Occupational asthma due to soft corrosive soldering fluxes containing zinc chloride and ammonium chloride.

PubMed Central

Weir, D C; Robertson, A S; Jones, S; Burge, P S

1989-01-01

Two cases of occupational asthma due to soft corrosive soldering fluxes used in metal jointing are described in which the diagnosis was based on work related deterioration in daily peak expiratory flow rate and positive responses in bronchial provocation tests. Both fluxes contained ammonium chloride and zinc chloride. Occupational asthma provoked by these agents has not previously been reported. PMID:2705153

Cough-variant asthma: a diagnostic dilemma in the occupational setting.

PubMed

Lipińska-Ojrzanowska, A; Wiszniewska, M; Walusiak-Skorupa, J

2015-03-01

Cough-variant asthma (Corrao's syndrome) is defined as the presence of chronic non-productive cough in patients with bronchial hyperresponsiveness (BHR) and response to bronchodilator therapy. This variant of asthma may present a diagnostic problem in occupational medicine. To describe additional evaluation of cough-variant asthma in a cyanoacrylate-exposed worker in whom standard diagnostic testing was negative. A female beautician was evaluated for suspected occupational allergic rhinitis and asthma. A specific inhalation challenge test (SICT) was performed with cyanoacrylate glues used for applying artificial eyelashes and nails. Spirometry and peak expiratory flow (PEF) measurements were recorded hourly for 24h; methacholine challenge testing was performed and nasal lavage (NL) samples were analysed for eosinophilia. After SICT, the patient developed sneezing, nasal airflow obstruction and cough. Declines in forced expiratory volume in 1 s and PEF were not observed. Eosinophil proportions in NL fluid increased markedly at 4 and 24h after SICT. A significant increase in BHR also occurred 24h after SICT. Clinical symptoms, post-challenge BHR and increased NL eosinophil counts confirmed a positive response to SICT and validated the diagnosis of cough-variant occupational asthma. SICT may be useful in cases where history and clinical data suggest cough-variant asthma and spirometric indices are negative. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Occupational asthma due to polyethylene shrink wrapping (paper wrapper's asthma).

PubMed Central

Gannon, P F; Burge, P S; Benfield, G F

1992-01-01

Occupational asthma due to the pyrolysis products of polyvinyl chloride (PVC) produced by shrink wrapping processes has previously been reported. The first case of occupational asthma in a shrink wrap worker using a different plastic, polyethylene, is reported; the association was confirmed by specific bronchial provocation testing. PMID:1440477

[Focus: baker's asthma. Epidemiology, diagnosis and treatment of baker's asthma].

PubMed

Romano, Canzio

2014-01-01

Baker's asthma, though having been recognized and studied since long time, still stays one of the most common causes of occupational asthma. Moreover, our understanding of the causative agents, the pathophysiological mnechanisms, the usefulness of medical surveillance, the proper treatment and prevention of the disease is still scanty. This is due to either to its complex pathogenesis or to possible confoundings, besides the still inadequate quality and standardization of the tools available as far as the allergologic diagnosis is concerned. Proper medical surveillance, validated causal therapies, efficient primary prevention are still uncertain. Change of employment or relocation is often impossible, particularly among artisan workers. Various evidences have been critically revised and summarized.

Occupational asthma in a national disability survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blanc, P.

1987-10-01

The contribution of workplace exposures to the prevalence of asthma in adults has been minimized in the epidemiology of this illness. Analysis of the 1978 Social Security Disability Survey provides a population-based assessment as a novel approach utilizing self-attributed, occupationally related asthma as a measure of disease. Of 6063 respondents, 468 (7.7 percent) identified asthma as a personal medical condition; 72 (1.2 percent (15.4 percent of all those with asthma)) attributed it to workplace exposures. These subjects were older and included more men and cigarette smokers than groups of both asthmatic and nonasthmatic subjects. The relative risk for occupationally attributedmore » asthma was elevated among industrial and agricultural workers as compared with white collar and service occupations. Analysis of disability benefit status did not indicate that this introduced major reporting bias in this survey. This study suggests that occupational factors may have a greater role in adult asthma than previously thought.« less

Investigation of occupational asthma: Do clinicians fail to identify relevant occupational exposures?

PubMed Central

de Olim, Carlo; Bégin, Denis; Boulet, Louis-Philippe; Cartier, André; Gérin, Michel; Lemière, Catherine

2015-01-01

BACKGROUND: Specific inhalation challenges (SIC) enable the identification of the agent responsible of occupational asthma (OA). A clinician may fail to identify a specific agent in the workplace, which may potentially lead to a misdiagnosis. The expert assessment method performed by an occupational hygienist has been used to evaluate occupational exposures in epidemiological studies. OBJECTIVE: The broad aim of the present study was to evaluate the contribution of an expert assessment performed by an occupational hygienist to the diagnosis of OA. The specific aim was to compare work-place exposures identified by an occupational hygienist and by chest physicians in subjects with positive SICs and subjects with asthma, but with a negative SIC. METHODS: SICs were performed in 120 cases: 67 were positive and 53 were negative. A clinician assessed occupational exposures to sensitizers during a routine clinical evaluation preceding the performance of the SIC. An expert assessment of occupational exposures was performed by an occupational hygienist blind to the result of the SIC. RESULTS: The occupational hygienist identified the causal agent in 96.7% of the 61 cases of positive SIC. In 33 (62.3%) cases of negative SICs, the occupational hygienist identified ≥1 sensitizing agent(s) that had not been identified by the clinician. CONCLUSION: The hygienist identified the causal agent in almost all subjects with OA. In contrast, the clinician failed to identify potential exposures to sensitizers in >60% of the negative SIC subjects, which may have resulted in some subjects being misdiagnosed as not having OA. PMID:26422401

Occupational asthma in greenhouse workers.

PubMed

Monsó, Eduard

2004-03-01

A prevalence of asthma over 5% has been reported in flower farmers,and work inside greenhouses has emerged as an additional risk factor. Workplace determinants behind this high prevalence has been examined, and a prevalence of sensitization to workplace allergens over 30% has been reported being pollens, moulds, and Tetranychus urticae allergens the main sensitizers. Bronchial challenge tests in the workplace have demonstrated occupational asthma in more than 20% of the sensitized greenhouse growers. Air contamination inside greenhouses is mainly related to moulds, and is facilitated by the high indoor temperature and humidity. Cladosporium, Penicillium, Aspergillus, and Alternaria and a wide range of flower pollens are able to sensitize the greenhouse worker and cause occupational asthma. Tetranychus urticae have allergens shared with other mites, but the low prevalence of cross-sensitization between them confirm that Tetranychus urticae contains species-specific allergens that may cause respiratory symptoms. Additionally, working inside greenhouses has been related to an increase in the prevalence of chronic bronchitis in nonsmokers. The cultivation of greenhouse crops may cause occupational asthma through sensitization to workplace pollens, moulds, and Tetranychus urticae allergens. In greenhouse flower growers, skin testing identifies sensitization to these allergens in one third of the growers, and more than one fifth of the sensitized workers will develop occupational asthma. Greenhouse work has also been related to chronic bronchitis in nonsmokers, suggesting a causal effect of greenhouse air contaminants on this disease as well.

Occupational asthma in a highly industrialized region of UK: report from a local surveillance scheme.

PubMed

Di Stefano, Fabio; Siriruttanapruk, Somkiat; McCoach, Jennifer; Di Gioacchino, Mario; Burge, Peter Sherwood

2004-02-01

Estimates of the incidence of occupational asthma may be derived from surveillance schemes established in several countries. SHIELD is a voluntary surveillance scheme for occupational asthma in the West Midlands, a highly industrialized region of UK. The aim of this study was to estimate the general and specific incidence of occupational asthma in the West Midlands in 1990-97. The annual incidence was 41.2/million. There was a two fold difference in the incidence by sex (male 59.6/million/yr; female 27.4/million/yr). The highest annual incidence (53.2/million) was observed in the age group 45-64 yr (male) and 45-59 yr (female). Spray painters were the occupation at the highest risk of developing occupational asthma, followed by electroplaters, rubber and plastic workers, bakery workers and moulders. Although the percentage of reported cases was low among healthcare workers, there was a raising trend. Isocyanates still remained the most common causative agents with 190 (17.3%) out of the total 1097 cases reported to the surveillance scheme in seven years. There was a decrease in the reported cases due to colophony (9.5% to 4.6%), flour & wheat (8.9% to 4.9%). There was an increase of reported cases due to latex (0.4% to 4.9%) and glutaraldehyde (1.3% to 5.6%). The serial mesurement of peak expiratory flow at and away from work was the most used method of diagnosis to confirm the occupational cause of asthma. Specific bronchial challenge test with the occupational agents were used when the serial measurement of peak expiratory flow was not able to confirm undoubtdely the diagnostic suspicion or when it was difficult to identify the possible causative agent due to multiple exposures in the workplace. Following diagnosis, 24% of the patients were moved away from exposure within the same workplace in 1997, compared to 15.8% in the previous years. Those remaining exposed to the causative agent in the same workplace decreased from 28.3% to 17.7% between 1990-97. The

Occupational exposures associated with severe exacerbation of asthma.

PubMed

Henneberger, P K; Liang, X; Lillienberg, L; Dahlman-Höglund, A; Torén, K; Andersson, E

2015-02-01

The exacerbation of asthma by workplace conditions is common, but little is known about which agents pose a risk. We used data from an existing survey of adults with asthma to identify occupational exposures associated with severe exacerbation of asthma. Questionnaires were completed by 557 working adults with asthma. Severe exacerbation of asthma in the past 12 months was defined as asthma-related hospitalization, or reports of both unplanned asthma care and treatment with a short course of oral corticosteroids. Occupational exposures for the same time period were assessed using an asthma-specific job exposure matrix. We modeled severe exacerbation to yield prevalence ratios (PRs) for exposures while controlling for potential confounders. A total of 164 participants (29%) were positive for severe exacerbation, and 227 (40.8%) were assessed as being exposed to asthma agents at work. Elevated PRs were observed for several specific agents, notably the irritant subcategories of environmental tobacco smoke (PR 1.84, 95%CI 1.34-2.51) among all participants, inorganic dusts (PR 2.53, 95%CI 1.37-4.67) among men, and the low molecular weight subcategory of other highly reactive agents (PR 1.97, 95%CI 1.08-3.60) among women. Among working adults with asthma, severe exacerbation was associated with several occupational agents.

Occupational asthma in maritime environments: an update.

PubMed

Lucas, David; Lodde, Brice; Jepsen, Jørgen Riis; Dewitte, Jean-Dominique; Jegaden, Dominique

2016-01-01

In 2006 we published our first review based on the available literature on occupational asthma in maritime environments in the "International Maritime Health" journal. Since then, we have obtained a great deal of new knowledge on asthma in seafood workers and fishermen and on the impact of exposures from sulphites preservatives, container fumigants etc. in maritime workers. This review aims to provide an update of the current knowledge base about occupational asthma in a maritime context and to provide recommendations regarding medical surveillance of workers at risk.

Opportunities and obstacles in translating evidence to policy in occupational asthma.

PubMed

Tarlo, Susan M; Arif, Ahmed A; Delclos, George L; Henneberger, Paul; Patel, Jenil

2018-06-01

Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices. Copyright © 2017 Elsevier Inc. All rights reserved.

Opportunities and obstacles in translating evidence to policy in occupational asthma

PubMed Central

Tarlo, Susan M.; Arif, Ahmed A.; Delclos, George L.; Henneberger, Paul; Patel, Jenil

2018-01-01

Purpose Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. Methods In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. Results and conclusions Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices. PMID:28434545

Health surveillance for occupational asthma in the UK.

PubMed

Fishwick, D; Sen, D; Barker, P; Codling, A; Fox, D; Naylor, S

2016-07-01

Periodic health surveillance (HS) of workers can identify early cases of occupational asthma. Information about its uptake and its content in the UK is lacking. To identify the overall levels of uptake and quality of HS for occupational asthma within three high-risk industry sectors in the UK. A telephone survey of employers, and their occupational health (OH) professionals, carried out in three sectors with exposures potentially capable of causing occupational asthma (bakeries, wood working and motor vehicle repair). A total of 457 organizations participated (31% response rate). About 77% employed <10 people, 17% between 10 and 50 and 6% >50. Risk assessments were common (67%) and 14% carried out some form of HS for occupational asthma, rising to 19% if only organizations reporting asthma hazards and risks were considered. HS was carried out both by in-house (31%) and external providers (69%). Organizational policies were often used to define HS approaches (80%), but infrequently shared with the OH provider. OH providers described considerable variation in practice. Record keeping was universal, but worker-held records were not reported. HS tools were generally developed in-house. Lung function was commonly measured, but only limited interpretation evident. Referral of workers to local specialist respiratory services was variable. This study provided new insights into the real world of HS for occupational asthma. We consider that future work could and should define simpler, more practical and evidence-based approaches to HS to ensure maximal consistency and use of high-quality approaches. © Crown copyright 2016.

Agents causing occupational asthma in Finland in 1986-2002: cow epithelium bypassed by moulds from moisture-damaged buildings.

PubMed

Piipari, R; Keskinen, H

2005-12-01

Occupational asthma is an avoidable form of asthma. In Finland, the diagnosis of occupational asthma entitles substantial compensation to the employee. The diagnostics are based on symptoms, exposure assessment, allergologic investigations, follow-up of peak expiratory flow (PEF) at work and at home and, in many cases, specific challenge tests. To study the causative agents of occupational asthma in Finland. The causative agents and the numbers of new occupational asthma cases notified to the Finnish Register of Occupational Diseases (FROD) during 1986-2002 are reported. The number of occupational asthma cases increased from 1986 until 1995, after which a downward trend, stabilizing during the last few years, has been observed. The majority of the cases (59%) in the beginning of the period (1986-1990) were associated with agriculture, but the percentage has fallen thereafter (42% of the cases in 1998-2002) along with the fall in the total number of cases. Since 1995, indoor moulds from water-damaged buildings have caused an increasing number of cases and have become the most important causative agents (0.5% cases, in 1986-1990 and 18% of the cases in 1998-2002). Chemicals have caused 10-30% of the cases, a decreasing number since 1990. The most important chemicals causing occupational asthma have been diisocyanates and welding fumes, followed by hairdressing chemicals and formaldehyde. The number of occupational asthma cases in Finland reached its height in the mid-1990s. The decrease in the number of total cases is because of the decrease in agriculture-associated cases, reflecting the number of employees in agriculture-associated occupations, which has greatly decreased since Finland joined the EU in 1995. An epidemic of mould-induced asthma, affecting mostly white-collar employees working in moisture-damaged buildings, has taken place since 1995.

Diagnosis of asthma: diagnostic testing.

PubMed

Brigham, Emily P; West, Natalie E

2015-09-01

Asthma is a heterogeneous disease, encompassing both atopic and non-atopic phenotypes. Diagnosis of asthma is based on the combined presence of typical symptoms and objective tests of lung function. Objective diagnostic testing consists of 2 components: (1) demonstration of airway obstruction, and (2) documentation of variability in degree of obstruction. A review of current guidelines and literature was performed regarding diagnostic testing for asthma. Spirometry with bronchodilator reversibility testing remains the mainstay of asthma diagnostic testing for children and adults. Repetition of the test over several time points may be necessary to confirm airway obstruction and variability thereof. Repeated peak flow measurement is relatively simple to implement in a clinical and home setting. Bronchial challenge testing is reserved for patients in whom the aforementioned testing has been unrevealing but clinical suspicion remains, though is associated with low specificity. Demonstration of eosinophilic inflammation, via fractional exhaled nitric oxide measurement, or atopy, may be supportive of atopic asthma, though diagnostic utility is limited particularly in nonatopic asthma. All efforts should be made to confirm the diagnosis of asthma in those who are being presumptively treated but have not had objective measurements of variability in the degree of obstruction. Multiple testing modalities are available for objective confirmation of airway obstruction and variability thereof, consistent with a diagnosis of asthma in the appropriate clinical context. Providers should be aware that both these characteristics may be present in other disease states, and may not be specific to a diagnosis of asthma. © 2015 ARS-AAOA, LLC.

Occupations with an increased prevalence of self-reported asthma in Indian adults.

PubMed

Agrawal, Sutapa; Pearce, Neil; Millett, Christopher; Subramanian, S V; Ebrahim, Shah

2014-10-01

Occupational asthma remains relatively under-recognized in India with little or no information regarding preventable causes. We studied occupations with an increased prevalence of self-reported asthma among adult men and women in India. Analysis is based on 64,725 men aged 15-54 years and 52,994 women aged 15-49 years who participated in India's third National Family Health Survey, 2005-2006, and reported their current occupation. Prevalence odds ratios (ORs) for specific occupations and asthma were estimated using multivariate logistic regression, separately for men and women, adjusting for age, education, household wealth index, current tobacco smoking, cooking fuel use, rural/urban residence and access to healthcare. The prevalence of asthma among the working population was 1.9%. The highest odds ratios for asthma were found among men in the plant and machine operators and assemblers major occupation category (OR: 1.67; 95% CI: 1.14-2.45; p = 0.009). Men working in occupation subcategories of machine operators and assemblers (OR: 1.85; 95% CI: 1.24-2.76; p = 0.002) and mining, construction, manufacturing and transport (OR: 1.33; 95% CI: 1.00-1.77; p = 0.051) were at the highest risk of asthma. Reduced odds of asthma prevalence in men was observed among extraction and building trades workers (OR: 0.72; 95% CI: 0.53-0.97; p = 0.029). Among women none of the occupation categories or subcategories was found significant for asthma risk. Men and women employed in high-risk occupations were not at a higher risk of asthma when compared with those in low-risk occupations. This large population-based, nationally representative cross-sectional study has confirmed findings from high income countries showing high prevalence of asthma in men in a number of occupational categories and subcategories; however, with no evidence of increased risks for women in the same occupations.

Occupational asthma in the developing and industrialised world: a review.

PubMed

Jeebhay, M F; Quirce, S

2007-02-01

Occupational asthma is the most common occupational lung disease in industrialised countries, and the second most common occupational lung disease reported after pneumoconioses in developing countries. The median proportion of adult cases of asthma attributable to occupational exposure is between 10% and 15%. The population attributable fraction appears to be similar in industrialised and developing countries characterised by rapid industrialisation (13-15%), but lower in less industrialised developing countries (6%). The high-risk occupations and industries associated with the development of occupational asthma vary depending on the dominant industrial sectors in a particular country. High-risk exposure to cleaning agents and pesticide exposure in developing countries appear to be as important as exposure to isocyanates, cereal flour/grain dust, welding fumes, wood dust and, more recently, hairdressing chemicals, commonly reported in industrialised countries. The reported mean annual incidence of occupational asthma in developing countries is less than 2 per 100 000 population, compared to very high rates of up to 18/100 000 in Scandinavian countries. While occupational asthma remains under-recognised, especially in developing countries, it remains poorly diagnosed and managed and inadequately compensated worldwide. Primary and secondary preventive strategies should be directed at controlling workplace exposures, accompanied by intense educational and managerial improvements. Appropriate treatment remains early removal from exposure to ensure that the worker has no further exposure to the causal agent, with preservation of income. However, up to one third of workers with occupational asthma continue to remain exposed to the causative agent or suffer prolonged work disruption, discrimination and risk of unemployment.

Occupations with an increased prevalence of self-reported asthma in Indian adults

PubMed Central

Pearce, Neil; Millett, Christopher; Subramanian, S.V.; Ebrahim, Shah

2014-01-01

Objectives Occupational asthma remains relatively under-recognized in India with little or no information regarding preventable causes. We studied occupations with an increased prevalence of self-reported asthma among adult men and women in India. Methods Analysis is based on 64 725 men aged 15–54 years and 52 994 women aged 15–49 years who participated in India’s third National Family Health Survey, 2005–2006, and reported their current occupation. Prevalence odds ratios (ORs) for specific occupations and asthma were estimated using multivariate logistic regression, separately for men and women, adjusting for age, education, household wealth index, current tobacco smoking, cooking fuel use, rural/urban residence and access to healthcare. Results The prevalence of asthma among the working population was 1.9%. The highest odds ratios for asthma were found among men in the plant and machine operators and assemblers major occupation category (OR: 1.67; 95% CI: 1.14–2.45; p = 0.009). Men working in occupation subcategories of machine operators and assemblers (OR: 1.85; 95% CI: 1.24–2.76; p = 0.002) and mining, construction, manufacturing and transport (OR: 1.33; 95% CI: 1.00–1.77; p = 0.051) were at the highest risk of asthma. Reduced odds of asthma prevalence in men was observed among extraction and building trades workers (OR: 0.72; 95% CI: 0.53–0.97; p = 0.029). Among women none of the occupation categories or subcategories was found significant for asthma risk. Men and women employed in high-risk occupations were not at a higher risk of asthma when compared with those in low-risk occupations. Conclusions This large population-based, nationally representative cross-sectional study has confirmed findings from high income countries showing high prevalence of asthma in men in a number of occupational categories and subcategories; however, with no evidence of increased risks for women in the same occupations. PMID:24712498

Occupational asthma and rhinitis due to detergent enzymes in healthcare.

PubMed

Adisesh, A; Murphy, E; Barber, C M; Ayres, J G

2011-08-01

The use of proteolytic enzymes to improve the cleaning efficacy of washing powders was introduced in the mid 1960s. Many microbial enzymes are known to be potent respiratory sensitizers but previously there has been only one case of occupational asthma associated with workplace exposure in a healthcare worker. To report two cases of occupational asthma associated with exposure to biological enzymes in health-care workers and related occupational cases. Reporting of clinical case reports from three different work places. One case of occupational asthma and three other cases with work-related asthma or rhinitis occurred in one workplace. A single case of probable occupational asthma presented at a second workplace with another case of work-related asthma at a third workplace. Exposures occurred in areas used for cleaning medical instruments and endoscopy suites. Hygiene measurements confirmed the potential for exposure. Control measures were not in place and recognition of the hazard was missing in these workplaces. Detergent enzymes when used in healthcare settings should be recognized as potential respiratory sensitizers. Healthcare institutions and professional bodies that recommend the use of detergent enzymes should review their risk assessments to ensure that the most appropriate methods for preventing or reducing exposure are in place.

Standards of care for occupational asthma: an update.

PubMed

Fishwick, David; Barber, Christopher Michael; Bradshaw, Lisa M; Ayres, Jon G; Barraclough, Richard; Burge, Sherwood; Corne, Jonathan M; Cullinan, Paul; Frank, Timothy Laszlo; Hendrick, David; Hoyle, Jennifer; Curran, Andrew D; Niven, Robert; Pickering, Tony; Reid, Peter; Robertson, Alastair; Stenton, Chris; Warburton, Christopher J; Nicholson, Paul J

2012-03-01

The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF). BOHRF updated the evidence base from 2004-2009 in 2010. This article summarises the changes in evidence and is aimed at physicians, nurses and other healthcare professionals in primary and secondary care, occupational health and public health and at employers, workers and their health, safety and other representatives. Various recommendations and evidence ratings have changed in the management of asthma that may have an occupational cause.

Control of occupational asthma and allergy in the detergent industry.

PubMed

Sarlo, Katherine

2003-05-01

To provide an overview of how a comprehensive preclinical, clinical, and industrial hygiene program has been successfully used to control allergy and asthma to enzymes used in the detergent industry. The author performed a PubMed and ToxLine search of English-language articles with the keywords enzymes, occupational allergy, occupational asthma, detergent, and detergent industry from January 1, 1995, to January 1, 2002. Scientific meeting abstracts, books, and industry association papers on allergy and asthma in the detergent industry were also reviewed. In addition, the practical experience of one major detergent company was included in the review. All published work on this topic was reviewed, and the work that discussed the key highlights of control of occupational allergy and asthma to enzymes used in the detergent industry was selected for this review. The detergent industry has developed guidelines for the safety assessment of enzymes, control of exposure to enzymes, and medical surveillance of enzyme-exposed workers. Because of these guidelines, occupational allergy and asthma to enzymes used in the detergent industry have become uncommon events. Cases of disease have been documented in some manufacturing sites that have had poor adherence to the guidelines. Those manufacturing sites that have adhered to the guidelines have had few cases of allergy and asthma to enzymes among exposed workers. A review of medical data from these sites has shown that workers who have developed IgE antibody to enzymes can continue to work with enzymes and remain symptom free. Occupational allergy and asthma to enzymes used in the detergent industry have been successfully controlled via the use of preclinical, clinical, and industrial hygiene safety programs designed to minimize sensitization to enzymes and development of disease. The basic principles of these programs can be applied to other industries where occupational allergy and asthma to proteins are common.

Occupational rhinitis and occupational asthma; one airway two diseases?

NASA Astrophysics Data System (ADS)

Seed, M. J.; Gittins, M.; DeVocht, F.; Agius, R. M.

2009-02-01

The concept of 'one airway, one disease' refers to the frequent comorbidity of asthma and rhinitis. However, only limited research has been done on this association for the diverse range of occupational respiratory sensitisers. The relative frequency of rhinitis was determined for the 15 respiratory sensitisers reported to cause at least 10 cases of rhinitis or asthma to The Health and Occupation Reporting (THOR) network between 1997 and 2006. Of 1408 cases, 1190 were sole diagnoses of asthma, 138 sole diagnoses of rhinitis and in 80 cases asthma coexisted with rhinitis. The six sensitisers for which rhinitis featured in over 15% of cases were all particulates and known to cause release of mast cell mediators, either directly or through IgE antibodies. Four of the other nine sensitisers often exist as vapours and only two have been consistently associated with IgE-mediated disease mechanisms. Particle size did not appear to correlate with the relative frequency of rhinitis. Despite its limitations this study would support the hypothesis that there are at least two mechanistic categories of respiratory sensitisation with rhinitis being relatively more common where the mechanism is IgE-mediated. Particulate nature may be another important factor to consider in future studies.

Occupational asthma caused by stainless steel welding fumes: a clinical study.

PubMed

Hannu, T; Piipari, R; Tuppurainen, M; Nordman, H; Tuomi, T

2007-01-01

The aim of the present study was to describe the cases of occupational asthma (OA) due to stainless steel welding fumes diagnosed at the Finnish Institute of Occupational Health during the period 1994-2003. OA was diagnosed according to patient history, lung function examinations and welding challenge tests with measurements of the forced expiratory volume in one second (FEV(1)) and peak expiratory flow (PEF) values. The present series comprised 34 patients, all male, with a mean age of 44.7 yrs (range 22-57), mainly working as welders. The mean duration of exposure was 22.4 yrs, and the mean duration of exposure before the onset of respiratory symptoms was 18 yrs. Dyspnoea was the most frequently reported work-related respiratory symptom. During the inhalation challenge tests, the mode of the asthmatic FEV(1)/PEF reaction was delayed in 16 (47%) patients, immediate in nine (26%) patients and dual (both immediate and delayed) in nine (26%) patients. In the follow-up assessment 6 months later, only six patients were considered able to continue performing welding tasks, whereas occupational injury pension was recommended for seven, and measures of vocational rehabilitation for 14 patients. In most cases, after the diagnosis of occupational asthma, the continuation of welding work was not possible.

[Occupational asthma in the Tunisian central region: etiologies and professional status].

PubMed

Chatti, S; Maoua, M; Rhif, H; Dahmoul, M; Abbassi, A; Mlaouah, A J; Hadj Salah, H; Debbabi, F; Mrizak, N

2011-10-01

To study the etiologies of occupational asthma and determine its impact on the professional status of asthmatic subjects. The authors carried out a descriptive study on all of the cases of asthma recognized as an occupational disease and declared in the private sector over nine years (2000-2008) in the Tunisian central region. Cases (219) of occupational asthma were listed, accounting for 16.8% of all of the occupational diseases recognized during the period studied. Occupational asthma concerned young adults (40±8.2 years), with a predominance of women (67.7%). The textile sector dominated (74.9%). The majority of the employees were exposed to high molecular weight allergens (82.3%) and cotton dust was the principal offending agent (75.3%). Involuntary unemployment was observed in about half of the cases (46.6%) and was associated with an age lower or equal to 35 years (p = 0.01) and under 15 years of professional seniority (p=0.03). Occupational asthma in the Tunisian central region prevails in the textile sector thereby justifying the reinforcement of preventive measures in this branch of industry. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Use of objective testing in the diagnosis of work-related asthma by physician specialty.

PubMed

Curwick, Christy C; Bonauto, David K; Adams, Darrin A

2006-10-01

Although early and accurate diagnosis of work-related asthma is critical to avoid unnecessary medical, legal, social, and economic consequences, little is currently known about the diagnostic practices of physicians treating workers with work-related asthma. To characterize the use of objective diagnostic testing for work-related asthma by physician specialty. A cross-sectional, descriptive, comparative evaluation was conducted of 301 workers' compensation claimants with work-related asthma. A few claimants (36.9%) were treated by specialists in work-related asthma (allergists, pulmonologists, or occupational medicine physicians) either initially or through the course of their claim. Workers with occupational asthma were more likely to have seen a specialist than those with work-aggravated asthma (47.9% vs 23.0%; P < .001). Less than half of the claimants with work-related asthma (43.2%) had received an objective evaluation of pulmonary function, through either pulmonary function testing or testing for reversible airflow limitation, for the evaluation of their work-related asthma. Claimants treated by specialists were significantly more likely to have received diagnostic testing during evaluation of their disease than those treated solely by generalists (82.9% vs 20.0%; P < .001). The results of this study point to the lack of appropriate diagnostic care received by workers with work-related asthma. Physicians who may have questions about diagnostic procedures should consider referral to a specialist. The development of referral networks for work-related asthma may be warranted and should be explored.

Occupational Risk Factors and Asthma among Health Care Professionals

PubMed Central

Delclos, George L.; Gimeno, David; Arif, Ahmed A.; Burau, Keith D.; Carson, Arch; Lusk, Christine; Stock, Thomas; Symanski, Elaine; Whitehead, Lawrence W.; Zock, Jan-Paul; Benavides, Fernando G.; Antó, Josep M.

2007-01-01

Rationale: Recent U.S. data suggest an increased risk of work-related asthma among health care workers, yet only a few specific determinants have been elucidated. Objectives: To evaluate associations of asthma prevalence with occupational exposures in a cross-sectional survey of health care professionals. Methods: A detailed questionnaire was mailed to a random sample (n = 5,600) of all Texas physicians, nurses, respiratory therapists, and occupational therapists with active licenses in 2003. Information on asthma symptoms and nonoccupational asthma risk factors obtained from the questionnaire was linked to occupational exposures derived through an industry-specific job-exposure matrix. Measurements: There were two a priori defined outcomes: (1) physician-diagnosed asthma with onset after entry into health care (“reported asthma”) and (2) “bronchial hyperresponsiveness–related symptoms,” defined through an 8-item symptom-based predictor. Main Results: Overall response rate was 66%. The final study population consisted of 862 physicians, 941 nurses, 968 occupational therapists, and 879 respiratory therapists (n = 3,650). Reported asthma was associated with medical instrument cleaning (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.34–3.67), general cleaning (OR, 2.02; 95% CI, 1.20–3.40), use of powdered latex gloves between 1992 and 2000 (OR, 2.17; 95% CI, 1.27–3.73), and administration of aerosolized medications (OR, 1.72; 95% CI, 1.05–2.83). The risk associated with latex glove use was not apparent after 2000. Bronchial hyperresponsiveness–related symptoms were associated with general cleaning (OR, 1.63; 95% CI, 1.21–2.19), aerosolized medication administration (OR, 1.40; 95% CI, 1.06–1.84), use of adhesives on patients (OR, 1.65; 95% CI, 1.22–2.24), and exposure to a chemical spill (OR, 2.02; 95% CI, 1.28–3.21). Conclusions: The contribution of occupational exposures to asthma in health care professionals is not trivial

Facilities for investigating occupational asthma in UK non-specialist respiratory departments.

PubMed

Barber, Christopher M; Naylor, Steven; Bradshaw, Lisa; Francis, Mandy; Harris-Roberts, Joanne; Rawbone, Roger; Curran, Andrew; Fishwick, David

2008-01-01

The facilities which should be available to physicians offering specialist occupational asthma services have recently been agreed upon by a UK panel of experts. This study aimed to investigate whether these facilities are available in UK non-specialist secondary care respiratory departments and to document tertiary care referral patterns. A random sample of 100 UK respiratory units was selected, and the lead consultant invited to participate. Face-to-face interviews were conducted to document information on departmental facilities available for investigating cases of occupational asthma and utilization of tertiary referral centres. In total, 66% of consultants interviewed had seen a case of occupational asthma in the previous month, and 76% reported having ever referred a patient with suspected occupational asthma to a specialist centre for further investigation (referral distance range 1-111 miles). All the departments were able to perform the investigations previously deemed an absolute necessity in all patients. The availability of in-house facilities that were deemed as must be available varied between 3-100%. The results of this study demonstrate that while the majority of basic facilities are widely available, many respiratory departments do not have direct access to investigations routinely required to investigate occupational asthma. Access to specialist occupational respiratory centres varies within the UK, and in some parts of the country involves long travelling distances for patients.

Occupational asthma in a steel coating plant.

PubMed

Venables, K M; Dally, M B; Burge, P S; Pickering, C A; Newman Taylor, A J

1985-08-01

An outbreak of occupational asthma, of unknown cause and extent, was detected in a steel coating plant. In 1979 a cross-sectional study which defined occupational asthma in terms of respiratory symptoms detected 21 people with suggestive symptoms among the 221 studied. They all worked in the coating shop, but the plastic coatings used at the plant contained many potential sensitising agents that might have caused the asthma. All 21 developed their symptoms after 1971, and it was found that in this year a supplier had modified a coating allowing, at the temperatures used in the process, toluene di-isocyanate to be liberated. Two of the symptomatic subjects were tested by inhalation of the isocyanate and showed asthmatic reactions and other subjects were found to have asthma related to periods spent at work by records of peak expiratory flow rate. Over half the 21 had a symptom free latent period after first exposure of three years or less, a pattern not seen in other subjects with respiratory symptoms. After the isocyanate had been removed from the process 17 of these subjects became asymptomatic or improved, a greater proportion than in other subjects with respiratory symptoms.

A Case of Occupational Asthma in a Plastic Injection Process Worker

PubMed Central

2013-01-01

Objectives We report a case of death due to asthma attack in a plastic injection process worker with a history of asthma. Methods To assess task relevance, personal history including occupational history and medical records were reviewed. Samples of the substances utilized in the injection process were collected by visiting the patient’s workplace. The work environment with the actual process was reproduced in the laboratory, and the released substances were evaluated. Results The medical records confirmed that the patient’s conventional asthma was in remission. The analysis of the resins discharged from the injection process simulation revealed styrene, which causes occupational asthma, and benzenepropanoic acid, 3,5-bis(1,1-dimethylethyl)-4-hydroxy-, and octadecyl ester. Even though it was not the case in the present study, various harmful substances capable of inducing asthma such as formaldehyde, acrolein, and acetic acid are released during resin processing. Conclusion A worker was likely to occur occupational asthma as a result of the exposure to the harmful substances generated during the plastic injection process. PMID:24472161

Occupational asthma and contact dermatitis in a spray painter after introduction of an aziridine cross-linker.

PubMed Central

Leffler, C T; Milton, D K

1999-01-01

A 23-year-old spray painter developed contact dermatitis and respiratory difficulty characterized by small airways obstruction shortly after the polyfunctional aziridine cross-linker CX-100 began to be used in his workplace as a paint activator. The symptoms resolved after he was removed from the workplace and was treated with inhaled and topical steroids. Painters may have an increased risk of asthma due to exposure to a variety of agents, such as isocyanates, alkyd resins, and chromates. This case illustrates the importance of using appropriate work practices and personal protective equipment to minimize exposure. Occupational asthma is diagnosed by a history of work-related symptoms and exposure to known causative agents. The diagnosis is confirmed by serial pulmonary function testing or inhalational challenge testing. The risk of asthma attributable to occupational exposures is probably underappreciated due to underreporting and to inappropriate use of narrow definitions of exposure in epidemiologic studies of attributable risk. Images Figure 1 PMID:10379008

Occupational Asthma Due to Inhalation of Aerosolized Lipophilic Coating Materials.

PubMed

Suresh, Karthik; Belchis, Deborah; Askin, Fred; Pearse, David B; Terry, Peter B

2016-10-01

We present a case of onset of severe asthma in a 59-year-old patient who worked in an aerospace plant. He was noted to have wheezing on exam and obstruction on PFTs. Review of his occupational history revealed exposure to lipophilic industrial compounds. We outline the radiographic and histologic findings that were found in the patient, and discuss occupational asthma due to inhalation of lipophilic compounds.

Occupational asthma caused by cellulase and lipase in the detergent industry.

PubMed

Brant, A; Hole, A; Cannon, J; Helm, J; Swales, C; Welch, J; Taylor, A Newman; Cullinan, P

2004-09-01

Three employees from two different detergent companies were investigated for occupational asthma, using skin prick tests, serum specific IgE, and specific bronchial challenge. Two were challenged with lipase and one with cellulase. All three cases had immunological evidence of sensitisation to the detergent enzymes with which they worked. Bronchial challenge in each provoked a reproducible dual asthmatic response, which reproduced their work related symptoms. These are the first reported cases of occupational asthma attributable to cellulase and lipase in the detergent industry. Four of the most common enzymes used in this industry have now been reported to cause occupational asthma; continued vigilance and caution are needed when working with these or other enzymes.

[Occupational asthma: Clinical and professional profile of the Tunisian asthmatic worker].

PubMed

Toujani, S; Hedhli, A; Mjid, M; Ben Salah, N; Ouahchy, Y; Louzir, B; Daghfous, J; Mhiri, N; Cherif, J; Beji, M

2016-08-01

Asthma takes up a great importance in occupational diseases but remains underestimated as it is insufficiently diagnosed. We aimed to access the clinical and professional profile of the Tunisian asthmatic worker. It was a retrospective descriptive study in a professional pathology unit in a university hospital. All patients referred by their doctor for symptoms suggestive of occupational asthma, during a period from 2000 to 2008, were included. Forty-eight patients were selected from 172. The mean age was 40 years, with a male predominance (56 %). In 2/3 of the cases, it was the textile workers, food and chemical industry. The etiological agents incriminated were textile dust in 18.8 % of cases followed by isocyanates and flour. Typical episodes of wheezing dyspnea were present in 52 % and atopy in 54.2 % of workers. In 2 % of cases, symptoms disappeared and worsened in 18.8 %. The prognosis of OA depends on early end accurate diagnosis. The physician's role is to initiate the appropriate diagnostic approach, which must comply with the Tunisian conditions. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Common Occupational Disorders: Asthma, COPD, Dermatitis, and Musculoskeletal Disorders.

PubMed

Bepko, Jennifer; Mansalis, Katherine

2016-06-15

An occupational illness is an event or exposure that occurs in the workplace that causes or contributes to a condition or worsens a preexisting condition. If an occupational disorder is suspected, a directed history should be taken with particular attention to establishing a temporal relationship of symptoms and exposure at work. Occupational asthma is the most prevalent occupational lung disorder in industrialized countries and presents with classic asthma symptoms (cough, difficulty breathing, chest tightness, wheezing). Occupational chronic obstructive pulmonary disease has been linked with exposure to nonspecific vapors, gases, dusts, fumes, and cigarette smoke. Occupational contact dermatitis is the most common dermal exposure. It can be caused by exposure to a variety of agents, including primary irritants or sensitizers, physical agents, mechanical trauma, and biologic agents. Occupational musculoskeletal disorders include many common repetitive injuries such as carpal tunnel syndrome and medial or lateral epicondylitis. Treatment of occupational disorders is generally the same as for nonoccupational disorders. Ideally, the exposure should be controlled to protect the worker. The impact of an occupational injury reaches beyond lost wages and can have a negative impact on quality of life.

Occupational exposures associated with work-related asthma and work-related wheezing among U.S. workers.

PubMed

Arif, Ahmed A; Delclos, George L; Whitehead, Lawrence W; Tortolero, Susan R; Lee, Eun S

2003-10-01

National estimates of occupational asthma (OA) in the United States are sparse. Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, we analyzed associations between occupation and work-related asthma and work-related wheezing among U.S. workers. This study identified several occupations that were at risk of developing work-related asthma and/or wheezing, with cleaners and equipment cleaners showing the highest risks. Other major occupations identified were farm and agriculture; entertainment; protective services; construction; mechanics and repairers; textile; fabricators and assemblers; other transportation and material moving occupations; freight, stock, and material movers; and motor vehicle operators. The population attributable risks for work-related asthma and work-related wheezing were 26% and 27%, respectively. This study adds evidence to the literature that identifies work-related asthma as an important public health problem. Several occupations are targeted for additional evaluation and study. Of particular interest are cleaners, which are being increasingly reported as a risk group for asthma. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace. Copyright 2003 Wiley-Liss, Inc.

Development of an accurate portable recording peak-flow meter for the diagnosis of asthma.

PubMed

Hitchings, D J; Dickinson, S A; Miller, M R; Fairfax, A J

1993-05-01

This article describes the systematic design of an electronic recording peak expiratory flow (PEF) meter to provide accurate data for the diagnosis of occupational asthma. Traditional diagnosis of asthma relies on accurate data of PEF tests performed by the patients in their own homes and places of work. Unfortunately there are high error rates in data produced and recorded by the patient, most of these are transcription errors and some patients falsify their records. The PEF measurement itself is not effort independent, the data produced depending on the way in which the patient performs the test. Patients are taught how to perform the test giving maximal effort to the expiration being measured. If the measurement is performed incorrectly then errors will occur. Accurate data can be produced if an electronically recording PEF instrument is developed, thus freeing the patient from the task of recording the test data. It should also be capable of determining whether the PEF measurement has been correctly performed. A requirement specification for a recording PEF meter was produced. A commercially available electronic PEF meter was modified to provide the functions required for accurate serial recording of the measurements produced by the patients. This is now being used in three hospitals in the West Midlands for investigations into the diagnosis of occupational asthma. In investigating current methods of measuring PEF and other pulmonary quantities a greater understanding was obtained of the limitations of current methods of measurement, and quantities being measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Medium-density fibreboard and occupational asthma. A case series.

PubMed

Burton, C; Bradshaw, L; Agius, R; Burge, S; Huggins, V; Fishwick, D

2011-08-01

Medium-density fibreboard (MDF) is a wood composite material, composed primarily of softwood, bonded with a synthetic formaldehyde-based resin. It is increasingly used, as it has various advantages over natural woods. Enquiry of the national reporting scheme data and three case reports were used to further the evidence base linking this exposure to occupational asthma (OA). From 1991 to 2007, 21 cases of occupational sensitization to MDF were reported to the UK voluntary reporting scheme, Surveillance of Work Related Occupational Respiratory Disease (SWORD): 18 reported as occupational asthma (OA) and 3 as occupational rhinitis. All workers were male, with a mean age of 48 years, working in education, furniture manufacturing or joinery among other employments. Whilst reporting scheme data identified relatively small numbers of cases of OA likely to be due to MDF, the evidence base supporting this link is generally lacking. The three cases presented, where OA was attributed to MDF exposure, add to this evidence.

