Work-related Respiratory Diseases Research Articles

ERS position paper: work-related respiratory diseases in the EU

According to a 2000 estimate based on workforce data and the CAREX (Carcinogen Exposure) database 1 there were 386,000 deaths worldwide due to non-cancer respiratory diseases (asthma: 38,000; chronic obstructive pulmonary disease (COPD): 318,000; pneumoconioses: 30,000) and nearly 6.6 million disability-adjusted life years (DALYs) (asthma: 1,621,000; COPD: 3,733,000; pneumoconioses: 1,288,000) attributable to occupational exposure to airborne particulates. The same figures for Europe were 52,700 deaths (asthma: 6,200; COPD: 39,300; pneumoconioses: 7,200) and 868,000 DALYs (asthma: 139,000; COPD: 468,000; pneumoconioses: 261,000). Respiratory diseases rank as the third most prevalent occupational disease category (after ergonomic and stress-related diseases) according to a survey of occupational diseases in the European Union (EU). The prevalence of respiratory diseases was 296 per 100,000 population, with the highest proportion found in the mining industry. This amounts to almost 600,000 persons in the former 15 member states. Many of these diseases, though induced while working, are chronic, thus explaining the highest prevalence among older workers (0.5% aged 55–64 yrs). Traditional high-risk occupations, such as mining, farming, manufacturing and service work ( e.g. hairdressers), are among the professions with a high prevalence of occupational lung diseases. However, high rates of occupational lung disease are also seen in newer professions, such as public administration, education 2 and occupational cleaning; the latter could be a reflection of problems related to new cleaning procedures, as found by the European Community Respiratory Health Survey (ECRHS) 3, or to problems with indoor air in public spaces. The pneumoconioses induced by exposure to mineral and other dusts at high concentrations were the dominating occupational lung diseases in the early industrialisation era. Their prevalence has been decreasing during the past decades. At the same time the obstructive lung diseases have gained increased importance, first because these diseases are widespread in the population, hence even small occupational contributions …

Measurement of trends in incidence of work-related skin and respiratory diseases, UK 1996–2005

Objectives:The ability to measure temporal trends in disease incidence is important, but valid methods are needed. This study investigates UK trends during 1996–2005 in work-related skin and respiratory diseases including...

Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant

Background:Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is...

Work-related respiratory diseases

Etwa 9–15% aller asthmatischen Krankheitsbilder bei Erwachsenen weisen einen konkreten Arbeitsplatzbezug auf, auch die COPD hat einen – tatigkeitsbezogen sehr variablen – relevanten berufsbedingten Anteil. Akute Inhalationsintoxikationen konnen vorrangig 6 unterschiedliche Effekte haben: Akute toxische Bronchitis/Tracheitis, Bronchokonstriktion, Bronchiolitis obliterans, Schaden im Alveolarbereich, Lungenoden, Asphyxie. Der chronischen Bronchitis durch Arbeitseinflusse kommt eine Warnfunktion zu. Beim Berufsasthma unterscheidet man im Wesentlichen zwischen immunologisch und vorwiegend chemisch-irritativ/toxisch wirkenden Auslosern. Die Diagnose basiert wesentlich auf der Anamnese, dem longitudinalen Funktionsverlauf einschlieslich Variabilitat der unspezifischen Atemwegsuberempfindlichkeit. Die Prognose ist oft ungunstig. Die chronisch-obstruktive Bronchitis und das Lungenemphysem treten als Berufskrankheit vorrangig im Bergbau auf, die chronisch-obstruktive Bronchitis aber auch nach langjahriger Exposition gegenuber chemisch-irritativen Arbeitsstoffen. Der begrundete Verdacht auf eine Berufskrankheit ist meldepflichtig. Bei den einzelnen Berufskrankheiten gelten spezifische gutachterliche Besonderheiten, die kurz skizziert werden.

Incidence by occupation and industry of acute work related respiratory diseases in the UK, 1992–2001

Aims: To summarise incidence rates and epidemiological characteristics of new cases of work related respiratory disease reported by specialist physicians in thoracic and occupational medicine, with particular reference to occupation,...

