactions--defined as irritative, follicular, or doubtful allergic reactions--were analysed in relationship with severity of chemical sensitivity. Associations were controlled for the possible confounding effects of sex, age, asthma, eczema, atopic dermatitis, psychological and social factors, and smoking habits. In unadjusted analyses we found associations between allergic and non-allergic cutaneous reactions on patch testing and the two most severe groups of self-reported sensitivity to airborne chemicals. When adjusting for confounding, associations were weakened, and only non-allergic cutaneous reactions were significantly associated with individuals most severely affected by inhalation of airborne chemicals (odds ratio = 2.5, p = 0.006). Our results suggest that individuals with self-reported chemical sensitivity show increased non-allergic cutaneous reactions based on day 2 readings of patch tests.

Natural Rubber Latex Allergy Among Health Care Workers: Significant Reduction of Sensitization and Clinical Relevant Latex Allergy After Introduction of Powder-free Latex Gloves

RATIONALE: An IgE mediated allergy to natural rubber latex (NRL) is a serious health problem. Health care workers are especially at risk due to their frequent contact with rubber gloves. The aim of the study was to estimate the prevalence of NRL sensitization and clinical NRL allergy, among operating room employees, before and ten years after the introduction of non powdered NRL gloves. (1998/2009)METHODS: Surgical NRL glove wearing operating room employees were asked to participate in a cross sectional study at two occasions (1998/2009). Characteristics and work related respiratory allergy symptoms were gathered by means of a questionnaire. Skin prick tests with allergen extracts were performed including latex extract(s) and cross-reacting foods such as kiwi, avocado, banana and common inhalant allergens.RESULTS: In 2009 and in 1998, respectively 187 and 163 employees were eligible to participate in the study. The two groups were comparable concerning e.g. age, gender and job characteristics. In 2009 the prevalence of sensitization was significantly lower compared to 1998 (3.9 % versus 14.1 %). Also clinical relevant NRL allergy was significantly less present in 2009 compared to 1998 (2.2 % versus 9.8%). Atopy was significantly associated with the development of sensitization to NRL.CONCLUSIONS: This study provides a clear indication that the introduction of non powdered latex gloves in 1998 is responsible for the reduction in prevalence of latex sensitization and clinical latex allergy. RATIONALE: An IgE mediated allergy to natural rubber latex (NRL) is a serious health problem. Health care workers are especially at risk due to their frequent contact with rubber gloves. The aim of the study was to estimate the prevalence of NRL sensitization and clinical NRL allergy, among operating room employees, before and ten years after the introduction of non powdered NRL gloves. (1998/2009) METHODS: Surgical NRL glove wearing operating room employees were asked to participate in a cross sectional study at two occasions (1998/2009). Characteristics and work related respiratory allergy symptoms were gathered by means of a questionnaire. Skin prick tests with allergen extracts were performed including latex extract(s) and cross-reacting foods such as kiwi, avocado, banana and common inhalant allergens. RESULTS: In 2009 and in 1998, respectively 187 and 163 employees were eligible to participate in the study. The two groups were comparable concerning e.g. age, gender and job characteristics. In 2009 the prevalence of sensitization was significantly lower compared to 1998 (3.9 % versus 14.1 %). Also clinical relevant NRL allergy was significantly less present in 2009 compared to 1998 (2.2 % versus 9.8%). Atopy was significantly associated with the development of sensitization to NRL. CONCLUSIONS: This study provides a clear indication that the introduction of non powdered latex gloves in 1998 is responsible for the reduction in prevalence of latex sensitization and clinical latex allergy.

Cement dust exposure-related emphysema in a construction worker

Although, smoking is considered the most important predisposing factor in development of emphysema; environmental exposures also play an important role. There have been several studies on work related respiratory symptoms and ventilatory disorders among employees of cement industry. We report a case of cement exposure related emphysema in 75 years old woman construction worker.

Skin Prick Tests and Dose Response Relationship between Pulmonary Function Tests and Chronic Exposure to Flour in Baking Industry

Background: flour dust is a respiratory sensitizer and chronic exposure to it could affect the pulmonary functions and stimulate allergic responses. Objectives: the objectives of this study were to: a) study the association between chronic exposure to flour among bakers and the prevalence of work related respiratory and allergic symptoms, b) assess allergic reaction to flour dust using Skin Prick Test (SPT), c) evaluate the existence of dose-response relationship between exposure to flour and the pulmonary function tests among Bakers. Subjects and Methods: The study was carried out on 60 bakers working at different bakeries at Dekernis, Dakahlia Governorate, Egypt; and 30 control subjects. All participants were submitted to a self administered questionnaire on respiratory symptoms, general medical examination, chest examination; spirometry and SPT. Results: All work related respiratory symptoms were more prevalent among bakers compared to the controls (P Keywords: respiratory, allergic, skin prick test, flour , bakers