Occupational Asthma in Korea

PubMed Central

Kim, Kyoo Sang

2010-01-01

Occupational asthma (OA) is the leading occupational respiratory disease. Cases compensated as OA by the Korea Workers' Compensation and Welfare Service (COMWEL) (218 cases), cases reported by a surveillance system (286 cases), case reports by related scientific journals and cases confirmed by the Occupational Safety and Health Research Institute (OSHRI) over 15 yr from 1992 to 2006 were analyzed. Annual mean incidence rate was 1.6 by compensation and 3.5 by surveillance system, respectively. The trend appeared to increase according to the surveillance system. Incidence was very low compared with other countries. The most frequently reported causative agent was isocyanate followed by reactive dye in dyeing factories. Other chemicals, metals and dust were also found as causative agents. OA was underreported according to compensation and surveillance system data. In conclusion, a more effective surveillance system is needed to evaluate OA causes and distribution, and to effectively prevent newly developing OA. PMID:21258586

Relationship between chemical structure and the occupational asthma hazard of low molecular weight organic compounds

PubMed Central

Jarvis, J; Seed, M; Elton, R; Sawyer, L; Agius, R

2005-01-01

Aims: To investigate quantitatively, relationships between chemical structure and reported occupational asthma hazard for low molecular weight (LMW) organic compounds; to develop and validate a model linking asthma hazard with chemical substructure; and to generate mechanistic hypotheses that might explain the relationships. Methods: A learning dataset used 78 LMW chemical asthmagens reported in the literature before 1995, and 301 control compounds with recognised occupational exposures and hazards other than respiratory sensitisation. The chemical structures of the asthmagens and control compounds were characterised by the presence of chemical substructure fragments. Odds ratios were calculated for these fragments to determine which were associated with a likelihood of being reported as an occupational asthmagen. Logistic regression modelling was used to identify the independent contribution of these substructures. A post-1995 set of 21 asthmagens and 77 controls were selected to externally validate the model. Results: Nitrogen or oxygen containing functional groups such as isocyanate, amine, acid anhydride, and carbonyl were associated with an occupational asthma hazard, particularly when the functional group was present twice or more in the same molecule. A logistic regression model using only statistically significant independent variables for occupational asthma hazard correctly assigned 90% of the model development set. The external validation showed a sensitivity of 86% and specificity of 99%. Conclusions: Although a wide variety of chemical structures are associated with occupational asthma, bifunctional reactivity is strongly associated with occupational asthma hazard across a range of chemical substructures. This suggests that chemical cross-linking is an important molecular mechanism leading to the development of occupational asthma. The logistic regression model is freely available on the internet and may offer a useful but inexpensive adjunct to the

Occupational asthma and allergy in the detergent industry: new developments.

PubMed

Sarlo, Katherine; Kirchner, Donald B

2002-04-01

This review highlights the latest developments in the control of enzyme-induced occupational asthma and allergy (rhinitis and conjunctivitis) in the detergent industry. The industry has developed guidelines for the safe handling of enzymes in order to reduce the risk of occupational allergy and asthma. Those manufacturing facilities that follow all of the guidelines enjoy very low or no cases of asthma and allergy among workers exposed to enzymes. The key to the success of the management of enzyme-induced allergy and asthma is prospective surveillance for the development of enzyme-specific IgE antibody before the onset of allergic symptoms. This allows for continuing interventions to reduce exposures, so as to minimize or eliminate those associated with symptoms. Workers with IgE to enzymes can still continue to work in the industry symptom-free for their entire career. This indicates that exposures needed to induce sensitization are different and probably lower than exposures needed to elicit enzyme allergic symptoms. The experience of the detergent enzyme industry in controlling occupational allergens can be applied to other industries. The detergent enzyme story can be viewed as a model for the control of type 1 protein allergens in the workplace.

Occupational asthma due to manual metal-arc welding of special stainless steels.

PubMed

Hannu, T; Piipari, R; Kasurinen, H; Keskinen, H; Tuppurainen, M; Tuomi, T

2005-10-01

Occupational asthma (OA) can be induced by fumes of manual metal-arc welding on stainless steel. In recent years, the use of special stainless steels (SSS) with high chromium content has increased. This study presents two cases of OA caused by manual metal-arc welding on SSS. In both cases, the diagnosis of OA was based on respiratory symptoms, occupational exposure and positive findings in the specific challenge tests. In the first case, a 46-yr-old welder had experienced severe dyspnoea while welding SSS (SMO steel), but not in other situations. Challenge tests with both mild steel and stainless steel using a common electrode were negative. Welding SSS with a special electrode caused a delayed 37% drop in forced expiratory volume in one second (FEV1). In the second case, a 34-yr-old male had started to experience dyspnoea during the past few years, while welding especially SSS (Duplex steel). The workplace peak expiratory flow monitoring was suggestive of OA. Challenge tests with both mild steel and stainless steel using a common electrode did not cause bronchial obstruction. Welding SSS with a special electrode caused a delayed 31% drop in FEV1. In conclusion, exposure to manual metal-arc welding fumes of special stainless steel should be considered as a new cause of occupational asthma.

Occupational rhinitis.

PubMed

Petrick, Maria M; Slavin, Raymond G

2003-05-01

This article aims to define occupational rhinitis, classify its various causes, review the steps in its diagnosis, and describe its nonpharmacologic and pharmacologic principles of management. Occupational rhinitis frequently coexists with asthma but also occurs alone. Although it does not have the same impact as occupational asthma, occupational rhinitis causes distress, discomfort, and work inefficiency. By concentrating on the patient's workplace, the clinician has an opportunity to practice preventive medicine: to recognize substances in the patient's micro- and macroenvironment that are causing the problems and then to intervene by altering the environment or removing the patient from the environment.

Prevalence of asthma by industry and occupation in the U.S. working population.

PubMed

McHugh, Michelle K; Symanski, Elaine; Pompeii, Lisa A; Delclos, George L

2010-05-01

Workers are potentially exposed to asthmagens daily. Our study was conducted to estimate the prevalence of asthma among working adults in the U.S. by industry and occupation. Using data from the National Health and Nutrition Examination Survey (2001-2004), multiple logistic regression was used to investigate associations between industry and occupation and current asthma as defined by positive responses to "Has a doctor or other health professional ever told you that you have asthma?" and "Do you still have asthma?" Workers in mining (17.0%), health-related industries (12.5%), teaching (13.1%), or in health-related occupations (12.6%) had the highest prevalence of asthma. As compared to construction industry workers, workers in mining (aOR = 5.2, 95% CI: 1.1-24.2) or health-related (aOR = 2.3, 95% CI: 1.1-4.8) industries had significantly higher odds of asthma. Our study adds to the increasing evidence that miners, healthcare workers and teachers remain high-risk working populations and appropriate evaluation and control measures are needed to protect these workers. 2010 Wiley-Liss, Inc.

Agents and trends in health care workers' occupational asthma.

PubMed

Walters, G I; Moore, V C; McGrath, E E; Burge, P S; Henneberger, P K

2013-10-01

There is a disproportionately high number of cases of work-related asthma occurring in health care occupations due to agents such as glutaraldehyde, latex and cleaning products. To understand the causes and measure trends over time of occupational asthma (OA) in health care workers (HCWs). We reviewed OA notifications from the Midland Thoracic Society's Surveillance Scheme of Occupational Asthma (SHIELD) database in the West Midlands, UK, from 1991 to 2011 and gathered data on occupation, causative agent and annual number of notifications. There were 182 cases of OA in HCWs (median annual notifications = 7; interquartile range [IQR] = 5-11), representing 5-19% of annual SHIELD notifications. The modal annual notification was 20 (in 1996); notifications have declined since then, in line with total SHIELD notifications. The majority of cases (136; 75%) occurred in nursing, operating theatre, endoscopy and radiology staff. The most frequently implicated agents were glutaraldehyde (n = 69), latex (n = 47) and cleaning products (n = 27), accounting for 79% of the 182 cases. Cleaning product-related OA was an emerging cause with 22 cases after 2001 and only 5 cases between 1991 and 2000. Control measures within the UK National Health Service have seen a decline in OA in HCWs due to latex and glutaraldehyde, though OA remains a problem amongst HCWs exposed to cleaning products. Continuing efforts are required to limit the number of cases in this employment sector.

Asthma Mortality Among Persons Aged 15-64 Years, by Industry and Occupation - United States, 1999-2016.

PubMed

Patel, Opal; Syamlal, Girija; Wood, John; Dodd, Katelynn E; Mazurek, Jacek M

2018-01-19

In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adult asthma deaths were reported (1). An estimated 11%-21% of asthma deaths might be attributable to occupational exposures (2). To describe asthma mortality among persons aged 15-64 years,* CDC analyzed multiple cause-of-death data † for 1999-2016 and industry and occupation information collected from 26 states § for the years 1999, 2003, 2004, and 2007-2012. Proportionate mortality ratios (PMRs) ¶ for asthma among persons aged 15-64 years were calculated. During 1999-2016, a total of 14,296 (42.9%) asthma deaths occurred among males and 19,011 (57.1%) occurred among females. Based on an estimate that 11%-21% of asthma deaths might be related to occupational exposures, during this 18-year period, 1,573-3,002 asthma deaths in males and 2,091-3,992 deaths in females might have resulted from occupational exposures. Some of these deaths might have been averted by instituting measures to prevent potential workplace exposures. The annual age-adjusted asthma death rate** per 1 million persons aged 15-64 years declined from 13.59 in 1999 to 9.34 in 2016 (p<0.001) among females, and from 9.14 (1999) to 7.78 (2016) (p<0.05) among males. The highest significantly elevated asthma PMRs for males were for those in the food, beverage, and tobacco products manufacturing industry (1.82) and for females were for those in the social assistance industry (1.35) and those in community and social services occupations (1.46). Elevated asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures.

Do young adults with childhood asthma avoid occupational exposures at first hire?

PubMed

Dumas, O; Smit, L A M; Pin, I; Kromhout, H; Siroux, V; Nadif, R; Vermeulen, R; Heederik, D; Hery, M; Choudat, D; Kauffmann, F; Le Moual, N

2011-05-01

Information on the healthy worker hire effect in relation to asthma is scant. We aimed to assess whether and how childhood asthma-related characteristics (before hire) relate to occupational exposures at first hire. Analyses were conducted in 298 children examined at the first survey of the Epidemiological Study on the Genetics and Environment of Asthma (1991-1995), who reported a training period or a job at follow-up in 2003-2007 (aged 17-29 yrs; 53% males). Exposure likelihood to dust, gases and/or fumes in their first occupation was estimated by the ALOHA job exposure matrix. Asthma before the first occupation and two asthma classifications for severity (Global Initiative for Asthma 2002 guidelines) and symptoms were defined by questionnaire. In their first job, 47% of subjects were exposed. After adjustment (age, sex and education), pre-hire onset asthmatics (59%) were nonsignificantly less likely to be exposed (OR 0.67, 95% CI 0.41-1.11). Associations were stronger when considering those with severe asthma or high symptom score in childhood (OR 0.27 (95% CI 0.11-0.63) and OR 0.49 (95% CI 0.25-0.99), respectively). The association was observed in those who completed a university degree (OR 0.55, 95% CI 0.29-1.04) but not in the others (OR 0.98, 95% CI 0.44-2.22), with consistent results for all asthma characteristics. Results suggest a healthy worker hire effect in subjects with more severe or more symptomatic asthma in childhood. Education may modulate self-selection.

Case report of occupational asthma induced by polyvinyl chloride and nickel.

PubMed

Song, Ga-Won; Ban, Ga-Young; Nam, Young-Hee; Park, Hae-Sim; Ye, Young-Min

2013-10-01

Polyvinyl chloride (PVC) is a widely used chemical for production of plastics. However occupational asthma (OA) caused by PVC has been reported only rarely. We report a 34-yr-old male wallpaper factory worker with OA due to PVC and nickel (Ni) whose job was mixing PVC with plasticizers. He visited the emergency room due to an asthma attack with moderate airflow obstruction and markedly increased sputum eosinophil numbers. A methacholine challenge test was positive (PC20 2.5 mg/mL). Bronchoprovocation tests with both PVC and Ni showed early and late asthmatic responses, respectively. Moreover, the fractional concentration of exhaled nitric oxide (FeNO) was increased after challenge with PVC. To our knowledge, this is the first case of OA in Korea induced by exposure to both PVC and Ni. We suggest that eosinophilic inflammation may be involved in the pathogenesis of PVC-induced OA and that FeNO monitoring can be used for its diagnosis.

Case Report of Occupational Asthma Induced by Polyvinyl Chloride and Nickel

PubMed Central

Song, Ga-Won; Ban, Ga-Young; Nam, Young-Hee; Park, Hae-Sim

2013-01-01

Polyvinyl chloride (PVC) is a widely used chemical for production of plastics. However occupational asthma (OA) caused by PVC has been reported only rarely. We report a 34-yr-old male wallpaper factory worker with OA due to PVC and nickel (Ni) whose job was mixing PVC with plasticizers. He visited the emergency room due to an asthma attack with moderate airflow obstruction and markedly increased sputum eosinophil numbers. A methacholine challenge test was positive (PC20 2.5 mg/mL). Bronchoprovocation tests with both PVC and Ni showed early and late asthmatic responses, respectively. Moreover, the fractional concentration of exhaled nitric oxide (FeNO) was increased after challenge with PVC. To our knowledge, this is the first case of OA in Korea induced by exposure to both PVC and Ni. We suggest that eosinophilic inflammation may be involved in the pathogenesis of PVC-induced OA and that FeNO monitoring can be used for its diagnosis. PMID:24133363

Occupational allergy and asthma among salt water fish processing workers.

PubMed

Jeebhay, Mohamed F; Robins, Thomas G; Miller, Mary E; Bateman, Eric; Smuts, Marius; Baatjies, Roslynn; Lopata, Andreas L

2008-12-01

Fish processing is a common economic activity in Southern Africa. The aim of this study was to determine the prevalence and host determinants of allergic symptoms, allergic sensitization, bronchial hyper-responsiveness and asthma among workers processing saltwater fish. A cross-sectional study was conducted on 594 currently employed workers in two processing plants involved in pilchard canning and fishmeal processing. A modified European Community Respiratory Health Survey (ECRHS) questionnaire was used. Skin prick tests (SPT) used extracts of common airborne allergens, fresh fish (pilchard, anchovy, maasbanker, mackerel, red eye) and fishmeal. Spirometry and methacholine challenge tests (MCTs; tidal breathing method) used ATS guidelines. Work-related ocular-nasal symptoms (26%) were more common than asthma symptoms (16%). The prevalence of atopy was 36%, while 7% were sensitized to fish species and 26% had NSBH (PC(20) < or = 8 mg/ml or > or =12% increase in FEV(1) post-bronchodilator). The prevalence of probable occupational asthma was 1.8% and fish allergic rhino-conjunctivitis 2.6%. Women were more likely to report work-related asthma symptoms (OR = 1.94) and have NSBH (OR = 3.09), while men were more likely to be sensitized to fish (OR = 2.06) and have airway obstruction (OR = 4.17). Atopy (OR = 3.16) and current smoking (OR = 2.37), but not habitual seafood consumption were associated with sensitization to fish. Based on comparison with previous published studies, the prevalence of occupational asthma to salt water fish is lower than due to shellfish. The gendered distribution of work and exposures in fish processing operations together with atopy and cigarette smoking are important determinants of occupational allergy and asthma. Copyright 2008 Wiley-Liss, Inc.

Asthma pathogenesis, diagnosis, and management in the elderly.

PubMed

Pasha, M Asghar; Sundquist, Britta; Townley, Robert

2017-05-01

Due to the aging population, there is an increase in the number of elderly patients with asthma. Although signs and symptoms are similar to those in younger patients, diagnosis can be challenging due to presence of coexisting conditions in this population. The purpose of this review was to highlight the challenges with regards to diagnosis, management, the high rates of medical costs and mortality in elderly asthmatics. Scientific literature regarding asthma in the elderly population was reviewed. When compared to younger patients, elderly asthmatics have different drug responses, higher rates of bronchial hyper reactivity, more severe phenotype, and lower prevalence of atopy. In addition, there are issues with the adverse effects of asthma medications, use of proper inhaler technique and compliance. There is an unmet need for research in elderly patients with asthma, specifically to facilitate diagnosis, and to investigate therapeutic strategies to improve quality of life in this population.

Occupational exposures and asthma in 14,000 adults from the general population

PubMed Central

Le Moual, Nicole; Kennedy, Susan M.; Kauffmann, Francine

2004-01-01

The association of occupational exposures and asthma were studied in 14151 adults, aged 25–59 years, from the general population of the French PAARC (Pollution Atmospherique et Affections Respiratoires Chroniques, 1975) Survey. Associations of asthma to specific jobs such as personal care workers, waiters, stock clerks were observed, with age, sex, smoking adjusted odds ratios between 1.5 and 1.7. Exposures to 18 asthmagenic agents (low, high molecular weight and mixed environment) were estimated by an asthma-specific job exposure matrix. Risks associated with asthma increased when excluding subjects with imprecise estimates of exposure. Risks further increased when increasing specificity of the definition of asthma considering jobs or specific agents such as industrial cleaning agents, latex, flour, highly reactive chemicals, and textiles. For example, for industrial cleaning agents, odds ratios increased from 1.55 (95% CI: 1.08, 2.23) for ever asthma, to 2.51 (95% CI: 1.33, 4.75) for asthma with airflow limitation, to 2.17 (95% CI: 1.41, 3.34) for asthma onset after age 14, and to 2.35 (95% CI: 1.38, 4.00) for asthma onset after beginning of current job. Results underlined the importance of the specificity of exposure and asthma definitions and indicated a deleterious role of occupational exposure on asthma, especially for cleaning agents. PMID:15561990

Agents and trends in health care workers' occupational asthma

PubMed Central

Walters, G. I.; Moore, V. C.; McGrath, E. E.; Burge, P. S.; Henneberger, P. K.

2015-01-01

Background There is a disproportionately high number of cases of work-related asthma occurring in health care occupations due to agents such as glutaraldehyde, latex and cleaning products. Aims To understand the causes and measure trends over time of occupational asthma (OA) in health care workers (HCWs). Methods We reviewed OA notifications from the Midland Thoracic Society's Surveillance Scheme of Occupational Asthma (SHIELD) database in the West Midlands, UK, from 1991 to 2011 and gathered data on occupation, causative agent and annual number of notifications. Results There were 182 cases of OA in HCWs (median annual notifications = 7; interquartile range [IQR] = 5–11), representing 5–19% of annual SHIELD notifications. The modal annual notification was 20 (in 1996); notifications have declined since then, in line with total SHIELD notifications. The majority of cases (136; 75%) occurred in nursing, operating theatre, endoscopy and radiology staff. The most frequently implicated agents were glutaraldehyde (n = 69), latex (n = 47) and cleaning products (n = 27), accounting for 79% of the 182 cases. Cleaning product-related OA was an emerging cause with 22 cases after 2001 and only 5 cases between 1991 and 2000. Conclusions Control measures within the UK National Health Service have seen a decline in OA in HCWs due to latex and glutaraldehyde, though OA remains a problem amongst HCWs exposed to cleaning products. Continuing efforts are required to limit the number of cases in this employment sector. PMID:23933593

Prevalence of Work-Related Asthma in Primary Health Care: Study Rationale and Design

PubMed Central

Rabell-Santacana, Ventura; Panadès-Valls, Rafael; Vila-Rigat, Rosa; Hernandez-Huet, Enric; Sivecas-Maristany, Joan; Blanché-Prat, Xavier; Prieto, Gemma; Muñoz, Laura; Torán, Pere

2015-01-01

Background : Occupational Asthma (OA) is the most frequent origin of occupational respiratory diseases in industrialized countries and accounts for between 5% and 25% of asthmatic patients. The correct and early diagnosis of OA is of great preventive and socio-economic importance. However, few studies exist on OA’s prevalence in Catalonia and in Spain and those affected are mainly treated by the public health services and not by the occupational health services, which are private. Objective : To determine the prevalence of OA in patients diagnosed with asthma in the Primary Healthcare system and to evaluate the socio-economic impact of OA in the Primary Healthcare system. Methods/Design : We will carry out an observational, transversal and multi-center study in the Primary Healthcare Service in the Barcelona region (Catalonia, Spain), with 385 asthmatic workers aged between 16 and 64 who are currently working or have been working in the past. We will confirm the asthma diagnosis in each patient, and those meeting the inclusion criteria will be asked to answer a questionnaire that aims to link asthma to the patient’s past employment history. The resulting diagnosis will be of either occupational asthma, work-aggravated asthma or common asthma. We will also collect socio-demographic information about the patients, about their smoking status, their exposure outside of the workplace, their work situation at the onset of the symptoms, their employment history, their symptoms of asthma, their present and past medical asthma treatment, and, in order to estimate the economic impact in the Primary Healthcare system, where they have been attended to and treated. Prevalence will link OA or work-aggravated asthma to the total of patients participating in the study with a asthma diagnosis. Discussion : The results will show the prevalence of OA and work-aggravated asthma, and shall provide valuable information to set out and apply the necessary personal and technical

[Occupational allergic "march". Rapid evolution of contact dermatitis to ammonium persulfate into airborne contact dermatitis with rhinitis and asthma in a hairdresser].

PubMed

Poltronieri, Anna; Patrini, L; Pigatto, P; Riboldi, L; Marsili, Chiara; Previdi, M; Margonari, M; Marraccini, P

2010-01-01

Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma. In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate. After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge. The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms. Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.

Isocyanate exposure and occupational asthma: a case-referent study

PubMed Central

Meredith, S; Bugler, J; Clark, R

2000-01-01

OBJECTIVE—To examine the quantitative relation between exposure to isocyanates and occupational asthma, and to explore the role of atopy and smoking in occurrence of the disease.
METHOD—A case-referent study was undertaken of cases from two manufacturing companies (A and B) from which referents without disease could be selected and reliable exposure measurements were available. In company A, 27 cases mainly attributed to toluene diisocyanate (TDI) were matched to 51 referents on work area, start and duration of employment, sex, and age. Exposures were estimated from existing measurements by job category. In company B there were seven cases attributed to 4,4'-diphenylmethane diisocyanate (MDI) in two areas of the plant; 12 non-cases from the same areas were used as referents. Personal exposure measurements were available for all cases and 11 referents.
RESULTS—No difference in peak exposures between cases and referents was found in either plant; but in both, time weighted average (TWA) exposures at the time of onset of asthma were higher for cases. In A, the mean TWA exposure for cases was 1.5 (95% confidence interval (95% CI) 1.2 to 1.8) ppb compared with 1.2 (1.0 to 1.4) ppb for referents. From a matched analysis, the odds ratio (OR) associated with 8 hour TWA exposure to isocyanates greater than 1.125 ppb (the median concentration for the referent group) was 3.2 (95% CI 0.96 to 10.6; p=0.06). Occupational asthma was associated with a pre-employment history of atopic illness (OR 3.5, p=0.04) and, less strongly, with smoking (OR 2.1, p=0.14). In B, small numbers limited analysis, but three of seven cases had at least one TWA exposure measurement greater than 5 ppb compared with one of 11 referents (OR 7.5, p=0.09).
CONCLUSION—Asthma can occur at low concentrations of isocyanates, but even at low concentrations, the higher the exposure the greater the risk. By contrast with other studies, smoking and atopy seemed to increase the odds

Occupational asthma from tafenoquine in the pharmaceutical industry: implications for QSAR.

PubMed

Cannon, J; Fitzgerald, B; Seed, M; Agius, R; Jiwany, A; Cullinan, P

2015-04-01

We report occupational asthma and rhinitis in a formulation pharmacist, employed in the development of tafenoquine. Tafenoquine is a new anti-malarial drug in development; the pure drug substance has an asthma hazard index of zero and previously was not known to be a respiratory sensitizing agent. The implications of this finding for the refinement of quantitative structural analysis of asthmagenic chemicals are discussed. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Depression or anxiety in adult twins is associated with asthma diagnosis but not with offspring asthma.

PubMed

Tedner, S G; Lundholm, C; Olsson, H; Almqvist, C

2016-06-01

Asthma is common in both children and adults in the Western world, just like anxiety and depression. While some research has revealed that these diseases might share important environmental and pathophysiological aspects, the exact mechanisms still remain unclear. To study the correlation firstly between depression or anxiety and asthma diagnosis in adult twins and secondly the association between parental depression or anxiety and offspring asthma in children of twins. In total, 24 685 adult twins aged 20-47 years were interviewed or completed a Web-based questionnaire and their children were identified through the Multi-Generation Register. Asthma diagnosis was obtained from the Patient Register and the Prescribed Drug Register. Assessment of depression and anxiety was obtained from questionnaires using Center for Epidemiologic Studies Depression Scale (CES-D), major depression and generalized anxiety disorder (GAD) from DSM-IV. The association between depression or anxiety and asthma was analyzed with logistic regression adjusting for confounders in twins and offspring. To address genetic and familial environmental confounding, we performed a cotwin analysis using disease-discordant twin pairs. We found an association between asthma and CES-D, major depression and GAD, for example adjusted OR for major depression and register-based asthma 1.56 (1.36-1.79). Most of the point estimates remained in the co-twin control analysis, indicating that the association was likely not due to genetic or familial environmental factors. There was no association between parental depression and/or anxiety and asthma diagnosis in the offspring which implies lack of genetic confounding. We found an association between own asthma diagnosis and anxiety or depression, but not with offspring asthma. Our results indicate that the associations were not due to confounding from genes or environment shared by the twins. © 2016 John Wiley & Sons Ltd.

Occupational exposure to cleaning products and asthma in hospital workers.

PubMed

Dumas, Orianne; Donnay, Carole; Heederik, Dick J J; Héry, Michel; Choudat, Dominique; Kauffmann, Francine; Le Moual, Nicole

2012-12-01

Cleaning products may cause work-related asthma, but information regarding the specific exposures involved is scarce. We aimed to determine the associations between asthma and occupational exposure to cleaning agents in hospital workers. Analyses were conducted in 179 (136 women) hospital workers and a reference population of 545 subjects (18-79 years) from the French case-control and familial Epidemiological study on the Genetics and Environment of Asthma (2003-2007). Exposures to cleaning agents were estimated using three methods: self-report, expert assessment and an asthma-specific job-exposure matrix (JEM). Associations between cleaning products and current asthma were evaluated by logistic regressions, stratified by sex and adjusted for age and smoking status. According to expert assessment, 55% of male and 81% of female hospital workers were exposed to cleaning/disinfecting tasks weekly (p<0.001). No association was observed between cleaning/disinfecting tasks and current asthma in men or in women whatever the assessment method used. In women, exposure to decalcifiers (expert assessment) was associated with current asthma (OR (95% CI):2.38 (1.06 to 5.33)). In hospital workers classified as exposed according to both the expert assessment and the JEM, additional associations were observed for exposure to ammonia (3.05 (1.19 to 7.82)) and to sprays with moderate/high intensity (2.87 (1.02 to 8.11)). Female hospital workers are often exposed to numerous cleaning products, some of which were markedly associated with current asthma. Low numbers prevented a meaningful analysis in men. Objective and more accurate estimates of occupational exposure to cleaning products are needed to better understand the adverse effects of cleaning products.

Asthma Diagnosis, Severity, Control and Medication Use In Low Income Minority Preteens

PubMed Central

Clark, Noreen M.; Dodge, Julia A.; Shah, Smita; Thomas, Lara J.; Andridge, Rebecca R.; Awad, Daniel

2010-01-01

Background Asthma severity, control, type of medical regimen provided and compliance with it are not well understood in minority patients at the transition stage from childhood to adolescence. Objective Identify factors in clinical practice and patient behavior associated with negative outcomes for children at this developmentally significant period. Methods Parents of 1292 children with asthma among 6827 pre-teens in 19 middle schools in predominantly African American (94%), low income neighborhoods in Detroit, Michigan were enrolled. Data collected through self administered survey and telephone interviews were useable for 936 parents. Study queries related to demographics, asthma symptoms, and medication use. Mixed effects models with a random intercept for school used to determine severity and control and association of medical regimens to these. Results Sixty-seven percent children with probable asthma had received a physician's diagnosis. Being female was associated with being undiagnosed (p=0.02); 47% with no diagnosis had persistent asthma and 68% with a diagnosis and asthma medicines were not controlled. Over half with a diagnosis and no medicine were not controlled. Thirty nine percent had controller medicine; 40% were not compliant with controller use; 9% nebulized controller medicine. Compliant use of controller medicine was not associated with asthma control (p=0.001). Conclusions Lack of an asthma diagnosis was significant in these low income communities. Adolescent girls were at risk for not receiving a diagnosis. Regimens provided children at an important stage in their development were not consistent with therapies recommended for asthma control. Patient compliance with asthma regimens was low. Both clinical and patient education regarding effective asthma management is needed regarding pre teens in low income minority communities. Clinical Implications Diagnosis and medical therapy choices for low income, African American pre-adolescents may not

Occupational asthma due to formaldehyde.

PubMed Central

Burge, P S; Harries, M G; Lam, W K; O'Brien, I M; Patchett, P A

1985-01-01

Bronchial provocation studies on 15 workers occupationally exposed to formaldehyde are described. The results show that formaldehyde exposure can cause asthmatic reactions, and suggest that these are sometimes due to hypersensitivity and sometimes to a direct irritant effect. Three workers had classical occupational asthma caused by formaldehyde fumes, which was likely to be due to hypersensitivity, with late asthmatic reactions following formaldehyde exposure. Six workers developed immediate asthmatic reactions, which were likely to be due to a direct irritant effect as the reactions were shorter in duration than those seen after soluble allergen exposure and were closely related to histamine reactivity. The breathing zone concentrations of formaldehyde required to elicit these irritant reactions (mean 4.8 mg/m3) were higher than those encountered in buildings recently insulated with urea formaldehyde foam, but within levels sometimes found in industry. Images PMID:4023975

Risks of exposure to occupational asthmogens in atopic and nonatopic asthma: a case-control study in Taiwan.

PubMed

Wang, Tsu-Nai; Lin, Meng-Chih; Wu, Chao-Chien; Leung, Sum-Yee; Huang, Ming-Shyan; Chuang, Hung-Yi; Lee, Chien-Hung; Wu, Deng-Chyang; Ho, Pei-Shan; Ko, Albert Min-Shan; Chang, Po-Ya; Ko, Ying-Chin

2010-12-01

Asthma is often work-related and can be classified as atopic or nonatopic on the basis of its pathogenesis. Few studies have reported an association between exposure to occupational asthmogens and asthma with and without atopy. We investigated, in adults with asthma, whether occupational exposure to asthmogens influenced the risk of having atopic or nonatopic asthma, and their level of lung function. We recruited 504 hospital-based adults with current asthma, 504 community-based control subjects, and 504 hospital-based control subjects in southern Taiwan. Asthma with atopy was defined as having asthma in combination with an increase in total IgE (≥100 U/ml) or a positive Phadiatop test (≥0.35 Pharmacia arbitrary unit/L) (Pharmacia ImmunoCAP; Pharmacia, Uppsala, Sweden). Occupational exposure to asthmogens was assessed with an asthma-specific job exposure matrix. We found a significant association between atopic asthma and exposure to high molecular weight asthmogens (adjusted odds ratio [AOR], 4.0; 95% confidence interval [CI], 1.8-8.9). Nonatopic asthma was significantly associated with exposure to low molecular weight asthmogens (AOR, 2.6; 95% CI, 1.6-4.3), including industrial cleaning agents and metal sensitizers. Agriculture was associated with both atopic and nonatopic asthma (AOR, 7.8; 95% CI, 2.8-21.8; and AOR, 4.1; 95% CI, 1.3-13.0, respectively). The ratio of FEV₁ to FVC in the high-risk group was significantly lower than in the no-risk group (P = 0.026) in currently employed patients with asthma. In adults with asthma, occupational exposure to high and low molecular weight asthmogens appears to produce differential risks for atopic and nonatopic asthma.

Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building.

PubMed

Park, J-H; Kreiss, K; Cox-Ganser, J M

2012-10-01

Mold exposure in damp buildings is associated with both nasal symptoms and asthma development, but the progression of building-related (BR) rhinosinusitis symptoms to asthma is unstudied. We examined the risk of developing BR-asthma symptoms in relation to prior BR-rhinosinusitis symptoms and microbial exposure among occupants of a damp building. We conducted four cross-sectional health and environmental surveys among occupants of a 20-story water-damaged office building. We defined BR-rhinosinusitis symptom (N=131) and comparison (N=361) groups from participants' first questionnaire responses. We compared the odds for the development of BR-asthma symptoms between these two groups over the subsequent surveys, using logistic regression models adjusted for demographics, smoking, building tenure, and first-survey exposures to fungi, endotoxin, and ergosterol. The BR-rhinosinusitis symptom group had higher odds for developing BR-asthma symptoms [odds ratio (OR)=2.2; 95% confidence interval (CI)=1.3-3.6] in any subsequent survey compared to those without BR-rhinosinusitis symptoms. The BR-rhinosinusitis symptom group with higher fungal exposure within the building had an OR of 7.4 (95% CI=2.8-19.9) for developing BR-asthma symptoms, compared to the lower fungal exposure group without BR-rhinosinusitis symptoms. Our findings suggest that rhinosinusitis associated with occupancy of water-damaged buildings may be a sentinel for increased risk for asthma onset in such buildings. Exposure to mold is associated with the development of asthma in damp building occupants, and rhinitis is known to be a risk factor for asthma. However, there is little information about the degree of risk for the progression of rhinosinusitis to asthma owing to mold exposures in damp buildings. Our study of damp building occupants demonstrates that building-related (BR) rhinosinusitis symptoms were a risk factor for the development of BR asthma symptoms and that exposure to mold (fungi) or other

Airborne seafood allergens as a cause of occupational allergy and asthma.

PubMed

Lopata, Andreas L; Jeebhay, Mohamed F

2013-06-01

Occupational allergy and asthma is a serious adverse health outcome affecting seafood-processing workers. Allergic reactions are directed to two major seafood groups: fish and shellfish, with the latter group comprising crustaceans and molluscs. Several allergenic proteins have been identified in these different groups, but few have been characterised on a molecular level. Parvalbumin appears to be the major fish allergen, while tropomyosin the major crustacean allergen. Other IgE-binding proteins have also been identified in molluscs and other seafood-associated agents (e.g. Anisakis sp), although their molecular nature has not been characterised. Aerosolised allergens can be identified and quantified using immunological and chemical approaches, detecting levels as low as 10 ng/m(3). This contemporary review discusses interesting and recent findings in the area of occupational seafood allergy including high-risk occupations, environmental risk factors for airborne exposures, major and minor allergens implicated and innovative approaches in diagnosing and managing occupational allergy and asthma associated with seafood processing.

Data linkage to estimate the extent and distribution of occupational disease: new onset adult asthma in Alberta, Canada.

PubMed

Cherry, Nicola; Beach, Jeremy; Burstyn, Igor; Fan, Xiangning; Guo, Na; Kapur, Nitin

2009-11-01

Although occupational asthma is a well recognized and preventable disease, the numbers of cases presenting for compensation may be far lower than the true incidence. Workers' Compensation Board (WCB) claims for any reason 1995-2004 were linked to physician billing data. New onset adult asthma (NOAA) was defined as a billing for asthma (ICD-9 code of 493) in the 12 months prior to a WCB claim without asthma in the previous 3 years. Incidence was calculated by occupation, industry and, in a case-referent analysis, exposures estimated from an asthma specific job exposure matrix. There were 782,908 WCB eligible claims, with an incidence rate for NOAA of 1.6%: 23 occupations and 21 industries had a significantly increased risk. Isocyanates (OR 1.54: 95% CI 1.01-2.36) and exposure to mixed agricultural allergens (OR = 1.59: 95% CI 1.17-2.18) were related to NOAA overall, as were exposures to cleaning chemicals in men (OR = 1.91:95% CI 1.34-2.73). Estimates of the number of cases of occupational asthma suggested a range of 4% to about half for the proportion compensated. Data linkage of administrative records can demonstrate under-reporting of occupational asthma and indicate areas for prevention. (c) 2009 Wiley-Liss, Inc.

Asthma caused by occupational exposures is common – A systematic analysis of estimates of the population-attributable fraction

PubMed Central

Torén, Kjell; Blanc, Paul D

2009-01-01

Background The aim of this paper is to highlight emerging data on occupational attributable risk in asthma. Despite well documented outbreaks of disease and the recognition of numerous specific causal agents, occupational exposures previously had been relegated a fairly minor role relative to other causes of adult onset asthma. In recent years there has been a growing recognition of the potential importance of asthma induced by work-related exposures Methods We searched Pub Med from June 1999 through December 2007. We identified six longitudinal general population-based studies; three case-control studies and eight cross-sectional analyses from seven general population-based samples. For an integrated analysis we added ten estimates prior to 1999 included in a previous review. Results The longitudinal studies indicate that 16.3% of all adult-onset asthma is caused by occupational exposures. In an overall synthesis of all included studies the overall median PAR value was 17.6%. Conclusion Clinicians should consider the occupational history when evaluating patients in working age who have asthma. At a societal level, these findings underscore the need for further preventive action to reduce the occupational exposures to asthma-causing agents. PMID:19178702

Occupational agriculture organic dust exposure and its relationship to asthma and airway inflammation in adults.

PubMed

Wunschel, Javen; Poole, Jill A

2016-06-01

Recent studies have made advances into understanding the complex agriculture work exposure environment in influencing asthma in adults. The objective of this study is to review studies of occupational agricultural exposures including dust, animal, and pesticide exposures with asthma in adult populations. PubMed databases were searched for articles pertaining to farming, agriculture, asthma, occupational asthma, airway inflammation, respiratory disease, lung disease, pesticides, and organic dust. Studies chosen were published in or after 1999 that included adults and asthma and farming/agricultural work or agricultural exposures and airway inflammatory disease measurements. The data remain inconclusive. Several retrospective studies demonstrate agricultural work to be protective against asthma in adults, especially with increased farming exposure over time. In contrast, other studies find increased risk of asthma with farming exposures, especially for the non-atopic adult. Mechanistic and genetic studies have focused on defining the wide variety and abundance of microorganisms within these complex organic dusts that trigger several pattern recognition receptor pathways to modulate the hosts' response. Asthma risk depends on the interplay of genetic factors, gender, atopic predisposition, type of livestock, pesticide exposure, and magnitude and duration of exposure in the adult subject. Longer exposure to occupational farming is associated with decreased asthma risk. However, studies also suggest that agricultural work and multiple types of livestock are independent risk factors for developing asthma. Prospective and longitudinal studies focusing on genetic polymorphisms, objective assessments, and environmental sampling are needed to further delineate the influence of agriculture exposure in the adult worker.

Occupational asthma due to colophony in non-industrial environments.

PubMed

Mariano, A; Paredes, I; Nuti, R; Innocenti, A

1993-01-01

Colophony is largely used in industrial environments, like the electronics and the rubber tyre industries, but it is also present in non-industrial environments as a constituent of glues and paper. For this reason it is one of the commonest skin sensitizers. Many cases of occupational asthma due to colophony have been described, but reports apart from electronic industry are not common. The case is described of a subject employed in administrative work who developed asthma due to colophony from using sealing wax to seal samples of food packages.

Asthma risk and occupation as a respiratory therapist.

PubMed

Christiani, D C; Kern, D G

1993-09-01

In the modern hospital environment, many health care workers are exposed to hazardous substances. Among these hazards are respiratory sensitizers, irritants, and infectious agents. A previous cross-sectional study of Rhode Island respiratory therapists reported an excess risk of asthma after entry into that profession. Before the results of that study were published, we conducted a confirmatory mailed questionnaire survey of 2,086 Massachusetts respiratory therapists and 2,030 physical therapists and physical therapy assistants. Neither the survey questionnaire nor the accompanying cover letter revealed the focus of our investigation. A history of physician-diagnosed asthma was reported by 16% of respiratory therapists and 8% of control subjects. When analysis was restricted to those who developed asthma after entry into their profession, respiratory therapists still had a significant excess, 7.4 versus 2.8%. The odds ratio for respiratory therapy was 2.5 (95% Cl, 1.6 to 3.3) after adjustment for age, family history, atopic history, smoking, and gender. These results confirm the previous report of excess risk of asthma among respiratory therapists. This excess risk develops after entry into the profession and does not appear to be explained by bias or confounding. Efforts should be directed to identifying potential agents responsible for this form of occupational asthma.

Epidemiologic evidence for asthma and exposure to air toxics: linkages between occupational, indoor, and community air pollution research.

PubMed Central

Delfino, Ralph J

2002-01-01

Outdoor ambient air pollutant exposures in communities are relevant to the acute exacerbation and possibly the onset of asthma. However, the complexity of pollutant mixtures and etiologic heterogeneity of asthma has made it difficult to identify causal components in those mixtures. Occupational exposures associated with asthma may yield clues to causal components in ambient air pollution because such exposures are often identifiable as single-chemical agents (e.g., metal compounds). However, translating occupational to community exposure-response relationships is limited. Of the air toxics found to cause occupational asthma, only formaldehyde has been frequently investigated in epidemiologic studies of allergic respiratory responses to indoor air, where general consistency can be shown despite lower ambient exposures. The specific volatile organic compounds (VOCs) identified in association with occupational asthma are generally not the same as those in studies showing respiratory effects of VOC mixtures on nonoccupational adult and pediatric asthma. In addition, experimental evidence indicates that airborne polycyclic aromatic hydrocarbon (PAH) exposures linked to diesel exhaust particles (DEPs) have proinflammatory effects on airways, but there is insufficient supporting evidence from the occupational literature of effects of DEPs on asthma or lung function. In contrast, nonoccupational epidemiologic studies have frequently shown associations between allergic responses or asthma with exposures to ambient air pollutant mixtures with PAH components, including black smoke, high home or school traffic density (particularly truck traffic), and environmental tobacco smoke. Other particle-phase and gaseous co-pollutants are likely causal in these associations as well. Epidemiologic research on the relationship of both asthma onset and exacerbation to air pollution is needed to disentangle effects of air toxics from monitored criteria air pollutants such as particle mass

Early markers of airways inflammation and occupational asthma: rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices.

PubMed

Tossa, Paul; Bohadana, Abraham; Demange, Valérie; Wild, Pascal; Michaely, Jean-Pierre; Hannhart, Bernard; Paris, Christophe; Zmirou-Navier, Denis

2009-04-23

Occupational asthma is a common type of asthma caused by a specific agent in the workplace. The basic alteration of occupational asthma is airways inflammation. Although most patients with occupational asthma are mature adults, there is evidence that airways inflammation starts soon after inception of exposure, including during apprenticeship. Airways hyper responsiveness to methacholine is a valid surrogate marker of airways inflammation, which has proved useful in occupational epidemiology. But it is time-consuming, requires active subject's cooperation and is not readily feasible. Other non-invasive and potentially more useful tests include the forced oscillation technique, measurement of fraction exhaled nitric oxide, and eosinophils count in nasal lavage fluid. This study aims to investigate early development of airways inflammation and asthma-like symptoms in apprentice bakers, pastry-makers and hairdressers, three populations at risk of occupational asthma whose work-related exposures involve agents of different nature. The objectives are to (i) examine the performance of the non-invasive tests cited above in detecting early airways inflammation that might eventually develop into occupational asthma; and (ii) evaluate whether, and how, constitutional (e.g. atopy) and behavioural (e.g. smoking) risk factors for occupational asthma modulate the effects of allergenic and/or irritative substances involved in these occupations. This paper presents the study rationale and detailed protocol. Among 441 volunteers included at the first visit, 354 attended the fourth one. Drop outs were investigated and showed unrelated to the study outcome. Sample size and follow-up participation rates suggest that the data collected in this study will allow it to meet its objectives.

Early markers of airways inflammation and occupational asthma: Rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices

PubMed Central

Tossa, Paul; Bohadana, Abraham; Demange, Valérie; Wild, Pascal; Michaely, Jean-Pierre; Hannhart, Bernard; Paris, Christophe; Zmirou-Navier, Denis

2009-01-01

Background Occupational asthma is a common type of asthma caused by a specific agent in the workplace. The basic alteration of occupational asthma is airways inflammation. Although most patients with occupational asthma are mature adults, there is evidence that airways inflammation starts soon after inception of exposure, including during apprenticeship. Airways hyper responsiveness to methacholine is a valid surrogate marker of airways inflammation, which has proved useful in occupational epidemiology. But it is time-consuming, requires active subject's cooperation and is not readily feasible. Other non-invasive and potentially more useful tests include the forced oscillation technique, measurement of fraction exhaled nitric oxide, and eosinophils count in nasal lavage fluid. Methods and design This study aims to investigate early development of airways inflammation and asthma-like symptoms in apprentice bakers, pastry-makers and hairdressers, three populations at risk of occupational asthma whose work-related exposures involve agents of different nature. The objectives are to (i) examine the performance of the non-invasive tests cited above in detecting early airways inflammation that might eventually develop into occupational asthma; and (ii) evaluate whether, and how, constitutional (e.g. atopy) and behavioural (e.g. smoking) risk factors for occupational asthma modulate the effects of allergenic and/or irritative substances involved in these occupations. This paper presents the study rationale and detailed protocol. Discussion Among 441 volunteers included at the first visit, 354 attended the fourth one. Drop outs were investigated and showed unrelated to the study outcome. Sample size and follow-up participation rates suggest that the data collected in this study will allow it to meet its objectives. PMID:19389222

Occupational asthma caused by exposure to asparagus: detection of allergens by immunoblotting.