Clara cell protein and surfactant protein�B in garbage collectors and in wastewater workers exposed to bioaerosols

Inhalation of bioaerosols has been hypothesised to cause "toxic pneumonitis" that should increase lung epithelial permeability at the bronchioloalveolar level. Serum Clara cell protein (CC16) and serum surfactant protein B (SPB) have been proposed as sensitive markers of lung epithelial injury. This study was aimed at looking for increased lung epithelial permeability by determining CC16 and SPB in workers exposed to bioaerosols from wastewater or garbage. Subjects (778 wastewater, garbage and control workers; participation 61%) underwent a medical examination, lung function tests [American Thoracic Society (ATS) criteria], and determination of CC16 and SPB. Symptoms of endotoxin exposure and several potential confounders (age, gender, smoking, kidney function, obesity) were looked for. Results were examined with multiple linear or logistic regression. Exposure to bioaerosols increased CC16 concentration in the wastewater workers. No effect of exposure on SPB was found. No clue to work-related respiratory diseases was found. The increase in CC16 in serum supports the hypothesis that bioaerosols cause subclinical "toxic pneumonitis", even at low exposure.

Spirometry at Home: Technology Within the Patient's Reach

Spirometry is a basic lung function test useful both for measuring and for monitoring expiratory volume. For many years monitoring has been performed by means of a portable peak flow meter capable of measuring maximal expiratory flow. We present a portable spirometer (Spirotel, Medical International Research, Rome, Italy) capable of transmitting stored lung function data from the patient's home by telephone. The device is easy to use, presents information graphically and numerically, and allows degrees of change in lung function to be monitored on-line. It may be useful for controlling asthma and work-related respiratory diseases.

Recent developments in airway and nose occupational sensitizers.

To describe the latest developments in the field of occupational asthma and occupational rhinitis in 2001 and 2002. Several surveillance programs of occupational diseases, such as Observatoire National des Asthmes Professionnels in France, Surveillance of work-related and Occupational Respiratory Diseases in South Africa (SORDSA), Surveillance of Work-related and Occupational Respiratory Diseases (SWORD) in UK, have reported on the frequency of occupational asthma. The causative agents were mainly flour, isocyanates and latex. The common methods of diagnosis - questionnaires, cutaneous tests, Peak Expiratory Flow Rate (PEFR), bronchial hyperresponsiveness - still create controversy. In addition, the specific bronchial challenge, the classical gold standard of diagnosis, has its limitations since it cannot be performed in every case. Other methods have been assessed as inflammatory markers in induced sputum. Occupational rhinitis appears to be a poorly diagnosed condition. Further studies are expected to explore the effect of environmental control and medical surveillance. The key to successful management of occupational asthma and occupational rhinitis may be prospective surveillance of the occurrence of specific IgE antibodies before the onset of allergic symptoms.

Occupational asthma as identified by the Surveillance of Work-related and Occupational Respiratory Diseases programme in South Africa.

The nationwide Surveillance of Work-related and Occupational Respiratory Diseases in South Africa, SORDSA, was established in 1996 to provide systematic information on occupational respiratory diseases. SORDSA's objectives are to monitor the nature, extent and distribution of occupational respiratory diseases, and to increase awareness of their diagnosis and prevention. This paper describes the programme and results obtained for occupational asthma in the first 2 years, ending in October 1998. SORDSA identifies newly diagnosed cases of occupational respiratory disease through voluntary reporting by pulmonologists, occupational medicine doctors and occupational health nurses. Initially, recruitment of the above health care providers was done through the membership infrastructure of their respective professional societies. Booklets with prescribed monthly reporting forms were distributed annually to all reporting members and a core of reporting providers was established through a proactive method of data collection. Information dissemination and reporting feedback takes place through quarterly newsletters and issue-specific brochures on certain hazardous agents. Over the initial 2-year period, 3285 cases of occupational respiratory disease were reported to SORDSA by 203 doctors and 97 occupational health nurses. After pneumoconiosis and associated respiratory conditions, occupational asthma was the second most commonly reported disease with 225 cases (6.9%). The average annual incidence for occupational asthma in South Africa was 13.1 per million employed people, with the highest incidence reported from the Western Cape province (37.6 per million). Latex was the most frequently reported agent for occupational asthma, followed by isocyanates and platinum salts. Low molecular weight agents accounted for 59.6% of the cases of occupational asthma. The results from this initial phase show that despite some limitations, SORDSA has the potential to obtain useful data on the industries, agents and occupations causing occupational asthma in South Africa.

The world wide problem of occupational asthma

The world wide problem of occupational asthma

Metalworking fluid-associated hypersensitivity pneumonitis: a workshop summary.