PubMed

Lopez-Rubio, A; Rodriguez, J; Crespo, J F; Vives, R; Daroca, P; Reaño, M

1998-12-01

Vegetables of the Liliaceae family, such as garlic or onion, have been reported to cause occupational asthma. However, there are few data on adverse reactions to asparagus. We evaluated the role of asparagus as a cause of asthma in a patient with respiratory symptoms occurring at work (horticulture) and studied relevant allergens. A 28-year-old man complained of rhinoconjunctivitis and asthma when harvesting asparagus at work. Eating cooked asparagus did not provoke symptoms. A positive skin test reaction was observed with raw asparagus, Alternaria alternata, and grass-pollen extracts. The methacholine test demonstrated mild bronchial hyperresponsiveness. The patient had an immediate asthmatic response after challenge with raw asparagus extract. Bronchial provocation tests with boiled asparagus, A. alternata, and control extracts were negative. Two unexposed subjects with seasonal allergic asthma did not react to the raw asparagus extract. The double-blind, placebo-controlled food challenge with raw asparagus was negative. Serum asparagus-specific IgE was 13.9 kU(A)/l. By SDS-PAGE immunoblot, at least six IgE-binding components, ranging from 22 to 73 kDa, were detected only in raw asparagus. We report a case of occupational asthma caused by asparagus inhalation, confirmed by specific bronchoprovocation. Immunoblot analysis showed that asparagus allergens are very labile and quite sensitive to heat denaturation.

Is the incidence of aliphatic amine-induced occupational rhinitis and asthma underestimated?

PubMed

Laborde-Castérot, Hervé; Rosenberg, Nicole; Dupont, Patricia; Garnier, Robert

2014-12-01

Amines, some of which are known to cause asthma, are frequently present in the work environment, but are rarely identified as being responsible for occupational rhinitis (OR) or asthma (OA). However, amine-induced OR/OA may be underreported. To discuss this hypothesis, we report a series of patients with positive amine-specific nasal provocation test (NPT). Review of the medical charts of 37 patients with OR (alone or associated with asthma), submitted to a NPT with an aliphatic or alicyclic amine (except for EDTA) present in a product used at work. Most patients worked in the healthcare sector or for a cleaning company. Amines were mostly present in cleaning products. Seven patients had a positive NPT. NPTs were positive for the following amines: bis(aminopropyl)laurylamine, C12-C18 alkyldimethylamine oxides, bis(2-hydroxyethyl)tallowamine oxides, 3-dimethylaminopropylamine, 2,2'-dimethyl-4,4'-methylene-bis(cyclohexylamine), lauryldimethylamine oxide. NPTs were negative for the following amines: monoethanolamine, diethanolamine, triethanolamine, isopropanolamine, triethylamine, triethylenetetramine, aminopropyltriethoxysilane, alkylpropylenediamineguanidine acetate. The frequency of amine-induced OR/OA may be underestimated, particularly when cleaning products are incriminated. Comprehensive investigation of all cases is mandatory to ensure an efficient prevention policy and consequently a good clinical and socio-occupational prognosis of occupational respiratory disease. © 2014 Wiley Periodicals, Inc.

Asthma and the employment experience.

PubMed

McClellan, V E; Garrett, J E

1990-08-22

Previous asthma research has had a medical focus, and only one study has investigated the relationship between asthma and employment. This study describes the employment experience in relation to occupational choice and career advancement in 93 sequentially selected adult asthmatics attending a hospital based asthma clinic serving a socially disadvantaged urban population. Repeated hospital admissions and frequent asthma related sick leave from work were identified as contributing factors to employer discrimination, job dismissal, and lack of career advancement. Seventy-seven percent had not informed their employers of their asthma and 32% of those currently employed stated that getting time off work was a problem in relation to Asthma Clinic attendance. Of those not employed, 22.9% were receiving sickness or invalid benefits and 8.3% had lost their jobs because of asthma. This study illustrates how the stigma attached to the diagnosis of asthma in this community may not only impact negatively on employment opportunity, but also on asthma care.

Practical Considerations for the Diagnosis and Management of Asthma in Older Adults.

PubMed

Yawn, Barbara P; Han, MeiLan K

2017-11-01

Although often considered a disease of childhood, the prevalence of asthma in US adults aged 65 years or older is similar to that in children, with the number of older patients needing care for asthma likely to continue to increase. As with most chronic diseases, there are challenges associated with the diagnosis and management of asthma in an older population. This review discusses these challenges, suggesting practical management strategies for primary care physicians and their teams. Asthma comprises a spectrum of phenotypes, some associated with adult onset. The symptoms and characteristics of patients with late-onset asthma can differ from those of patients with early-onset disease. Furthermore, older patients may fail to recognize respiratory symptoms as abnormal and have other comorbidities, complicating the differential diagnosis of asthma. Once diagnosed, the long-term goals of asthma management are no different in older adults than in anyone with asthma, with inhaled corticosteroids being the cornerstone of therapy. Comorbid conditions become more common with age and have a direct impact on a patient's respiratory symptoms and potential adverse effects of therapy, thereby influencing the choice of therapies and delivery systems and potentially increasing the likelihood of complex polypharmacy. In conclusion, asthma, although traditionally considered a disease of the young, should be considered as a potential diagnosis in older adults with respiratory symptoms, even without a history of asthma or allergies. As with all patients, the primary goals of asthma management in older adults are symptom control and exacerbation reduction. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Guidance on the diagnosis and management of asthma among adults in resource limited settings.

PubMed

Kirenga, Bruce J; Schwartz, Jeremy I; de Jong, Corina; van der Molen, Thys; Okot-Nwang, Martin

2015-12-01

Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings. Review of international asthma guidelines and other published studies on diagnosis and management of asthma. We establish that clinical diagnosis of asthma can be made if recurrent respiratory symptoms especially current wheeze or wheeze in the last 12 months are present. Presence of a trigger, other allergic diseases, personal or family history of asthma; clinical improvement and increase in the peak flow and forced expiratory volume in one second of ≥12% after salbutamol administration increases the likelihood of asthma. At diagnosis severity grading, patient education, removal or reduction of trigger should be done. Follow up 2-6 weeks and assessment of control during therapy is essential. Therapy should be adjusted up or down depending on control levels. Patients should be instructed to increase the frequency of their bronchodilators and/or steroids therapy when they start to experience worsening symptoms. Good quality asthma care can be achieved in resource limited settings by use of clinical data and simple tests.

Trends in Occupations and Work Sectors Among Patients With Work-Related Asthma at a Canadian Tertiary Care Clinic.

PubMed

Gotzev, Simeon; Lipszyc, Joshua C; Connor, Dale; Tarlo, Susan M

2016-10-01

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. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Occupational asthma caused by samba (Triplochiton scleroxylon) wood dust in a professional maker of wooden models of airplanes: a case study.

PubMed

Krawczyk-Szulc, Patrycja; Wiszniewska, Marta; Pałczyński, Cezary; Nowakowska-Świrta, Ewa; Kozak, Anna; Walusiak-Skorupa, Jolanta

2014-06-01

Wood dust is a known occupational allergen that may induce, in exposed workers, respiratory diseases including asthma and allergic rhinitis. Samba (obeche, Triplochiton scleroxylon) is a tropical tree, which grows in West Africa, therefore, Polish workers are rarely exposed to it. This paper describes a case of occupational asthma caused by samba wood dust. The patient with suspicion of occupational asthma due to wood dust was examined at the Department of Occupational Diseases and Clinical Toxicology in the Nofer Institute of Occupational Medicine. Clinical evaluation included: analysis of occupational history, skin prick tests (SPT) to common and occupational allergens, determination of serum specific IgE to occupational allergens, serial spirometry measurements, metacholine challenge test and specific inhalation challenge test with samba dust SPT and specific serum IgE assessment revealed sensitization to common and occupational allergens including samba. Spirometry measurements showed mild obstruction. Metacholine challenge test revealed a high level of bronchial hyperactivity. Specific inhalation challenge test was positive and cellular changes in nasal lavage and induced sputum confirmed allergic reaction to samba. IgE mediated allergy to samba wood dust was confirmed. This case report presents the first documented occupational asthma and rhinitis due to samba wood dust in wooden airplanes model maker in Poland.

EAACI position paper on occupational rhinitis

PubMed Central

Moscato, Gianna; Vandenplas, Olivier; Van Wijk, Roy Gerth; Malo, Jean-Luc; Perfetti, Luca; Quirce, Santiago; Walusiak, Jolanta; Castano, Roberto; Pala, Gianni; Gautrin, Denyse; De Groot, Hans; Folletti, Ilenia; Yacoub, Mona Rita; Siracusa, Andrea

2009-01-01

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item. PMID:19257881

Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway

PubMed Central

Abrahamsen, R; Fell, A K M; Svendsen, M V; Andersson, E; Torén, K; Henneberger, P K; Kongerud, J

2017-01-01

Objectives The aim of this study was to estimate the prevalence of respiratory symptoms and physician-diagnosed asthma and assess the impact of current occupational exposure. Design Cross-sectional analyses of the prevalence of self-reported respiratory health and association with current occupational exposure in a random sample of the general population in Telemark County, Norway. Settings In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16–50, in Telemark, Norway. The overall response rate was 33%, comprising 16 099 responders. Outcome measures The prevalence for respiratory symptoms and asthma, and OR of respiratory symptoms and asthma for occupational groups and exposures were calculated. Occupational exposures were assessed using self-reported exposure and an asthma-specific job-exposure matrix (JEM). Results The prevalence of physician-diagnosed asthma was 11.5%. For the occupational groups, the category with agriculture/fishery workers and craft/related trade workers was associated with wheezing and asthma attack in the past 12 months, showing OR 1.3 (1.1 to 1.6) and 1.9 (1.2 to 2.8), respectively. The group including technicians and associated professionals was also associated with wheezing OR 1.2 (1.0 to 1.3) and asthma attack OR 1.4 (1.1 to 1.9). The JEM data show that exposure to flour was associated with wheezing OR 3.2 (1.4 to 7.3) and woken with dyspnoea OR 3.5 (1.3 to 9.5), whereas exposures to diisocyanates, welding/soldering fumes and exposure to vehicle/motor exhaust were associated with dyspnoea OR 2.9 (1.5 to 5.7), 3.2 (1.6 to 6.4) and 1.4 (1.0 to 1.8), respectively. Conclusions The observed prevalence of physician-diagnosed asthma was 11.5%. The ‘manual’ occupations were associated with respiratory symptoms. Occupational exposure to flour, diisocyanates, welding/soldering fumes and vehicle/motor exhaust was associated with respiratory symptoms in the past 12 months and use of

Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway.

PubMed

Abrahamsen, R; Fell, A K M; Svendsen, M V; Andersson, E; Torén, K; Henneberger, P K; Kongerud, J

2017-03-22

The aim of this study was to estimate the prevalence of respiratory symptoms and physician-diagnosed asthma and assess the impact of current occupational exposure. Cross-sectional analyses of the prevalence of self-reported respiratory health and association with current occupational exposure in a random sample of the general population in Telemark County, Norway. In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16-50, in Telemark, Norway. The overall response rate was 33%, comprising 16 099 responders. The prevalence for respiratory symptoms and asthma, and OR of respiratory symptoms and asthma for occupational groups and exposures were calculated. Occupational exposures were assessed using self-reported exposure and an asthma-specific job-exposure matrix (JEM). The prevalence of physician-diagnosed asthma was 11.5%. For the occupational groups, the category with agriculture/fishery workers and craft/related trade workers was associated with wheezing and asthma attack in the past 12 months, showing OR 1.3 (1.1 to 1.6) and 1.9 (1.2 to 2.8), respectively. The group including technicians and associated professionals was also associated with wheezing OR 1.2 (1.0 to 1.3) and asthma attack OR 1.4 (1.1 to 1.9). The JEM data show that exposure to flour was associated with wheezing OR 3.2 (1.4 to 7.3) and woken with dyspnoea OR 3.5 (1.3 to 9.5), whereas exposures to diisocyanates, welding/soldering fumes and exposure to vehicle/motor exhaust were associated with dyspnoea OR 2.9 (1.5 to 5.7), 3.2 (1.6 to 6.4) and 1.4 (1.0 to 1.8), respectively. The observed prevalence of physician-diagnosed asthma was 11.5%. The 'manual' occupations were associated with respiratory symptoms. Occupational exposure to flour, diisocyanates, welding/soldering fumes and vehicle/motor exhaust was associated with respiratory symptoms in the past 12 months and use of asthma medication. However, prospective data are needed to confirm the

TRIMELLITIC ANHYDRIDE-INDUCED EOSINOPHILLA IN A MOUSE MODEL OF OCCUPATIONAL ASTHMA

EPA Science Inventory

Trimellitic anhydride (TMA) is a low molecular weight chemical known to cause occupational asthma. The present study was designed to determine if TMA could elicit eosinophil infiltration into the lung of a sensitized mouse similarly to previous studies with the protein allergen ...

TRIMELLITIC ANHYDRIDE-INDUCED EOSINOPHILIA IN A MURINE MODEL OF OCCUPATIONAL ASTHMA

EPA Science Inventory

TRIMELLITIC ANHYDRIDE-INDUCED EOSINOPHILIA IN A MURINE MODEL OF OCCUPATIONAL ASTHMA. J F Regal, ME Mohrman, E Boykin and D Sailstad. Dept. of Pharmacology, University of Minnesota, Duluth, MN, USA and NHEERL, ORD, US EPA, RTP, NC, USA.
Trimellitic anhydride (TMA) is a small m...

Occupational Asthma in Antibiotic Manufacturing Workers: Case Reports and Systematic Review

PubMed Central

Díaz Angulo, Sara; Szram, Joanna; Welch, Jenny; Cannon, Julie; Cullinan, Paul

2011-01-01

Background. The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature. Methods. Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature. Results. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness. 36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5–8%. Conclusions. OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required. PMID:21603168

Physical Deconditioning as a Cause of Breathlessness among Obese Adolescents with a Diagnosis of Asthma

PubMed Central

Herring, Richard C.; Weltman, Judith; Patrie, James T.; Weltman, Arthur L.; Platts-Mills, Thomas A.

2013-01-01

Background Obese children frequently complain of breathlessness. Asthma and obesity can both contribute to the symptoms during exercise, and this symptom can contribute to a diagnosis of asthma in these children. Despite the high prevalence of obesity few studies have investigated the cardiopulmonary physiology of breathlessness in obese children with a diagnosis of asthma. Methods In this case-control study, thirty adolescents between age 12 and 19 were studied with baseline spirometry and a cardiopulmonary exercise test. Ten adolescents were normal controls, ten had obesity without a diagnosis of asthma, and ten had obesity with a history of physician-diagnosed asthma. Results Baseline characteristics including complete blood count and spirometry were comparable between obese adolescents with and without a diagnosis of asthma. During exercise, obese asthmatic and obese non-asthmatic adolescents had significantly reduced physical fitness compared to healthy controls as evidenced by decreased peak oxygen uptake after adjusting for actual body weight (21.7±4.5 vs. 21.4±5.4 vs. 35.3±5.8 ml/kg/min, respectively). However, pulmonary capacity at the peak of exercise was comparable among all three groups as evidenced by similar pulmonary reserve. Conclusion In this study, breathlessness was primarily due to cardiopulmonary deconditioning in the majority of obese adolescents with or without a diagnosis of asthma. PMID:23637784

Web based listing of agents associated with new onset work-related asthma.

PubMed

Rosenman, K D; Beckett, W S

2015-05-01

Work-related asthma is common and yet remains a challenge to diagnose. Access to a listing of agents associated with work-related asthma has been suggested as useful in assisting in the diagnosis. The Association of Occupational and Environmental Clinics (AOEC) developed criteria that were used to review the peer-reviewed medical literature published in English. Based on this review, substances were designated either as a sensitizing agent or an irritant. The reviews were conducted by a board certified internist/pulmonologist/occupational medicine specialist from 2002 to 2007 and a board certified internist/occupational medicine physician from 2008- date. All reviews were then reviewed by the nine member AOEC board of directors. The original list of agents associated with new onset work-related asthma was derived from the tables of a text book on work-related asthma. After 13 years of review, there are 327 substances designated as asthma agents on the AOEC list; 173 (52.9%) coded as sensitizers, 35 (10.7%) as generally recognized as an asthma causing agent, four (1.2%) as irritants, two (0.6%) as both a sensitizer and an irritant and 113(34.6%) agents that still need to be reviewed. The AOEC has developed a readily available web based listing of agents associated with new onset work-related asthma in adults. The listing is based on peer-reviewed criteria. The listing is updated twice a year. Regular review of the peer-reviewed medical literature is conducted to determine whether new substances should be added to the list. Clinicians should find the list useful when considering the diagnosis of work-related asthma. Copyright © 2015 Elsevier Ltd. All rights reserved.

A current picture of asthma diagnosis, severity, and control in a low-income minority preteen population.

PubMed

Clark, Noreen M; Dodge, Julia A; Shah, Smita; Thomas, Lara J; Andridge, Rebecca R; Awad, Daniel

2010-03-01

Asthma severity, control, type of medical regimen provided, and compliance with it are not well understood in minority patients at the transition stage from childhood to adolescence. Describe the level of asthma severity and control and the clinical regimens provided to a large population of low-income, African American children at this developmentally significant period. Parents of 1292 children with asthma among 6827 preteens in 19 middle schools in predominantly African American (94%), low-income neighborhoods in Detroit, Michigan, were enrolled in the study. Data were collected through self-administered survey and telephone interviews and were useable for 936 participants. Study queries related to demographics, asthma symptoms, and medication use. Mixed effects models with a random intercept for school were used to determine severity and control and the association of medical regimens to these. Sixty-seven percent of children with probable asthma had received a physician's diagnosis. Being female was associated with being undiagnosed (p = .02). Forty-seven with no diagnosis had persistent asthma and 10% of these were classified as severe. Sixty-eight percent with a diagnosis and asthma medicine prescriptions were not controlled. Compliant use of controller medicine was associated with poorer asthma control compared to noncompliant controller users (p = .04) and reliever-only users (p < .001). Thirty-nine percent of children had controller medicine; of those 40% were not compliant with controller use; 9% nebulized their controller medicine. Care provided low-income minority children at an important stage in their development was not consistent with guidelines for asthma control. Therapy choices for treatment did not account for the actual level of their symptoms. Lack of an asthma diagnosis was significant in the population. Adolescent girls were at risk for not receiving a diagnosis. Patient compliance with asthma regimens was limited. Both clinician and

Occupational asthma induced by tall oil in the rubber tyre industry.

PubMed

Tarlo, S M

1992-01-01

A worker in the rubber tyre industry is described with occupational asthma from exposure to a solution of tall oil, a pine resin, confirmed by specific inhalation challenge. This supports studies of contact dermatitis which have suggested abietic and dehydroabietic acid oxidants to be the cause of colophony induced allergic reactions.

Occupational asthma in electronics workers caused by colophony fumes: follow-up of affected workers.

PubMed

Burge, P S

1982-05-01

Thirty-nine electronics workers were investigated by bronchial provocation testing to soldering fluxes containing colophony and were followed up one to four years later. At presentation and on follow-up each worker had nonspecific bronchial reactivity measured with inhaled histamine, and also had detailed measurements of lung function and estimation of total immunoglobulin levels. They completed a questionnaire designed to detect residual disability. The workers were divided into three groups. Twenty had left work after their initial diagnosis, eight had been moved to alternative work within their original factories, and 11 were thought to have asthma unrelated to colophony exposure as they failed to react to colophony at presentation. Histamine reactivity had returned to normal in half the workers who had left their original factories, but in only one worker who had moved within her original factory. This suggested that the nonspecific bronchial reactivity to histamine was the result rather than the cause of the occupational asthma, and that indirect exposure at work was sufficient to delay recovery of histamine reactivity. However, only two of the 20 affected workers who had left their original factories were symptom free on follow-up, and most had a considerable reduction in their quality of life by continuing asthma, which was particularly provoked by exercise, respiratory infections, and nonspecific irritants. Continuing symptoms may have been caused by domestic sources of colophony, or possibly the failure to eliminate colophony from the lungs.

Occupational asthma in electronics workers caused by colophony fumes: follow-up of affected workers.

PubMed Central

Burge, P S

1982-01-01

Thirty-nine electronics workers were investigated by bronchial provocation testing to soldering fluxes containing colophony and were followed up one to four years later. At presentation and on follow-up each worker had nonspecific bronchial reactivity measured with inhaled histamine, and also had detailed measurements of lung function and estimation of total immunoglobulin levels. They completed a questionnaire designed to detect residual disability. The workers were divided into three groups. Twenty had left work after their initial diagnosis, eight had been moved to alternative work within their original factories, and 11 were thought to have asthma unrelated to colophony exposure as they failed to react to colophony at presentation. Histamine reactivity had returned to normal in half the workers who had left their original factories, but in only one worker who had moved within her original factory. This suggested that the nonspecific bronchial reactivity to histamine was the result rather than the cause of the occupational asthma, and that indirect exposure at work was sufficient to delay recovery of histamine reactivity. However, only two of the 20 affected workers who had left their original factories were symptom free on follow-up, and most had a considerable reduction in their quality of life by continuing asthma, which was particularly provoked by exercise, respiratory infections, and nonspecific irritants. Continuing symptoms may have been caused by domestic sources of colophony, or possibly the failure to eliminate colophony from the lungs. PMID:7112471

Direct health care costs of occupational asthma in Spain: an estimation from 2008.

PubMed

García Gómez, Montserrat; Urbanos Garrido, Rosa; Castañeda López, Rosario; López Menduiña, Patricia

2012-10-01

Occupational asthma (OA) is the most common work-related disease in industrialized countries. In 2008, only 556 cases of OA had been diagnosed in Spain, which is quite far from even the most conservative estimates. In this context, the aim of this paper is to estimate the number of asthma cases attributable to the work setting in Spain in 2008 as well as the related health care costs for the same year. The number of cases of OA was calculated from estimates of attributable risk given by previous studies. The cost estimation focused on direct health-care costs and it was based both on data from the National Health System's (NHS) analytical accounting and from secondary sources. The number of prevalent cases of work-related asthma in Spain during 2008 ranges between 168 713 and 204 705 cases based on symptomatic diagnosis, entailing an associated cost from 318.1 to 355.8 million Euros. These figures fall to a range between 82 635 and 100 264 cases when bronchial hyperreactivity is included as a diagnostic criterion, at a cost of 155.8-174.3 million Euros. Slightly more than 18 million Euros represent the health-care costs of those cases requiring specialized care. Estimations of OA are very relevant to adequately prevent this disease. The treatment of OA, which involves a significant cost, is being financed by the NHS, although it should be covered by Social Security. Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.

Prevalence of Work-Related Asthma and its Impact in Primary Health Care.

PubMed

Vila-Rigat, Rosa; Panadès Valls, Rafael; Hernandez Huet, Enric; Sivecas Maristany, Joan; Blanché Prat, Xavier; Muñoz-Ortiz, Laura; Torán Monserrat, Pere; Rabell Santacana, Ventura

2015-09-01

To determine the prevalence of occupational asthma (OA) and work-exacerbated asthma (WEA) among asthmatic patients diagnosed in Primary Health Care (PHC). To analyze the impact at PHC level caused by under-diagnosis and inappropriate referral of OA. A descriptive, cross-sectional multicenter study in patients aged between 16 and 64years diagnosed with asthma, according to their medical record; all were working or had worked, and were assigned to one of 16 PHC centers in a healthcare district. Based on the responses to the questionnaire completed at the study visit, which included a thorough review of the subject's entire working history, patients were classified into three categories by an expert in occupational asthma: OA, WEA or common asthma (CA). Three hundred and sixty-eight patients completed the questionnaire. The prevalence of OA was 18.2% (25% in men and 14.6% in women, P=.046), and 54 patients (14.7%) were classified as WEA. The proportion of patients with work-related asthma (WRA) was therefore 32.9%. Asthmatic patients with WRA took more sick leave than CA patients (P<.001). A high prevalence of WRA was found, mostly treated in PHC. Under-diagnosis of WRA is widespread in PHC. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Prevalence and Occupational and Environmental Risk Factors of Self-Reported Asthma: Evidence from a Cross-Sectional Survey in Seven Chinese Cities.

PubMed

Fu, Qing-Ling; Du, Yue; Xu, Geng; Zhang, Hua; Cheng, Lei; Wang, Yan-Jun; Zhu, Dong-Dong; Lv, Wei; Liu, Shi-Xi; Li, Pei-Zhong; Shi, Jian-Bo; Ou, Chun-Quan

2016-11-04

Asthma is one of the most common chronic diseases and associated with significant morbidity and mortality. However, few data on occupational and environmental risk factors of asthma are available, particularly in Asian adults. Based on a national cross-sectional survey, we assessed the prevalence and risk factors of asthma in Chinese adults. A total of 9974 participants aged 15 years and over in seven Chinese cities were selected using a stratified four-stage random sampling. All participants were interviewed face-to-face in their homes using a standardized self-administered questionnaire. Multivariate logistic regression analyses were adopted to determine various risk factors for asthma. The prevalence of self-reported lifetime asthma was 2.46% among the entire adult population, 3.02% among males and 1.93% among females. The prevalence varied by age group, ethnicity, marital status, education, and floor space per person ( p < 0.05). After adjusting for socio-demographic variables and smoking, we found independent occupational and environmental determinants of asthma, including a clearance-related job (OR = 2.28, 95%CI: 1.07-4.89), occupational exposure to industrial or occupational poisonous gas (OR = 4.21, 95%CI: 2.43-7.30), having large amounts of carpet in the workplace (OR = 2.61, 95%CI: 1.20-5.69) and using coal for cooking (OR = 2.65, 95%CI: 1.26-5.57). Asthma is a serious public health problem in China. Our study provides important updated information on the prevalence of asthma and its associated risk factors, which may help us better understand the epidemiology of asthma and prevent this disorder.

The contribution of an asthma diagnostic consultation service in obtaining an accurate asthma diagnosis for primary care patients: results of a real-life study.

PubMed

Gillis, R M E; van Litsenburg, W; van Balkom, R H; Muris, J W; Smeenk, F W

2017-05-19

Previous studies showed that general practitioners have problems in diagnosing asthma accurately, resulting in both under and overdiagnosis. To support general practitioners in their diagnostic process, an asthma diagnostic consultation service was set up. We evaluated the performance of this asthma diagnostic consultation service by analysing the (dis)concordance between the general practitioners working hypotheses and the asthma diagnostic consultation service diagnoses and possible consequences this had on the patients' pharmacotherapy. In total 659 patients were included in this study. At this service the patients' medical history was taken and a physical examination and a histamine challenge test were carried out. We compared the general practitioners working hypotheses with the asthma diagnostic consultation service diagnoses and the change in medication that was incurred. In 52% (n = 340) an asthma diagnosis was excluded. The diagnosis was confirmed in 42% (n = 275). Furthermore, chronic rhinitis was diagnosed in 40% (n = 261) of the patients whereas this was noted in 25% (n = 163) by their general practitioner. The adjusted diagnosis resulted in a change of medication for more than half of all patients. In 10% (n = 63) medication was started because of a new asthma diagnosis. The 'one-stop-shop' principle was met with 53% of patients and 91% (n = 599) were referred back to their general practitioner, mostly within 6 months. Only 6% (n = 41) remained under control of the asthma diagnostic consultation service because of severe unstable asthma. In conclusion, the asthma diagnostic consultation service helped general practitioners significantly in setting accurate diagnoses for their patients with an asthma hypothesis. This may contribute to diminish the problem of over and underdiagnosis and may result in more appropriate treatment regimens. SERVICE HELPS GENERAL PRACTITIONERS MAKE ACCURATE DIAGNOSES: A consultation service can

Developments in laboratory diagnostics for isocyanate asthma

PubMed Central

Wisnewski, Adam V.

2011-01-01

Purpose of review Isocyanates, reactive chemicals used to generate polyurethane, are a leading cause of occupational asthma worldwide. Workplace exposure is the best-recognized risk factor for disease development, but is challenging to monitor. Clinical diagnosis and differentiation of isocyanates as the cause of asthma can be difficult. The gold-standard test, specific inhalation challenge, is technically and economically demanding, and is thus only available in a few specialized centers in the world. With the increasing use of isocyanates, efficient laboratory tests for isocyanate asthma and exposure are urgently needed. Recent findings The review focuses on literature published in 2005 and 2006. Over 150 articles, identified by searching PubMed using keywords ‘diphenylmethane’, ‘toluene’ or ‘hexamethylene diisocyanate’, were screened for relevance to isocyanate asthma diagnostics. New advances in understanding isocyanate asthma pathogenesis are described, which help improve conventional radioallergosorbent and enzyme-linked immunosorbent assay approaches for measuring isocyanate-specific IgE and IgG. Newer immunoassays, based on cellular responses and discovery science readouts are also in development. Summary Contemporary laboratory tests that measure isocyanate-specific human IgE and IgG are of utility in diagnosing a subset of workers with isocyanate asthma, and may serve as a biomarker of exposure in a larger proportion of occupationally exposed workers. PMID:17351466

Occupational asthma induced by Chrysonilia sitophila in a worker exposed to coffee grounds.

PubMed

Francuz, Beata; Yera, Helene; Geraut, Laurent; Bensefa-Colas, Lynda; Nghiem, Zuong Hung; Choudat, Dominique

2010-10-01

A new case of occupational asthma caused by Chrysonilia sitophila (asexual state of Neurospora sitophila) was diagnosed by molecular identification of the mold and confirmed by skin prick test, peak expiratory flow rate measurements, and experimental immunoglobulin E analysis.

Occupational IgE-mediated asthma, rhinoconjunctivitis, and contact urticaria caused by Easter lily (Lilium longiflorum) and tulip.

PubMed

Piirilä, P; Kanerva, L; Alanko, K; Estlander, T; Keskinen, H; Pajari-Backas, M; Tuppurainen, M

1999-03-01

We report on IgE-mediated asthma, rhinoconjunctivitis, and contact urticaria to two Liliaceae plants, tulip and Easter lily (Lilium longiflorum), diagnosed in a floral shop worker. Occupational asthma was diagnosed according to patient history, PEF monitoring, and a work-simulating provocation test. Flower-specific IgE was studied, and RAST inhibition tests were performed. Skin prick testing showed positive reactions to tulip, Easter lily, and chrysanthemum. Total IgE was 180 kU/I, and specific IgE to tulip was 2.6 and to Easter lily 6.5 kU/I. In the RAST-inhibition test, no cross-reactivity was found. Occupational asthma was diagnosed by peak flow monitoring at work and at home, as well as specific inhalation challenge with Easter lily, with an immediate 18% reduction in PEF. In addition, contact urticaria and conjunctivitis were diagnosed. After a 9-year follow-up without exposure to lilies, the skin prick tests to L. longiflorum and tulip were still positive, but the specific IgE had disappeared. A case of IgE-mediated occupational asthma, rhinoconjunctivitis, and contact urticaria caused by L. longiflorum and tulip is presented. RAST inhibition tests indicated concomitant sensitization to the two Liliaceae plants.

Occupational Asthma Induced by Chrysonilia sitophila in a Worker Exposed to Coffee Grounds▿

PubMed Central

Francuz, Beata; Yera, Helene; Geraut, Laurent; Bensefa-Colas, Lynda; Nghiem, Zuong Hung; Choudat, Dominique

2010-01-01

A new case of occupational asthma caused by Chrysonilia sitophila (asexual state of Neurospora sitophila) was diagnosed by molecular identification of the mold and confirmed by skin prick test, peak expiratory flow rate measurements, and experimental immunoglobulin E analysis. PMID:20685936

Reported occupational respiratory diseases in Catalonia.

PubMed

Orriols, R; Costa, R; Albanell, M; Alberti, C; Castejon, J; Monso, E; Panades, R; Rubira, N; Zock, J-P

2006-04-01

A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary

Reported occupational respiratory diseases in Catalonia

PubMed Central

Orriols, R; Costa, R; Albanell, M; Alberti, C; Castejon, J; Monso, E; Panades, R; Rubira, N; Zock, J‐P

2006-01-01

Objectives A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. Methods In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. Results Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. Conclusions The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A

Diesel exhaust causing low-dose irritant asthma with latency?

PubMed

Adewole, Femi; Moore, Vicky C; Robertson, Alastair S; Burge, P S

2009-09-01

Diesel exhaust exposure may cause acute irritant-induced asthma and potentiate allergen-induced asthma. There are no previous reports of occupational asthma due to diesel exhaust. To describe occupational asthma with latency in workers exposed to diesel exhaust in bus garages. The Shield database of occupational asthma notifications in the West Midlands, UK, was searched between 1990 and 2006 for workers where diesel exhaust exposure was thought to be the cause of the occupational asthma. Those without other confounding exposures whose occupational asthma was validated by serial peak expiratory flow (PEF) analysis using Oasys software were included. Fifteen workers were identified with occupational asthma attributed to diesel exhaust. Three had validated new-onset asthma with latency. All worked in bus garages where diesel exhaust exposure was the only likely cause of their occupational asthma. Occupational asthma was confirmed by measures of non-specific reactivity and serial measurements of PEF with Oasys scores of 2.9, 3.73 and 4 (positive score > 2.5). The known non-specific irritant effects of diesel exhaust suggest that this is an example of low-dose irritant-induced asthma and that exposures to diesel exhaust in at least some bus garages are at a sufficient level to cause this.

Occupational rhinitis.

PubMed

Sublett, J Wesley; Bernstein, David I

2011-11-01

Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinoconjunctivitis (OR), is two to three times more common than occupational asthma. High molecular weight proteins and low molecular weight chemicals have been implicated as causes of OR. The diagnosis of work-related rhinitis is established based on occupational history and documentation of immunoglobulin E (IgE) mediated sensitization to the causative agent if possible. Management of work-related rhinitis is similar to that of other causes of rhinitis and includes elimination or reduction of exposure to causative agents combined with pharmacotherapy. If allergens are commercially available, allergen immunotherapy can be considered. Copyright © 2011 Elsevier Inc. All rights reserved.

An official American Thoracic Society Workshop Report: presentations and discussion of the fifth Jack Pepys Workshop on Asthma in the Workplace. Comparisons between asthma in the workplace and non-work-related asthma.

PubMed

Malo, Jean-Luc; Tarlo, Susan M; Sastre, Joaquin; Martin, James; Jeebhay, Mohamed F; Le Moual, Nicole; Heederik, Dick; Platts-Mills, Thomas; Blanc, Paul D; Vandenplas, Olivier; Moscato, Gianna; de Blay, Frédéric; Cartier, André

2015-07-01

The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non-work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home.

An Official American Thoracic Society Workshop Report: Presentations and Discussion of the Fifth Jack Pepys Workshop on Asthma in the Workplace. Comparisons between Asthma in the Workplace and Non–Work-related Asthma

PubMed Central

Malo, Jean-Luc; Sastre, Joaquin; Martin, James; Jeebhay, Mohamed F.; Le Moual, Nicole; Heederik, Dick; Platts-Mills, Thomas; Blanc, Paul D.; Vandenplas, Olivier; Moscato, Gianna; de Blay, Frédéric; Cartier, André

2015-01-01

The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non–work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home. PMID:26203621

Bronchial asthma and COPD due to irritants in the workplace - an evidence-based approach

PubMed Central

2012-01-01

Background Respiratory irritants represent a major cause of occupational obstructive airway diseases. We provide an overview of the evidence related to irritative agents causing occupational asthma or occupational COPD. Methods We searched MEDLINE via PubMed. Reference lists of relevant reviews were also screened. The SIGN grading system was used to rate the quality of each study. The modified RCGP three-star system was used to grade the body of evidence for each irritant agent regarding its causative role in either occupational asthma or occupational COPD. Results A total of 474 relevant papers were identified, covering 188 individual agents, professions or work-sites. The focus of most of the studies and the predominant diagnosis was occupational asthma, whereas occupational COPD arose only incidentally. The highest level assigned using the SIGN grading was 2+ (well-conducted systematic review, cohort or case–control study with a low risk of confounding or bias). According to the modified RCGP three-star grading, the strongest evidence of association with an individual agent, profession or work-site (“**”) was found for 17 agents or work-sites, including benzene-1,2,4-tricarboxylicacid-1,2-anhydride, chlorine, platinum salt, isocyanates, cement dust, grain dust, animal farming, environmental tobacco smoke, welding fumes or construction work. Phthalic anhydride, glutaraldehyde, sulphur dioxide, cotton dust, cleaning agents, potrooms, farming (various), foundries were found to be moderately associated with occupational asthma or occupational COPD (“*[+]”). Conclusion This study let us assume that irritant-induced occupational asthma and especially occupational COPD are considerably underreported. Defining the evidence of the many additional occupational irritants for causing airway disorders will be the subject of continued studies with implications for diagnostics and preventive measures. PMID:23013890

Early incidence of occupational asthma among young bakers, pastry-makers and hairdressers: design of a retrospective cohort study

PubMed Central

2010-01-01

Background Occupational exposures are thought to be responsible for 10-15% of new-onset asthma cases in adults, with disparities across sectors. Because most of the data are derived from registries and cross-sectional studies, little is known about incidence of occupational asthma (OA) during the first years after inception of exposure. This paper describes the design of a study that focuses on this early asthma onset period among young workers in the bakery, pastry making and hairdressing sectors in order to assess early incidence of OA in these "at risk" occupations according to exposure duration, and to identify risk factors of OA incidence. Methods/Design The study population is composed of subjects who graduated between 2001 and 2006 in these sectors where they experience exposure to organic or inorganic allergenic or irritant compounds (with an objective of 150 subjects by year) and 250 young workers with no specific occupational exposure. A phone interview focusing on respiratory and 'Ear-Nose-Throat' (ENT) work-related symptoms screen subjects considered as "possibly OA cases". Subjects are invited to participate in a medical visit to complete clinical and lung function investigations, including fractional exhaled nitric oxide (FENO) and carbon monoxide (CO) measurements, and to collect blood samples for IgE (Immunoglobulin E) measurements (total IgE and IgE for work-related and common allergens). Markers of oxidative stress and genetic polymorphisms exploration are also assessed. A random sample of 200 "non-cases" (controls) is also visited, following a nested case-control design. Discussion This study may allow to describ a latent period between inception of exposure and the rise of the prevalence of asthma symptoms, an information that would be useful for the prevention of OA. Such a time frame would be suited for conducting screening campaigns of this emergent asthma at a stage when occupational hygiene measures and adapted therapeutic interventions

Early incidence of occupational asthma among young bakers, pastry-makers and hairdressers: design of a retrospective cohort study.

PubMed

Rémen, Thomas; Coevoet, Vincent; Acouetey, Dovi-Stéphanie; Guéant, Jean-Louis; Guéant-Rodriguez, Rosa-Maria; Paris, Christophe; Zmirou-Navier, Denis

2010-04-26

Occupational exposures are thought to be responsible for 10-15% of new-onset asthma cases in adults, with disparities across sectors. Because most of the data are derived from registries and cross-sectional studies, little is known about incidence of occupational asthma (OA) during the first years after inception of exposure. This paper describes the design of a study that focuses on this early asthma onset period among young workers in the bakery, pastry making and hairdressing sectors in order to assess early incidence of OA in these "at risk" occupations according to exposure duration, and to identify risk factors of OA incidence. The study population is composed of subjects who graduated between 2001 and 2006 in these sectors where they experience exposure to organic or inorganic allergenic or irritant compounds (with an objective of 150 subjects by year) and 250 young workers with no specific occupational exposure. A phone interview focusing on respiratory and 'Ear-Nose-Throat' (ENT) work-related symptoms screen subjects considered as "possibly OA cases". Subjects are invited to participate in a medical visit to complete clinical and lung function investigations, including fractional exhaled nitric oxide (FENO) and carbon monoxide (CO) measurements, and to collect blood samples for IgE (Immunoglobulin E) measurements (total IgE and IgE for work-related and common allergens). Markers of oxidative stress and genetic polymorphisms exploration are also assessed. A random sample of 200 "non-cases" (controls) is also visited, following a nested case-control design. This study may allow to describ a latent period between inception of exposure and the rise of the prevalence of asthma symptoms, an information that would be useful for the prevention of OA. Such a time frame would be suited for conducting screening campaigns of this emergent asthma at a stage when occupational hygiene measures and adapted therapeutic interventions might be effective. Clinical trial

Assessment of public health impact of work-related asthma.

PubMed

Jaakkola, Maritta S; Jaakkola, Jouni J K

2012-03-05

Asthma is among the most common chronic diseases in working-aged populations and occupational exposures are important causal agents. Our aims were to evaluate the best methods to assess occurrence, public health impact, and burden to society related to occupational or work-related asthma and to achieve comparable estimates for different populations. We addressed three central questions: 1: What is the best method to assess the occurrence of occupational asthma? We evaluated: 1) assessment of the occurrence of occupational asthma per se, and 2) assessment of adult-onset asthma and the population attributable fractions due to specific occupational exposures. 2: What are the best methods to assess public health impact and burden to society related to occupational or work-related asthma? We evaluated methods based on assessment of excess burden of disease due to specific occupational exposures. 3: How to achieve comparable estimates for different populations? We evaluated comparability of estimates of occurrence and burden attributable to occupational asthma based on different methods. Assessment of the occurrence of occupational asthma per se can be used in countries with good coverage of the identification system for occupational asthma, i.e. countries with well-functioning occupational health services. Assessment based on adult-onset asthma and population attributable fractions due to specific occupational exposures is a good approach to estimate the occurrence of occupational asthma at the population level. For assessment of public health impact from work-related asthma we recommend assessing excess burden of disease due to specific occupational exposures, including excess incidence of asthma complemented by an assessment of disability from it. International comparability of estimates can be best achieved by methods based on population attributable fractions. Public health impact assessment for occupational asthma is central in prevention and health policy planning

Occupational exposure to chemicals drives the increased risk of asthma and rhinitis observed for exposure to vapours, gas, dust and fumes: a cross-sectional population-based study.

PubMed

Schyllert, Christian; Rönmark, Eva; Andersson, Martin; Hedlund, Ulf; Lundbäck, Bo; Hedman, Linnea; Lindberg, Anne

2016-10-01

Occupational exposure to the composite measure vapours, gases, dusts and fumes (VGDF), contribute to the burden of asthma and rhinitis. The objective was to evaluate occupational exposure to VGDF, which is further divided into the components chemicals, organic and inorganic dust in relation to asthma and rhinitis. Previously examined participants from three population-based cohorts in the Obstructive Lung disease In Northern Sweden (OLIN) studies were re-examined during 2002-2004. In total, 4036 participated in a structured interview and answered a questionnaire on occupational exposures. Occupational exposure to VGDF increased the risk of asthma, and concomitant asthma and rhinitis. Exposure to chemicals, but not dust, showed a similar pattern. Exposure to chemicals increased the risks (OR, 95% CI) of rhinitis without asthma (1.29, 1.10 to 1.52), asthma without rhinitis (1.42, 1.15 to 1.77) and concomitant asthma and rhinitis (1.60, 1.31 to 1.96) when adjusted for confounders such as age, smoking habits, body mass index and sex. The association between exposure to chemicals and asthma and rhinitis remained independent of exposure to dust and was also so when excluding exposure to isocyanates and welding fumes. The results were similar for women and men, as well as for never-smokers and participants without a history of allergy. In this cross-sectional population-based study, occupational exposure to chemicals contributed substantially to the increased risk of asthma and rhinitis observed for occupational exposure to VGDF. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Identifying biomarkers for asthma diagnosis using targeted metabolomics approaches.

PubMed

Checkley, William; Deza, Maria P; Klawitter, Jost; Romero, Karina M; Klawitter, Jelena; Pollard, Suzanne L; Wise, Robert A; Christians, Uwe; Hansel, Nadia N

2016-12-01

The diagnosis of asthma in children is challenging and relies on a combination of clinical factors and biomarkers including methacholine challenge, lung function, bronchodilator responsiveness, and presence of airway inflammation. No single test is diagnostic. We sought to identify a pattern of inflammatory biomarkers that was unique to asthma using a targeted metabolomics approach combined with data science methods. We conducted a nested case-control study of 100 children living in a peri-urban community in Lima, Peru. We defined cases as children with current asthma, and controls as children with no prior history of asthma and normal lung function. We further categorized enrollment following a factorial design to enroll equal numbers of children as either overweight or not. We obtained a fasting venous blood sample to characterize a comprehensive panel of targeted markers using a metabolomics approach based on high performance liquid chromatography-mass spectrometry. A statistical comparison of targeted metabolites between children with asthma (n = 50) and healthy controls (n = 49) revealed distinct patterns in relative concentrations of several metabolites: children with asthma had approximately 40-50% lower relative concentrations of ascorbic acid, 2-isopropylmalic acid, shikimate-3-phosphate, and 6-phospho-d-gluconate when compared to children without asthma, and 70% lower relative concentrations of reduced glutathione (all p < 0.001 after Bonferroni correction). Moreover, a combination of 2-isopropylmalic acid and betaine strongly discriminated between children with asthma (2-isopropylmalic acid ≤ 13 077 normalized counts/second) and controls (2-isopropylmalic acid > 13 077 normalized counts/second and betaine ≤ 16 47 121 normalized counts/second). By using a metabolomics approach applied to serum, we were able to discriminate between children with and without asthma by revealing different metabolic patterns. These results suggest that

Occupational asthma

MedlinePlus

... exposure; Irritant-induced reactive airways disease Images Spirometry Respiratory system References Lemiere C, Vandenplas O. Asthma in the workplace. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and ... of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016: ...

Irritant-induced asthma.

PubMed

Labrecque, Manon

2012-04-01

To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management. IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA. IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.

Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme.

PubMed

Bakerly, N Diar; Moore, V C; Vellore, A D; Jaakkola, M S; Robertson, A S; Burge, P S

2008-05-01

Trends of occupational asthma (OA) differ between regions depending on local industries, provisions for health and safety at the workplace and the availability of a reporting scheme to help in data collection and interpretation. To assess trends in OA in an industrialized part of the UK over a 15-year period. Occupational and chest physicians in the West Midlands were invited to submit details of newly diagnosed cases with OA. Data were then transferred to the regional centre for occupational lung diseases for analysis. A total of 1461 cases were reported to the scheme. Sixty-eight per cent were males with mean (standard deviation) age of 44 (12) years. The annual incidence of OA was 42 per million of working population (95% CI = 37-45). OA was most frequently reported in welders (9%) and health care-related professions (9%) while < 1% of cases were reported in farmers. Isocyanates were the commonest offending agents responsible for 21% of reports followed by metal working fluids (MWFs) (11%), adhesives (7%), chrome (7%), latex (6%) and glutaraldehyde (6%). Flour was suspected in 5% of cases while laboratory animals only in 1%. Our data confirm a high annual incidence of OA in this part of the UK. MWFs are an emerging problem, while isocyanates remain the commonest cause. Incidence remained at a fairly stable background level with many small and a few large epidemics superimposed. Schemes like Midland Thoracic Society's Rare Respiratory Disease Registry Surveillance Scheme of Occupational Asthma could help in identifying outbreaks by linking cases at the workplace.

Choosing wisely: adherence by physicians to recommended use of spirometry in the diagnosis and management of adult asthma.

PubMed

Sokol, Kristin C; Sharma, Gulshan; Lin, Yu-Li; Goldblum, Randall M

2015-05-01

The National Asthma Education and Prevention Program (NAEPP) and the American Thoracic Society provide guidelines stating that physicians should use spirometry in the diagnosis and management of asthma. The aim of this study was to evaluate the trends, over a 10-year period, in the utilization of spirometry in patients newly diagnosed with asthma. We hypothesized that spirometry use would increase in physicians who care for asthma patients, especially since 2007, when the revised NAEPP guidelines were published. This retrospective cohort analysis of spirometry use in subjects newly diagnosed with asthma used a privately insured adult population for the years 2002-2011. Our primary outcome of interest was spirometry performed within a year (± 365 days) of the initial date of asthma diagnosis. We also examined the type of asthma medications prescribed. In all, 134,208 patients were found to have a diagnosis of asthma. Only 47.6% had spirometry performed within 1 year of diagnosis. Younger patients, males, and those residing in the Northeast were more likely to receive spirometry. Spirometry use began to decline in 2007. Patients cared for by specialists were more likely to receive spirometry than those cared for by primary care physicians; 80.1% vs 23.3%, respectively. Lastly, even without spirometry, a significant portion of patients (78.3%) was prescribed asthma drugs. Our study suggests that spirometry is underutilized in newly diagnosed asthma patients. Moreover, the use of controller medications in those diagnosed with asthma without spirometry remains high. Copyright © 2015 Elsevier Inc. All rights reserved.

A smart spirometry device for asthma diagnosis.

PubMed

Kassem, A; Hamad, M; El Moucary, C

2015-08-01

In this paper an innovative prototype for smart asthma spirometry device to be used by doctors and asthma patients is presented. The novelty in this prototype relies in the fact that it is destined to subtend not only adults but offers an efficient and attractive manner to accommodate children patients as well thus, making it efficient for doctors, patients and parents to detect and monitor such intricate cases at stages as early as six years old. Moreover, the apparatus used enables us to integrate a vital parameter representing the Forced Expiratory Volume to the final diagnosis. Besides, the presented device will automatically diagnose those patients, assess their asthma condition, and schedule their medication process without excessive visits to medical centers whilst providing doctors with accurate and pertinent and comprehensive medical data in a chronological fashion. Zooming into under the hood of the device, a fully reliable hardware digital system lies along with a flowmeter detector and a Bluetooth emitter to interface with a user-friendly GUI-based application installed on smartphones which incorporates appealing animated graphics to encourage children to take the test. Furthermore, the device offers the capability of storing chronological data and a relevant resourceful display for accurate tracking of patients' medical record, the evolvement of their asthma condition, and the administered medication. Finally, the entire device is aligned with the medical requirements as per doctors' and telemedicine specialists' recommendations; the experiments carried out demonstrated the effectiveness and sustainable use of such device.

Occupational asthma due to turpentine in art painter--case report.

PubMed

Dudek, Wojciech; Wittczak, Tomasz; Swierczyńska-Machura, Dominika; Walusiak-Skorupa, Jolanta; Pałczyński, Cezary

2009-01-01

Turpentine is a fluid obtained by distillation of wood resins containing mixture of terpens. It can act as an irritant and sensitiser. Most common health problem among workers exposed to turpentine is contact dermatitis. Little is know about turpentine to cause type I hypersensitivity reaction. We present a case of a 27-year old art painter using turpentine as a thinner for oil-based paints. She developed asthmatic reactions after 5 years of working with turpentine. A number of clinical procedures were performed, including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens, metal salts, oil-based paints and balsamic turpentine, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specific inhalation challenge with balsamic turpentine. Clinical findings and laboratory test results were normal but a significant bronchial hyperreactivity was found. During the specific challenge, dyspnoea and decreased forced expiratory volume (FEV1) were observed in late phase of asthmatic reaction. An increased proportion of eosinophils in induced sputum could also be noted 24 h after the challenge. Positive clinical response to the specific challenge as well as the morphological changes found in induced sputum served as the basis for diagnosing occupational asthma. To our knowledge, this is the first well-documented case of turpentine-induced occupational asthma.

Occupational asthma induced by cephalosporins.

PubMed

Sastre, J; Quirce, S; Novalbos, A; Lluch-Bernal, M; Bombín, C; Umpiérrez, A

1999-05-01

A 20-yr-old pharmaceutical worker who developed attacks of shortness of breath and wheezing 9 months after beginning work on a process in which cefadroxil powder was bottled or encapsulated will be described. Skin test with cefaxodril was negative. Baseline spirometry and methacholine inhalation test were normal. A controlled bronchial challenge test was carried out in a closed-circuit system with assessment of respirable dust concentration. Exposure to cefadroxil powder at a mean concentration of 10 mg x m(-3) for 10 min elicited an isolated immediate asthmatic response, but no response was observed to control challenge with lactose. Single-blind oral challenge test with amoxicillin up to 500 mg was well tolerated, whereas the oral challenge with cephalexin (25 mg) elicited an immediate asthmatic response. This patient had developed occupational asthma caused by inhalation of cefadroxil as confirmed by specific inhalation test. Since she tolerated oral amoxicillin, a synthetic penicillin with the side-chain identical to that of cefadroxil, it seems that she may be sensitized to the dihydrothiazine ring of cephalosporins.

Incidence of asthma among Finnish construction workers.

PubMed

Karjalainen, Antti; Martikainen, Rami; Oksa, Panu; Saarinen, Kimmo; Uitti, Jukka

2002-08-01

We wanted to explore the risk of asthma among male workers of the construction industry. All Finnish male construction industry workers and all those employed in administrative work were followed for asthma incidence through a register linkage in 1986 through 1998. Age-adjusted relative risks (RR) were estimated for 24 construction occupations. The risk was increased in nearly all construction occupations studied, but it was highest among welders and flame cutters (RR 2.34), asphalt roofing workers (RR 2.04), plumbers (RR 1.90), and brick layers and tile setters (RR 1.83). Only 45 (2%) of the cases of asthma among construction workers had been recognized as occupational asthma. Construction industry workers have an increased risk of adult-onset persistent asthma and cases of occupational asthma caused by well-established causative agents have only a minor contribution to this overall asthma excess.

The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

PubMed Central

Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

2016-01-01

This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

Gender and snow crab occupational asthma in Newfoundland and Labrador, Canada.

PubMed

Howse, Dana; Gautrin, Denyse; Neis, Barbara; Cartier, André; Horth-Susin, Lise; Jong, Michael; Swanson, Mark C

2006-06-01

Fish and shellfish processing employs many thousands of people globally, with shellfish processing becoming more important in recent years. Shellfish processing is associated with multiple occupational health and safety (OHS) risks. Snow crab occupational asthma (OA) is work-related asthma associated with processing snow crab. We present a gender analysis of findings from a 3-year multifaceted study of snow crab OA in Newfoundland and Labrador, Canada. The study was carried out in four snow crab processing communities between 2001 and 2004. An anonymous survey questionnaire on knowledge, beliefs, and concerns related to processing snow crab administered to 158 workers attending community meetings at the start of the research found that women were significantly more likely than men to associate certain health problems, especially chest tightness, difficulty breathing, and cough, with crab processing (P<0.001). Worker health assessments carried out with 215 processing workers (187 current/28 former; 120 female/95 male) found that female participants were more likely to be diagnosed as almost certain/highly probable snow crab OA and allergy (P=0.001) and to be sensitized to snow crab (P=0.01) than male participants. Work histories from the health assessments were used to classify processing jobs as male or female. Allergen sampling (211 allergen samples: 115 area, 96 personal breathing zone) indicated that the plant areas where these male jobs were concentrated were associated with lower levels of aerosolized crab allergens (the agents responsible for OA to snow crab) than areas associated with female jobs. This difference was statistically significant in the two plants with poor ventilation (p<0.001 and P=0.017 for these plants). A gender analysis of work history data showed that female health assessment participants were likely to have worked longer processing snow crab than males (5 years versus 3.5 years, respectively). Cross-referencing of work history results

Development of a validated algorithm for the diagnosis of paediatric asthma in electronic medical records

PubMed Central

Cave, Andrew J; Davey, Christina; Ahmadi, Elaheh; Drummond, Neil; Fuentes, Sonia; Kazemi-Bajestani, Seyyed Mohammad Reza; Sharpe, Heather; Taylor, Matt

2016-01-01

An accurate estimation of the prevalence of paediatric asthma in Alberta and elsewhere is hampered by uncertainty regarding disease definition and diagnosis. Electronic medical records (EMRs) provide a rich source of clinical data from primary-care practices that can be used in better understanding the occurrence of the disease. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database includes cleaned data extracted from the EMRs of primary-care practitioners. The purpose of the study was to develop and validate a case definition of asthma in children 1–17 who consult family physicians, in order to provide primary-care estimates of childhood asthma in Alberta as accurately as possible. The validation involved the comparison of the application of a theoretical algorithm (to identify patients with asthma) to a physician review of records included in the CPCSSN database (to confirm an accurate diagnosis). The comparison yielded 87.4% sensitivity, 98.6% specificity and a positive and negative predictive value of 91.2% and 97.9%, respectively, in the age group 1–17 years. The algorithm was also run for ages 3–17 and 6–17 years, and was found to have comparable statistical values. Overall, the case definition and algorithm yielded strong sensitivity and specificity metrics and was found valid for use in research in CPCSSN primary-care practices. The use of the validated asthma algorithm may improve insight into the prevalence, diagnosis, and management of paediatric asthma in Alberta and Canada. PMID:27882997

Development of a validated algorithm for the diagnosis of paediatric asthma in electronic medical records.

PubMed

Cave, Andrew J; Davey, Christina; Ahmadi, Elaheh; Drummond, Neil; Fuentes, Sonia; Kazemi-Bajestani, Seyyed Mohammad Reza; Sharpe, Heather; Taylor, Matt

2016-11-24

An accurate estimation of the prevalence of paediatric asthma in Alberta and elsewhere is hampered by uncertainty regarding disease definition and diagnosis. Electronic medical records (EMRs) provide a rich source of clinical data from primary-care practices that can be used in better understanding the occurrence of the disease. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database includes cleaned data extracted from the EMRs of primary-care practitioners. The purpose of the study was to develop and validate a case definition of asthma in children 1-17 who consult family physicians, in order to provide primary-care estimates of childhood asthma in Alberta as accurately as possible. The validation involved the comparison of the application of a theoretical algorithm (to identify patients with asthma) to a physician review of records included in the CPCSSN database (to confirm an accurate diagnosis). The comparison yielded 87.4% sensitivity, 98.6% specificity and a positive and negative predictive value of 91.2% and 97.9%, respectively, in the age group 1-17 years. The algorithm was also run for ages 3-17 and 6-17 years, and was found to have comparable statistical values. Overall, the case definition and algorithm yielded strong sensitivity and specificity metrics and was found valid for use in research in CPCSSN primary-care practices. The use of the validated asthma algorithm may improve insight into the prevalence, diagnosis, and management of paediatric asthma in Alberta and Canada.

Occupational asthma in the commercial fishing industry: a case series and review of the literature.

PubMed

Lucas, David; Lucas, Raymond; Boniface, Keith; Jegaden, Dominique; Lodde, Brice; Dewitte, Jean-Ariel

2010-01-01

We present a case series of snow crab-induced occupational asthma (OA) from a fishing and processing vessel, followed by a review of OA in the commercial fishing industry. OA is typically caused from an IgE-mediated hypersensitivity reaction after respiratory exposure to aerosolized fish and shellfish proteins. It more commonly occurs due to crustaceans, but molluscs and fin fish are implicated as well. Standard medical therapy for asthma may be used acutely; however, steps to reduce atmospheric allergen concentrations in the workplace have proven to be preventive for this disease.

Update of an occupational asthma-specific job exposure matrix to assess exposure to 30 specific agents.

PubMed

Le Moual, Nicole; Zock, Jan-Paul; Dumas, Orianne; Lytras, Theodore; Andersson, Eva; Lillienberg, Linnéa; Schlünssen, Vivi; Benke, Geza; Kromhout, Hans

2018-07-01

We aimed to update an asthmagen job exposure matrix (JEM) developed in the late 1990s. Main reasons were: the number of suspected and recognised asthmagens has since tripled; understanding of the aetiological role of irritants in asthma and methodological insights in application of JEMs have emerged in the period. For each agent of the new occupational asthma-specific JEM (OAsJEM), a working group of three experts out of eight evaluated exposure for each International Standard Classification of Occupations, 1988 (ISCO-88) job code into three categories: 'high' (high probability of exposure and moderate-to-high intensity), 'medium' (low-to-moderate probability or low intensity) and 'unexposed'. Within a working group, experts evaluated exposures independently from each other. If expert assessments were inconsistent the final decision was taken by consensus. Specificity was favoured over sensitivity, that is, jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high. In the final review, all experts checked assigned exposures and proposed/improved recommendations for expert re-evaluation after default application of the JEM. The OAsJEM covers exposures to 30 sensitisers/irritants, including 12 newly recognised, classified into seven broad groups. Initial agreement between the three experts was mostly fair to moderate (κ values 0.2-0.5). Out of 506 ISCO-88 codes, the majority was classified as unexposed (from 82.6% (organic solvents) to 99.8% (persulfates)) and a minority as 'high-exposed' (0.2% (persulfates) to 2.6% (organic solvents)). The OAsJEM developed to improve occupational exposure assessment may improve evaluations of associations with asthma in epidemiological studies and contribute to assessment of the burden of work-related asthma. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless

The healthy worker effect in asthma: work may cause asthma, but asthma may also influence work.

PubMed

Le Moual, Nicole; Kauffmann, Francine; Eisen, Ellen A; Kennedy, Susan M

2008-01-01

Despite the increasing attention to the relationship between asthma and work exposures, occupational asthma remains underrecognized and its population burden underestimated. This may be due, in part, to the fact that traditional approaches to studying asthma in populations cannot adequately take into account the healthy worker effect (HWE). The HWE is the potential bias caused by the phenomenon that sicker individuals may choose work environments in which exposures are low; they may be excluded from being hired; or once hired, they may seek transfer to less exposed jobs or leave work. This article demonstrates that population- and workplace-based asthma studies are particularly subject to HWE bias, which leads to underestimates of relative risks. Our objective is to describe the HWE as it relates to asthma research, and to discuss the significance of taking HWE bias into account in designing and interpreting asthma studies. We also discuss the importance of understanding HWE bias for public health practitioners and for clinicians. Finally, we emphasize the timeliness of this review in light of the many longitudinal "child to young adult" asthma cohort studies currently underway. These prospective studies will soon provide an ideal opportunity to examine the impact of early workplace environments on asthma in young adults. We urge occupational and childhood asthma epidemiologists collaborate to ensure that this opportunity is not lost.

Occupational asthma in an electronics factory: a case control study to evaluate aetiological factors

PubMed Central

Burge, P Sherwood; Perks, W H; O'Brien, I M; Burge, A; Hawkins, R; Brown, D; Green, M

1979-01-01

This is the final part of a study carried out to investigate occupational asthma due to sensitivity to colophony fumes (a component of soldering flux) in an electronics factory. Fifty-eight workers with occupational asthma employed on the main shop floor were investigated. In them the interval between first exposure and sensitisation varied widely with a group becoming sensitive within one to two years of first exposure, and another group whose sensitisation was delayed for three to 23 years. Once sensitised the interval between arriving at work and the onset of daily symptoms seemed to be bimodally distributed, resembling the immediate and late asthmatic symptoms seen on provocation testing. Twenty-three out of 58 had no definite daily deterioration at work but improved at the weekends. Wheeze and breathlessness occurred in the evenings at home in most, and one-third were woken by breathlessness at least on some nights. These 58 cases were compared with 48 controls without occupational asthma who had worked on the same shop floor for at least four years. Mean levels of FEV1 were significantly worse in the cases before exposure on Monday morning. The cases also had more than twice as much sickness absence as controls. FEV1 fell by more than 10% over a working shift in 33% of cases and 5% of controls. Atopy (a positive skin prick test to one or more common allergens) and a past history of allergic disease were weakly but significantly associated with being a case. The effects of smoking and a family history of allergic disease were trivial. Prick testing with an antigen derived from the colophony in the solder flux was completely negative, but cases and controls had significantly raised levels of total IgM compared with blood bank controls, perhaps suggesting some previously unrecognised immunological process. PMID:483204

Webinar: Know the Drill for Healthy IAQ: Training School Staff and Occupants to Reduce Indoor Asthma Triggers

EPA Pesticide Factsheets

A page to register to view the first webinar in the IAQ Knowledge-to-Action Professional Training Webinar Series: Know the Drill for Healthy IAQ: Training School Staff and Occupants to Reduce Indoor Asthma Triggers

Exposure to potential occupational asthmogens: prevalence data from the National Occupational Exposure Survey.

PubMed

de la Hoz, R E; Young, R O; Pedersen, D H

1997-02-01

Few data are available about the prevalence of occupational exposures to agents which can cause occupational asthma or aggravate preexisting asthma (asthmogens). Using potential occupational exposure data from the National Occupational Exposure Survey (NOES) of 1980-1983, we investigated the number of asthmogen exposures, asthmogen-exposure(s) per production worker, and unprotected occupational asthmogen exposures in different industries and occupations. Data for the entire United States were used to generate estimates of occupational exposure at two selected state and local levels. It was estimated that 7,864,000 workers in the surveyed industries were potentially exposed to one or more occupational asthmogen(s) in the United States. The average number of observed potential exposures per asthmogen-exposed worker was 4.4, and varied from 11.9, in the Water Transportation industry, to 1.2 in Local and Suburban transportation. The largest number of observed potential exposures was recorded in the Apparel and Other Finished Products (garment) industry. This work and further analyses using this approach are expected to contribute to a better understanding of the epidemiology of occupational asthma, and to serve as a guide to target future occupational asthma surveillance efforts.

3-(Bromomethyl)-2-chloro-4-(methylsulfonyl)- benzoic acid: a new cause of sensitiser induced occupational asthma, rhinitis and urticaria.

PubMed

Suojalehto, Hille; Karvala, Kirsi; Ahonen, Saana; Ylinen, Katriina; Airaksinen, Liisa; Suuronen, Katri; Suomela, Sari; Lindström, Irmeli

2018-04-01

3-(Bromomethyl)-2-chloro-4-(methylsulfonyl)-benzoic acid (BCMBA) has not previously been identified as a respiratory sensitiser. We detected two cases who presented respiratory and urticaria symptoms related to BCMBA and had positive skin prick tests to the agent. Subsequently, we conducted outbreak investigations at the BCMBA-producing factory and performed clinical examinations to confirm occupational diseases. The outbreak investigations included observations of work processes, assessment of exposure, a medical survey with a questionnaire and skin prick tests with 0.5% BCMBA water solution on 85 exposed workers and 9 unexposed workers. We used specific inhalation or nasal challenge and open skin application test to investigate BCMBA-related occupational asthma, rhinitis and contact urticaria. We identified nine workers with respiratory and/or skin symptoms and positive skin prick tests to BCMBA in a chemical factory. A survey among chemical factory workers indicated a BCMBA-related sensitisation rate of 8% among all exposed workers; the rate was highest (25%) among production workers in the production hall. Sensitisation was detected only in workers with the estimated highest exposure levels. Six cases of occupational asthma, rhinitis and/or contact urticaria caused by BCMBA were confirmed with challenge tests. Asthma-provoking doses in specific inhalation challenges were very low (0.03% or 0.3% BCMBA in lactose). We identified a new low molecular weight agent causing occupational asthma, rhinitis and contact urticaria. A typical clinical picture of allergic diseases and positive skin prick tests suggest underlying IgE-mediated disease mechanisms. Stringent exposure control measures are needed in order to prevent BCMBA-related diseases. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Genes Interacting with Occupational Exposures to Low Molecular Weight Agents and Irritants on Adult-Onset Asthma in Three European Studies

PubMed Central

Rava, Marta; Ahmed, Ismail; Kogevinas, Manolis; Le Moual, Nicole; Bouzigon, Emmanuelle; Curjuric, Ivan; Dizier, Marie-Hélène; Dumas, Orianne; Gonzalez, Juan R.; Imboden, Medea; Mehta, Amar J.; Tubert-Bitter, Pascale; Zock, Jan-Paul; Jarvis, Deborah; Probst-Hensch, Nicole M.; Demenais, Florence; Nadif, Rachel

2016-01-01

Background: The biological mechanisms by which cleaning products and disinfectants—an emerging risk factor—affect respiratory health remain incompletely evaluated. Studying genes by environment interactions (G × E) may help identify new genes related to adult-onset asthma. Objectives: We identified interactions between genetic polymorphisms of a large set of genes involved in the response to oxidative stress and occupational exposures to low molecular weight (LMW) agents or irritants on adult-onset asthma. Methods: Our data came from three large European cohorts: Epidemiological Family-based Study of the Genetics and Environment of Asthma (EGEA), Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA), and European Community Respiratory Health Survey in Adults (ECRHS). A candidate pathway–based strategy identified 163 genes involved in the response to oxidative stress and potentially related to exposures to LMW agents/irritants. Occupational exposures were evaluated using an asthma job-exposure matrix and job-specific questionnaires for cleaners and healthcare workers. Logistic regression models were used to detect G × E interactions, adjusted for age, sex, and population ancestry, in 2,599 adults (mean age, 47 years; 60% women, 36% exposed, 18% asthmatics). p-Values were corrected for multiple comparisons. Results: Ever exposure to LMW agents/irritants was associated with current adult-onset asthma [OR = 1.28 (95% CI: 1.04, 1.58)]. Eight single nucleotide polymorphism (SNP) by exposure interactions at five loci were found at p < 0.005: PLA2G4A (rs932476, chromosome 1), near PLA2R1 (rs2667026, chromosome 2), near RELA (rs931127, rs7949980, chromosome 11), PRKD1 (rs1958980, rs11847351, rs1958987, chromosome 14), and PRKCA (rs6504453, chromosome 17). Results were consistent across the three studies and after accounting for smoking. Conclusions: Using a pathway-based selection process, we identified novel genes potentially involved

Diagnostic challenges of childhood asthma.

PubMed

Bakirtas, Arzu

2017-01-01

Diagnosis of asthma in childhood is challenging. Both underdiagnosis and overdiagnosis of asthma are important issues. The present review gives information about challenging factors for an accurate diagnosis of childhood asthma. Although underdiagnosis of asthma in childhood has always been the most important diagnostic problem, overdiagnosis of asthma has also been increasingly recognized. This is probably due to diagnosis of asthma based on symptoms and signs alone. Demonstration of variable airflow obstruction by lung function tests is the most common asthma diagnostic tests used in practice and is therefore strongly recommended in children who can cooperate. Recently, an asthma guideline combining the clinical and economic evidences with sensitivity and specificity of diagnostic procedures was developed to improve accuracy of diagnosis and to avoid overdiagnosis. This guideline provided an algorithmic clinical and cost-effective approach and included fractional exhaled nitric oxide measurement as one of the diagnostic tests in addition to lung function. Diagnosis of asthma in children should be made by combining relevant history with at least two confirmatory diagnostic tests whenever possible. Diagnosis based on short-period treatment trials should be limited to young children who are unable to cooperate with these tests.

Environmental and occupational allergies.

PubMed

Peden, David; Reed, Charles E

2010-02-01

Airborne allergens are the major cause of allergic rhinitis and asthma. Daily exposure comes from indoor sources, chiefly at home but occasionally at schools or offices. Seasonal exposure to outdoor allergens, pollens, and molds is another important source. Exposure to unusual substances at work causes occupational asthma, accounting for about 5% of asthma in adults. Indoor and outdoor air pollutants trigger airway inflammation and increase the severity of asthma. Diesel exhaust particles increase the production of IgE antibodies. Identification and reduction of exposure to allergens is a very important part of the management of respiratory allergic diseases. The first section of this chapter discusses domestic allergens, arthropods (mites and cockroaches), molds, and mammals (pets and mice). Indoor humidity and water damage are important factors in the production of mite and mold allergens, and discarded human food items are important sources of proliferation of cockroaches and mice. Means of identifying and reducing exposure are presented. The second section discusses outdoor allergens: pollens and molds. The particular plants or molds and the amount of exposure to these allergens is determined by the local climate, and local pollen and mold counts are available to determine the time and amount of exposure. Climate change is already having an important effect on the distribution and amount of outdoor allergens. The third section discusses indoor and outdoor air pollution and methods that individuals can take to reduce indoor pollution in addition to eliminating cigarette smoking. The fourth section discusses the diagnosis and management of occupational asthma. Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

An outbreak of occupational asthma due to chromium and cobalt.

PubMed

Walters, G I; Moore, V C; Robertson, A S; Burge, C B S G; Vellore, A-D; Burge, P S

2012-10-01

Five metal turners employed by an aerospace manufacturer presented to the Birmingham Chest Clinic occupational lung disease unit. Four cases of occupational asthma (OA) due to chromium salt (3) and cobalt (1) were diagnosed by serial peak-expiratory flow measurements and specific inhalation challenge testing. To measure the extent of the outbreak and to provide epidemiological data to ascertain the aetiology. Participants answered a detailed, self-administered questionnaire, designed to detect occupational lung disease. Urine chromium and cobalt excretion, spirometry and exhaled nitric oxide measurements were taken. Those with possible, probable or definite non-OA or OA, after questionnaire, were invited to undertake two-hourly peak flow measurements and received specialist follow-up. A total of 62 workers (95% of workforce) participated. Sixty-one per cent of employees were working in higher metalworking fluid (MWF) exposure areas. Ninety per cent of workers had urinary chromium excretion indicating occupational exposure. Sixty-six per cent of workers reported active respiratory symptoms, although there were no significant differences between exposure groups. Two further workers with probable OA were identified and had significantly higher urinary chromium and cobalt concentration than asymptomatic controls. Eighteen cases of occupational rhinitis (OR) were identified, with significantly raised urinary chromium concentration compared with asymptomatic controls. Chromium salt and cobalt can be responsible for OA and OR in workers exposed to MWF aerosols. Onset of symptoms in those with positive specific challenges followed change in MWF brand. Workers with OA had increased urinary concentrations of chromium and cobalt, and those with OR had increased urinary concentrations of chromium.

[Application of the International Guide for the Diagnosis and Treatment of Asthma using first-contact physicians, before and after an educational strategy].

PubMed

Segura Méndez, Nora Hilda; Herrera, Sonia; Hernández Martínez, Eduardo; Torres Salazar, Augusto; Espinola Reyna, Gerardo; del Rivero Hernández, Leonel

2003-01-01

The objective of the International Guide on Diagnosis and Treatment of Asthma is to reduce prevalence, mortality and morbidity of asthma. To demonstrate that implementation of educational workshop increases the knowledge of first contact physicians on the International Guide for Diagnosis and Treatment of Asthma. Fifty-nine first contact physicians participated. A validated questionnaire was applied before and after the workshop on the International Guide on Diagnosis and Treatment of Asthma. The Student's t test of the program SPSS was used for a statistical analysis. The grades obtained were 36% of correct answers before the workshop and 59% of correct answers after the workshop with a significant p < 0.05 specially in the general area of knowledge. As an educational technique this workshop improves the level of knowledge on the International Guide on Diagnosis and Treatment of Asthma of first contact physicians.

Latex-induced occupational asthma: time trend in incidence and relationship with hospital glove policies.

PubMed

Vandenplas, O; Larbanois, A; Vanassche, F; François, S; Jamart, J; Vandeweerdt, M; Thimpont, J

2009-03-01

Natural rubber latex (NRL) has become as a major cause of occupational asthma (OA) in workers using NRL gloves. Few population-based studies have assessed the impact of changes in the patterns of glove usage on the incidence of NRL-induced OA. To characterize the time trends in incident cases of NRL-induced OA in Belgium and examine whether incidence rates were related to the types of gloves used in hospitals. Incident cases of NRL-induced OA were identified through a retrospective review of all claims submitted to the Workers' Compensation Board up to December 2004. Based on the results of diagnostic procedures, the diagnosis of NRL-induced OA was categorized as definite, probable, unlikely, or indeterminate. The patterns of glove usage were characterized through a questionnaire survey of Belgian hospitals. A total of 298 claims for NRL-induced OA were identified, including 127 subjects with definite OA and 68 with probable OA. Categorized by the year of asthma onset, the incident cases of definite and probable NRL-induced OA markedly decreased from 1999 onwards. The use of powdered NRL gloves fell from 80.9% in 1989 to 17.9% in 2004. Powdered NRL gloves were predominantly substituted with NRL-free gloves, especially in the case of non-sterile procedures. These national compensation-based data confirm that a persistent decline in the incidence of NRL-induced OA has occurred since late 1990s. This downward trend has temporally been associated with a decreasing usage of powdered NRL, further supporting a beneficial role of changes in glove policies.

Holy Saturday asthma

PubMed Central

O'Connor, Terence M; Cusack, Ruth; Landers, Sarah; Bredin, Charles Patrick

2014-01-01

A 61-year-old man complained of cough and dyspnoea after exposure to colophony-containing solder fumes at work. A histamine challenge test confirmed airway hyper-responsiveness, and colophony-challenge demonstrated a 16.7% drop in peak expiratory flow rate (PEFR), supporting a diagnosis of colophony-induced occupational asthma. At review, the patient presented with cough, dyspnoea and wheeze that occurred acutely when exposed to the fumes from burning incense during Easter Saturday services, necessitating his departure from the church. Inhalation challenge tests using two blends of incense used at his church (Greek and Vatican) led to identical symptoms and a significant reduction in forced expiratory volume in 1 s 15 min after exposure and PEFRs up to 48 h after exposure, indicating an early and late phase asthmatic reaction. This is the first report of coexistent colophony and incense-induced asthma. The similarities in chemical structures between abietic acid in colophony and boswellic acid in incense suggest a common mechanism. PMID:24626388

Clinical applications of exhaled nitric oxide for the diagnosis and management of asthma: a consensus report.

PubMed

Zitt, Myron

2005-08-01

Patients with asthma routinely exhibit elevated levels of fractionated exhaled nitric oxide (FE(NO)), and this observation has led to studies investigating FE(NO) as a potential marker of airway inflammation. FE(NO) has been shown to enhance the diagnosis of asthma, detect deterioration in control of patients with asthma, and monitor response to anti-inflammatory therapy. The aim of this work was to determine if FE(NO) measurement provides a noninvasive, well-tolerated, and standardized technique to monitor airway inflammation, and if it has the potential to complement standard asthma monitoring tools (eg, symptom diaries, control questionnaires, and pulmonary function testing) and to improve asthma control and patient outcomes. Thirteen experts in the diagnosis and treatment of asthma met to discuss the use of FE(NO) in the diagnosis and management of patients with asthma. Participants were selected by Aerocrine, a medical, technical company with headquarters in Stockholm, Sweden, in consultation with their medical education partner Cadent Medical Communications located in Irving, Texas, to represent a diversity of specialists, including both clinicians and investigators, in the fields of allergy, immunology, and pulmonology. All participants were nominally compensated for their time to attend this closed scientific roundtable discussion. The meeting was supported by an educational grant from Aerocrine. This report represents the overall consensus reached by the participants on the clinical applicability of this technique. Our understanding of asthma has expanded so that investigators are now focusing on inflammation in addition to airway obstruction and hyper-reactivity. Whereas patient history, symptoms, and pulmonary function testing can assist in diagnosing asthma, they are not direct measures of the extent of airway inflammation. Elevated FE(NO) levels have been shown to reflect airway inflammation and to occur together with other conventional markers used to

Global strategy for the diagnosis and management of asthma in children 5 years and younger.

PubMed

Pedersen, Soren Erik; Hurd, Suzanne S; Lemanske, Robert F; Becker, Allan; Zar, Heather J; Sly, Peter D; Soto-Quiroz, Manuel; Wong, Gary; Bateman, Eric D

2011-01-01

Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisation. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non-specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms-only descriptive approach that includes the definition of various wheezing phenotypes has been recommended. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information. In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in

Occupational asthma induced by garlic dust.

PubMed

Añibarro, B; Fontela, J L; De La Hoz, F

1997-12-01

Garlic dust has not been a frequently encountered cause of IgE-mediated disease. We report on 12 patients (all of them garlic workers) with the clinical criteria for occupational asthma. Skin prick tests and serum-specific IgE determinations were performed with common inhalants, garlic, and other members of the Liliaceae family (onion, leek, and asparagus). Bronchial challenge test with garlic powder was performed in all patients. Garlic and onion extract proteins were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis. Immunoblot and IgE immunoblot inhibition analyses were performed with patients' sera on extracts of garlic, onion, and pollens of Phleum pratense and Chenopodium album. Garlic sensitization was demonstrated by bronchial challenge test in seven patients (group 1) and ruled out in the remaining five (group 2). Clinical data were similar in both groups. The patients with garlic allergy had a mean age of 27 years, and all of them had pollen allergy; sensitization to other members of the Liliaceae family was also common. Electrophoresis of garlic extract revealed two major protein bands at approximately 12 and 54 kd. During IgE immunoblotting, the pool of sera reacted with garlic proteins mainly at 54 kd. Preincubation with onion, Phleum, and Chenopodium partially abolished the IgE binding to several allergens of garlic. We report on seven patients in whom an occupational garlic allergy was demonstrated. Garlic allergy is relatively rare but seems to affect young subjects with pollen allergy, and sensitization to other members of the Liliaceae family is common. The results of this study confirm the presence of some structurally similar allergens in garlic, onion, and certain pollens.

Comparison of biomarkers in serum and induced sputum of patients with occupational asthma and chronic obstructive pulmonary disease.

PubMed

Kleniewska, Aneta; Walusiak-Skorupa, Jolanta; Piotrowski, Wojciech; Nowakowska-Świrta, Ewa; Wiszniewska, Marta

2016-07-22

Occupational asthma and chronic obstructive pulmonary disease (COPD) are associated with the airway inflammatory process. The aim of this study was to compare the sputum and serum markers of inflammation in patients with occupational asthma and COPD. The study group included 20 patients with stable COPD, 24 patients with asthma, and 22 healthy subjects. Interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, matrix metalloproteinase (MMP)-9 levels in serum and induced sputum as well as fibrinogen and CRP in serum were determined in all the subjects. Higher concentrations of IL-1β, IL-6, TNF-α, and MMP-9 in induced sputum and an increased concentration of acute-phase proteins in serum were observed in COPD patients compared with healthy subjects. Higher concentrations of IL-1β and MMP-9 in induced sputum and a higher concentration of C-reactive protein (CRP) were detected in COPD patients than in asthmatic subjects. Never smokers with COPD had significantly higher levels of IL-1β and MMP-9 in induced sputum than never smoker controls. There was no significant difference between the serum and sputum levels of cytokines and MMP-9 of never smokers and smokers with COPD. Higher concentrations of IL-1β and MMP-9 in induced sputum and a higher concentration of CRP in serum allow distinguishing between biomarker profiles of COPD patients and asthmatic patients. Occupational exposure induces a systemic proinflammatory state with increased levels of acute-phase proteins in stable COPD patients. MMP-9 and IL-1β concentrations are increased in induced sputum of never smokers with COPD, which is associated with occupational exposure.

Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control.

PubMed

Heijkenskjöld Rentzhog, C; Janson, C; Berglund, L; Borres, M P; Nordvall, L; Alving, K; Malinovschi, A

2017-12-01

Classic spirometry is effort dependent and of limited value in assessing small airways. Peripheral airway involvement, and relation to poor control, in asthma, has been highlighted recently. Forced oscillation technique (FOT) offers an effort-independent assessment of overall and peripheral lung mechanics. We studied the association between lung function variables, obtained either by spirometry or multifrequency (5, 11 and 19 Hz) FOT, and asthma diagnosis and control. Spirometry measures, resistance at 5 (R5) and 19 Hz (R19), reactance at 5 Hz (X5), resonant frequency (f res ), resistance difference between 5-19 Hz (R5-R19) and Asthma Control Test scores were determined in 234 asthmatic and 60 healthy subjects (aged 13-39 years). We used standardized lung function variables in logistic regression analyses, unadjusted and adjusted for age, height, gender and weight. Lower FEV 1 /FVC (OR [95% CI] 0.47 [0.32, 0.69]) and FEF 50 (0.62 [0.46, 0.85]) per standard deviation increase, and higher R5 (3.31 [1.95, 5.62]) and R19 (2.54 [1.65, 3.91]) were associated with asthma diagnosis. Independent predictive effects of FEV 1 /FVC and R5 or R19, respectively, were found for asthma diagnosis. Lower FEV 1 /FVC and altered peripheral FOT measures (X5, f res and R5-R19) were associated with uncontrolled asthma (P-values < .05). Resistance FOT measures were equally informative as spirometry, related to asthma diagnosis, and, furthermore, offered additive information to FEV 1 /FVC, supporting a complementary role for FOT. Asthma control was related to FOT measures of peripheral airways, suggesting a potential use in identifying such involvement. Further studies are needed to determine a clinical value and relevant reference values in children, for the multifrequency FOT measurements. © 2017 John Wiley & Sons Ltd.

[Diagnosis and treatment guidelines for difficult-to-control asthma in children].

PubMed

Navarro Merino, M; Andrés Martín, A; Asensio de la Cruz, O; García García, M L; Liñán Cortes, S; Villa Asensi, J R

2009-12-01

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier.

Can the ceramic industry be a new and hazardous sector for work-related asthma?

PubMed

Kurt, Ozlem Kar; Ergun, Dilek; Basaran, Nursen

2018-04-01

Work-related asthma (WRA) constitutes a significant proportion of all asthma cases and continues to be reported from different industries. The aim of the study was to identify the occupations that can be related to WRA and diagnostic steps used in suspected WRA patients. We retrospectively reviewed the clinical records of WRA suspected patients who were referred to Ankara Occupational and Environmental Diseases Hospital, Turkey from January 2015 to January 2017. Detailed occupational history, the diagnostic steps such as pulmonary function testing (PFT), peak expiratory flow (PEF) monitoring and nonspecific bronchial provocation tests (NSBPT) were recorded. Among 160 patients, 148 were male and 12 were female. Only 2 of them were diagnosed as work-exacerbated asthma (WEA). Diagnosis of asthma was based on using reversible airflow limitation 28.8% (n = 46) or NSBPT 31.9% (n = 51). Toxicological analysis showed that 28 patients had heavy metal poisoning, 9 patients had solvent poisoning, 4 patients had both. According to occupations, 32 of them were ceramic workers (20.0%) and 27 of them were metal workers (16.9%). Plastic workers (4 ± 2.8 years), cleaners (6.2 ± 5.7 years), metal workers (7.4 ± 5.4 years), painters (10 ± 5.2 years), ceramic workers (10.8 ± 5.9 years) had the shortest exposure durations for development of occupational asthma (OA). An analysis of variance showed that the effect of heavy metal and solvent poisoning on mean time for onset of OA was not significant. The results demonstrate that besides the sectors known to cause WRA, ceramic and metal industries can be related to important exposures related to WRA. Medical surveillance of employees in this sector is important in early detection. Copyright © 2018 Elsevier Ltd. All rights reserved.

Comparison of Psychological, Quality of Life, Work-Limitation, and Socioeconomic Status Between Patients With Occupational Asthma and Work-Exacerbated Asthma.

PubMed

Lipszyc, Joshua C; Silverman, Frances; Holness, Dorothy Linn; Liss, Gary M; Lavoie, Kim L; Tarlo, Susan M

2017-07-01

The aim of this study was to compare psychological status, quality of life (QoL), work limitation, and socioeconomic status between patients with occupational asthma (OA) and work-exacerbated asthma (WEA). The following questionnaires were administered to participants: Beck anxiety and depression (II) inventories, Marks' Asthma Quality of Life Questionnaire, and Work Limitations Questionnaire. Cross-sectional analyses between OA and WEA subgroups were completed. There were 77 participants. WEA subjects had a trend to higher anxiety scores (OA = 9.2 ± 8.0, WEA = 12.8 ± 8.3, P = 0.07, Cohen d = 0.4). Depression scores trended higher for those with WEA (OA = 9.6 ± 10.3, WEA = 13.4 ± 13.5, P = 0.2, Cohen d = 0.3). QoL was comparable between groups. WEA subjects had fewer work limitations (N = 50, OA = 25.1 ± 27.3, WEA = 20.6 ± 24.4, P = 0.56, Cohen d = 0.3) and OA subjects were more likely to have reduced income. In a tertiary clinic, there were some modest differences for specific variables between OA and WEA subjects that may help inform management.

Occupational asthma prevention and management in industry--an example of a global programme.