A workshop discussing eight clusters of hypersensitivity pneumonitis in the automotive industry among metalworking fluid-exposed workers concluded that a risk exists for this granulomatous lung disease where water-based fluids are used and unusual microbial contaminants predominate. Strong candidates for microbial etiology are nontuberculous mycobacteria and fungi. Cases of hypersensitivity pneumonitis occur among cases with other work-related respiratory symptoms and chest diseases. Reversibility of disease has occurred in many cases with exposure cessation, allowing return to work to jobs without metalworking fluid exposures or, in some situations, to jobs without the same metalworking fluid exposures. Cases have been recognized with metalworking fluid exposures generally less than 0.5 mg/m3. The workshop participants identified knowledge gaps regarding risk factors, exposure-response relationships, intervention efficacy, and natural history, as well as surveillance needs to define the extent of the problem in this industry. In the absence of answers to these questions, guidance for prevention is necessarily limited.

Metalworking fluid‐associated hypersensitivity pneumonitis: A workshop summary

A workshop discussing eight clusters of hypersensitivity pneumonitis in the automotive industry among metalworking fluid-exposed workers concluded that a risk exists for this granulomatous lung disease where water-based fluids are used and unusual microbial contaminants predominate. Strong candidates for microbial etiology are nontuberculous mycobacteria and fungi. Cases of hypersensitivity pneumonitis occur among cases with other work-related respiratory symptoms and chest diseases. Reversibility of disease has occurred in many cases with exposure cessation, allowing return to work to jobs without metalworking fluid exposures or, in some situations, to jobs without the same metalworking fluid exposures. Cases have been recognized with metalworking fluid exposures generally less than 0.5 mg/m3. The workshop participants identified knowledge gaps regarding risk factors, exposure-response relationships, intervention efficacy, and natural history, as well as surveillance needs to define the extent of the problem in this industry. In the absence of answers to these questions, guidance for prevention is necessarily limited. Am. J. Ind. Med. 32:423ndash;432, 1997. © 1997 Wiley-Liss, Inc.

Workers exposed to respiratory hazards show altered expression of cell surface markers.

Workplace exposure to toxic materials may cause changes in both the activity and the activation state of some cells, and this can be accurately monitored using flow cytometry. We are interested in using flow cytometry to monitor workers exposed to materials which can cause work related respiratory diseases, particularly occupational asthma. T-cells are important in the aetiology of asthma, since they serve to recruit effector cells to the site of local inflammation [l]. Therefore, we have used flow cytometry to investigate differences between T-cell populations in two groups of workers reporting work related respiratory symptoms, but exposed to different respiratory hazards. Results were compared with a control population of 58 individuals reporting no respiratory ill health. Ten workers exposed to irritant fumes, and nine bakers exposed to the respiratory sensitiser wheat flour were recruited for the study: all subjects reported work related respiratory symptoms. 58 healthy controls were recruited as control subjects. Local ethics commitee approval was obtained, and each volunteer gave written consent before participating in the study. Each subject provided a sample of venous blood for flow cytometry, and 1OOpL aliquots were stained with combinations of fluorescently labelled monoclonal antibodies. lsotype controls were included to determine the background flourescence (antibodies purchased from Coulter Electronics, UK and Becton Dickinson). Lymphocytes were gated on CD14-CD45+ staining, and 10,000 events were collected for each sample. The percentage of lymphocytes expressing each marker was calculated, and differences from controls were calculated using Student's t-test. We found a significant increase above control values for cell types associated with inflammation in bakers who reported work related respiratory symptoms. In particular, helper T-cells (CD3+CD4+: pc0.005), activated helper T-cells (CD4+ CD25+: p<O.Ol), and the CD4:CDE T-cell ratio (pc0.05) (see figure 1). In contrast, workers with the same respiratory symptoms, but exposed to irritant chemicals showed a different pattern of cell surface lymphocyte markers, with a significant decrease in total T-cells (CD3+: pcO.05) (see figure la-id).

Work‐related respiratory disorders among finnish farmers

Several research projects on work-related respiratory diseases have been conducted in Finland. One of the largest, "Farmers' Occupational Health Programme," was conducted by the Social Insurance Institution of Finland during 1973-1983 in cooperation with Kuopio Regional Institute of Occupational Health and the National Board of Health. The main objective of the program was to develop a model for occupational health services for farmers. As a part of the program, postal surveys were conducted in 1979 and 1982. The surveys allowed an analysis of both the prevalence and the mean annual incidence of asthma, farmer's lung, and chronic bronchitis as well as of background variables related to the diseases. More than every tenth farmer suffered from these respiratory diseases. The occurrence of chronic bronchitis (the most common disease) was, in general, related to farming types in which grain crops (including animal feeds) were handled. Chronic bronchitis was most prevalent among farmers who worked in piggeries, implying a combined effect of grain dusts, dusts of animal origin, and development of the disease. Atopy predisposed to and had an additive effect with smoking on chronic bronchitis.