PubMed

Gannon, Paul F G; Berg, A S; Gayosso, R; Henderson, B; Sax, S E; Willems, H M J

2005-12-01

Isocyanates are widely used in the manufacture of polyurethane foams, plastics, coatings and adhesives, and are known to cause occupational asthma in a proportion of exposed workers. Substitution as a prevention strategy is not currently a feasible option. For this reason, health and safety professionals working together in an automotive coatings business created a proactive global programme to address the known potential effects of isocyanates on its workers. The goals of the programme are prevention, early detection and mitigation of effect of key endpoints, especially asthma and to a lesser degree dermatitis, in people who are occupationally exposed, or potentially exposed, to isocyanates and products containing isocyanates. The surveillance programme for isocyanates has several important components, which include assessment of exposure, pre-placement questionnaire and spirometry, training and education of employees, regularly administered periodic questionnaires, medical assessment for abnormal questionnaire responses, process for early reporting and investigation of symptomatic employees and incidents, group data review and management reporting. Although regional differences exist regarding availability of specialized services, we have successfully implemented this programme in parts of North America, Europe and Latin America, and are currently implementing elsewhere. These simple control measures are relatively inexpensive and can be applied in even small business settings. It is recommended that all employers who manufacture, handle or use isocyanate-containing products consider such a strategy.

Alveolar macrophages have a dual role in a rat model for trimellitic anhydride-induced occupational asthma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valstar, Dingena L.; Schijf, Marcel A.; Nijkamp, Frans P.

2006-02-15

Occupational exposure to low molecular weight chemicals, like trimellitic anhydride (TMA), can result in occupational asthma. Alveolar macrophages (AMs) are among the first cells to encounter inhaled compounds. These cells can produce many different mediators that have a putative role in asthma. In this study, we examined the role of AMs in lung function and airway inflammation of rats exposed to TMA. Female Brown Norway rats were sensitized by dermal application of TMA or received vehicle alone on days 0 and 7. One day before challenge, rats received intratracheally either empty or clodronate-containing liposomes to deplete the lungs of AMs.more » On day 21, all rats were challenged by inhalation of TMA in air. Lung function parameters were measured before, during, within 1 h after, and 24 h after challenge. IgE levels and parameters of inflammation and tissue damage were assessed 24 h after challenge. Sensitization with TMA led to decreased lung function parameters during and within 1 h after challenge as compared to non-sensitized rats. AM depletion alleviated the TMA-induced drop in lung function parameters and induced a faster recovery compared to sham-depleted TMA-sensitized rats. It also decreased the levels of serum IgE 24 h after challenge, but did not affect the sensitization-dependent increase in lung lavage fluid IL-6 and tissue TNF-{alpha} levels. In contrast, AM depletion augmented the TMA-induced tissue damage and inflammation 24 h after challenge. AMs seem to have a dual role in this model for TMA-induced occupational asthma since they potentiate the immediate TMA-induced decrease in lung function but tended to dampen the TMA-induced inflammatory reaction 24 h later.« less

Diagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997-2001.

PubMed

Pearson, Mike; Ayres, Jon G; Sarno, Maria; Massey, Dan; Price, David

2006-01-01

Asthma and COPD require different management strategies, but differentiation in primary care is difficult. This primary care support initiative observed the impact of spirometry and clinical assessment on the diagnosis of airway disease. Of 61,191 patients aged > or =40 years being treated for respiratory conditions within 1003 UK primary care practices, 43,203 underwent a diagnostic review including standardized spirometric assessment. The proportion of patients in whom the diagnosis was changed by the additional information was determined. The relationship of various patient characteristics was compared with the baseline and review diagnoses and with any change in diagnosis. Asthma was initially diagnosed in 43% of patients, COPD in 35%, mixed disease in 9%, and other respiratory condition in 13%. Patients initially diagnosed with asthma, mixed disease, or another condition were more likely to have their diagnosis changed at review (54%, 46%, and 63%, respectively) than those initially diagnosed with COPD (14%). A change from asthma to COPD was associated with male gender, smoking, older age, and reduced lung function, the opposite being associated with a change from COPD to asthma. In this study, a clinical review supplemented by additional information including spirometry highlights apparent mislabeling of significant numbers of patients with chronic obstructive disease in general practice with significant implications for individual treatment and healthcare provision. This study shows that the addition of more clinical information can have a major effect on diagnostic tendency in patients with airway disease. An initial diagnosis of COPD seems less likely to change following review than an asthma diagnosis. While it is likely that greater information leads to a more accurate diagnosis, the differential effect of new information on diagnostic labeling highlights the insecurity of the diagnostic process in primary care in the UK.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

PubMed

Larenas Linnemann, D E S; Del Río Navarro, B E; Luna Pech, J A; Romero Lombard, J; Villaverde Rosas, J; Cano Salas, M C; Fernández Vega, M; Ortega Martell, J A; López Estrada, E C; Mayorga Butrón, J L; Salas Hernández, J; Vázquez García, J C; Ortiz Aldana, I; Vargas Becerra, M H; Bedolla Barajas, M; Rodríguez Pérez, N; Aguilar Aranda, A; Jiménez González, C A; García Bolaños, C; Garrido Galindo, C; Mendoza Hernández, D A; Mendoza López, E; López Pérez, G; Wakida Kuzonoki, G H; Ruiz Gutiérrez, H H; León Molina, H; Martínez de la Lanza, H; Stone Aguilar, H; Gómez Vera, J; Olvera Salinas, J; Oyoqui Flores, J J; Gálvez Romero, J L; Lozano Saenz, J S; Salgado Gama, J I; Jiménez Chobillon, M A; García Avilés, M A; Guinto Balanzar, M P; Medina Ávalos, M A; Camargo Angeles, R; García Torrentera, R; Toral Freyre, S; Montes Narvaez, G; Solorio Gómez, H; Rosas Peña, J; Romero Tapia, S J; Reyes Herrera, A; Cuevas Schacht, F; Esquer Flores, J; Sacre Hazouri, J A; Compean Martínez, L; Medina Sánchez, P J; Garza Salinas, S; Baez Loyola, C; Romero Alvarado, I; Miguel Reyes, J L; Huerta Espinosa, L E; Correa Flores, M Á; Castro Martínez, R

With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma. Copyright © 2017. Published by Elsevier España, S.L.U.

[Need for occupational and environmental allergology in occupational health - the 45th Japanese society of Occupational and Environmental Allergy Annual Meeting 2014 in Fukuoka].

PubMed

Kishikawa, Reiko; Oshikawa, Chie

2014-12-01

The 45th Japanese Society of Occupational and Environmental Allergy (OEA) Annual Meeting 2014 was held in Fukuoka city in conjunction with a technical course for occupational health physicians to learn occupational and environmental diseases more deeply. Allergic reaction due to low concentrations of chemical and biological materials is important in toxicological diseases due to highly concentrated chemical materials in the field of occupational and environmental medicine. In this paper we describe the activities of the OEA, which was established in 1970 and has completely cured patients with severe occupational asthma, such as the regional Konjac asthma in Gunma prefecture and Sea Squirt asthma in Hiroshima prefecture. Regard for the occupational environment will prevent the onset and/or exacerbation of allergic occupational disease in individual employees with allergy. Occupational cancer of the bile duct and asbestosis are also current, serious issues that should be resolved as soon as possible. It is desirable for the occupational health physician to have a large stock of knowledge about toxicological and allergic diseases in various occupational settings to maintain the health and safety of workers.

Exposure-response relationships of occupational inhalative allergens.

PubMed

Baur, X; Chen, Z; Liebers, V

1998-05-01

Only a few threshold limit values exist at present for allergens in the workplace known to cause bronchial asthma. This contrasts with the great number of occupational asthma cases observed in industrialized countries. Recently published studies provide clear evidence for exposure intensity response relationships of occupational allergens of plant, microbiological, animal or man-made origin. If allergen exposure levels fall short of determined limit values, they are not associated with an increased risk of occupational asthma. Corresponding data are available for wheat flour (1-2.4 mg/m3), fungal alpha-amylase (0.25 ng/m3), natural rubber latex (0.6 ng/m3), western red cedar (0.4 mg/m3) and rat allergens (0.7 microg/m3). It is suggested to stipulate legally binding threshold limit values (TLV/TWA) on this basis in order to induce more effective primary preventive measures. If no reliable data on the health risk of an occupational airborne noxa exist, the lowest reasonably practicable exposure level has to be achieved. Appropriate secondary preventive measures have to be initiated in all workplaces contaminated with airborne allergens. Verified exposure-response relationships provide the basis for risk assessment and for targeted interventions to reduce the incidence of occupational asthma also in consideration of cost benefit aspects. 'Occupational asthma is a disease characterized by variable airflow limitation and/or airway hyperresponsiveness due to causes in a working environment. These causes can give rise to asthma through immunological or non-immunological mechanisms. Up to 15% of all asthma cases are of occupational origin or have at least a significant causal occupational factor. According to the New Zealand part of the European Respiratory Health Survey, an increased risk of asthma prevalence was found for several occupations such as laboratory technicians, food producers, chemical workers, plastic and rubber workers. The Spain part of this study

Early diagnosis of asthma in young children by using non-invasive biomarkers of airway inflammation and early lung function measurements: study protocol of a case-control study

PubMed Central

van de Kant, Kim DG; Klaassen, Ester MM; Jöbsis, Quirijn; Nijhuis, Annedien J; van Schayck, Onno CP; Dompeling, Edward

2009-01-01

Background Asthma is the most common chronic disease in childhood, characterized by chronic airway inflammation. There are problems with the diagnosis of asthma in young children since the majority of the children with recurrent asthma-like symptoms is symptom free at 6 years, and does not have asthma. With the conventional diagnostic tools it is not possible to differentiate between preschool children with transient symptoms and children with asthma. The analysis of biomarkers of airway inflammation in exhaled breath is a non-invasive and promising technique to diagnose asthma and monitor inflammation in young children. Moreover, relatively new lung function tests (airway resistance using the interrupter technique) have become available for young children. The primary objective of the ADEM study (Asthma DEtection and Monitoring study), is to develop a non-invasive instrument for an early asthma diagnosis in young children, using exhaled inflammatory markers and early lung function measurements. In addition, aetiological factors, including gene polymorphisms and gene expression profiles, in relation to the development of asthma are studied. Methods/design A prospective case-control study is started in 200 children with recurrent respiratory symptoms and 50 control subjects without respiratory symptoms. At 6 years, a definite diagnosis of asthma is made (primary outcome measure) on basis of lung function assessments and current respiratory symptoms ('golden standard'). From inclusion until the definite asthma diagnosis, repeated measurements of lung function tests and inflammatory markers in exhaled breath (condensate), blood and faeces are performed. The study is registered and ethically approved. Discussion This article describes the study protocol of the ADEM study. The new diagnostic techniques applied in this study could make an early diagnosis of asthma possible. An early and reliable asthma diagnosis at 2–3 years will have consequences for the management of

Natural rubber latex-related occupational asthma: association with interventions and glove changes over time.

PubMed

Liss, G M; Tarlo, S M

2001-10-01

Exposure to natural rubber latex (NRL) has been recognized as a cause of occupational asthma (OA), especially among health care workers (HCWs) associated with use of gloves. Little or no population-based data are available which chart the changes over time in the number of cases of OA as this problem was increasingly recognized and then interventions instituted. We obtained the numbers of allowed asthma claims with exposure to latex by year in the province of Ontario, Canada from the Ontario Workplace Safety and Insurance Board; details of the cases from the largest teaching hospital were reviewed. Interventions included: (1) in 1996, the Board recommended in its focus for accommodation of sensitized workers, the reduction of aerosols of latex proteins and that hospital facilities use powder-free, low-protein or nonlatex gloves; and (2) hospitals instituted latex policies and glove changes at various dates. For example, at the largest teaching hospital, interventions included education and voluntary medical surveillance in 1994; substitution of low protein, "powder-free" NRL gloves for non-sterile powdered gloves in 1995; and replacement of powdered sterile NRL gloves by lower protein, "powder-free" NRL gloves in 1997. Through 1999, there were 60 allowed claims for asthma in Ontario with exposure to latex; of these 49 (82%) were among HCWs. The number of claims among HCWs changed from 0 to 2 per year up to 1990; increased to 7 to 11 per year between 1991-1994; and declined to 3 per year in 1995-1996 and 1 to 2 per year in 1997-1999. Of the ten institutions having two or more OA latex claims, all claims occurred in 1996 or earlier at 8 (80%). At the largest hospital, there were five accepted claims with year of diagnosis in 1993 (1 case), 1994 (3 cases), and 1995 (1 case). These findings suggest that, despite the effect of increasing recognition, the introduction of gloves with reduced powder and/or protein, as well as other interventions have been associated

Diagnosis and Management of Exercise-Induced Asthma.

ERIC Educational Resources Information Center

Rupp, Ned T.

1996-01-01

Exercise-induced asthma (EIA) affects 12-15% of the population. This comprehensive guide suggests that nearly all individuals with EIA can be active, highlighting both pharmacologic and nonpharmacologic management of asthma and stressing the importance of rigorous patient education in controlling underlying asthma and EIA. (SM)

Asthma and Pneumonia among Children Less Than Five Years with Acute Respiratory Symptoms in Mulago Hospital, Uganda: Evidence of Under-Diagnosis of Asthma

PubMed Central

Nantanda, Rebecca; Tumwine, James K.; Ndeezi, Grace; Ostergaard, Marianne S.

2013-01-01

Background Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among “under-fives” with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. Methods We enrolled 614 children aged 2–59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as “asthma syndrome” due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant’s case report post hoc and made a diagnosis according to the study criteria. Results Of the 614 children, 41.2% (95% CI: 37.3–45.2) had asthma syndrome, 27.2% (95% CI: 23.7–30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1–30.2) had viral pneumonia, while 5.1% (95% CI: 3.5–7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9–97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1–91.5) for bronchodilators and 43.1% (95% CI: 36.9–49.4) for steroids. Conclusion Although reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools

[A case of Churg-Strauss syndrome with short duration from the onset of asthma to diagnosis of vasculitis].

PubMed

Fuse, Yoshikazu

2013-01-01

A 68-year-old woman was hospitalized because of bronchial asthma and a high myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) level. She had suffered from rhinitis from one year before hospitalization, body weight loss from three months before, and asthma from one month before. On admission, she complained of dyspnea and body weight loss of over 6 kg. On laboratory tests, high MPO-ANCA and urinary abnormalities were found. On the next day, a renal biopsy was performed and histology showed necrotizing vasculitis with cellular crescents. Churg-Strauss syndrome (CSS) was diagnosed on the basis of the clinical course and histological findings. Prednisolone therapy induced rapid symptom remission, which was achieved within one month from the onset of asthma to the diagnosis of CSS. Early diagnosis and early care led to a good prognosis.

Neutrophil infiltration and release of IL-8 in airway mucosa from subjects with grain dust-induced occupational asthma.

PubMed

Park, H S; Jung, K S; Hwang, S C; Nahm, D H; Yim, H E

1998-06-01

The immuno-pathological mechanism for occupational asthma induced by grain dust (GD) remains to be clarified. There have been few reports suggesting the involvement of neutrophils inducing bronchoconstriction after inhalation of GD. To further understand the role of neutrophil in the pathogenesis of GD-induced asthma. We studied the phenotype of leucocytes of the bronchial mucosa in patients with GD-induced asthma. Bronchial biopsy specimens were obtained by fibreoptic bronchoscopy from six subjects with GD-induced asthma. Six allergic asthma patients sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistochemistry with a panel of monoclonal antibodies to tryptase-containing mast cell (AA1), activated eosinophil (EG2), pan T-lymphocyte (CD3) and neutrophil elastase (NE). Induced sputum was collected before and after the GD-bronchoprovocation test. The IL-8 level in the sputum was measured using ELISA. There was a significant increase in the number of AA1+ and NE+ cells in bronchial mucosa of GD-induced asthma, compared with those of allergic asthma (P=0.01, P=0.01, respectively). No significant differences were observed in the number of EG2+ and CD3+ cells (P = 0.13, P=0.15, respectively). IL-8 was abundant in the sputum of all GD-induced asthma patients and significantly increased after the bronchial challenges compared with the baseline value (P = 0.03). These findings support the view that neutrophil recruitment together with mast cells may contribute to the bronchoconstriction induced by GD. A possible involvement of IL-8 was suggested.

Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study.

PubMed

Medina-Ramón, M; Zock, J P; Kogevinas, M; Sunyer, J; Torralba, Y; Borrell, A; Burgos, F; Antó, J M

2005-09-01

Women employed in domestic cleaning are at increased risk for symptoms of obstructive lung disease, but the agents responsible are unknown. To investigate common tasks and products in occupational domestic cleaning in relation to respiratory morbidity. Case-control study in domestic cleaning women nested within a large population based survey of women aged 30-65 years; 160 domestic cleaning women with asthma symptoms, chronic bronchitis symptoms, or both and 386 without a history of respiratory symptoms were identified. Detailed exposures were evaluated for 40 cases who reported still having symptoms at the recruitment interview, and 155 controls who reported not having symptoms. All tasks performed and products used when cleaning houses were determined in a face-to-face interview. Lung function, methacholine challenge, and serum IgE testing were performed. Personal exposure measurements of airborne chlorine and ammonia were performed in a subsample. Associations between asthma, chronic bronchitis, and cleaning exposures were evaluated using multiple logistic regression analysis. Airborne chlorine (median level 0-0.4 ppm) and ammonia (0.6-6.4 ppm) were detectable during occupational domestic cleaning activities. Cases used bleach more frequently than controls; adjusted odds ratio (OR) for intermediate exposure was 3.3 (95% CI 0.9 to 11) and for high exposure 4.9 (1.5 to 15). Other independent associations included accidental inhalation of vapours and gases from cleaning agents and washing dishes. These associations were more pronounced for cases with asthma symptoms than for those with symptoms of chronic bronchitis, but were not related to sensitisation to common allergens. Asthma symptoms in domestic cleaning women are associated with exposure to bleach and possibly other irritant agents. The public health impact of the use of irritant cleaning products could be widespread since the use of these products is common both in the workplace and at home.

Diagnostic approach in cases with suspected work-related asthma

PubMed Central

2013-01-01

Background Work-related asthma (WRA) is a major cause of respiratory disease in modern societies. The diagnosis and consequently an opportunity for prevention are often missed in practice. Methods Based on recent studies and systematic reviews of the literature methods for detection of WRA and identification of specific causes of allergic WRA are discussed. Results and Conclusions All workers should be asked whether symptoms improve on days away from work or on holidays. Positive answers should lead to further investigation. Spirometry and non-specific bronchial responsiveness should be measured, but carefully performed and validly analysed serial peak expiratory flow or forced expiratory volume in one second (FEV1) measurements are more specific and confirm occupational asthma in about 82% of those still exposed to the causative agent. Skin prick testing or specific immunoglobulin E assays are useful to document allergy to high molecular weight allergens. Specific inhalational challenge tests come closest to a gold standard test, but lack standardisation, availability and sensitivity. Supervised workplace challenges can be used when specific challenges are unavailable or the results non-diagnostic, but methodology lacks standardisation. Finally, if the diagnosis remains unclear a follow-up with serial measurements of FEV1 and non-specific bronchial hyperresponsiveness should detect those likely to develop permanent impairment from their occupational exposures. PMID:23768266

Advances in environmental and occupational disorders in 2013.

PubMed

Peden, David B; Bush, Robert K

2014-05-01

In this review of articles published in the Journal in 2013, we report on the significant advances in environmental and occupational disorders. Research advances have led to the identification and defined the structure and function of several major allergens. A meta-analysis confirmed the importance of mold exposure in patients with allergic rhinitis, and a new immunologic classification of aspergillosis emerged. Insights into the role of diesel exhaust particles in patients with severe asthma were clarified. Improvements in stinging insect allergy diagnostics were reported. Genetic, immunologic, and biomarker studies advanced the understanding of adverse drug reactions. New practice parameters for cockroach allergen control were presented. The pathologic role of viruses and bacterial agents in patients with asthma and chronic obstructive pulmonary disease were further defined. An excellent review of allergen bronchoprovocation testing was reported. The roles of bronchoprovocation and bronchodilator responsiveness in asthma diagnosis were further clarified. A biomarker for neutrophilic asthma was identified. Therapeutic advances in asthma research include the inhibition of IL-13 by lebrikizumab, use of montelukast in asthmatic smokers, and a thorough review of bronchial thermoplasty in patients with severe asthma. Lastly, maternal asthma was linked to a number of adverse neonatal outcomes. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Work-Related Asthma in Korea - Findings from the Korea Work-Related Asthma Surveillance (KOWAS) program, 2004-2009.

PubMed

Kwon, Soon-Chan; Song, Jaechul; Kim, Yong-Kyu; Calvert, Geoffrey M

2015-01-01

To determine the incidence and epidemiological characteristics of work-related asthma in Korea. During 2004-2009, the Korea Work-Related Asthma Surveillance (KOWAS) program collected data on new cases of work-related asthma from occupational physicians, allergy and chest physicians, regional surveillance systems, and workers' compensation schemes. The incidence was calculated on the basis of industry, occupation, sex, age, and region. In addition, the distribution of causal agents was determined. During the study period, 236 cases of work-related asthma were reported, with 77 cases from more than 1 source. A total of 22.0% (n=52) were reported by occupational physicians, 52.5% (n=124) by allergy and chest physicians, 24.2% (n=57) by regional surveillance systems, and 43.2% (n=102) by workers' compensation schemes. The overall average annual incidence was 3.31 cases/million workers, with a rate of 3.78/million among men and 2.58/million among women. The highest incidence was observed in the 50-59-year age group (7.74/million), in the Gyeonggi/Incheon suburb of Seoul (8.50/million), in the furniture and other instrument manufacturing industries (67.62/million), and among craft and related trades workers (17.75/million). The most common causal agents were isocyanates (46.6%), flour/grain (8.5%), metal (5.9%), reactive dyes (5.1%), and solvents (4.2%). The incidence of work-related asthma in Korea was relatively low, and varied according to industry, occupation, gender, age, and region. Data provided by workers' compensation schemes and physician reports have been useful for determining the incidence and causes of work-related asthma.

An investigation of the housing environment for persons with asthma and persons without asthma.

PubMed

Frisk, Margot; Arvidsson, Helena; Kiviloog, Jaak; Ivarsson, Ann-Britt; Kamwendo, Kitty; Stridh, Göran

2006-03-01

Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons' well-being. An important issue in occupational therapy is to improve the relationship between a person's functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n = 49) and persons without asthma (controls, n = 48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmental medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-family houses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person-environment relationship for persons with asthma, focusing on their ability to perform daily activities.

Validation of an asthma questionnaire for use in healthcare workers

PubMed Central

Delclos, G L; Arif, A A; Aday, L; Carson, A; Lai, D; Lusk, C; Stock, T; Symanski, E; Whitehead, L W; Benavides, F G; Antó, J M

2006-01-01

Background Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. Aims To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. Methods An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk‐through surveys and review of material safety data sheets. A cross‐sectional validation study was conducted in 118 non‐smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. Results The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test–retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's α ⩾ 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self‐reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. Conclusions Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross‐validation in a larger healthcare worker

Cobalt asthma in metalworkers from an automotive engine valve manufacturer.

PubMed

Walters, G I; Robertson, A S; Moore, V C; Burge, P S

2014-07-01

Cobalt asthma has previously been described in cobalt production workers, diamond polishers and glassware manufacturers. To describe a case series of occupational asthma (OA) due to cobalt, identified at the Birmingham Heartlands Occupational Lung Disease Unit, West Midlands, UK. Cases of cobalt asthma from a West Midlands' manufacturer of automotive engine valves, diagnosed between 1996 and 2005, were identified from the SHIELD database of OA. Case note data on demographics, employment status, asthma symptoms and diagnostic tests, including spirometry, peak expiratory flow (PEF) measurements, skin prick testing (SPT) and specific inhalational challenge (SIC) tests to cobalt chloride, were gathered, and descriptive statistics used to illustrate the data. The natural history of presentations has been described in detail, as well as a case study of one of the affected workers. Fourteen metalworkers (86% male; mean age 44.9 years) were diagnosed with cobalt asthma between 1996 and 2005. Workers were principally stellite grinders, stellite welders or machine setter-operators. All workers had positive Occupational Asthma SYStem analyses of serial PEF measurements, and sensitization to cobalt chloride was demonstrated in nine workers, by SPT or SIC. We have described a series of 14 workers with cobalt asthma from the automotive manufacturing industry, with objective evidence for sensitization. Health care workers should remain vigilant for cobalt asthma in the automotive manufacturing industry. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Occupational obstructive airway diseases in Germany: Frequency and causes in an international comparison

DOE Office of Scientific and Technical Information (OSTI.GOV)

Latza, U.; Baur, X.

2005-08-01

Occupational inhalative exposures contribute to a significant proportion of obstructive airway diseases (OAD), namely chronic obstructive pulmonary disease (COPD) and asthma. The number of occupational OAD in the German industrial sector for the year 2003 are presented. Other analyses of surveillance data were retrieved from Medline. Most confirmed reports of OAD are cases of sensitizer induced occupational asthma (625 confirmed cases) followed by COPD in coal miners (414 cases), irritant induced occupational asthma (156 cases), and isocyanate asthma (54 cases). Main causes of occupational asthma in Germany comprise flour/flour constituents (35.9%), food/feed dust (9.0%), and isocyanates (6.5%). Flour and grainmore » dust is a frequent cause of occupational asthma in most European countries and South Africa. Isocyanates are still a problem worldwide. Although wide differences in the estimated incidences between countries exist due to deficits in the coverage of occupational OAD, the high numbers necessitate improvement of preventive measures.« less

Hazardous air pollutants and asthma.

PubMed

Leikauf, George D

2002-08-01

Asthma has a high prevalence in the United States, and persons with asthma may be at added risk from the adverse effects of hazardous air pollutants (HAPs). Complex mixtures (fine particulate matter and tobacco smoke) have been associated with respiratory symptoms and hospital admissions for asthma. The toxic ingredients of these mixtures are HAPs, but whether ambient HAP exposures can induce asthma remains unclear. Certain HAPs are occupational asthmagens, whereas others may act as adjuncts during sensitization. HAPs may exacerbate asthma because, once sensitized, individuals can respond to remarkably low concentrations, and irritants lower the bronchoconstrictive threshold to respiratory antigens. Adverse responses after ambient exposures to complex mixtures often occur at concentrations below those producing effects in controlled human exposures to a single compound. In addition, certain HAPs that have been associated with asthma in occupational settings may interact with criteria pollutants in ambient air to exacerbate asthma. Based on these observations and past experience with 188 HAPs, a list of 19 compounds that could have the highest impact on the induction or exacerbation of asthma was developed. Nine additional compounds were identified that might exacerbate asthma based on their irritancy, respirability, or ability to react with biological macromolecules. Although the ambient levels of these 28 compounds are largely unknown, estimated exposures from emissions inventories and limited air monitoring suggest that aldehydes (especially acrolein and formaldehyde) and metals (especially nickel and chromium compounds) may have possible health risk indices sufficient for additional attention. Recommendations for research are presented regarding exposure monitoring and evaluation of biologic mechanisms controlling how these substances induce and exacerbate asthma.

Hazardous air pollutants and asthma.

PubMed Central

Leikauf, George D

2002-01-01

Asthma has a high prevalence in the United States, and persons with asthma may be at added risk from the adverse effects of hazardous air pollutants (HAPs). Complex mixtures (fine particulate matter and tobacco smoke) have been associated with respiratory symptoms and hospital admissions for asthma. The toxic ingredients of these mixtures are HAPs, but whether ambient HAP exposures can induce asthma remains unclear. Certain HAPs are occupational asthmagens, whereas others may act as adjuncts during sensitization. HAPs may exacerbate asthma because, once sensitized, individuals can respond to remarkably low concentrations, and irritants lower the bronchoconstrictive threshold to respiratory antigens. Adverse responses after ambient exposures to complex mixtures often occur at concentrations below those producing effects in controlled human exposures to a single compound. In addition, certain HAPs that have been associated with asthma in occupational settings may interact with criteria pollutants in ambient air to exacerbate asthma. Based on these observations and past experience with 188 HAPs, a list of 19 compounds that could have the highest impact on the induction or exacerbation of asthma was developed. Nine additional compounds were identified that might exacerbate asthma based on their irritancy, respirability, or ability to react with biological macromolecules. Although the ambient levels of these 28 compounds are largely unknown, estimated exposures from emissions inventories and limited air monitoring suggest that aldehydes (especially acrolein and formaldehyde) and metals (especially nickel and chromium compounds) may have possible health risk indices sufficient for additional attention. Recommendations for research are presented regarding exposure monitoring and evaluation of biologic mechanisms controlling how these substances induce and exacerbate asthma. PMID:12194881

Priorities for future research into asthma diagnostic tools: A PAN-EU consensus exercise from the European asthma research innovation partnership (EARIP).

PubMed

Garcia-Marcos, L; Edwards, J; Kennington, E; Aurora, P; Baraldi, E; Carraro, S; Gappa, M; Louis, R; Moreno-Galdo, A; Peroni, D G; Pijnenburg, M; Priftis, K N; Sanchez-Solis, M; Schuster, A; Walker, S

2018-02-01

The diagnosis of asthma is currently based on clinical history, physical examination and lung function, and to date, there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state of the art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients. Using a two-stage e-Delphi process and a summarizing workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face-to-face workshop. The three most important diagnostic/predictive tools ranked were as follows: "New biological markers of asthma (eg genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring," "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath." © 2018 John Wiley & Sons Ltd.

Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: asthma call-back survey, 37 states and District of Columbia, 2006 to 2008.

PubMed

Knoeller, Gretchen E; Mazurek, Jacek M; Moorman, Jeanne E

2011-12-01

Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. A total of 27,927 ever-employed adults aged ≥18 years with current asthma. Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43-1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22-1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39-1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41-2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36-1.75). After stratifying for financial barriers to asthma care, the associations did not change. Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

Prevention Guidance for Isocyanate-Induced Asthma Using Occupational Surveillance Data

PubMed Central

Reeb-Whitaker, Carolyn; Anderson, Naomi J.; Bonauto, David K.

2013-01-01

Data from Washington State's work-related asthma surveillance system were used to characterize isocyanate-induced asthma cases occurring from 1999 through 2010. Injured worker interviews and medical records were used to describe the industry, job title, work process, workers’ compensation cost, and exposure trends associated with 27 cases of isocyanate-induced asthma. The majority (81%) of cases were classified within the surveillance system as new-onset asthma while 19% were classified as work-aggravated asthma. The workers’ compensation cost for isocyanate-induced asthma cases was $1.7 million; this was 14% of the total claims cost for all claims in the asthma surveillance system. The majority of cases (48%) occurred from paint processes, followed by foam application or foam manufacturing (22%). Nine of the asthma cases associated with spray application occurred during application to large or awkward-shaped objects. Six workers who did not directly handle isocyanates (indirect exposure) developed new-onset asthma. Two cases suggest that skin contact and processes secondary to the isocyanate spray application, such as cleanup, contributed to immune sensitization. Surveillance data provide insight for the prevention of isocyanate-induced respiratory disease. Key observations are made regarding the development of work-related asthma in association with a) paint application on large objects difficult to ventilate, b) indirect exposure to isocyanates, c) exposure during secondary or cleanup processes, and d) reports of dermal exposure. PMID:24116665

Prevention guidance for isocyanate-induced asthma using occupational surveillance data.

PubMed

Reeb-Whitaker, Carolyn; Anderson, Naomi J; Bonauto, David K

2013-01-01

Data from Washington State's work-related asthma surveillance system were used to characterize isocyanate-induced asthma cases occurring from 1999 through 2010. Injured worker interviews and medical records were used to describe the industry, job title, work process, workers' compensation cost, and exposure trends associated with 27 cases of isocyanate-induced asthma. The majority (81%) of cases were classified within the surveillance system as new-onset asthma while 19% were classified as work-aggravated asthma. The workers' compensation cost for isocyanate-induced asthma cases was $1.7 million; this was 14% of the total claims cost for all claims in the asthma surveillance system. The majority of cases (48%) occurred from paint processes, followed by foam application or foam manufacturing (22%). Nine of the asthma cases associated with spray application occurred during application to large or awkward-shaped objects. Six workers who did not directly handle isocyanates (indirect exposure) developed new-onset asthma. Two cases suggest that skin contact and processes secondary to the isocyanate spray application, such as cleanup, contributed to immune sensitization. Surveillance data provide insight for the prevention of isocyanate-induced respiratory disease. Key observations are made regarding the development of work-related asthma in association with a) paint application on large objects difficult to ventilate, b) indirect exposure to isocyanates, c) exposure during secondary or cleanup processes, and d) reports of dermal exposure.

Prevalence, risk factors and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study.

PubMed

Gonzalez-Garcia, Mauricio; Caballero, Andres; Jaramillo, Claudia; Maldonado, Dario; Torres-Duque, Carlos A

2015-10-01

There are differences in the prevalence and risk factors of asthma around the world. The epidemiological situation of adults 40 years and older is not well established. Our aim was to determine the prevalence, underdiagnosis and risk factors of asthma and wheezing in adults in Colombia. A cross-sectional, population-based study including 5539 subjects from 40 to 93 years selected by a probabilistic sampling technique in five cities was conducted. respiratory symptoms and risk factors questionnaire and spirometry. (a) Wheezing: Affirmative answer to the question "have you ever had two or more attacks of "wheezes" causing you to feel short of breath?" (b) Asthma: Wheezing definition and FEV1/FVC post-bronchodilator ≥ 70%. (c) Underdiagnosis: Asthma definition without a physician-diagnosis. Logistic regression was used for exploring risk factors. Prevalence of asthma was 9.0% (95% CI: 8.3-9.8) and wheezing 11.9% (95% CI: 11.0-12.8). Asthma underdiagnosis was 69.9% and increased to 79.0% in subjects 64 years or older. The risk factors related to asthma and/or wheezing were: living in Bogota or Medellin, female gender, first degree relative with asthma, respiratory disease before 16 years of age, obesity, no education, indoor wood smoke exposure and occupational exposure to dust particles, gases or fumes. We described the epidemiologic situation of asthma in adults 40 years and older in Colombia. In addition to some recognized risk factors, our data supports the association of indoor wood smoke and occupational exposures with asthma and wheezing. Underdiagnosis of asthma in adults was high, particularly in older subjects.

Occupational asthma due to methyl methacrylate and cyanoacrylates.

PubMed Central

Lozewicz, S; Davison, A G; Hopkirk, A; Burge, P S; Boldy, D A; Riordan, J F; McGivern, D V; Platts, B W; Davies, D; Newman Taylor, A J

1985-01-01

Five patients had asthma provoked by cyanoacrylates and one by methyl methacrylate, possibly because of the development of a specific hypersensitivity response. Acrylates have wide domestic as well as industrial uses, and inhalation of vapour emitted during their use can cause asthma. PMID:4071461

Asthma and Respiratory Foundation NZ adult asthma guidelines: a quick reference guide.

PubMed

Beasley, Richard; Hancox, Robert J; Harwood, Matire; Perrin, Kyle; Poot, Betty; Pilcher, Janine; Reid, Jim; Talemaitoga, Api; Thayabaran, Darmiga

2016-11-18

The purpose of the Asthma and Respiratory Foundation NZ Adult Asthma Guidelines is to provide simple, practical and evidence-based recommendations for the diagnosis, assessment and management of asthma in adults (aged 16 and over) in a quick reference format. The intended users are health professionals responsible for delivering asthma care in the community and hospital Emergency Department settings, and those responsible for the training of such health professionals.

[The role of acoustic impedance test in the diagnosis for occupational noise induced deafness].

PubMed

Chen, H; Xue, L J; Yang, A C; Liang, X Y; Chen, Z Q; Zheng, Q L

2018-01-20

Objective: To investigate the characteristics of acoustic impedance test and its diagnostic role for occupational noise induced deafness, in order to provide an objective basis for the differential diagnosis of occupational noise induced deafness. Methods: A retrospective study was conducted to investigate the cases on the diagnosis of occupational noise-induced deafness in Guangdong province hospital for occupational disease prevention and treatment from January 2016 to January 2017. A total of 198 cases (396 ears) were divided into occupation disease group and non occupation disease group based on the diagnostic criteria of occupational noise deafness in 2014 edition, acoustic conductivity test results of two groups were compared including tympanograms types, external auditory canal volume, tympanic pressure, static compliance and slope. Results: In the occupational disease group, 204 ears were found to have 187 ears (91.67%) of type A, which were significantly higher than those in the non occupational disease group 143/192 (74.48%) , the difference was statistically significant (χ(2)=21.038, P <0.01). Detection of Ad or As type, occupation disease group in other type were 16/204 (7.84%) , 3/204 (1.47%) , were lower than Ad or As type of occupation disease group (15.63%) , other type (9.38%) , the differences were statistically significant[ (χ(2)=5.834, P <0.05) , (χ(2)=12.306, P <0.01) ]. Occupation disease group canal volume average (1.68±0.39) ml higher than that of non occupation disease group (1.57 ± 0.47) ml, the difference was statistically significant ( t =2.756, P <0.01) ; occupation disease group mean static compliance (1.06±0.82) ml higher than that of non occupation disease group (0.89±0.64) ml. The difference was statistically singificant ( t =2.59, P <0.01) . Conclusion: We observed that acoustic impedance test had obvious auxiliary function in the differential diagnosis of occupational noise induced deafness, More than 90% of the confirmed

Environment and asthma in adults.

PubMed

Le Moual, Nicole; Jacquemin, Bénédicte; Varraso, Raphaëlle; Dumas, Orianne; Kauffmann, Francine; Nadif, Rachel

2013-09-01

The present review addresses recent advances and especially challenging aspects regarding the role of environmental risk factors in adult-onset asthma, for which the causes are poorly established. In the first part of the review, we discuss aspects regarding some environmental risk factors for adult-onset asthma: air pollution, occupational exposures with a focus on an emerging risk represented by exposure to cleaning agents (both at home and in the workplace), and lifestyle and nutrition. The second part is focused on perspectives and challenges, regarding relevant topics on which research is needed to improve the understanding of the role of environmental factors in asthma. Aspects of exposure assessment, the complexity of multiple exposures, the interrelationships of the environment with behavioral characteristics and the importance of studying biological markers and gene-environment interactions to identify the role of the environment in asthma are discussed. We conclude that environmental and lifestyle exposures play an important role in asthma or related phenotypes. The changes in lifestyle and the environment in recent decades have modified the specific risk factors in asthma even for well-recognized risks such as occupational exposures. To better understand the role of the environment in asthma, the use of objective (quantitative measurement of exposures) or modern tools (bar code, GPS) and the development of multidisciplinary collaboration would be very promising. A better understanding of the complex interrelationships between socio-economic, nutritional, lifestyle and environmental conditions might help to study their joint and independent roles in asthma. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Asthma history, job type and job changes among US nurses.

PubMed

Dumas, Orianne; Varraso, Raphaëlle; Zock, Jan Paul; Henneberger, Paul K; Speizer, Frank E; Wiley, Aleta S; Le Moual, Nicole; Camargo, Carlos A

2015-07-01

Nurses are at increased risk of occupational asthma, an observation that may be related to disinfectants exposure. Whether asthma history influences job type or job changes among nurses is unknown. We investigated this issue in a large cohort of nurses. The Nurses' Health Study II is a prospective study of US female nurses enrolled in 1989 (ages 24-44 years). Job status and asthma were assessed in biennial (1989-2011) and asthma-specific questionnaires (1998, 2003). Associations between asthma history at baseline (diagnosis before 1989, n=5311) and job type at baseline were evaluated by multinomial logistic regression. The relations of asthma history and severity during follow-up to subsequent job changes were evaluated by Cox models. The analytic cohort included 98 048 nurses. Compared with nurses in education/administration (likely low disinfectant exposure jobs), women with asthma history at baseline were less often employed in jobs with likely high disinfectant exposure, such as operating rooms (odds ratio 0.73 (95% CI 0.63 to 0.86)) and emergency room/inpatient units (0.89 (0.82 to 0.97)). During a 22-year follow-up, nurses with a baseline history of asthma were more likely to move to jobs with lower exposure to disinfectants (HR 1.13 (1.07 to 1.18)), especially among those with more severe asthma (HR for mild persistent: 1.13; moderate persistent 1.26; severe persistent: 1.50, compared with intermittent asthma, p trend: 0.004). Asthma history was associated with baseline job type and subsequent job changes among nurses. This may partly reflect avoidance of tasks involving disinfectant use, and may introduce bias in cross-sectional studies on disinfectant exposure and asthma in nurses. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Baker's asthma in a child.

PubMed

Alonso, E; Ausín, A; Elices, A; Moreno-Escobosa, M; Ibáñez, M; Laso, M

2001-01-01

baker's asthma is a well-known occupational lung disease which usually develops in adults. We report the case of a two years old boy who suffered from asthma, urticaria and atopic dermatitis for twelve months, whose symptoms were associated to visits to his grandfather's bakery. skin prick tests (SPT) were made to dust mites, moulds, flours, alfa-amylase and egg. It was also determined total IgE and specific IgE antibodies to alfa-amylase and flours. Subsequently, a challenge test was carried out with wheat flour. The SPTs were positive to flours, alfa-amylase and egg. The determination of specific IgE antibodies showed 2.64 kU/L to wheat, 0.79 kU/L to glyadin and 2.98 kU/L to alfa-amylase. The patient developed asthma and rhinitis after manipulating wheat flour for 10 min. we demonstrated a type I hypersensitivity to wheat flour and alfa-amylase in a two years old child by SPT, specific IgE antibodies and challenge test. This case in the childhood equivalent of occupational baker's asthma.

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II).

PubMed

Kogevinas, Manolis; Zock, Jan-Paul; Jarvis, Debbie; Kromhout, Hans; Lillienberg, Linnéa; Plana, Estel; Radon, Katja; Torén, Kjell; Alliksoo, Ada; Benke, Geza; Blanc, Paul D; Dahlman-Hoglund, Anna; D'Errico, Angelo; Héry, Michel; Kennedy, Susan; Kunzli, Nino; Leynaert, Bénédicte; Mirabelli, Maria C; Muniozguren, Nerea; Norbäck, Dan; Olivieri, Mario; Payo, Félix; Villani, Simona; van Sprundel, Marc; Urrutia, Isabel; Wieslander, Gunilla; Sunyer, Jordi; Antó, Josep M

2007-07-28

The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

First evidence of occupational asthma to argan powder in a cosmetic factory.

PubMed

Paris, C; Herin, F; Penven, E; Thaon, I; Richard, C; Jacquenet, S; Barbaud, A; Poussel, M

2016-04-01

Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder. Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests, and immunoblotting analysis. We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts, and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin. High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy, and workers handling argan powder should be carefully investigated. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Environmental Causes of Asthma.

PubMed

Cockcroft, Donald W

2018-02-01

Environmental factors which cause asthma are those that induce airway inflammation with eosinophils (more common) or neutrophils along with airway hyperresponsiveness (AHR). The most common of these (indeed the most common cause of asthma) are IgE-mediated inhalant allergen exposures. Allergen-induced AHR and inflammation are both associated with the allergen-induced late asthmatic response (LAR). Although allergens were previously recognized only as causes of symptoms and bronchoconstriction in asthmatics, we now appreciate them as causes of the fundamental pathophysiologic features of asthma. Low-molecular-weight chemical sensitizers, causes of occupational asthma, also cause asthma in a manner analogous to allergen. Acute irritant-induced asthma (reactive airways dysfunction syndrome) following a very heavy irritant exposure and chronic irritant-induced asthma following repeated high exposures can also induce persistent or permanent changes (inflammation and AHR) consistent with asthma. Textile dust exposure produces a different form of airway disease (byssinosis) which is less frequently observed currently. Environmental exposure to tobacco smoke facilitates the development of asthma in children. Personal smoking and environmental air pollution have an inconsistent and likely generally small effect in causing asthma. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Developing an Intelligent System for Diagnosis of Asthma Based on Artificial Neural Network.

PubMed

Alizadeh, Behrouz; Safdari, Reza; Zolnoori, Maryam; Bashiri, Azadeh

2015-08-01

Lack of proper diagnosis and inadequate treatment of asthma, leads to physical and financial complications. This study aimed to use data mining techniques and creating a neural network intelligent system for diagnosis of asthma. The study population is the patients who had visited one of the Lung Clinics in Tehran. Data were analyzed using the SPSS statistical tool and the chi-square Pearson's coefficient was the basis of decision making for data ranking. The considered neural network is trained using back propagation learning technique. According to the analysis performed by means of SPSS to select the top factors, 13 effective factors were selected, in different performances, data was mixed in various forms, so the different modes was made for training the data and testing networks and in all different modes, the network was able to predict correctly 100% of all cases. Using data mining methods before the design structure of system, aimed to reduce the data dimension and the optimum choice of the data, will lead to a more accurate system. So considering the data mining approaches due to the nature of medical data is necessary.

[Clinical, biochemical and allergological indices characterizing occupational diseases of the bronchial and pulmonary system in employees at aluminium production].

PubMed

Kudaeva, I V; Dyakovich, O A; Beygel, E A; Masnavieva, L B; Naumova, O V; Budarina, L A

There are many harmful factors that possess a damaging impact on the body of employees at aluminum production. It leads to the development of bronchial asthma (BA), chronic nonobstructive bronchitis (CNB) and chronic obstructive pulmonary disease (COPD). The pathogenesis of these disorders, as well as sensitizing effect offluorine in the aluminum production is not fully understood. The purpose of this work was to study the characteristics of laboratory indices in patients with occupational diseases of the respiratory system. In workers of aluminum production with the diagnosis of occupational diseases of respiratory system (15 patients with a diagnosis of asthma, 30 CNB cases, 20 COPD patients) we evaluated the content of total protein, total cholesterol, high density lipoprotein cholesterol (HDLC), total calcium, phosphorus, ceruloplasmin, hematological indices and performed emigration of leukocytes braking test (TTEEL). Clinical and biochemical profile ofpersons with occupational asthma was characterized by a low level of total calcium and ceruloplasmin, a high concentration of phosphorus in the blood serum and inhibition of leukocyte emigration in the test with sodium fluoride. For aluminum production CNB workers characteristic active proatherogenic process was pronounced by a decrease in the HDLC level and an increase in atherogenic index; higher hematocrit value and concentration of erythrocytes, and more than 50% of cases of sensitization to the presence of sodium fluoride. COPD cases had occupational lower average concentration of hemoglobin in the erythrocyte, total protein in serum, as well as polymorphic variant response to sodium fluoride in the form of a depression and activation of leucocytes emigration.

Obesity increases the prevalence and the incidence of asthma and worsens asthma severity.

PubMed

Barros, R; Moreira, P; Padrão, P; Teixeira, V H; Carvalho, P; Delgado, L; Moreira, A

2017-08-01

We aimed to explore the association between obesity and asthma prevalence, incidence and severity. The study included 32,644 adults, 52.6% female, from a representative sample of the 4th Portuguese National Health Survey. The following asthma definitions were used: ever asthma (ever medical doctor asthma diagnosis), current asthma (asthma within the last 12 months), current persistent asthma (required asthma medication within the last 12 months), current severe asthma (attending an emergency department because of asthma within the last 12 months), and incident asthma (asthma diagnosis within the last 12 months). Body mass index was calculated based on self-reported weight and height and categorised according to WHO classification. Logistic regression models adjusted for confounders were performed. Prevalence of ever asthma was 5.3%, current asthma 3.5%, current persistent asthma 3.0%, current severe asthma 1.4%, and incident asthma 0.2%. Prevalence of obesity was 16%, overweight 37.6%, normal weight 44.6% and underweight 0.2%. Being overweight, obesity class I and II, and obesity class III were associated with an OR (95% CI) with ever asthma 1.22 (1.21-1.24), 1.39 (1.36-1.41), 3.24 (3.08-3.40) respectively; current asthma 1.16 (1.14-1.18), 1.86 (1.82-1.90), 4.73 (4.49-4.98) respectively; current persistent asthma 1.08 (1.06-1.10), 2.06 (2.01-2.10), 5.24 (4.96-5.53), and current severe asthma 1.36 (1.32-1.40), 1.50 (1.45-1.55) and 3.70 (3.46-3.95), respectively. Considering the incidence of asthma, obesity more than quadrupled the odds (OR = 4.46, 95% CI 4.30, 4.62). Obesity is associated in a dose dependent way with an increase of prevalent and incident asthma, and it seems to increase the odds of a more persistent and severe asthma phenotype independently of socio-demographic determinants, physical activity, and dietary patterns. Our results provide rational for future lifestyle intervention studies for weight reduction in the obesity-asthma phenotype. Copyright

Clinician Agreement, Self-Efficacy, and Adherence with the Guidelines for the Diagnosis and Management of Asthma.

PubMed

Cloutier, Michelle M; Salo, Paivi M; Akinbami, Lara J; Cohn, Richard D; Wilkerson, Jesse C; Diette, Gregory B; Williams, Sonja; Elward, Kurtis S; Mazurek, Jacek M; Spinner, Jovonni R; Mitchell, Tracey A; Zeldin, Darryl C

The 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines. To assess clinician-reported adherence with specific guideline recommendations, as well as agreement with and self-efficacy to implement guidelines. We analyzed 2012 National Asthma Survey of Physicians data for 1412 primary care clinicians and 233 asthma specialists about 4 cornerstone guideline domains: asthma control, patient education, environmental control, and pharmacologic treatment. Agreement and self-efficacy were measured using Likert scales; 2 overall indices of agreement and self-efficacy were compiled. Adherence was compared between primary care clinicians and asthma specialists. Logistic regression models assessed the association of agreement and self-efficacy indices with adherence. Asthma specialists expressed stronger agreement, higher self-efficacy, and greater adherence with guideline recommendations than did primary care clinicians. Adherence was low among both groups for specific core recommendations, including written asthma action plan (30.6% and 16.4%, respectively; P < .001); home peak flow monitoring, (12.8% and 11.2%; P = .34); spirometry testing (44.7% and 10.8%; P < .001); and repeated assessment of inhaler technique (39.7% and 16.8%; P < .001). Among primary care clinicians, greater self-efficacy was associated with greater adherence. For specialists, self-efficacy was associated only with increased odds of spirometry testing. Guideline agreement was generally not associated with adherence. Agreement with and adherence to asthma guidelines was higher for specialists than for primary care clinicians, but was low in both groups for several key recommendations. Self-efficacy was a good predictor of guideline adherence among primary care clinicians but not among specialists. Published by Elsevier Inc.

[Occupational cancer. The role of the occupational physician in systematic search and aetiological diagnosis of lung cancer. Analysis of a case list].

PubMed

Porru, S; di Carlo, A Scotto; Placidi, Donatella; Arici, Cecilia; Tassi, G; Alessio, L

2006-01-01

About 15% of lung cancers (LC) might be attributable to occupation. However, clinical practice shows that LC percentage for which occupational aetiology is recognized is lower than expected. To address the role of Occupational Physicians (OP) in systematic search and aetiological diagnosis of LC. The search was carried out at a university hospital in Brescia, northern Italy, a highly industrialized area with many workers potentially exposed to occupational lung carcinogens. Through short occupational history forms, physicians of various departments refer all new cases of primary LC to OP When occupational exposure to lung carcinogens is presumed, the OP evaluates the case at the occupational health clinic and sends clinical reports to notifying physicians, containing aetiological diagnosis and indications for medico-legal obligations. Before 1998, few cases were referred to the OP and even less were compensated. The search yielded 1502 LC; after screening, full occupational health evaluation was performed in 693 cases: occupational aetiology was recognized in 182 (26%). Risk factors were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, road paving; many workers were exposed to multiple carcinogens. 48 cases were compensated, many others are under litigation. A systematic LC search made it possible to: reach an aetiological diagnosis and reduce the gap between expected LC and those reported/compensated; inform health authorities and undertake preventive action in workplaces; detect sentinel events; provide epidemiological data at community level; promote cooperation among health professionals (oncologists, surgeons, pneumologists, general practitioners, plant OP); increase teaching opportunities for medical students, those taking a specialisation course in occupational health; provide counselling and expert opinions for individual subjects, trade unions, employers, law courts.

Occupational allergic contact dermatitis caused by epoxy chemicals: occupations, sensitizing products, and diagnosis.

PubMed

Aalto-Korte, Kristiina; Pesonen, Maria; Suuronen, Katri

2015-12-01

Epoxy products are among the most common causes of occupational allergic contact dermatitis. Diglycidyl ether of bisphenol A resin (DGEBA-R) is the most important sensitizer in epoxy systems. To describe patients with occupational allergic contact dermatitis caused by epoxy products. Patients with allergic reactions to epoxy chemicals were chosen from test files (January 1991 to June 2014). Only patients with occupational contact allergy to some component of epoxy resin systems were included. We analysed patch test results, occupation, symptoms, and exposure data. We found a total of 209 cases with occupational contact allergy to epoxy chemicals. The largest occupational groups were painters (n = 41), floor layers (n = 19), electrical industry workers (n = 19), tile setters (n = 16), and aircraft industry workers (n = 15). A total of 82% of the patients reacted to DGEBA-R. Diagnosis of the DGEBA-R-negative patients required testing with m-xylylenediamine, N,N'-tetraglycidyl-4,4'-methylenedianiline, 1,4-butanediol diglycidyl ether, 2,4,6-tris-(dimethylaminomethyl)phenol, diglycidyl ether of bisphenol F resin, N,N'-diglycidyl-4-glycidyloxyaniline, isophoronediamine, 4,4'-diaminodiphenylmethane, diethylenetriamine, and cresyl glycidyl ether. The hands/upper extremities were most commonly affected (69%), but facial symptoms were also frequent (60%). Allergic contact dermatitis caused by to epoxy products cannot always be diagnosed by the use of commercial test substances. Workplace products need to be tested. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Principles of diagnosis, treatment and prevention of occupational injuries in ballet dancers].

PubMed

Volkov, M V; Mironova, Z S; Badnin, I A

1975-05-01

In the paper, a 20-year experience with practice of the sport and ballet-trauma department at Central Institute of Traumatology and Orthopedy, named after N. N. Priorov, and 7-year activities of the medical-ballet dispensary at Bolshoi Theatre of the USSR on diagnosis, treatment and prophylaxis of occupational traumas in ballet-dancers are summarized. Some basic principles of diagnosis, treatment and prophylaxis in occupational injuries in ballet-dancers are described. As a result of the employed prophylactic measures the incidence of trauma has fallen thrice as low.

Differentiating occupational asthmatics from non-occupational asthmatics and irritant-exposed workers.

PubMed

Anees, W; Blainey, D; Moore, V C; Robertson, K; Burge, P S

2011-05-01

Serial peak expiratory flow (PEF) records have been recommended as a first-line investigation in workers suspected as having occupational asthma (OA). To determine which PEF variability index best differentiates workers with OA from non-occupational asthmatics and unaffected irritant-exposed workers. PEF was measured at least four times daily for at least 3 weeks in three groups of subjects: (i) forty healthy grain-exposed farmers and dockers, (ii) forty-two consecutive workers with independently confirmed OA and (iii) forty-eight non-occupational asthmatics. Indices of PEF variability were compared between groups. The difference in mean PEF between rest and work periods best separated the occupational asthmatic workers from the others. The upper 95% confidence limit of this index for grain-exposed workers was 2.8% of predicted PEF (16 l/min) and 3.3% (15 l/min) for non-occupational asthmatics. Sensitivity for diagnosing OA using this index was 70%. An increase in diurnal variation on workdays of >7% had a sensitivity of only 27% for the diagnosis of OA. The difference between maximum PEF on workdays and minimum PEF on rest days had a sensitivity of <10% against non-occupational asthmatic controls. Difference in mean PEF between workdays and rest days is the best simple index for differentiating subjects with OA from those with non-OA or irritant-exposed healthy subjects. Differences >16 l/min are unlikely to be due to significant irritant exposure in healthy workers.

Update on asthma and cleaning agents.

PubMed

Folletti, Ilenia; Siracusa, Andrea; Paolocci, Giulia

2017-04-01

Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.

Isocyanate exposure and asthma in the UK vehicle repair industry.

PubMed

Stocks, S J; Jones, K; Piney, M; Agius, R M

2015-12-01

Organic diisocyanates are a common cause of occupational asthma, particularly in motor vehicle repair (MVR) workers. The UK Health & Safety Laboratory provides screening for urinary hexamethylenediamine (UHDA), a biomarker of exposure to 1,6-hexamethylene diisocyanate (HDI). The UK Surveillance of Work-related and Occupational Respiratory Disease scheme (SWORD) has collected reports of occupational asthma since 1996. To compare trends in HDI exposure with trends in the incidence of work-related asthma attributed to isocyanates or paint spraying in MVR workers reported to SWORD. Two-level regression models were used to estimate trends in UHDA levels and work-related asthma in MVR workers reported to SWORD. The direction and magnitude of the trends were compared descriptively. From 2006 to 2014, there was a significant decline in the number of urine samples with detectable levels of UHDA (odds ratio = 0.96; 95% confidence intervals 0.94-0.98) and minimal change in those over the guidance value (1.03; 1.00-1.06). Over the same period, there was a significant decline in all asthma cases attributed to isocyanates or paint spraying reported to SWORD (0.90; 0.86-0.94) and a non-significant decline among MVR workers (0.94; 0.86-1.02). The simultaneous decrease in HDI exposure and incident cases of asthma reported to SWORD is temporally consistent with a reduction in exposure to airborne isocyanate leading to a reduction in asthma. Although this is not direct evidence of a causal relationship between the two trends, it is suggestive. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

[Analysis of qualifications of medical and health institutions and certified doctors for providing occupational disease diagnosis in China].

PubMed

Wang, Huan-qiang; Li, Tao; Qi, Fang; Wu, Rui; Nie, Wu; Yu, Chen

2013-10-01

To investigate the qualifications and current situations of the medical and health institutions and certified doctors for providing occupational disease diagnosis in China and to provide a reference for developing relevant policies. Work reports and questionnaires survey were used to investigate the qualifications of all medical and health institutions and certified doctors for providing occupational disease diagnosis in China and their acceptance and diagnosis of occupational disease cases from 2006 to 2010. The rate for the work reports was 100%, and the response rate for the questionnaires was 71.0%. By the end of 2010, in the 31 provincial-level regions (excluding Hong Kong, Macao, and Taiwan) in China, there had been 503 medical and health institutions which were qualified for providing occupational disease diagnosis, including 207 centers for disease control and prevention, accounting for 41.2%, 145 general hospitals, accounting for 28.8%, 69 enterprise-owned hospitals, accounting for 13.7%, and 64 institutes or centers for occupational disease prevention and control, accounting for 12.7%; 4986 certified doctors got the qualification for providing occupational disease diagnosis, with 9.4 certified doctors on average in each institution, and there was 0.65 certified doctor per 100 000 employees. In addition, 16.5% of the institutions got all the qualifications for diagnosing 9 occupational diseases, and 17.1% of the institutions got the qualification for diagnosing one occupational disease. Each certified doctor accepted diagnosis of 16.8 cases of occupational diseases on average every year. A national occupational disease diagnosis network has been established in China, but the imbalance in regional distribution and specialty programs still exists among the qualified medical and health institutions and certified doctors. It is essential to further strengthen the development of regional qualified medical and health institutions and training of qualified

Predictors of work-related sensitisation, allergic rhinitis and asthma in early work life.

PubMed

Kellberger, Jessica; Peters-Weist, Astrid S; Heinrich, Sabine; Pfeiffer, Susanne; Vogelberg, Christian; Roller, Diana; Genuneit, Jon; Weinmayr, Gudrun; von Mutius, Erika; Heumann, Christian; Nowak, Dennis; Radon, Katja

2014-09-01

Although work-related asthma and allergies are a huge burden for society, investigation of occupational exposures in early work life using an unexposed reference group is rare. Thus, the present analyses aimed to assess the potential impact of occupational exposure and other risk factors on the prevalence of work-related sensitisation and incidence of allergic rhinitis/asthma using a population-based approach and taking into account an unexposed reference group. In SOLAR (Study on Occupational Allergy Risks) II, German participants of ISAAC (International Study of Asthma and Allergies in Childhood) phase II were followed from childhood (9-11 years) until early adulthood (19-24 years). Data on 1570 participants were available to fit predictive models. Occupational exposure was not statistically significantly associated with disease prevalence/incidence. Sensitisation in childhood, parental asthma, environmental tobacco smoke exposure during puberty, sex and study location were statistically significant predictors of outcome. Our results indicate that occupational exposure is of little relevance for work-related sensitisation prevalence and allergic rhinitis/asthma incidence in early work life, while other risk factors can be used to improve career guidance for adolescents. Further research on the role of a potential healthy hire effect and the impact of longer exposure duration is needed. ©ERS 2014.

Exploring asthma in the workplace: A triangulation of perspectives from management, employees and people with asthma.

PubMed

Zhao, Denise H; Cheung, Janet M Y; Smith, Lorraine; Saini, Bandana

2017-08-31

People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. Using purposive and convenience sampling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.

Indoor exposure to formaldehyde and relation to asthma ...

EPA Pesticide Factsheets

Formaldehyde exposure is associated with asthma-like symptoms in occupational settings, but does exposure at lower concentrations in residential settings contribute to the current high burden of this respiratory disease? We conducted a systematic review and meta-analysis of asthma and lung function in humans, focusing on effects from long-term exposures. Our literature search through August 2013 identified 20 studies of asthma or asthma symptoms and 11 studies of lung function in PubMed and Web of Science meeting our inclusion criteria. For the asthma analysis, significant heterogeneity was present in the entire set of studies (p 0.051 mg/m3) and high occupational (> 0.1 mg/m3). Risk ratios (95% confidence interval) for these three categories, respectively, were 0.99 (0.93, 1.06), 1.5 (1.04, 2.1) and 6.3 (3.8, 10.6). The studies of lung function reported results as percent of predicted accounting for gender, age and height. These were occupational exposures with time-weighted formaldehyde concentrations of 0.1 – 1.5 mg/m3, primarily involving woodworking or chemical production. Overall, mean differences in lung function (95% confidence interval) between exposed and referent groups were -4.48 percent (-6.88, -2.09) for forced expiratory volume 1 second (FEV1), -4.08 percent (-6.33, -1.82) for forced vital capacity (FVC) and -7.29 percent (-11.

Defining Emergency Department Asthma Visits for Public Health Surveillance, North Carolina, 2008–2009

PubMed Central

Lich, Kristen Hassmiller; Lippmann, Steven J.; Weinberger, Morris; Yeatts, Karin B.; Liao, Winston; Waller, Anna

2014-01-01

Introduction When using emergency department (ED) data sets for public health surveillance, a standard approach is needed to define visits attributable to asthma. Asthma can be the first (primary) or a subsequent (2nd through 11th) diagnosis. Our study objective was to develop a definition of ED visits attributable to asthma for public health surveillance. We evaluated the effect of including visits with an asthma diagnosis in primary-only versus subsequent positions. Methods The study was a cross-sectional analysis of population-level ED surveillance data. Of the 114 North Carolina EDs eligible to participate in a statewide surveillance system in 2008–2009, we used data from the 111 (97%) that participated during those years. Included were all ED visits with an ICD-9-CM diagnosis code for asthma in any diagnosis position (1 through 11). We formed 11 strata based on the diagnosis position of asthma and described common chief complaint and primary diagnosis categories for each. Prevalence ratios compared each category’s proportion of visits that received either asthma- or cardiac-related procedure codes. Results Respiratory diagnoses were most common in records of ED visits in which asthma was the first or second diagnosis, while primary diagnoses of injury and heart disease were more common when asthma appeared in positions 3–11. Asthma-related chief complaints and procedures were most common when asthma was the first or second diagnosis, whereas cardiac procedures were more common in records with asthma in positions 3–11. Conclusion ED visits should be defined as asthma-related when asthma is in the first or second diagnosis position. PMID:24921898

Age-Related Differences in the Rate, Timing, and Diagnosis of 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbation.

PubMed

Hasegawa, Kohei; Gibo, Koichiro; Tsugawa, Yusuke; Shimada, Yuichi J; Camargo, Carlos A

2016-04-01

Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission. To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences. Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission. Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P < .001). The higher rate attenuated with adjustment (OR, 1.19 [95% CI, 1.13-1.26]; P < .001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with nonrespiratory diagnoses (41.7% vs 53.8%; P < .001). After asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Occupational asthma caused by guar gum.

PubMed

Lagier, F; Cartier, A; Somer, J; Dolovich, J; Malo, J L

1990-04-01

Some vegetable gums have been reported to cause asthma. We describe three subjects who were exposed at work to guar gum, which is derived from the outer part of Cyanopsis tetragonolobus, a vegetable that grows in India. The first subject worked for a pharmaceutical company; the second and third subjects worked at a carpet-manufacturing plant. All three subjects developed symptoms of rhinitis and asthma after the onset of exposure to guar gum. All subjects were atopic and demonstrated mild bronchial hyperresponsiveness to inhaled histamine at the time they were observed. Skin prick tests demonstrated an immediate skin reaction to guar gum. All three subjects had high levels of serum IgE antibodies to guar gum. Specific inhalation challenges in which the three subjects were exposed for short intervals (less than or equal to 4 minutes) to powder of guar gum elicited isolated immediate bronchospastic reactions in two subjects and a dual reaction in the other subject.

Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults

PubMed Central

Lougheed, M Diane; Lemiere, Catherine; Ducharme, Francine M; Licskai, Chris; Dell, Sharon D; Rowe, Brian H; FitzGerald, Mark; Leigh, Richard; Watson, Wade; Boulet, Louis-Philippe

2012-01-01

BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines. METHODS: Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS/long-acting beta2-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations. RESULTS: The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified. CONCLUSIONS: The present clinical practice guideline

Chest radiography in supporting the diagnosis of asthma in children with persistent cough.

PubMed

Halaby, Claudia; Feuerman, Martin; Barlev, Dan; Pirzada, Melodi

2014-03-01

To establish whether chest radiographic findings suggestive of lower airway obstruction (LAO) disease support the diagnosis of asthma in pediatric patients with persistent cough in an outpatient setting. 180 patient charts were reviewed. The patients were children aged 1 to 18 years referred over a 3-year period to a pediatric pulmonary subspecialty clinic for evaluation of cough lasting ≥ 4 weeks. Chest radiographic images obtained after the initial evaluation of 90 patients diagnosed with cough-variant asthma and 90 patients diagnosed with persistent cough from nonasthma origins were compared with radiologic findings of a control group consisting of patients with a positive tuberculin skin test and no respiratory symptoms. Increased peribronchial markings/peribronchial cuffing and hyperinflation were considered radiographically suggestive findings of LAO disease. Children diagnosed with cough-variant asthma at the initial evaluation had higher rates of chest radiographic findings suggestive of LAO disease (30.00%) than children with persistent cough from other causes (17.80%) or those with a positive tuberculin skin test and no respiratory symptoms (8.16%) (overall P value = 0.0063). They also had higher rates of spirometry abnormalities suggestive of an LAO defect. Children with chest radiographic findings suggestive of LAO disease were found to be younger than those with normal chest radiographic findings (5.0 ± 2.7 years vs 8.6 ± 4.7 years; P < 0.0001). This study suggests that chest radiographic findings indicative of an LAO in correlation with the clinical presentation can support the diagnostic suspicion of asthma, especially in younger children unable to perform spirometry.

[Internalization disorders in children with asthma].

PubMed

Carrera-Bojorges, Xûchitl Beatriz; Pérez-Romero, Luis Francisco; Trujillo-Garcìa, José Ubaldo; Jiménez-Sandoval, Jaime Omar; Machorro-Muñoz, Olga Stephanie

2013-01-01

The presence of asthma may increase the risk for internalizing disorders such as major depression and anxiety. To determine if the diagnosis of asthma in children is associated with other internalizing disorders such as panic disorder, social phobia, separation anxiety, and total anxiety. In this analytical, descriptive and comparative cross sectional study, 144 asthmatic and 144 nonasthmatic patients, with ages between 8 and 17 years, were included. We used the GINA asthma diagnostic criteria. We applied the Hospital Anxiety and Depression Scale for diagnosis of internalizing disorders. Asthmatic children had a significant association with panic disorder P 0.001, RP 2.7; with social phobia P 0.026, RP 2.5; with separation anxiety P 0.002, RP 3.3; and with total anxiety P 0.017, RP 2.3. Nonasthmatic children did not have these associations. Asthma severity was intermittent in 36 cases (12.5%), mild persistent in 86 (29.9%) cases, and moderate persistent in 22 (7.6%) cases. We observed no statistically significant relationship between the severity of asthma and the diagnosis of an internalization disorder. We observed a meaningful association between asthma and internalizing disorders such as panic disorder, social phobia, separation anxiety and total anxiety in children.

Seasonal Allergies: Diagnosis, Treatment & Research

MedlinePlus

... turn JavaScript on. Feature: Seasonal Allergies Diagnosis, Treatment & Research Past Issues / Spring 2015 Table of Contents Diagnosis ... Asthma exacerbation Sinus infection Asthma exacerbation Seasonal Allergy Research at NIH Asthma and Allergic Diseases Cooperative Research ...

[Exercise-induced inspiratory stridor. An important differential diagnosis of exercise-induced asthma].

PubMed

Christensen, Pernille; Thomsen, Simon Francis; Rasmussen, Niels; Backer, Vibeke

2007-11-19

Recent studies suggest that exercise-induced inspiratory stridor (EIIS) is an important and often overlooked differential diagnosis of exercise-induced asthma. EIIS is characterised by astma-like symptoms, but differs by inspiratory limitation, fast recovery, and a lack of effect of inhaled bronchodilators. The prevalence of EIIS is reported to be 5-27%, and affects both children and adults. The pathophysiology, the pathogenesis, and the treatment of the condition are not yet clarified. At present, a population-based study is being conducted in order to address these points.

A longitudinal study of adult-onset asthma incidence among HMO members.

PubMed

Sama, Susan R; Hunt, Phillip R; Cirillo, C I H Priscilla; Marx, Arminda; Rosiello, Richard A; Henneberger, Paul K; Milton, Donald K

2003-08-07

HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of

Referral for Occupational Therapy after Diagnosis of Developmental Disorder by German Child Psychiatrists

ERIC Educational Resources Information Center

Konrad, Marcel; Drosselmeyer, Julia; Kostev, Karel

2016-01-01

Aims: The aims of this study were to assess how many patients received occupational therapy after diagnosis of developmental disorder (DD) in child psychiatrist practices in Germany and which factors influenced the prescription of occupational therapy. Methods: This study was a retrospective database analysis in Germany utilising the Disease…

Association of hand and arm disinfection with asthma control in US nurses.

PubMed

Dumas, Orianne; Varraso, Raphäelle; Boggs, Krislyn M; Descatha, Alexis; Henneberger, Paul K; Quinot, Catherine; Speizer, Frank E; Zock, Jan-Paul; Le Moual, Nicole; Camargo, Carlos A

2018-05-01

To investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses. In 2014, we invited female nurses with asthma drawn from the Nurses' Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, response rate: 80%). Among 4055 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT). Nurses were asked about the daily frequency of hand hygiene tasks: 'wash/scrub hands with disinfectants/hand sanitizers' (hand hygiene) and 'wash/scrub arms with disinfecting products' (surrogate of surgical hand/arm antisepsis). Analyses were adjusted for age, race, ethnicity, smoking status and body mass index. Nurses with partly controlled asthma (ACT: 20-24, 50%) and poorly controlled asthma (ACT ≤19, 18%) were compared with nurses with controlled asthma (ACT=25, 32%). In separate models, both hand and arm hygiene were associated with poorly controlled asthma. After mutual adjustment, only arm hygiene was associated with poorly controlled asthma: OR (95% CI) for <1 time/day, 1.38 (1.06 to 1.80); ≥1 time/day, 1.96 (1.52 to 2.51), versus never. We observed a consistent dose-response relationship between frequency of arm hygiene tasks (never to >10 times/day) and poor asthma control. Associations persisted after further adjustment for surfaces/instruments disinfection tasks. Frequency of hand/arm hygiene tasks in nurses was associated with poor asthma control. The results suggest an adverse effect of products used for surgical hand/arm antisepsis. This potential new occupational risk factor for asthma warrants further study. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Isocyanate exposure and asthma in the UK vehicle repair industry

PubMed Central

Jones, K.; Piney, M.; Agius, R. M.

2015-01-01

Background Organic diisocyanates are a common cause of occupational asthma, particularly in motor vehicle repair (MVR) workers. The UK Health & Safety Laboratory provides screening for urinary hexamethylenediamine (UHDA), a biomarker of exposure to 1,6-hexamethylene diisocyanate (HDI). The UK Surveillance of Work-related and Occupational Respiratory Disease scheme (SWORD) has collected reports of occupational asthma since 1996. Aims To compare trends in HDI exposure with trends in the incidence of work-related asthma attributed to isocyanates or paint spraying in MVR workers reported to SWORD. Methods Two-level regression models were used to estimate trends in UHDA levels and work-related asthma in MVR workers reported to SWORD. The direction and magnitude of the trends were compared descriptively. Results From 2006 to 2014, there was a significant decline in the number of urine samples with detectable levels of UHDA (odds ratio = 0.96; 95% confidence intervals 0.94–0.98) and minimal change in those over the guidance value (1.03; 1.00–1.06). Over the same period, there was a significant decline in all asthma cases attributed to isocyanates or paint spraying reported to SWORD (0.90; 0.86–0.94) and a non-significant decline among MVR workers (0.94; 0.86–1.02). Conclusions The simultaneous decrease in HDI exposure and incident cases of asthma reported to SWORD is temporally consistent with a reduction in exposure to airborne isocyanate leading to a reduction in asthma. Although this is not direct evidence of a causal relationship between the two trends, it is suggestive. PMID:26209793

Occupation and chronic bronchitis among Chinese women

PubMed Central

Krstev, Srmena; Ji, Bu-Tian; Shu, Xiao-Ou; Gao, Yu-Tang; Blair, Aaron; Lubin, Jay; Vermeulen, Roel; Dosemeci, Mustafa; Zheng, Wei; Rothman, Nathaniel; Chow, Wong-Ho

2011-01-01

Objective To examine the association between occupation and chronic bronchitis among a cross-section of Chinese women who participated in the Shanghai Women’s Health Study (SWHS). Methods Cases were 4,873 women who self-reported a physician-diagnosed bronchitis during adulthood. Controls were 9,746 women randomly selected from SWHS participants and matched to the cases by year of birth and age at diagnosis. Lifetime occupational histories were obtained. Logistic regressions were used to evaluate the association between chronic bronchitis and occupation, adjusting for smoking, education, family income, and concurrent asthma. Results We observed excess prevalence of bronchitis for textile occupation (OR=1.09; 1.01–1.18) and industry (OR=1.11; 1.04–1.25), welders (OR=1.40; 1.01–1.92), packing and baling workers (OR=1.39; 1.15–1.68), and warehousing industry (OR=1.58; 1.08–2.30). We also identified several new associations that may warrant further exploration and confirmation, including employment in some metal fabrication industries, postal and telecommunication industry, and a few white collar occupations and industries. Conclusions Our study indicates that the risk of chronic bronchitis among women may be increased in some occupations and industries. PMID:18188083

Diet, occupational exposure and early asthma incidence among bakers, pastry makers and hairdressers.

PubMed

Rémen, Thomas; Acouetey, Dovi-Stéphanie; Paris, Christophe; Zmirou-Navier, Denis

2012-05-29

The natural history of occupational asthma (OA) is influenced by many determinants. This study aims to assess the combined roles of personal characteristics, including occupational exposure and nutritional habits, on the incidence of OA during the first years at work. A nested case-control study was conducted within a retrospective cohort of young workers in the bakery, pastry-making and hairdressing sectors. Cases were subjects diagnosed as 'confirmed' or 'probable' OA consecutively to a medical visit (N = 31). Controls were subjects without OA (N = 196). Atopy was defined after blood specific IgE analysis, based on the PhadiatopTM test. Occupational exposure was characterized by standardized questionnaires and diet patterns by a food frequency questionnaire. Among bakers and pastry-makers, only atopy is an independent risk factor of OA (OR = 10.07 95%CI [2.76 - 36.65]). Among hairdressers, several variables are associated with OA. Body mass index (unit OR = 1.24 [1.03 - 1.48]) and the score of exposure intensity (unit OR = 1.79 [1.05 - 3.05]) are independent predictors of OA, but the role of atopy is weak (OR = 4.94 [0.66 - 36.75]). Intake of vitamin A is higher among hairdressers cases (crude p = 0.002, adjusted p = 0.01 after control for body mass index and atopy); the same observation is made for vitamin D (crude p = 0.004, adjusted p = 0.01). This study suggests that the influence of several factors on the incidence of OA, including dietary vitamins, might vary across exposure settings.

Specific immunotherapy and biological treatments for occupational allergy.

PubMed

Moscato, Gianna; Pala, Gianni; Sastre, Joaquin

2014-12-01

Occupational allergy represents a substantial health, social, and financial burden for the society. Its management is a complex task that, in selected cases, may also include allergen-specific immunotherapy. The purpose of this article is to review clinical data on allergen immunotherapy and biological treatments applied to occupational allergy in 2013. Immunotherapy in occupational allergic diseases has been scarcely used, and only for a few sensitizers, such as latex, flour, and Hymenoptera venom, partly due to the lack of standardized extracts. The recent use of the molecular diagnosis can improve the indication and selection of suitable allergens for preparing new standardized and powerful extracts for immunotherapy. Some recent reports suggest a beneficial role of treatment with omalizumab in workers with occupational asthma who continue to be exposed to the causal agent. Although scarce, available data suggest that immunotherapy and biological treatments may allow allergic workers to continue their work activity, but further studies are needed to standardize extracts and to evaluate the cost-effectiveness of these treatments, when exposure at the workplace cannot be avoided.

Asthma and Allergic Rhinitis Correlation in Palm Tree Workers of Jahrom City in 2016.

PubMed

Farahmand Fard, Mohammad Amin; Khanjani, Narges; Arabi Mianroodi, Aliasghar; Ashrafi Asgarabad, Ahad

2017-05-01

Allergic rhinitis and asthma can be related to occupation. The present study aimed to investigate the correlation between asthma or allergic rhinitis and employment in the palm tree gardens of Jahrom, Iran. This was a cross-sectional study including 50 palm tree garden workers and a control group of 50 office employees. Data collection included demographics, as well as standard International Study of Asthma and Allergies in Childhood (ISAAC) and A New Symptom-Based Questionnaire for Predicting the Presence of Asthma (ASQ) questionnaires. Data were analyzed using SPSS22. Descriptive statistics, chi-square test, t-test, and logistics regression were used to analyze data. The correlation between asthma and occupation was significant ( P=0.046); and asthma prevalence was higher in palm tree garden workers. However, no relationship was observed between age, duration of employment, smoking cigarettes, hookah, or opium addiction with asthma. Furthermore, in this study, no significant relation was observed between the prevalence of asthma and contact with dust, contact with pets' skin and hair, family history of asthma, or the use of perfume and air freshener. The symptoms of allergic rhinitis (including sneezing, runny nose, and blocked nose) were significantly greater in palm tree garden workers (P=0.038). These symptoms in both workers and office employees were higher in spring. In our study, allergic rhinitis and asthma were more common in palm tree garden workers than in the general population. According to our study, people working in this occupation should take necessary precautions.

[Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology].

PubMed

Buhl, R; Bals, R; Baur, X; Berdel, D; Criée, C-P; Gappa, M; Gillissen, A; Greulich, T; Haidl, P; Hamelmann, E; Kardos, P; Kenn, K; Klimek, L; Korn, S; Lommatzsch, M; Magnussen, H; Nicolai, T; Nowak, D; Pfaar, O; Rabe, K F; Riedler, J; Ritz, T; Schultz, K; Schuster, A; Spindler, T; Taube, C; Taube, K; Vogelmeier, C; von Leupold, A; Wantke, F; Weise, S; Wildhaber, J; Worth, H; Zacharasiewicz, A

2017-12-01

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma. © Georg Thieme Verlag KG Stuttgart · New York.

Treating Asthma in Children under 5

MedlinePlus

... pieces of information to make a diagnosis. Medical history Your doctor will likely ask a number of ... conditions/childhood-asthma/in-depth/asthma-in-children/ART-20044376 . Mayo Clinic Footer Legal Conditions and Terms ...

Asthma

MedlinePlus

... BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 55. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...

Occupational lung diseases in Australia.

PubMed

Hoy, Ryan F; Brims, Fraser

2017-11-20

Occupational exposures are an important determinant of respiratory health. International estimates note that about 15% of adult-onset asthma, 15% of chronic obstructive pulmonary disease and 10-30% of lung cancer may be attributable to hazardous occupational exposures. One-quarter of working asthmatics either have had their asthma caused by work or adversely affected by workplace conditions. Recently, cases of historical occupational lung diseases have been noted to occur with new exposures, such as cases of silicosis in workers fabricating kitchen benchtops from artificial stone products. Identification of an occupational cause of a lung disease can be difficult and requires maintaining a high index of suspicion. When an occupational lung disease is identified, this may facilitate a cure and help to protect coworkers. Currently, very little information is collected regarding actual cases of occupational lung diseases in Australia. Most assumptions about many occupational lung diseases are based on extrapolation from overseas data. This lack of information is a major impediment to development of targeted interventions and timely identification of new hazardous exposures. All employers, governments and health care providers in Australia have a responsibility to ensure that the highest possible standards are in place to protect workers' respiratory health.

Childhood asthma management pre- and post-incident asthma hospitalization.

PubMed

Bianchi, Marina; Clavenna, Antonio; Sequi, Marco; Bortolotti, Angela; Fortino, Ida; Merlino, Luca; Bonati, Maurizio

2013-01-01

Many hospitalizations for asthma could potentially be avoided with appropriate management. The aim of this study was to analyze data on disease management of a paediatric population with a hospitalization for asthma. The study population comprised 6-17 year old subjects belonging to three local health units of the Lombardy Region, northern Italy. Regional administrative databases were used to collect data on: the number of children with an incident hospitalization for asthma during the 2004-2006 period, anti-asthma therapy, specialist visit referrals, and claims for spirometry, released in the 12 months before and after hospitalization. Each patient's asthma management profile was compared with GINA guideline recommendations. Among the 183 hospitalized subjects, 101 (55%) received therapy before hospitalization and 82 (45%) did not. 10% did not receive any therapy either before or after hospital admission and in 13% the therapy was discontinued afterward. Based on GINA guidelines, asthma management adhered to recommendations only for 55% of subjects. Results may suggest that for half of hospitalized subjects, inaccurate diagnosis, under-treatment/scarce compliance with asthma guidelines by physicians, and/or scarce compliance to therapy by patients/their parents occurred. In all these cases, hospitalization would be a proxy indicator of preventable poor control of disease, rather than a proxy indicator of severity.

Quality of Life in Adolescents With Mild Asthma

PubMed Central

Hallstrand, Teal S.; Curtis, J. Randall; Aitken, Moira L.; Sullivan, Sean D.

2007-01-01

Summary The majority of individuals with asthma have mild disease, often in conjunction with allergic rhinitis and exercise-induced bronchoconstriction (EIB). Although health-related quality-of-life (HRQoL) is reduced in moderate to severe asthma and allergic rhinitis, little is known about the effect of mild asthma, mild allergic rhinitis, and EIB on HRQoL outcomes. The objective of this study was to determine the effect of mild asthma, allergic rhinitis, and EIB on HRQoL. A cross-sectional study was conducted of 160 adolescent athletes participating in a screening program to detect EIB. Generic HRQoL was assessed with the teen version of the pediatric quality-of-life inventory (PedsQL™). Prior diagnoses of asthma, allergic rhinitis, and EIB, and current symptoms of dyspnea during exercise and asthma, were recorded. Lung function and the presence of EIB were determined by spirometry before and after an exercise challenge test. Adolescent athletes with a prior physician diagnosis of asthma had a lower HRQoL scale summary score (P < 0.01) and lower physical functioning, emotional functioning, and school functioning domain scores (P values, 0.01–0.02) in comparison to adolescent athletes with no prior diagnosis of these disorders. Athletes with a prior diagnosis of asthma reported dyspnea during exercise more frequently than did those without asthma (P < 0.001). Adolescent athletes with dyspnea during exercise had a lower scale summary score, and lower physical functioning, general well-being, and emotional functioning domain scores (P values, 0.02–0.03). These data show that mild asthma and dyspnea without asthma significantly affect HRQoL. Symptoms of dyspnea during exercise are common in asthma and are associated with lower HRQoL. The clinical significance of these differences in HRQoL is unclear. PMID:14618647

Parental psychosocial stress and asthma morbidity in Puerto Rican twins

PubMed Central

Lange, Nancy E.; Bunyavanich, Supinda; Silberg, Judy L.; Canino, Glorisa; Rosner, Bernard A.; Celedón, Juan C.

2010-01-01

Background Little is known about paternal psychosocial factors and childhood asthma. Objective To examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children. Methods Parents of 339 pairs of Puerto Rican twins were interviewed individually about their own psychosocial stress and about asthma in their children at age 1 and again about their child’s asthma at age 3. Fathers were asked about symptoms of post-traumatic stress disorder (PTSD), depression, and anti-social behavior. Mothers were asked about depressive symptoms. Outcomes assessed in children included recent asthma symptoms, oral steroid use and hospitalizations for asthma in the prior year, and asthma diagnosis. Generalized estimated equation models were used for the multivariate analysis of parental psychosocial stress and asthma morbidity in childhood. Results After multivariable adjustment, paternal PTSD symptoms, depression, and anti-social behavior were each associated with increased asthma symptoms at age 1 (e.g., OR =1.08 for each 1-point increase in PTSD score, 95% CI=1.03–1.14). Maternal depressive symptoms were associated with an increased risk of asthma hospitalizations at age 1 year. At age 3 years, maternal depressive symptoms were associated with asthma diagnosis and hospitalizations for asthma (OR for each 1-point increase in symptoms=1.16, 95% CI=1.00–1.36]). In an analysis combining 1 and 3 year outcomes, paternal depression was associated with oral steroid use, maternal depressive symptoms were associated with asthma hospitalizations and asthma diagnosis, and parental depression was associated with hospitalizations for asthma. Conclusions Both paternal and maternal psychosocial factors may influence asthma morbidity in young Puerto Rican children. PMID:21194742

Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide.

PubMed

Asher, Innes; McNamara, David; Davies, Cheryl; Demetriou, Teresa; Fleming, Theresa; Harwood, Matire; Hetaraka-Stevens, Lorraine; Ingham, Tristram; Kristiansen, John; Reid, Jim; Rickard, Debbie; Ryan, Debbie

2017-12-01

The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of asthma in children and adolescents in New Zealand, with the aim of improving outcomes and reducing inequities. The intended users are health professionals responsible for delivering asthma care in the community and hospital emergency department settings, and those responsible for the training of such health professionals.

Diet, occupational exposure and early asthma incidence among bakers, pastry makers and hairdressers

PubMed Central

2012-01-01

Background The natural history of occupational asthma (OA) is influenced by many determinants. This study aims to assess the combined roles of personal characteristics, including occupational exposure and nutritional habits, on the incidence of OA during the first years at work. Methods A nested case–control study was conducted within a retrospective cohort of young workers in the bakery, pastry-making and hairdressing sectors. Cases were subjects diagnosed as ‘confirmed’ or ‘probable’ OA consecutively to a medical visit (N = 31). Controls were subjects without OA (N = 196). Atopy was defined after blood specific IgE analysis, based on the PhadiatopTM test. Occupational exposure was characterized by standardized questionnaires and diet patterns by a food frequency questionnaire. Results Among bakers and pastry-makers, only atopy is an independent risk factor of OA (OR = 10.07 95%CI [2.76 – 36.65]). Among hairdressers, several variables are associated with OA. Body mass index (unit OR = 1.24 [1.03 – 1.48]) and the score of exposure intensity (unit OR = 1.79 [1.05 – 3.05]) are independent predictors of OA, but the role of atopy is weak (OR = 4.94 [0.66 – 36.75]). Intake of vitamin A is higher among hairdressers cases (crude p = 0.002, adjusted p = 0.01 after control for body mass index and atopy); the same observation is made for vitamin D (crude p = 0.004, adjusted p = 0.01). Conclusion This study suggests that the influence of several factors on the incidence of OA, including dietary vitamins, might vary across exposure settings. PMID:22642690

EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies.

PubMed

van Kampen, V; de Blay, F; Folletti, I; Kobierski, P; Moscato, G; Olivieri, M; Quirce, S; Sastre, J; Walusiak-Skorupa, J; Raulf-Heimsoth, M

2013-01-01

Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA (Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Japanese guidelines for childhood asthma 2017.

PubMed

Arakawa, Hirokazu; Hamasaki, Yuhei; Kohno, Yoichi; Ebisawa, Motohiro; Kondo, Naomi; Nishima, Sankei; Nishimuta, Toshiyuki; Morikawa, Akihiro

2017-04-01

The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2017 (JAGL 2017) includes a minor revision of the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. The section on child asthma in JAGL 2017 provides information on how to diagnose asthma between infancy and adolescence (0-15 years of age). It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. This guideline will be of interest to non-specialist physicians involved in the care of children with asthma. JAGL differs from the Global Initiative for Asthma Guideline in that JAGL emphasizes diagnosis and early intervention of children with asthma at <2 years or 2-5 years of age. The first choice of treatment depends on the severity and frequency of symptoms. Pharmacological management, including step-up or step-down of drugs used for long-term management based on the status of asthma control levels, is easy to understand; thus, this guideline is suitable for the routine medical care of children with asthma. JAGL also recommends using a control test in children, so that the physician aims for complete control by avoiding exacerbating factors and appropriately using anti-inflammatory drugs (for example, inhaled corticosteroids and leukotriene receptor antagonists). Copyright © 2016 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Environmental triggers and avoidance in the management of asthma

PubMed Central

Gautier, Clarisse; Charpin, Denis

2017-01-01

Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs), molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and hospitalizations. Since avoidance is not easy to achieve, clean air policies remain the most effective strategy. Indoor air is also affected by air pollutants, such as cigarette smoke and

Value of a negative aeroallergen skin-prick test result in the diagnosis of asthma in young adults: correlative study with methacholine challenge testing.

PubMed

Graif, Yael; Yigla, Mordechai; Tov, Naveh; Kramer, Mordechai R

2002-09-01

None of the existing tests for the diagnosis of asthma are considered to be definitive. Certain circumstances require prompt diagnosis, and a test able to predict the absence of asthma would be very useful. To evaluate the contribution of a skin-prick test (SPT) to the diagnostic workup of subjects with suspected asthma. The study included three groups of subjects aged 18 to 24 years: group A, asthmatic patients (n = 175); group B, control subjects (n = 100); and group C, subjects with suspected asthma (n = 150) with normal spirometry findings and a negative exercise challenge test result. All underwent an SPT to a battery of common aeroallergens, and group C underwent a methacholine challenge test (MCT) in addition. The sensitivity, specificity, positive predictive value, and negative predictive values (NPV) of the SPT were calculated using provocative concentrations of methacholine causing a 20% fall in FEV(1) (PC(20)) of < 4 mg/mL and < 8 mg/mL as diagnostic cutoff values for asthma in the MCT. Bayes' formula was used to determine posttest probabilities of having asthma, both for positive and negative SPT results. A positive SPT result to at least one allergen was found in 95.5%, 54%, and 69% of patients in the three groups, respectively. The sensitivity, specificity, and NPV of the SPT were 90.7%, 52.0%, and 84.8%, respectively, with a cutoff value of PC(20) < 8 mg/mL. The lower cutoff, PC(20) < 4 mg/mL, increased the sensitivity and NPV to 98.2% and 97.8%, respectively. A negative SPT result decreased the probability of having asthma by 10-fold to 20-fold in subjects whose pretest probability was low to moderate. Incorporating an SPT into the workup of subjects with suspected asthma can reduce the cost of this process significantly. The SPT may be used as a simple, fast, safe, inexpensive, and reliable method to predict the absence of asthma in young adults.

Occupational lung disease survey of respiratory physicians in Northern Ireland.

PubMed

McKeagney, T F P; Addley, K; Asanati, K

2015-12-01

Respiratory physicians are likely to encounter occupational lung disease (OLD) in their daily practice. To assess the profile of cases being encountered by general respiratory physicians in Northern Ireland (NI) and determine satisfaction with training, confidence in diagnosis and management of OLD. An online survey of all consultant respiratory physicians currently practising in NI. Questions assessed the numbers of new cases seen over the preceding year, case type, satisfaction with specialist registrar training in OLD and degree of confidence in the diagnosis and management of these conditions. Of the 40 consultants identified, the response rate was 80% (n = 32) with 94% of respondents (n = 30) indicating they had dealt with patients suspected of having occupation-related respiratory symptoms. The most commonly encountered OLDs were pleural plaques (91% of respondents), occupational asthma (88%), asbestosis (84%), non-asbestosis pulmonary fibrosis (76%), hypersensitivity pneumonitis (67%) and mesothelioma (66%). Just over one third of consultants (36%, n = 10) indicated a lack of confidence in diagnosis and management of OLD with almost half (48%) dissatisfied with OLD training as a registrar and a further 78% (n = 25) indicating they would value additional training in OLD as a consultant. The majority of respiratory consultants in NI encountered OLD in their day to day practice and half were dissatisfied with their specialist registrar training in OLD and express a lack of confidence in the diagnosis and management of these conditions. This highlights the need for additional training at both registrar and consultant level. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

In the strategies to prevent asthma exacerbations, allergic asthma needs specific treatment.

PubMed

Incorvaia, Cristoforo; Ridolo, Erminia

2015-04-01

No generally accepted definition of asthma exacerbation is thus far available, though in 2012 an expert committee endorsed by the National Institute of Health proposed such definition as "a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome". Graham and Eid reviewed the impact of asthma exacerbations, and noted that, analysing the outcomes with existing treatments, many patients with asthma remain symptomatic and experience exacerbations. This requires the introduction of new strategies to more effectively reduce the exacerbation risk, based on correct diagnosis, stopping smoking, correct inhaler technique, consistent adherence, weight management, and gaining control with the addition of medication". Indeed, as allergic asthma is the most common form, a specific approach by allergen immunotherapy should receive more attention. Actually, the efficacy of immunotherapy in allergic asthma, by the subcutaneous or the sublingual route, is supported by robust meta-analyses. The most important allergen source causing asthma is the house dust mite, but an increasing role for molds is apparent due to the ongoing climate change.

Parental psychosocial stress and asthma morbidity in Puerto Rican twins.

PubMed

Lange, Nancy E; Bunyavanich, Supinda; Silberg, Judy L; Canino, Glorisa; Rosner, Bernard A; Celedón, Juan C

2011-03-01

Little is known about paternal psychosocial factors and childhood asthma. We sought to examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children. Parents of 339 pairs of Puerto Rican twins were interviewed individually about their own psychosocial stress and about asthma in their children at age 1 year and again about their child's asthma at age 3 years. Fathers were asked about symptoms of posttraumatic stress disorder (PTSD), depression, and antisocial behavior. Mothers were asked about depressive symptoms. Outcomes assessed in children included recent asthma symptoms, oral steroid use and hospitalizations for asthma in the prior year, and asthma diagnosis. Generalized estimated equation models were used for the multivariate analysis of parental psychosocial stress and asthma morbidity in childhood. After multivariable adjustment, paternal PTSD symptoms, depression, and antisocial behavior were each associated with increased asthma symptoms at age 1 year (eg, odds ratio, 1.08 for each 1-point increase in PTSD score; 95% CI, 1.03-1.14). Maternal depressive symptoms were associated with an increased risk of asthma hospitalizations at age 1 year. At age 3 years, maternal depressive symptoms were associated with asthma diagnosis and hospitalizations for asthma (odds ratio for each 1-point increase in symptoms, 1.16; 95% CI, 1.00-1.36). In an analysis combining 1- and 3-year outcomes, paternal depression was associated with oral steroid use, maternal depressive symptoms were associated with asthma hospitalizations and asthma diagnosis, and parental depression was associated with hospitalizations for asthma. Both paternal and maternal psychosocial factors can influence asthma morbidity in young Puerto Rican children. Copyright © 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Occupational seafood allergy: a review

PubMed Central

Jeebhay, M; Robins, T; Lehrer, S; Lopata, A

2001-01-01

BACKGROUND—Recent years have seen increased levels of production and consumption of seafood, leading to more frequent reporting of allergic reactions in occupational and domestic settings. This review focuses on occupational allergy in the fishing and seafood processing industry.
REVIEW—Workers involved in either manual or automated processing of crabs, prawns, mussels, fish, and fishmeal production are commonly exposed to various constituents of seafood. Aerosolisation of seafood and cooking fluid during processing are potential occupational situations that could result in sensitisation through inhalation. There is great variability of aerosol exposure within and among various jobs with reported allergen concentrations ranging from 0.001 to 5.061(µg/m3). Occupational dermal exposure occurs as a result of unprotected handling of seafood and its byproducts. Occupational allergies have been reported in workers exposed to arthropods (crustaceans), molluscs, pisces (bony fish) and other agents derived from seafood. The prevalence of occupational asthma ranges from 7% to 36%, and for occupational protein contact dermatitis, from 3% to 11%. These health outcomes are mainly due to high molecular weight proteins in seafood causing an IgE mediated response. Cross reactivity between various species within a major seafood grouping also occurs. Limited evidence from dose-response relations indicate that development of symptoms is related to duration or intensity of exposure. The evidence for atopy as a risk factor for occupational sensitisation and asthma is supportive, whereas evidence for cigarette smoking is limited. Disruption of the intact skin barrier seems to be an important added risk factor for occupational protein contact dermatitis.
CONCLUSION—The range of allergic disease associated with occupational exposure to crab is well characterised, whereas for other seafood agents the evidence is somewhat limited. There is a need for further epidemiological

Turkish Thoracic Society asthma management and prevention guideline: key points.

PubMed

Yıldız, Füsun; Oğuzülgen, I Kıvılcım; Dursun, Berna; Mungan, Dilşad; Gemicioğlu, Bilun; Yorgancıoğlu, Arzu

2011-01-01

Asthma still has high morbidity and cost despite all advances in pathogenesis, diagnosis and treatment. Although asthma can be controlled with proper diagnosis and treatment, the low rates of control in our country and in the world can not be attributed to the variable course of the disease and patients' psycho-social behaviours for chronic disease. In this context, Turkish Thoracic Society (TTS) has decided to update Asthma Diagnosis and Management Guide latest published in 2000. National data were collected, compiled and prepared by authors, and final form given by the TTS Asthma and Allergy Study Group, after presenting to consultant individuals and institutions. In June 2009, the National Asthma Management and Prevention Guideline were published in Turkish. In this paper, we aimed to present the national guide in English with its basics and individual differences.

A workforce-based study of occupational exposures and asthma symptoms in cleaning workers.

PubMed

Vizcaya, David; Mirabelli, Maria C; Antó, Josep-Maria; Orriols, Ramon; Burgos, Felip; Arjona, Lourdes; Zock, Jan-Paul

2011-12-01

To study associations between use of cleaning products and asthma symptoms in cleaning workers. Information on respiratory symptoms, history of asthma, workplaces, use of cleaning products and acute inhalation incidents were obtained through a self-administered questionnaire. 917 employees of 37 cleaning companies in Barcelona were studied. 761 (83%) were current cleaners, 86 (9%) former cleaners and 70 (8%) had never worked as cleaners. Multivariable logistic regression analyses were used to evaluate the associations between specific exposures among current cleaners and wheeze without having a cold, chronic cough and current asthma. Associations with an asthma symptom score were also studied using negative binomial regression analyses to report mean ratios. After adjusting for sex, age, nationality and smoking status, the prevalence of current asthma was non-significantly higher among current (OR 1.9; 95% CI 0.5 to 7.8) and former cleaners (OR 1.9; CI 0.6 to 5.5) than in never cleaners. Cleaners working in hospitals during the last year had a significantly increased prevalence of wheeze, current asthma and a 1.8 (95% CI 1.2 to 2.8) times higher mean asthma score. Use of hydrochloric acid was strongly associated with asthma score (mean ratio 1.7; 95% CI 1.1 to 2.6). Use of ammonia, degreasers, multiple purpose products and waxes was also associated with asthma score. Cleaning work in places with high demand for disinfection, high cleaning standards and use of cleaning products containing respiratory irritants is associated with higher risk of asthma symptoms. This suggests irritants have an important role in cleaning-related asthma.

Artificial intelligence-assisted occupational lung disease diagnosis.

PubMed

Harber, P; McCoy, J M; Howard, K; Greer, D; Luo, J

1991-08-01

An artificial intelligence expert-based system for facilitating the clinical recognition of occupational and environmental factors in lung disease has been developed in a pilot fashion. It utilizes a knowledge representation scheme to capture relevant clinical knowledge into structures about specific objects (jobs, diseases, etc) and pairwise relations between objects. Quantifiers describe both the closeness of association and risk, as well as the degree of belief in the validity of a fact. An independent inference engine utilizes the knowledge, combining likelihoods and uncertainties to achieve estimates of likelihood factors for specific paths from work to illness. The system creates a series of "paths," linking work activities to disease outcomes. One path links a single period of work to a single possible disease outcome. In a preliminary trial, the number of "paths" from job to possible disease averaged 18 per subject in a general population and averaged 25 per subject in an asthmatic population. Artificial intelligence methods hold promise in the future to facilitate diagnosis in pulmonary and occupational medicine.

"Cold air" and/or "talking" as cough triggers, a sign for the diagnosis of cough variant asthma.

PubMed

Kanemitsu, Yoshihiro; Matsumoto, Hisako; Osman, Nuriamina; Oguma, Tsuyoshi; Nagasaki, Tadao; Izuhara, Yumi; Ito, Isao; Tajiri, Tomoko; Iwata, Toshiyuki; Niimi, Akio; Mishima, Michiaki

2016-11-01

Fractional exhaled nitric oxide (FeNO) is considered an alternative marker of eosinophilic airway inflammation and is sometimes incorporated in the diagnosis of asthma. However, many patients with cough variant asthma (CVA) demonstrate an FeNO in the normal range. Therefore, additional information is needed to confirm the diagnosis of CVA, particularly in patients with low FeNO levels. We aimed to investigate the feasibility of using cough triggers to help diagnose CVA. We studied 163 patients presenting with prolonged/chronic cough alone (including 104 CVA patients) who underwent FeNO measurements and an airway responsiveness test, and answered a questionnaire listing 18 cough triggers. The sensitivity and specificity of FeNO levels and cough triggers for the diagnosis of CVA were determined. CVA patients showed higher FeNO levels than non-CVA patients. When the cut-off value of FeNO levels for the diagnosis of CVA was set at 22ppb, its sensitivity was 57%. CVA patients more frequently responded to "cold air" and "talking" as cough triggers than non-CVA patients. When the analysis was confined to those with a low FeNO (<22ppb) group, the sensitivity and positive predictive values of "cold air" and "talking" for the diagnosis of CVA were 36% and 70% for "cold air", and 44% and 74% for "talking", respectively. Their specificity was 81%. "Cold air" was associated with airway hyperresponsiveness in all patients with an emphasis on those with low FeNO levels. "Cold air" and/or "talking" as cough triggers could be signs for the diagnosis of CVA, particularly when FeNO levels are low. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

A longitudinal study of adult-onset asthma incidence among HMO members

PubMed Central

Sama, Susan R; Hunt, Phillip R; Cirillo, CIH Priscilla; Marx, Arminda; Rosiello, Richard A; Henneberger, Paul K; Milton, Donald K

2003-01-01

Background HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. Methods We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. Results The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Conclusion Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case

The management of work-related asthma guidelines: a broader perspective.

PubMed

Baur, Xaver; Aasen, Tor Brøvig; Burge, P Sherwood; Heederik, Dick; Henneberger, Paul K; Maestrelli, Piero; Schlünssen, Vivi; Vandenplas, Olivier; Wilken, Dennis

2012-06-01

The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures.

[Occupational asthma caused by scented gravel in cat litter boxes].

PubMed

Jensen, O C; Petersen, I

1991-03-25

Perfumes are now added to articles in everyday use to an increasing extent. One example of this is addition of perfume to gravel in cat toilets. It is recognized that perfumes may cause toxic and allergic skin reactions while perfume as the cause of asthma is not so well recognized. In the case described here, exposure to industrial perfume resulted in asthma on account of irritation.

School-Based Asthma Case Finding: The Arkansas Experience

ERIC Educational Resources Information Center

Vargas, Perla A.; Magee, James S.; Bushmiaer, Margo; Simpson, Pippa M.; Jones, Craig A.; Feild, Charles R.; Jones, Stacie M.

2006-01-01

This population-based case-finding study sought to determine asthma prevalence and characterize disease severity and burden among school-aged children in the Little Rock School District. Asthma cases were identified by validated algorithm and parental report of asthma diagnosis. The overall response rate was low. Among schools with greater than…

Cleaning agents and asthma.

PubMed

Quirce, S; Barranco, P

2010-01-01

Although cleaners represent a significant part of the working population worldwide, they remain a relatively understudied occupational group. Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. Cleaning workers are exposed to a large variety of cleaning products containing both irritants and sensitizers, as well as to common indoor allergens and pollutants. Thus, the onset or aggravation of asthma in this group could be related to an irritant-induced mechanism or to specific sensitization. The main sensitizers contained in cleaning products are disinfectants, quaternary ammonium compounds (such as benzalkonium chloride), amine compounds, and fragrances.The strongest airway irritants in cleaning products are bleach (sodium hypochlorite), hydrochloric acid, and alkaline agents (ammonia and sodium hydroxide), which are commonly mixed together. Exposure to the ingredients of cleaning products may give rise to both new-onset asthma, with or without a latency period, and work-exacerbated asthma. High-level exposure to irritants may induce reactive airways dysfunction syndrome. Cleaning workers may also have a greater relative risk of developing asthma due to prolonged low-to-moderate exposure to respiratory irritants. In addition, asthma-like symptoms without confirmed asthma are also common after exposure to cleaning agents. In many cleaners, airway symptoms induced by chemicals and odors cannot be explained by allergic or asthmatic reactions. These patients may have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity, and this condition is termed airway sensory hyperreactivity.

[Evaluation of the standard application of Delphi in the diagnosis of chronic obstructive pulmonary disease caused by occupational irritant chemicals].

PubMed

Zhao, L; Yan, Y J

2017-11-20

Objective: To investigate the problems encountered in the application of the standard (hereinafter referred to as standard) for the diagnosis of chronic obstructive pulmonary disease caused by occu-pational irritant chemicals, to provide reference for the revision of the new standard, to reduce the number of missed patients in occupational COPD, and to get rid of the working environment of those who suffer from chronic respiratory diseases due to long-term exposure to poisons., slowing the progression of the disease. Methods: Using Delphi (Delphi) Expert research method, after the senior experts to demonstrate, to under-stand the GBZ 237-2011 "occupational irritant chemicals to the diagnosis of chronic obstructive pulmonary dis-ease" standard evaluation of the system encountered problems, to seek expert advice, The problems encoun-tered during the clinical implementation of the standards promulgated in 2011 are presented. Results: Through the Delphi Expert investigation method, it is found that experts agree on the content evaluation and implemen-tation evaluation in the standard, but the operational evaluation of the standard is disputed. According to the clinical experience, the experts believe that the range of occupational irritant gases should be expanded, and the operation of the problem of smoking, seniority determination and occupational contact history should be challenged during the diagnosis. Conclusions: Since the promulgation in 2011 of the criteria for the diagnosis of chronic obstructive pulmonary disease caused by occupational stimulant chemicals, there have been some problems in the implementation process, which have caused many occupationally exposed to irritating gases to suffer from "occupational chronic respiratory Diseases" without a definitive diagnosis.

Asthma prevalence and severity in low-resource communities.

PubMed

Cruz, Álvaro A; Stelmach, Rafael; Ponte, Eduardo V

2017-06-01

The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under

Asthma - children

MedlinePlus

... BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 53. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...

Exercise-induced asthma

MedlinePlus

... warm, moist air helps keep asthma symptoms away. Football, baseball, and other sports with periods when you ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

Complementary and alternative medicine for the treatment and diagnosis of asthma and allergic diseases.

PubMed

Passalacqua, G; Compalati, E; Schiappoli, M; Senna, G

2005-03-01

The use of Complementary/Alternative Medicines (CAM) is largely diffused and constantly increasing, especially in the field of allergic diseases and asthma. Homeopathy, acupuncture and phytotherapy are the most frequently utilised treatments, whereas complementary diagnostic techniques are mainly used in the field of food allergy-intolerance. Looking at the literature, the majority of clinical trials with CAMS are of low methodological quality, thus difficult to interpret. There are very few studies performed in a rigorously controlled fashion, and those studies provided inconclusive results. In asthma, none of the CAM have thus far been proved more effective than placebo or equally effective as standard treatments. Some herbal products, containing active principles, have displayed some clinical effect, but the herbal remedies are usually not standardised and not quantified, thus carry the risk of toxic effects or interactions. None of the alternative diagnostic techniques (electrodermal testing, kinesiology, leukocytotoxic test, iridology, hair analysis) have been proved able to distinguish between healthy and allergic subjects or to diagnose sensitizations. Therefore these tests must not be used, since they can lead to delayed or incorrect diagnosis and therapy.

Update on asthma and cleaners

PubMed Central

Zock, Jan-Paul; Vizcaya, David; Le Moual, Nicole

2010-01-01

Purpose of review This paper summarises the recent literature on the relation between cleaning exposures and respiratory health, in particular asthma, including reviews, epidemiological surveys, surveillance programmes and exposure studies. The authors also aimed to identify gaps in the current knowledge and to recommend future research on the topic. Recent findings A large international general population study showed an increased risk of new-onset asthma associated with cleaning work, with professional use of cleaning products, and with domestic use of cleaning sprays. Three surveillance studies confirm the recognition of occupational asthma cases among cleaners and among others who use cleaning products at work. Six workforce-based studies show that respiratory symptoms are partly work-related, and are associated with certain specific exposures including sprays, chlorine bleach and other disinfectants. Summary Recent studies have strengthened the evidence of asthma and other adverse respiratory effects in cleaning workers. Similar effects were seen in other settings where cleaning products are used such as healthcare professionals and homemakers. Both new-onset asthma and work-exacerbated asthma due to cleaning exposures may play a role. Exposure to cleaning sprays, chlorine bleach and other disinfectants may be particularly relevant. The predominant effect mechanisms remain largely unclear and may include both specific sensitisation and irritant-related features. PMID:20093933

Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact.

PubMed

Laulan, Jacky; Fouquet, Bernard; Rodaix, Camille; Jauffret, Penelope; Roquelaure, Yves; Descatha, Alexis

2011-09-01

Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment. The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.

Gum Arabic as a Cause of Occupational Allergy

PubMed Central

Viinanen, Arja; Salokannel, Maija; Lammintausta, Kaija

2011-01-01

Background. Gum arabic is a potential sensitizer in food industry. Methods. We examined 11 candy factory workers referred to examinations due to respiratory and skin symptoms paying attention to exposure and sensitization to gum arabic. Skin tests, pulmonary function tests, and respiratory provocation tests were carried out as indicated by the symptoms and findings. Results. Occupational asthma, caused by gum arabic was diagnosed in 4/11 candy factory workers and two of them had also occupational contact urticaria and one had occupational rhinitis. One of them had oral symptoms associated with ingestion of products containing gum arabic. Conclusions. Airborne exposure to gum arabic may cause sensitization leading to allergic rhinitis, asthma, and urticaria. PMID:21747872

Eosinophilic Endotype of Asthma.

PubMed

Aleman, Fernando; Lim, Hui Fang; Nair, Parameswaran

2016-08-01

Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by elevated sputum and/or blood eosinophils on at least 2 occasions and by a significant response to treatments that suppress eosinophilia. Histopathologic demonstration of eosinophils in the airways provides the most direct diagnosis of eosinophilic asthma; but it is invasive, thus, impractical in clinical practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of short-term increases in ambient air pollution and timing of initial asthma diagnosis among Medicaid-enrolled children in a metropolitan area.

PubMed

Wendt, Judy K; Symanski, Elaine; Stock, Thomas H; Chan, Wenyaw; Du, Xianglin L

2014-05-01

We investigated associations of short-term changes in ambient ozone (O3), fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations and the timing of new-onset asthma, using a large, high-risk population in an area with historically high ozone levels. The study population included 18,289 incident asthma cases identified among Medicaid-enrolled children in Harris County Texas between 2005-2007, using Medicaid Analytic Extract enrollment and claims files. We used a time-stratified case-crossover design and conditional logistic regression to assess the effect of increased short-term pollutant concentrations on the timing of asthma onset. Each 10 ppb increase in ozone was significantly associated with new-onset asthma during the warm season (May-October), with the strongest association seen when a 6-day cumulative average period was used as the exposure metric (odds ratio [OR]=1.05, 95% confidence interval [CI], 1.02-1.08). Similar results were seen for NO2 and PM2.5 (OR=1.07, 95% CI, 1.03-1.11 and OR=1.12, 95% CI, 1.03-1.22, respectively), and PM2.5 also had significant effects in the cold season (November-April), 5-day cumulative lag (OR=1.11. 95% CI, 1.00-1.22). Significantly increased ORs for O3 and NO2 during the warm season persisted in co-pollutant models including PM2.5. Race and age at diagnosis modified associations between ozone and onset of asthma. Our results indicate that among children in this low-income urban population who developed asthma, their initial date of diagnosis was more likely to occur following periods of higher short-term ambient pollutant levels. Copyright © 2014 Elsevier Inc. All rights reserved.

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

PubMed Central

McDonald, J; Chen, Y; Zekveld, C; Cherry, N

2005-01-01

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, industry, and causal agents for asthma, inhalation accidents, and allergic alveolitis. Methods: Cases reported 1992–2001 to the SWORD and OPRA national surveillance schemes, in which almost all UK chest and occupational physicians participate, were analysed by age, sex, cause, occupation, and industry, with incidence rates calculated against appropriate denominators. Results: Excluding diseases of long latency, infrequently seen by occupational physicians, the distribution of diagnoses in the two specialties was similar, but with rates generally much higher in occupational than chest physicians. Occupational asthma was responsible for about 25% of cases overall, affecting mainly craft related occupations and machinists, and most often attributed to isocyanates, metals, grains, wood dusts, solders, and welding fume. These same occupations were those at highest risk from inhalation injuries, most frequently caused by irritant gases, vapours, and fume. Among medical technicians and nurses, however, glutaraldehyde and latex were the main causes of occupational asthma. Allergic alveolitis was seldom reported, with almost all cases in agriculture, forestry, and fishing. Conclusion: During the 10 year period studied, there were few changes in level of reported incidence, apart from some decline in occupational asthma and inhalation injuries. These results and their implications should be distinguished from much higher estimates of asthma made worse by work derived from population surveys, based on prevalence rather than incidence, and self-reported symptoms rather than diagnoses made by specialist physicians. Even so, the reported incidence of new cases of acute respiratory illness caused by work remains substantial. PMID:16299091

Influence of occupation and education level on breast cancer stage at diagnosis, and treatment options in China

PubMed Central

Liu, Yang; Zhang, Jian; Huang, Rong; Feng, Wei-Liang; Kong, Ya-Nan; Xu, Feng; Zhao, Lin; Song, Qing-Kun; Li, Jing; Zhang, Bao-Ning; Fan, Jin-Hu; Qiao, You-Lin; Xie, Xiao-Ming; Zheng, Shan; He, Jian-Jun; Wang, Ke

2017-01-01

Abstract The objective of this study was to evaluate the impact of occupation and education level of Chinese female breast cancer patients on their cancer staging at diagnosis, clinical and pathological features, rate of implementation, and selection of treatment. The medical charts of 4211 confirmed female breast cancer cases diagnosed between 1999 and 2008, from 7 breast cancer centers spread across the whole of China, were reviewed. Data including information on the patient's sociodemographic status, clinical and pathological characteristics, implementation of clinical examination and treatment modalities were analyzed. In parallel, the associations between different occupations and level of educational attainment were analyzed in relation to tumor stage through TNM staging, clinical and pathological characteristics, implementation of clinical examination, and treatment patterns. Multivariate logistic regression was used to identify whether the occupation and education level of patients are independent factors of TNM staging at diagnosis. There were significant differences among different occupation groups and the education level of patients in regards to pathological characteristics and treatment choice. Both the occupation and education level of patients were independent factors of TNM staging at diagnosis. For patients within the lower-income occupation or lower educational attainment group, the tumor stage was later, the rates of implementation of relevant investigations were lower, as were the rates of radiotherapy, chemotherapy, and endocrine therapy. This study suggests that strategies should work toward developing more accurate and effective breast cancer prevention and treatment strategies aimed specifically at patients with lower educational attainment levels and at specific occupation groups. PMID:28403116

The public health implications of asthma.

PubMed Central

Bousquet, Jean; Bousquet, Philippe J.; Godard, Philippe; Daures, Jean-Pierre

2005-01-01

Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries. The workplace environment contributes significantly to the general burden of asthma. Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers. The surveillance of asthma as part of a global WHO programme is essential. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death). Direct costs are significant in most countries. In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs. Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes. A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease. This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease. PMID:16175830

[Field investigation of occupational disease diagnosis in Guangdong Provincial Hospital for Occupational Disease Prevention and Treatment from 2009 to 2014: an analysis of 136 cases].

PubMed

Fan, C Y; Li, X D; Wen, W; Wang, Y Y; Zhang, Y; Lang, L

2016-04-20

To investigate the characteristics of 136 patients with occupational diseases, to summarize key techniques used in field investigation, and to provide a scientific basis for the development of standard operating procedures for field investigation of occupational disease diagnosis. Field investigation and routine data analysis were performed to analyze the cases diagnosed by Guangdong Provincial Hospital for Occupational Disease Prevention and Treatment from January 2009 to December 2014. A total of 136 cases of occupational diseases were diagnosed by Guangdong Provincial Hospital for Occupational Disease Prevention and Treatment from 2009 to 2014, and there were 66 cases of leukemia, 18 cases of suspected occupational benzene poisoning, 12 cases of suspected occupational handarm vibration disease, and 11 cases of suspected pneumoconiosis. Of all these patients, 41.91% were engaged in at least three types of work, 70.59% were exposed to at least three types of chemicals, 25.74% experienced changes in technical processes and chemicals, and 47.06% had disputes on the chemicals they were exposed to during verification by both parties. Occupational hazard factors were detected. Most samples (358)were used to measure benzene concentration in workplace air, among which 11.7% had a benzene concentration of >6.00 mg/m(3)(exceeding standard), 13.41% had a benzene concentration of 3.26~6.00 mg/m(3), 75.42% had a benzene concentration of<0.03 to <3.25 mg/m(3). The samples of suspected occupational hand-arm vibration disease, suspected pneumoconiosis, and suspected occupational noiseinduced hearing loss had high overstandard rates (100%, 93.8%, and 83.3%, respectively). Field investigation of occupational disease diagnosis reveals large numbers of cases of leukemia, suspected occupational benzene poisoning, suspected occupational hand-arm vibration disease, and suspected pneumoconiosis. The key aspects of field investigation include confirmation of the history of occupational

Quality of life of patients with asthma related to damp and moldy work environments.

PubMed

Karvala, Kirsi; Uitti, Jukka; Luukkonen, Ritva; Nordman, Henrik

2013-01-01

Long-term outcomes of asthma related to exposure to workplace dampness are not well known. The aim of this study was to evaluate the quality of life (QOL) of patients with asthma related to damp and moldy workplaces and characterize factors influencing QOL. Using a questionnaire, we followed 1267 patients previously examined for suspected occupational respiratory disease related to exposure to damp and moldy indoor environments. In addition to demographic and other background data, the questionnaire included sections on current employment status, QOL, anxiety and depression, somatization, hypochondria, and asthma medication. We compared the QOL of patients with occupational asthma (OA) with that of patients with work-exacerbated asthma (WEA) or symptoms without asthma. Impaired QOL was found among patients diagnosed with OA when they were compared with patients in corresponding environments with WEA or symptoms only. Not working and greater use of asthma medication were major determinants of worse QOL. Psychological factors did not explain the differences between the groups. OA induced by exposure to workplace moisture and molds is associated with QOL deterioration. The impairment is related to being unemployed (due to disability, retirement, job loss or other reasons) and the need for medication.

Developing an interactive story for children with asthma.

PubMed

Wyatt, Tami H; Li, Xueping; Huang, Yu; Farmer, Rachel; Reed, Delanna; Burkhart, Patricia V

2013-06-01

Despite advancements in asthma treatment and diagnosis, asthma still remains the number 1 cause for hospitalizations in school-aged children. This usability study aimed to develop a child-friendly interactive narrative, Okay with Asthma v2.0, based on the Biopsychosocial Family Model using feedback from children. This fun and kid-friendly program encourages children to manage their own asthma with the help of peers, families, communities, and health care services. With these support structures, children can identify and avoid triggers, monitor their asthma, manage their condition with medications based on an action plan, and learn to live happily with asthma. Copyright © 2013 Elsevier Inc. All rights reserved.

Asthma-like symptoms, atopy, and bronchial responsiveness in furniture workers.

PubMed

Talini, D; Monteverdi, A; Benvenuti, A; Petrozzino, M; Di Pede, F; Lemmi, M; Carletti, A; Macchioni, P; Serretti, N; Viegi, G; Paggiaro, P

1998-11-01

To study the role of individual and occupational risk factors for asthma in furniture workers. 296 workers were examined (258 men, 38 women) with a questionnaire of respiratory symptoms and diseases, baseline spirometry, bronchial provocative test with methacholine, and skin prick tests. Non-specific bronchial hyperreactivity was defined as when a provocative dose with a fall of 20% in forced expiratory volume in 1 second (PD20FEV1) was < 0.8 mg and atopy in the presence of at least one positive response to skin prick tests. Workers were subdivided into spray painters (exposed to low concentrations of diisocyanates and solvents), woodworkers (exposed to wood dusts), and assemblers (control group). The prevalences of attacks of shortness of breath with wheezing and dyspnoea were higher in spray painters (13.5% and 11.5% respectively) than in woodworkers (7.7% and 6.3%) or in assemblers (1.6% and 1.6%); prevalences of chronic cough, asthma, and rhinitis were also slightly but not significantly higher in spray painters and in woodworkers than in assemblers. The difference in the prevalence of respiratory symptoms among the job titles was due to the atopic subjects, who showed a higher prevalence of chronic cough, wheeze, shortness of breath with wheeze, dyspnoea, and asthma in spray painters than in the other groups. The prevalence of non-specific bronchial hyperreactivity in subjects who performed bronchial provocative tests was 17.7%, with no significant difference among groups. Asthma symptoms were significantly associated with non-specific bronchial hyperreactivity. Asthma-like symptoms plus non-specific bronchial hyperreactivity was found in 4% of assemblers, 10% of woodworkers, and 13.3% of spray painters (chi 2 = 2.6, NS). Multiple logistic analysis taking into account individual (smoke, atopy, age) and occupational (job titles) risk factors confirmed that spray painters had higher prevalence of chronic cough than assemblers, and a trend in increasing the

Asthma-like symptoms, atopy, and bronchial responsiveness in furniture workers

PubMed Central

Talini, D.; Monteverdi, A.; Benvenuti, A.; Petrozzino, M.; Di, P; Lemmi, M.; Carletti, A.; Macchioni, P.; Serretti, N.; Viegi, G.; Paggiaro, P.

1998-01-01

OBJECTIVES: To study the role of individual and occupational risk factors for asthma in furniture workers. METHODS: 296 workers were examined (258 men, 38 women) with a questionnaire of respiratory symptoms and diseases, baseline spirometry, bronchial provocative test with methacholine, and skin prick tests. Non-specific bronchial hyperreactivity was defined as when a provocative dose with a fall of 20% in forced expiratory volume in 1 second (PD20FEV1) was < 0.8 mg and atopy in the presence of at least one positive response to skin prick tests. Workers were subdivided into spray painters (exposed to low concentrations of diisocyanates and solvents), woodworkers (exposed to wood dusts), and assemblers (control group). RESULTS: The prevalences of attacks of shortness of breath with wheezing and dyspnoea were higher in spray painters (13.5% and 11.5% respectively) than in woodworkers (7.7% and 6.3%) or in assemblers (1.6% and 1.6%); prevalences of chronic cough, asthma, and rhinitis were also slightly but not significantly higher in spray painters and in woodworkers than in assemblers. The difference in the prevalence of respiratory symptoms among the job titles was due to the atopic subjects, who showed a higher prevalence of chronic cough, wheeze, shortness of breath with wheeze, dyspnoea, and asthma in spray painters than in the other groups. The prevalence of non-specific bronchial hyperreactivity in subjects who performed bronchial provocative tests was 17.7%, with no significant difference among groups. Asthma symptoms were significantly associated with non-specific bronchial hyperreactivity. Asthma-like symptoms plus non-specific bronchial hyperreactivity was found in 4% of assemblers, 10% of woodworkers, and 13.3% of spray painters (chi 2 = 2.6, NS). Multiple logistic analysis taking into account individual (smoke, atopy, age) and occupational (job titles) risk factors confirmed that spray painters had higher prevalence of chronic cough than assemblers, and a

Asthma control in Saudi Arabia: Gender implications.

PubMed

Torchyan, Armen A

2017-05-01

Gender-related factors in asthma control should be considered in clinical consultations to substantially improve asthma control in women. Meanwhile, a limited number of studies have been reported on gender differences in factors related to asthma control, especially in Saudi Arabia. To study the potential gender differences in factors associated with asthma control among adult patients with physician-diagnosed asthma. A cross-sectional study was conducted in adult patients with asthma who attended primary care clinics at three major hospitals in Riyadh, Saudi Arabia. Asthma control was measured by using the Asthma Control Test. Asthma control status was classified as either controlled (Asthma Control Test score of >19) or uncontrolled (Asthma Control Test score of ≤19). Multiple logistic regression analysis was performed. In this study, 58.9% of men and 77.0% of women had uncontrolled asthma (p = 0.002). Factors associated with uncontrolled asthma were different between men and women, except for household income. Reporting higher levels of stress (odds ratio [OR] 4.3 [95% confidence interval {CI}, 1.7-11.1]), daily tobacco smoking (OR 5.8 [95% CI, 1.5-23.5]), and a monthly household income of <15,000 Saudi Arabian Riyals (OR 4.5 [95% CI, 1.9-10.5]) were associated with uncontrolled asthma in men. Being unemployed (OR 3.4 [95% CI, 1.3-9.4]), being obese (OR 3.2 [95% CI, 1.1-9.2]), or having a monthly household income of <15,000 Saudi Arabian Riyals (OR 3.1 [95% CI, 1.2-8.0]) were associated with uncontrolled asthma in women. This study demonstrated that many factors, such as stress, occupation, and obesity, had a differential relationship with uncontrolled asthma among men and women in Saudi Arabia that could provide more insight into methods of improving asthma control, especially in women.

Worsening of Asthma with Systemic Corticosteroids

PubMed Central

Sheth, Ankur; Reddymasu, Savio; Jackson, Robert

2006-01-01

Despite widespread use for treatment of asthma and allergies, glucocorticoids may cause allergic reactions, even anaphylaxis. The incidence of adverse reactions to systemic glucocorticoids is 0.3%. The most commonly reported corticosteroids causing anaphylaxis like reactions are hydrocortisone, prednisone, and methylprednisolone. Most authors agree that allergic reactions to systemic corticosteroids are possibly immunoglobulin E mediated. We report a patient with asthma, aspirin allergy, and nasal polyps who developed bronchospasm following the administration of intravenous methylprednisolone sodium succinate during an acute asthmatic attack. We discuss the differential diagnosis of worsening asthma despite adequate treatment, and suggest corticosteroid-induced bronchospasm in our patient. Corticosteroid-induced bronchospasm should be considered when asthmatics fail to improve, or frankly deteriorate with systemic corticosteroid therapy, particularly when a history of aspirin allergy is present. Teaching Point: Know the differential diagnosis for worsening of asthma despite adequate treatment.Consider corticosteroid-induced bronchospasm when asthmatics fail to improve, or frankly deteriorate with systemic corticosteroid therapy.Corticosteroid-induced bronchospasm is more commonly seen in asthmatics with a history of aspirin allergy. PMID:16606375

Between-Visit Variability in FEV1 as a Diagnostic Test for Asthma in Adults.

PubMed

Dean, Benjamin W; Birnie, Erin E; Whitmore, G A; Vandemheen, Katherine L; Boulet, Louis-Philippe; FitzGerald, J Mark; Ainslie, Martha; Gupta, Samir; Lemiere, Catherine; Field, Stephen K; McIvor, R Andrew; Hernandez, Paul; Mayers, Irvin; Aaron, Shawn D

2018-06-07

The reliability of using between-visit variation in FEV1 to diagnose asthma is understudied, and hence uncertain. To determine if FEV1 variability measured over recurrent visits is significantly associated with a diagnosis of current asthma. Randomly-selected adults (N=964) with a history of physician-diagnosed asthma were studied from 2005-2007 and from 2012-2016. A diagnosis of current asthma was confirmed in those participants who exhibited bronchial hyper-responsiveness to methacholine and/or acute worsening of asthma symptoms while being weaned off asthma medications. Regression analyses and receiver operating curves were used to evaluate the ability of between-visit FEV1 variability to diagnose asthma. A current diagnosis of asthma was confirmed in 584 of 964 participants (60%). Between-visit absolute variability in FEV1 was significantly greater in those in whom current asthma was confirmed, compared to those in whom current asthma was ruled out (7.3% vs 4.8%, mean difference between the 2 groups = 2.5%; 95% CI: 1.7-3.3%). However, a 12 percent and 200 mL between-visit variation in FEV1, which is the diagnostic threshold recommended by GINA, exhibited a sensitivity of only 0.17 and a specificity of 0.94 for confirming current asthma. A between-visit absolute variability in FEV1 ≥ 12% and 200 ml increased the pre-test probability of asthma from 60% to a post-test probability of 81%. A 12% and 200 mL between-visit variation in FEV1, if present, has reasonably good specificity for diagnosing asthma, but has poor sensitivity compared to bronchial challenge testing. Between-visit variability in FEV1 is a relatively unhelpful test to establish a diagnosis of asthma.

Work stress, asthma control and asthma-specific quality of life: Initial evidence from a cross-sectional study.

PubMed

Hartmann, Bettina; Leucht, Verena; Loerbroks, Adrian

2017-03-01

Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap. In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression. Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p < 0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively). The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.

An international comparison of asthma, wheeze, and breathing medication use among children.

PubMed

Lawson, Joshua A; Brozek, Grzegorz; Shpakou, Andrei; Fedortsiv, Olga; Vlaski, Emilija; Beridze, Vakhtangi; Rennie, Donna C; Afanasieva, Anna; Beridze, Sophio; Zejda, Jan

2017-12-01

There is variation in childhood asthma between countries with typically higher prevalence in "Westernized" nations. We compared asthma, respiratory symptoms, and medication prevalence in Eastern and Central European regions and Canada. We conducted a cross-sectional survey study of children (5-15 years) from one urban centre in each of Canada, Belarus, Poland, Republic of Georgia (Adjara), Republic of Macedonia, and Ukraine. Surveys were distributed through randomly selected schools to parents (2013-2015). The prevalence of asthma differed by country from 20.6% in Canada to 1.5% in Ukraine (p < 0.001). This association remained after confounder adjustment. Except for Canada (58.7%) and Poland (42.5%), less than 10% of children with a history of wheeze had a diagnosis of asthma. Regardless of country, more than 50% of children with a diagnosis of asthma used breathing medications in the past year. Finally, except for Georgia (12.1%), all countries had a prevalence of ever wheeze above 20% (23.8% in Poland to 30.9% in Macedonia). Despite large differences in asthma prevalence, respiratory morbidity was more comparable suggesting asthma prevalence may be underestimated. Further validation of asthma diagnosis is needed. It is important to promote best diagnostic practices among first contact physicians. Copyright © 2017 Elsevier Ltd. All rights reserved.

National Athletic Trainers' Association Position Statement: Management of Asthma in Athletes

PubMed Central

Miller, Michael G; Weiler, John M; Baker, Robert; Collins, James; D'Alonzo, Gilbert

2005-01-01

Objective: To present guidelines for the recognition, prophylaxis, and management of asthma that lead to improvement in the quality of care certified athletic trainers and other heath care providers can offer to athletes with asthma, especially exercise-induced asthma. Background: Many athletes have difficulty breathing during or after athletic events and practices. Although a wide variety of conditions can predispose an athlete to breathing difficulties, the most common cause is undiagnosed or uncontrolled asthma. At least 15% to 25% of athletes may have signs and symptoms suggestive of asthma, including exercise-induced asthma. Athletic trainers are in a unique position to recognize breathing difficulties caused by undiagnosed or uncontrolled asthma, particularly when asthma follows exercise. Once the diagnosis of asthma is made, the athletic trainer should play a pivotal role in supervising therapies to prevent and control asthma symptoms. It is also important for the athletic trainer to recognize when asthma is not the underlying cause for respiratory difficulties, so that the athlete can be evaluated and treated properly. Recommendations: The recommendations contained in this position statement describe a structured approach for the diagnosis and management of asthma in an exercising population. Athletic trainers should be educated to recognize asthma symptoms in order to identify patients who might benefit from better management and should understand the management of asthma, especially exercise-induced asthma, to participate as active members of the asthma care team. PMID:16284647

Occupational health and safety in the Moroccan construction sites: preliminary diagnosis

NASA Astrophysics Data System (ADS)

Tarik, Bakeli; Adil, Hafidi Alaoui

2018-05-01

Managing occupational health and safety on Moroccan construction sector represents the first step for projects' success. In fact, by avoiding accidents, all the related direct and indirect costs and delays can be prevented. That leads to an important question always asked by any project manager: what are the factors responsible for accidents? How can they be avoided? Through this research, the aim is to go through these questions, to contribute in occupational health and safety principles understanding, to identify construction accidentology and risk management opportunities and to approach the case of Moroccan construction sites by an accurate diagnosis. The approach is to make researchers, managers, stakeholders and deciders aware about the criticality of construction sites health and safety situation. And, to do the first step for a scientific research project in relation with health and safety in the Moroccan construction sector. For this, the paper will study the related state of art namely about construction sites accidents causation, and will focus on Reason's `Swiss cheese' model and its utilization for Moroccan construction sites health and safety diagnosis. The research will end with an estimation of an accidents fatality rate in the Moroccan construction sector and a benchmarking with the international rates. Finally, conclusions will be presented about the necessity of Occupational Health and Safety Management System (OHSMS) implementation, which shall cover all risk levels, and insure, at the same time, that the necessary defenses against accidents are on place.

[Reactive airway dysfunction syndrome: more flexible application of diagnostic criteria are important for occupational accident victims].

PubMed

Testud, F; Lambert-Chhum, R

2004-06-01

Reactive airway dysfunction syndrome (RADS), or Brooks syndrome, is a complication observed after inhalation of caustic or highly irritating substances. The diagnosis is based on a group of criteria which include the absence of prior respiratory disease. Strict application of these criteria could have a prejudicial effect for certain victims. Three serious cases of RADS were observed in workers who were exposed to massive inhalation of caustic substances. The products implicated (phosphoric oxychloride, titanium tetrachloride, and trichloroacetyl chloride) hydrolyze to hydrochloric acid when they come in contact with the airway mucosa. After an initial period of acute respiratory distress, the patients encountered serious difficulties in achieving an appropriate diagnosis, and in having their sequellae recognized as resulting from an occupational accident. The problem was that these patients had a history of cured allergic asthma or smoking-related COPD. The presence of prior respiratory disorders must not exclude the diagnosis of RADS. A prior respiratory disorder cannot be used as an argument to exclude such victims from indemnities for occupational accident sequelae.

Survey of asthma management in Thailand - the asthma insight and management study.

PubMed

Boonsawat, Watchara; Thompson, Philip J; Zaeoui, Uraiwan; Samosorn, Chanee; Acar, Gurbet; Faruqi, Rab; Poonnoi, Piriya

2015-03-01

Previous Thai surveys of asthma care have shown suboptimal management and poor control. Since then several editions of the Thailand National Asthma Guidelines have been distributed to help improve asthma control. A new survey was undertaken to see if any improvement in care had occurred. It examined patients' insights, attitudes and perceptions about their asthma and its treatment. Asthma patients (>12 years) were randomly selected and participated in face-to-face interviews. Patients answered 53 questions exploring general health, diagnosis, symptoms, exacerbations, patient burden, disease management, treatment and attitudes. The Global Initiative for Asthma guidelines were used to assess asthma control. Data were obtained from 400 asthma patients from 8,177 screened households. This showed that 36% had had exacerbations in the previous year, 17% had been hospitalized and 35% had had an unscheduled emergency visit to hospital or a doctor's office or clinic. Work or school was missed by 44% due to asthma while a similar number had had an asthma episode that made them feel their life was in danger. Only 8% had good asthma control. Patients had low expectations with respect to asthma treatment and their understanding of how to use therapies was poor. Forty-four percent of participants reported day-time symptoms and about one-third (34%) of adults and adolescents in the survey reported night-time symptoms at least once a week in the previous 4 weeks. Asthma patients in Thailand rated their average productivity when asthma was at its worst at 48%, on a scale of 0 to 100%, which equates to a 36% decline in productivity. Rescue medication during the previous four weeks had been used by 44% of asthma patients while 54% had used a controller medication. Pill controller medication is the most used form among those reporting controller medication use (67%), whereas 57% reported taking an inhaler. Oral steroids had been used in the previous 12 months by 40% of patients with

Nasal polyps and the severity of asthma.

PubMed

Ceylan, Erkan; Gencer, Mehmet; San, Imran

2007-03-01

Upper airway pathologies often accompany asthma. Because this represents a single airway, the diagnosis, follow up and treatment of both upper and lower respiratory diseases is essential. Samter Syndrome (SS) is known to be associated with more severe asthma. The presence of nasal polyps (NPs) is also associated with asthma. However, the incidence of NPs in asthma and the effect of NPs on asthma severity are not well documented. Three hundred and forty-two asthma patients were evaluated by endoscopic nasal examination, pulmonary function test, skin prick tests and paranasal sinus tomography. Three hundred and eleven patients with asthma without NP, 19 asthma patients with NP and 12 patients with SS were included. It was found that 54.3% of patients without NPs, 63.2% with NP and 66.7% with SS were at step 3 on the Global Initiative for Asthma scale of severity, and 1.9%, 15.8% and 33.3% were at step 4, respectively. The presence of NPs in asthma patients is associated with an increase in asthma severity. In patients with asthma, the possibility of NPs should be investigated and treatment planned accordingly.

My child is diagnosed with asthma, now what?: motivating parents to help their children control asthma.

PubMed

Stepney, Cesalie; Kane, Katelyn; Bruzzese, Jean-Marie

2011-10-01

Pediatric asthma is often undiagnosed, and therefore untreated. It negatively impacts children's functioning, including school attendance and performance, as well as quality of life. Schoolwide screening for asthma is becoming increasingly common, making identification of possible asthma particularly relevant for school nurses. Nurses may need to help parents cope with the new diagnosis, and teach them skills to manage the illness. The aim of this article is to present a three-phase model of how parents cope with a newly diagnosed pediatric chronic illness. Using asthma as an example, we describe these phases (Emotional Crisis, Facing Reality, and Reclaiming Life), illustrate how parents progress through the phases, and discuss situations associated with possible regression. Next, we offer strategies framed around a theory of asthma self-management to assist school nurses and other medical providers to motivate parents to develop successful disease management skills.

Integrating asthma hazard characterization methods for consumer products.

PubMed

Maier, A; Vincent, M J; Gadagbui, B; Patterson, J; Beckett, W; Dalton, P; Kimber, I; Selgrade, M J K

2014-10-01

Despite extensive study, definitive conclusions regarding the relationship between asthma and consumer products remain elusive. Uncertainties reflect the multi-faceted nature of asthma (i.e., contributions of immunologic and non-immunologic mechanisms). Many substances used in consumer products are associated with occupational asthma or asthma-like syndromes. However, risk assessment methods do not adequately predict the potential for consumer product exposures to trigger asthma and related syndromes under lower-level end-user conditions. A decision tree system is required to characterize asthma and respiratory-related hazards associated with consumer products. A system can be built to incorporate the best features of existing guidance, frameworks, and models using a weight-of-evidence (WoE) approach. With this goal in mind, we have evaluated chemical hazard characterization methods for asthma and asthma-like responses. Despite the wealth of information available, current hazard characterization methods do not definitively identify whether a particular ingredient will cause or exacerbate asthma, asthma-like responses, or sensitization of the respiratory tract at lower levels associated with consumer product use. Effective use of hierarchical lines of evidence relies on consideration of the relevance and potency of assays, organization of assays by mode of action, and better assay validation. It is anticipated that the analysis of existing methods will support the development of a refined WoE approach. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

[Safe local anesthesia in patients with bronchial asthma].

PubMed

Anisimova, E N; Gromovik, M V

The paper presents the analysis of studies of local anesthesia in patients with bronchial asthma. It was found that the diagnosis of hypersensitivity to sodium metabisulfite in patients with bronchial asthma must be optimized for development of local anesthesia selection algorithm in outpatient dentistry.

Emergency Department Allies: a Web-based multihospital pediatric asthma tracking system.

PubMed

Kelly, Kevin J; Walsh-Kelly, Christine M; Christenson, Peter; Rogalinski, Steven; Gorelick, Marc H; Barthell, Edward N; Grabowski, Laura

2006-04-01

To describe the development of a Web-based multihospital pediatric asthma tracking system and present results from the initial 18-month implementation of patient tracking experience. The Emergency Department (ED) Allies tracking system is a secure, password-protected data repository. Use-case methodology served as the foundation for technical development, testing, and implementation. Seventy-seven data elements addressing sociodemographics, wheezing history, quality of life, triggers, and ED managment were included for each subject visit. The ED Allies partners comprised 1 academic pediatric ED and 5 community EDs. Subjects with a physician diagnosis of asthma who presented to the ED for acute respiratory complaints composed the asthma group; subjects lacking a physician diagnosis of asthma but presenting with wheezing composed the wheezing group. The tracking-system development and implementation process included identification of data elements, system database and use case development, and delineation of screen features, system users, reporting functions, and help screens. For the asthma group, 2005 subjects with physician-diagnosed asthma were enrolled between July 15, 2002 and January 14, 2004. These subjects accounted for 2978 visits; 10.4% had > or = 3 visits. Persistent asthma was noted in 68% of the subjects. During the same time period, 1297 wheezing subjects with a total of 1628 ED visits (wheezing group) were entered into the tracking system. After enrollment, 57% of the subjects with > or = 1 subsequent ED visits received a physician diagnosis of asthma. Our sophisticated tracking system facilitated data collection and identified key intervention opportunities for a diverse ED wheezing population. A significant asthma burden was identified with significant rates of hospitalization, acute care visits and persistent asthma in 68% of subjects. The surveillance component provided important insights into health care issues of both asthmatic subjects and

Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes.

PubMed

Schyllert, Christian; Andersson, Martin; Hedman, Linnea; Ekström, Magnus; Backman, Helena; Lindberg, Anne; Rönmark, Eva

2018-01-01

Objectives : To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background : Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden ( n  = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results : Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary

A systematic review of predictive models for asthma development in children.

PubMed

Luo, Gang; Nkoy, Flory L; Stone, Bryan L; Schmick, Darell; Johnson, Michael D

2015-11-28

Asthma is the most common pediatric chronic disease affecting 9.6 % of American children. Delay in asthma diagnosis is prevalent, resulting in suboptimal asthma management. To help avoid delay in asthma diagnosis and advance asthma prevention research, researchers have proposed various models to predict asthma development in children. This paper reviews these models. A systematic review was conducted through searching in PubMed, EMBASE, CINAHL, Scopus, the Cochrane Library, the ACM Digital Library, IEEE Xplore, and OpenGrey up to June 3, 2015. The literature on predictive models for asthma development in children was retrieved, with search results limited to human subjects and children (birth to 18 years). Two independent reviewers screened the literature, performed data extraction, and assessed article quality. The literature search returned 13,101 references in total. After manual review, 32 of these references were determined to be relevant and are discussed in the paper. We identify several limitations of existing predictive models for asthma development in children, and provide preliminary thoughts on how to address these limitations. Existing predictive models for asthma development in children have inadequate accuracy. Efforts to improve these models' performance are needed, but are limited by a lack of a gold standard for asthma development in children.

Current concepts of severe asthma

PubMed Central

Raundhal, Mahesh; Oriss, Timothy B.; Ray, Prabir; Wenzel, Sally E.

2016-01-01

The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development. PMID:27367183

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing.

PubMed

Cutuli, J J; Herbers, Janette E; Lafavor, Theresa L; Ahumada, Sandra M; Masten, Ann S; Oberg, Charles N

2014-05-01

Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

Canadian asthma consensus report, 1999

PubMed Central

Boulet, L P; Becker, A; Bérubé, D; Beveridge, R; Ernst, P

1999-01-01

OBJECTIVES: To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adults, including pregnant women and the elderly, in office, emergency department, hospital and clinic settings. OPTIONS: The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. OUTCOMES: Provision of the best control of asthma by confirmation of the diagnosis using objective measures, rapid achievement and maintenance of control and regular follow-up. EVIDENCE: The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence. Differences of opinion were resolved by consensus following discussion. VALUES: Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality. BENEFITS, HARMS AND COSTS: Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms, reduced morbidity and mortality, fewer emergency and hospital admissions, fewer adverse side-effects from medications, better quality of life for patients and reduced costs. RECOMMENDATIONS: Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified, a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education

Prevalence of asthma in Galway school children 2004.

PubMed

Shabu, A; Flanagan, O; Dineen, B; Loftus, B G

2007-06-01

We aimed to ascertain the prevalence of asthma amongst Galway schoolchildren aged 9-10, and to compare the results to a similar study carried out in 1992. A questionnaire was distributed to parents of all children attending 4th class in Galway city schools. 652 of 750(87%) questionnaires were returned. Prevalence of "wheeze ever" was 27.6%, and "current wheeze" 16.3%. The prevalence of asthma was 18.5%. Of those with asthma there was a 2 to 1 male preponderance, 80% had mild asthma, 14% moderate, and 6% severe asthma. 80% were taking anti-asthma therapy, with 48% taking regular inhaled steroids. 84% had a diagnosis of asthma made by a doctor. Comparison with the study of 1992 shows little change in the prevalence of current wheeze, or asthma. There has however been a significant decline in the severity of asthma, and an increase in the use of prophylactic anti-asthma medication. Asthma prevalence appears to be stable in the age group studied. There is a much greater willingness to diagnose, and treat asthma in the community. The severity of asthma, as measured by attack frequency, has declined.

School-based asthma disease management.

PubMed

Tinkelman, David; Schwartz, Abby

2004-06-01

Asthma is the most common chronic childhood illness and the leading cause of missed school days. School is a potential location for establishing an asthma education program for children and their parents/caregivers designed to improve disease management. To determine whether a comprehensive, school-based asthma management program, in addition to a conventional disease management program, can reduce measures of asthma control, student absenteeism, and caregiver lost workdays. School nurses recruited parents/caregivers of students with asthma from three urban elementary and middle schools. Children were identified as having asthma by a previous diagnosis from their personal physician. Parents were invited to attend educational sessions about the program. Students received peak flow meters and training in their use and had access to an interactive asthma diary to record symptoms, peak flow, and medicine usage. They received monthly asthma education at school and had access to an online asthma education program and additional handouts. Parents received several educational calls regarding asthma and had a 24-hour, 7-days-a-week emergency number to call if problems arose. At 6 months, missed school days and unscheduled doctor visits were reduced by two thirds (n = 41; p< 0.01 for each). Caregivers' perception of children's activity level increased by 11% (n = 26; p = 0.037). Daytime and nighttime frequency of symptoms dropped by 62% and 34%, respectively (n = 32; p < 0.007 and p<0.03 for each). These trends continued at 12 months, although only reduction in frequency of symptoms attained statistical significance. A comprehensive, school-based asthma management program can successfully improve asthma control and reduce absenteeism in elementary and middle school students and caregiver lost workdays.

[Respiratory allergies among bakers and pastry cooks: epidemiologic survey done in 1991 by the occupational physicians of the Loire-Atlantique].

PubMed

Anton, M; Bataille, A; Mollat, F; Bobe, M; Bonneau, C; Caramaniam, M N; Géraut, C; Dupas, D

1995-01-01

The aim was to study the prevalence of respiratory allergy (rhinitis and asthma) in a population of bakers and pastrycooks. In 1991, 485 bakers and pastry cooks were examined by 27 work-physicians of Loire-Atlantic. The investigation was composed of a standardised questionnaire (signs of respiratory function, atopic history, smoking of tobacco ...), a clinical examination, and tests of respiratory function. An allergy assessment was made of all subjects with symptoms. 14.4% of subjects had rhinitis and 6.4% asthma. Development of these pathologies was clearly job-related for 2/3 of those with rhinitis and more than half of the asthmatics (55%). Occupational rhinitis and asthma were significantly more frequent in bakers than in pastrycooks and were linked to atopic history. Occupational asthma was associated with length of exposure to flour and with occupational rhinitis. In conclusion, these findings are comparable with or a little less than those that have been reported in occupational literature. They under-estimate the importance of the problem because of the occupational selection effect that is associated with these pathologies. Rhinitis and asthma are 1.5 to 3 time more common in bakers than in pastrycooks.

Development of a prototype system for statewide asthma surveillance.

PubMed

Deprez, Ronald D; Asdigian, Nancy L; Oliver, L Christine; Anderson, Norman; Caldwell, Edgar; Baggott, Lee Ann

2002-12-01

We developed and evaluated a statewide and community-level asthma surveillance system. Databases and measures included a community prevalence survey, hospital admissions data, emergency department/outpatient clinic visit records, and a physician survey of diagnosis and treatment practices. We evaluated the system in 5 Maine communities varying in population and income. Asthma hospitalizations were high in the rural/low-socioeconomic-status communities studied, although diagnosed asthma was low. Males were more likely than females to experience asthma symptoms, although they were less likely to have been diagnosed with asthma or to have used hospital-based asthma care. Databases were useful for estimating asthma burden and identifying service needs as well as high-risk groups. They were less useful in estimating severity or in identifying environmental risks.

Association of hospitalizations for asthma with seasonal and pandemic influenza.

PubMed

Gerke, Alicia K; Yang, Ming; Tang, Fan; Foster, Eric D; Cavanaugh, Joseph E; Polgreen, Philip M

2014-01-01

Although influenza has been associated with asthma exacerbations, it is not clear the extent to which this association affects health care use in the United States. The first goal of this project was to determine whether, and to what extent, the incidence of asthma hospitalizations is associated with seasonal variation in influenza. Second, we used influenza trends (2000-2008) to help predict asthma admissions during the 2009 H1N1 influenza pandemic. We identified all hospitalizations between 1998 and 2008 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project during which a primary diagnosis of asthma was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We performed time series regression analyses to investigate the association of monthly asthma admissions with influenza incidence. Finally, we applied these time series regression models using 1998-2008 data, to forecast monthly asthma admissions during the 2009 influenza pandemic. Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of asthma hospitalizations (P-value < 0.0001). Use of influenza data to predict asthma admissions during the 2009 H1N1 pandemic improved the mean squared prediction error by 60.2%. Influenza activity in the population is significantly associated with asthma hospitalizations in the United States, and this association can be exploited to more accurately forecast asthma admissions. Our results suggest that improvements in influenza surveillance, prevention and treatment may decrease hospitalizations of asthma patients. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment.

PubMed

Sánchez, Trinidad; Castro-Rodríguez, José A; Brockmann, Pablo E

2016-01-01

The objective was to perform a systematic review in order to describe the relationship between asthma and sleep-disordered breathing (SDB) in children, especially regarding the impact of treatment and management. We performed an electronic search in MEDLINE, EMBASE, and LILACS database. Study inclusion criteria were the following: 1) studies that examined the relationship between asthma/wheezing and SDB/obstructive sleep apnea (OSA); and 2) studies conducted in children <18 years of age. Primary outcomes were the prevalence of asthma and SDB, the tests used for diagnosis, and the influence of their treatment and management. One thousand and twenty studies were identified, among which 32 were selected (n=143,343 children; 51% males; age [mean ± standard deviation] 8.4±2.5 years). Most studies (n=26) diagnosed SDB using questionnaires or clinical history. Nine studies performed a sleep study for diagnosing OSA. The diagnosis of asthma was based on clinical history (n=16), previous medical diagnosis (n=4), questionnaires (n=12), and spirometry (n=5). Children with asthma were more likely to develop habitual snoring and OSA, and children with SDB were more likely to develop asthma. Moreover, asthma was associated with more severe OSA, and the presence of SDB was associated with severe asthma. Treatment of SDB with adenotonsillectomy was associated with significant asthma improvement. The relationship between asthma and SDB appears to be bidirectional, and adenotonsillectomy appears to improve asthma control. Future trials on how asthma treatment could impact on SDB are needed.

Prevalence of childhood asthma in Korea: international study of asthma and allergies in childhood.

PubMed

Lee, Sang-Il

2010-04-01

Childhood asthma is a major concern because it leads to more hospital visits and a heavy economic burden. Proper management and prevention strategies for childhood asthma must be based on correct evaluation of prevalence and risk factors for its development. In Korea, nationwide studies were conducted in 1995 and 2000 on students from 68 elementary schools (age, 6-12 years) and junior high schools (age, 12-15 years) by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We used the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) written and video questionnaires at the same schools during the same period (October-November). The prevalence of asthma in junior high school children seemed to increase over 5 years. However, in elementary school children, the prevalence of asthma symptoms decreased, although the prevalence of 'diagnosis of asthma, ever' and 'treatment of asthma, last 12 months' increased. In addition, it was found that various factors, such as obesity, passive smoking, dietary habits, raising pets at home, and fever/antibiotic use during infancy were associated with childhood asthma. When prevalence of asthma in Korea was compared with that in different regions, the prevalence changes in the 6-7 years age group did not seem to be consistent between regions, whereas similar trends were observed among children aged 13-14 years. To conduct another epidemiological study to evaluate the time trend over time, a third nationwide survey is planned in 2010, and we anticipate ISAAC Phase 3 will explore recent changes in the prevalence of childhood asthma and assess its risk factors in Korean children. On the basis of accurate data on the current status of childhood asthma in 2010, we will be able to establish proper management strategies.

Early incidence of occupational asthma is not accelerated by atopy in the bakery/pastry and hairdressing sectors.

PubMed

Rémen, T; Acouetey, D-S; Paris, C; Hannhart, B; Poussel, M; Chenuel, B; Barbaud, A; Zmirou-Navier, D

2013-07-01

Occupational asthma (OA) is most likely to develop in the very early years of exposure. To describe the early incidence of OA among bakers/pastry-makers (BP) and hairdressers and to explore the role of atopy. Following a retrospective follow-up design, subjects were invited to undergo telephone interviews. Those who declared work-related respiratory or rhinitis symptoms and a sample group of others were offered a medical visit for OA investigations. Data from interviews and from medical visits were used to estimate the incidence of OA according to increasing durations of exposure. A total of 866 subjects were interviewed (mean age 25.3 years, 43.8% females), of whom 282 underwent a medical visit. Total estimated incidence rates of 'confirmed or probable' OA during the first 12 years of exposure were high in BP (2.63 per 100 person-years [py]) and in hairdressers (0.58/100 py), particularly in the first 4 years. Atopy is a strong risk factor for incidence among BP but, irrespective of the occupational sector, it does not influence the timing of OA symptoms. OA symptoms occur soon after the start of exposure. Our results suggest that atopy does not precipitate the occurrence of symptoms in two different allergen exposure settings.

Occupational asthma caused by turbot allergy in 3 fish-farm workers.

PubMed

Pérez Carral, C; Martín-Lázaro, J; Ledesma, A; de la Torre, F

2010-01-01

We report 3 patients (26, 31, and 33 years) who worked at the same fish farm for several years. They experienced symptoms of rhinoconjunctivitis and bronchial asthma while classifying fish by size. Their asthma gradually worsened to the extent that it became persistent and required daily medication with inhaled corticosteroids and bronchodilators. Symptoms improved during weekends and holidays. All 3 patients could eat turbot. Our study showed that the patients were allergic and that sensitization was probably by inhalation. The allergens were parvalbumin in 1 case and a different allergen in the remaining 2 patients.

Occupational rhinitis in the Slovak Republic--a long-term retrospective study.

PubMed

Perečinský, Slavomir; Legáth, L'ubomír; Varga, Marek; Javorský, Martin; Bátora, Igor; Klimentová, Gabriela

2014-12-01

Allergic and non-allergic rhinitis ranks among the common occupational health problems. However, data on the incidence of occupational rhinitis are lacking, since comprehensive studies are rare. The study includes a group of patients in the Slovak Republic who were reported as having occupational rhinitis in the years 1990-2011. The following parameters were tracked in the investigated sample: age, gender, number of cases by individual years, occupations, causative factors and the length of exposure to the given agent. Possible progression of rhinitis to bronchial asthma was evaluated as well. The diagnostic algorithm was also analysed retrospectively, which included skin tests, the examination of specific IgE antibodies and nasal provocation tests. A total of 70 cases of occupational rhinitis were reported. The disease most often occurred in food industry workers (50% of cases). The most common aetiological factor was flour. Among other relatively common allergens were synthetic textile, wool, cotton and different types of moulds. Significant agents were also different chemical factors causing allergic and irritant rhinitis. The average length of exposure was 14.8 years. Exposure was shorter in men than in women (11 years vs. 16 years) (p = 0.04). Bronchial asthma as a comorbidity was diagnosed in 13 patients (19.7%). The critical diagnostic method on the basis of which the causal association between rhinitis and work environments was confirmed in 59% of cases was skin test; confirmation of the occupational cause using nasal provocation test was less frequent (18%). Food industry, textile industry and agriculture were the most risky occupational environments. Workers in these sectors require preventive intervention. In case of showing rhinitis symptoms it is necessary to confirm the occupational aetiology of the disease by the objective diagnostic methods. Since occupational rhinitis mostly precedes the occupational asthma, the elimination from the workplace is

Decreasing frequency of asthma education in primary care.

PubMed

Hersh, Adam L; Orrell-Valente, Joan K; Maselli, Judith H; Olson, Lynn M; Cabana, Michael D

2010-02-01

Provision of asthma education is associated with decreased hospitalizations and emergency department visits for patients with asthma. Our objective was to describe national trends in the provision of asthma education by primary care physicians in office settings. We used the National Ambulatory Medical Care Survey, a nationally representative dataset of patient visits to office-based physicians. We identified visits to primary care physicians for patients where asthma was a reason for the visit (asthma-related visits) or who had a diagnosis of asthma, but asthma was not a specific reason for the visit (asthma-unrelated visits) and estimated the percentage of visits where asthma education was provided. Data were available for asthma-related visits from 2001-2006 and from 2005-2006 only for asthma-unrelated visits. We examined time trends in asthma education and used multivariable logistic regression to identify independent patient and system-related factors that were predictors of asthma education. The percentage of asthma-related visits where asthma education was provided declined during the study period, from 50% in 2001-2002 to 38% in 2005-2006 (p = 0.03). Asthma education was provided less frequently during asthma-unrelated visits compared to asthma-related visits (12% vs. 38%, p<0.0001). Independent predictors of providing asthma education included age < or = 18 years, receipt of a controller medication, incorporation of an allied health professional during the visit, longer visit duration and Northeast region. Asthma education is underused by primary care physicians and rates have declined from 2001-2006. Interventions designed to promote awareness and greater use of asthma education are needed.

Cleaning products and work-related asthma.

PubMed

Rosenman, Kenneth D; Reilly, Mary Jo; Schill, Donald P; Valiante, David; Flattery, Jennifer; Harrison, Robert; Reinisch, Florence; Pechter, Elise; Davis, Letitia; Tumpowsky, Catharine M; Filios, Margaret

2003-05-01

To describe the characteristics of individuals with work-related asthma associated with exposure to cleaning products, data from the California-, Massachusetts-, Michigan-, and New Jersey state-based surveillance systems of work-related asthma were used to identify cases of asthma associated with exposure to cleaning products at work. From 1993 to 1997, 236 (12%) of the 1915 confirmed cases of work-related asthma identified by the four states were associated with exposure to cleaning products. Eighty percent of the reports were of new-onset asthma and 20% were work-aggravated asthma. Among the new-onset cases, 22% were consistent with reactive airways dysfunction syndrome. Individuals identified were generally women (75%), white non-Hispanic (68%), and 45 years or older (64%). Their most likely exposure had been in medical settings (39%), schools (13%), or hotels (6%), and they were most likely to work as janitor/cleaners (22%), nurse/nurses' aides (20%), or clerical staff (13%). However, cases were reported with exposure to cleaning products across a wide range of job titles. Cleaning products contain a diverse group of chemicals that are used in a wide range of industries and occupations as well as in the home. Their potential to cause or aggravate asthma has recently been recognized. Further work to characterize the specific agents and the circumstances of their use associated with asthma is needed. Additional research to investigate the frequency of adverse respiratory effects among regular users, such as housekeeping staff, is also needed. In the interim, we recommend attention to adequate ventilation, improved warning labels and Material Safety Data Sheets, and workplace training and education.

[The NHG guidelines 'Adult asthma' and 'COPD'].

PubMed

Geijer, Roeland M M; Tuut, Mariska K; in't Veen, Johannes C C M; Broekhuizen, Berna D L; Chavannes, Niels H; Smeele, Ivo J M

2015-01-01

The Dutch College of General Practitioners (NHG) guidelines 'Adult asthma' and 'COPD' have been revised. New spirometry reference values from the Global Lung Function Initiative are recommended. Airway obstruction is defined as a FEV1/FVC ratio below the 5th percentile for the reference population. Spirometry for diagnosis takes place without use of patients' inhaled medication and consists of measurements before and after standardized bronchodilation. In monitoring spirometry, patients continue using inhaled medication and standardized bronchodilation is not indicated. The goal of asthma management is optimal asthma control, tailored to individual goals. The most important non-drug intervention in asthma and COPD is to recommend stopping smoking. The goal of COPD management is to limit symptoms, improve exercise capacity and quality of life, and reduce the burden of disease. Inhaled corticosteroids are usually not indicated in COPD treatment. Patients with comorbid asthma and COPD are treated with non-drug interventions according to the COPD guideline and with medication according to the asthma guideline.

Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment

PubMed Central

Sánchez, Trinidad; Castro-Rodríguez, José A; Brockmann, Pablo E

2016-01-01

Background The objective was to perform a systematic review in order to describe the relationship between asthma and sleep-disordered breathing (SDB) in children, especially regarding the impact of treatment and management. Methods We performed an electronic search in MEDLINE, EMBASE, and LILACS database. Study inclusion criteria were the following: 1) studies that examined the relationship between asthma/wheezing and SDB/obstructive sleep apnea (OSA); and 2) studies conducted in children <18 years of age. Primary outcomes were the prevalence of asthma and SDB, the tests used for diagnosis, and the influence of their treatment and management. Results One thousand and twenty studies were identified, among which 32 were selected (n=143,343 children; 51% males; age [mean ± standard deviation] 8.4±2.5 years). Most studies (n=26) diagnosed SDB using questionnaires or clinical history. Nine studies performed a sleep study for diagnosing OSA. The diagnosis of asthma was based on clinical history (n=16), previous medical diagnosis (n=4), questionnaires (n=12), and spirometry (n=5). Children with asthma were more likely to develop habitual snoring and OSA, and children with SDB were more likely to develop asthma. Moreover, asthma was associated with more severe OSA, and the presence of SDB was associated with severe asthma. Treatment of SDB with adenotonsillectomy was associated with significant asthma improvement. Conclusion The relationship between asthma and SDB appears to be bidirectional, and adenotonsillectomy appears to improve asthma control. Future trials on how asthma treatment could impact on SDB are needed. PMID:27143940

Genome-Wide Association Study Identifies Novel Loci Associated With Diisocyanate-Induced Occupational Asthma

PubMed Central

Yucesoy, Berran; Kaufman, Kenneth M.; Lummus, Zana L.; Weirauch, Matthew T.; Zhang, Ge; Cartier, André; Boulet, Louis-Philippe; Sastre, Joaquin; Quirce, Santiago; Tarlo, Susan M.; Cruz, Maria-Jesus; Munoz, Xavier; Harley, John B.; Bernstein, David I.

2015-01-01

Diisocyanates, reactive chemicals used to produce polyurethane products, are the most common causes of occupational asthma. The aim of this study is to identify susceptibility gene variants that could contribute to the pathogenesis of diisocyanate asthma (DA) using a Genome-Wide Association Study (GWAS) approach. Genome-wide single nucleotide polymorphism (SNP) genotyping was performed in 74 diisocyanate-exposed workers with DA and 824 healthy controls using Omni-2.5 and Omni-5 SNP microarrays. We identified 11 SNPs that exceeded genome-wide significance; the strongest association was for the rs12913832 SNP located on chromosome 15, which has been mapped to the HERC2 gene (p = 6.94 × 10−14). Strong associations were also found for SNPs near the ODZ3 and CDH17 genes on chromosomes 4 and 8 (rs908084, p = 8.59 × 10−9 and rs2514805, p = 1.22 × 10−8, respectively). We also prioritized 38 SNPs with suggestive genome-wide significance (p < 1 × 10−6). Among them, 17 SNPs map to the PITPNC1, ACMSD, ZBTB16, ODZ3, and CDH17 gene loci. Functional genomics data indicate that 2 of the suggestive SNPs (rs2446823 and rs2446824) are located within putative binding sites for the CCAAT/Enhancer Binding Protein (CEBP) and Hepatocyte Nuclear Factor 4, Alpha transcription factors (TFs), respectively. This study identified SNPs mapping to the HERC2, CDH17, and ODZ3 genes as potential susceptibility loci for DA. Pathway analysis indicated that these genes are associated with antigen processing and presentation, and other immune pathways. Overlap of 2 suggestive SNPs with likely TF binding sites suggests possible roles in disruption of gene regulation. These results provide new insights into the genetic architecture of DA and serve as a basis for future functional and mechanistic studies. PMID:25918132

Inhaler Reminders Significantly Improve Asthma Patients' Use of Controller Medications

MedlinePlus

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Occupational exposure to pesticides and respiratory health.

PubMed

Mamane, Ali; Baldi, Isabelle; Tessier, Jean-François; Raherison, Chantal; Bouvier, Ghislaine

2015-06-01

This article aims to review the available literature regarding the link between occupational exposure to pesticides and respiratory symptoms or diseases. Identification of epidemiological studies was performed using PubMed. 41 articles were included, 36 regarding agricultural workers and five regarding industry workers. Among the 15 cross-sectional studies focusing on respiratory symptoms and agricultural pesticide exposure, 12 found significant associations with chronic cough, wheeze, dyspnoea, breathlessness or chest tightness. All four studies on asthma found a relationship with occupational exposure, as did all three studies on chronic bronchitis. The four studies that performed spirometry reported impaired respiratory function linked to pesticide exposure, suggestive of either obstructive or restrictive syndrome according to the chemical class of pesticide. 12 papers reported results from cohort studies. Three out of nine found a significant relationship with increased risk of wheeze, five out of nine with asthma and three out of three with chronic bronchitis. In workers employed in pesticide production, elevated risks of chronic obstructive pulmonary disease (two studies out of three) and impaired respiratory function suggestive of an obstructive syndrome (two studies out of two) were reported. In conclusion, this article suggests that occupational exposure to pesticides is associated with an increased risk of respiratory symptoms, asthma and chronic bronchitis, but the causal relationship is still under debate. Copyright ©ERS 2015.

Validation of asthma recording in the Clinical Practice Research Datalink (CPRD)

PubMed Central

Morales, Daniel R; Mullerova, Hana; Smeeth, Liam; Douglas, Ian J; Quint, Jennifer K

2017-01-01

Objectives The optimal method of identifying people with asthma from electronic health records in primary care is not known. The aim of this study is to determine the positive predictive value (PPV) of different algorithms using clinical codes and prescription data to identify people with asthma in the United Kingdom Clinical Practice Research Datalink (CPRD). Methods 684 participants registered with a general practitioner (GP) practice contributing to CPRD between 1 December 2013 and 30 November 2015 were selected according to one of eight predefined potential asthma identification algorithms. A questionnaire was sent to the GPs to confirm asthma status and provide additional information to support an asthma diagnosis. Two study physicians independently reviewed and adjudicated the questionnaires and additional information to form a gold standard for asthma diagnosis. The PPV was calculated for each algorithm. Results 684 questionnaires were sent, of which 494 (72%) were returned and 475 (69%) were complete and analysed. All five algorithms including a specific Read code indicating asthma or non-specific Read code accompanied by additional conditions performed well. The PPV for asthma diagnosis using only a specific asthma code was 86.4% (95% CI 77.4% to 95.4%). Extra information on asthma medication prescription (PPV 83.3%), evidence of reversibility testing (PPV 86.0%) or a combination of all three selection criteria (PPV 86.4%) did not result in a higher PPV. The algorithm using non-specific asthma codes, information on reversibility testing and respiratory medication use scored highest (PPV 90.7%, 95% CI (82.8% to 98.7%), but had a much lower identifiable population. Algorithms based on asthma symptom codes had low PPVs (43.1% to 57.8%)%). Conclusions People with asthma can be accurately identified from UK primary care records using specific Read codes. The inclusion of spirometry or asthma medications in the algorithm did not clearly improve accuracy

Childhood adversity, early-onset depressive/anxiety disorders, and adult-onset asthma.

PubMed

Scott, Kate M; Von Korff, Michael; Alonso, Jordi; Angermeyer, Matthias C; Benjet, Corina; Bruffaerts, Ronny; de Girolamo, Giovanni; Haro, Josep Maria; Kessler, Ronald C; Kovess, Viviane; Ono, Yutaka; Ormel, Johan; Posada-Villa, José

2008-11-01

To investigate a) whether childhood adversity predicts adult-onset asthma; b) whether early-onset depressive/anxiety disorders predict adult-onset asthma; and c) whether childhood adversity and early-onset depressive/anxiety disorders predict adult-onset asthma independently of each other. Previous research has suggested, but not established, that childhood adversity may predict adult-onset asthma and, moreover, that the association between mental disorders and asthma may be a function of shared risk factors, such as childhood adversity. Ten cross-sectional population surveys of household-residing adults (>18 years, n = 18,303) assessed mental disorders with the Composite International Diagnostic Interview (CIDI 3.0) as part of the World Mental Health surveys. Assessment of a range of childhood family adversities was included. Asthma was ascertained by self-report of lifetime diagnosis and age of diagnosis. Survival analyses calculated hazard ratios (HRs) for risk of adult-onset (>age 20 years) asthma as a function of number and type of childhood adversities and early-onset (asthma with risk increasing with the number of adversities experienced (HRs = 1.49-1.71). Early-onset depressive and anxiety disorders also predicted adult-onset asthma (HRs = 1.67-2.11). Childhood adversities and early-onset depressive and anxiety disorders both predicted adult-onset asthma after mutual adjustment (HRs = 1.43-1.91). Childhood adversities and early-onset depressive/anxiety disorders independently predict adult-onset asthma, suggesting that the mental disorder-asthma relationship is not a function of a shared background of childhood adversity.

Asthma related to cleaning agents: a clinical insight

PubMed Central

Vandenplas, Olivier; D'Alpaos, Vinciane; Evrard, Geneviève; Jamart, Jacques; Thimpont, Joel; Huaux, François; Renauld, Jean-Christophe

2013-01-01

Objective To determine the agents causing asthmatic reactions during specific inhalation challenges (SICs) in workers with cleaning-related asthma symptoms and to assess the pattern of bronchial responses in order to identify the mechanisms involved in cleaning-related asthma. Design A retrospective case series analysis. Setting The study included all participants who completed an SIC procedure with the cleaning/disinfection products suspected of causing work-related asthma over the period 1992–2011 in a tertiary centre, which is the single specialised centre of the French-speaking part of Belgium where all participants with work-related asthma are referred to for SIC. Results The review identified 44 participants who completed an SIC with cleaning/disinfection agents. Challenge exposure to the suspected cleaning agents elicited a ≥20% fall in forced expiratory volume in 1 s (FEV1) in 17 (39%) participants. The cleaning products that induced a positive SIC contained quaternary ammonium compounds (n=10), glutaraldehyde (n=3), both of these agents (n=1) and ethanolamines (n=2). Positive SICs were associated with a significant decrease in the median (IQR) value of the provocative concentration of histamine causing a 20% fall in FEV1 (PC20) from 1.4 (0.2–4.2) mg/mL at baseline to 0.5 (0.4–3.0) mg/mL after the challenge and a significant increase in sputum eosinophils from 1.8 (0.8–7.2)% at baseline to 10.0 (4.1–15.9)% 7 h after the challenge exposure while these parameters did not significantly change in participants with a negative SIC. Overall, 11 of 17 participants with positive SICs showed greater than threefold decrease in postchallenge histamine PC20 value, a >2% increase in sputum eosinophils, or both of these outcomes. Conclusions These data indicate that a substantial proportion of workers who experience asthma symptoms related to cleaning materials show a pattern of bronchial reaction consistent with sensitiser-induced occupational asthma. The

Determinants of asthma phenotypes in supermarket bakery workers.

PubMed

Baatjies, R; Lopata, A L; Sander, I; Raulf-Heimsoth, M; Bateman, E D; Meijster, T; Heederik, D; Robins, T G; Jeebhay, M F

2009-10-01

While baker's asthma has been well described, various asthma phenotypes in bakery workers have yet to be characterised. Our study aims to describe the asthma phenotypes in supermarket bakery workers in relation to host risk factors and self-reported exposure to flour dust. A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, skin prick tests, and specific immunoglobulin E to wheat, rye and fungal alpha-amylase and methacholine challenge testing. The prevalence of probable occupational asthma (OA, 13%) was higher than atopic (6%), nonatopic (6%) and work-aggravated asthma (WAA, 3%) phenotypes. Previous episodes of high exposure to dusts, fumes and vapours causing asthma symptoms were more strongly associated with WAA (OR 5.8, 95% CI 1.7-19.2) than OA (2.8, 1.4-5.5). Work-related ocular-nasal symptoms were significantly associated with WAA (4.3, 1.3-13.8) and OA (3.1, 1.8-5.5). Bakers with OA had an increased odds ratio of reporting adverse reactions to ingested grain products (6.4, 2.0-19.8). OA is the most common phenotype among supermarket bakery workers. Analysis of risk factors contributes to defining clinical phenotypes, which will guide ongoing medical surveillance and clinical management of bakery workers.

Presence of Headache and Migraine in Asthma Patients.

PubMed

Turan, Muzaffer Onur; Susuz, Çiğdem Çelik; Turan, Pakize Ayşe

2017-04-01

Migraine is a diseases characterized with severe headaches, with neurological and systemic findings. The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders, parental history and migraine in asthma patients. A total of 288 asthma outpatients, who had the diagnosis by an early or late test of reversibility showing a reversible airway obstruction according to hospital database were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department and investigated about the presence of migraine. The diagnosis of migraine headache was made if patients fulfilled the International Headache Society (IHS) criteria. 60.4% of patients described a headache. There were 94 patients (32.6%) with headaches meeting the IHS criteria for migraine. Only 12 patients had migraine with aura. There were atopic symptoms in 86.8% of patients. According to parental history, there were asthma in 47.9%, atopic symptoms in 39.6% and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headaches (65.3%) "p=0.007". The prevalence of migraine was significantly high in patients with parental atopic symptoms (54%) "p=0.002". Multiple logistic regression analysis identified that gender, parental history of asthma, allergia and migraine, and smoking were independent risk factors for presence of migraine in asthmatics. There is a high prevalence of migraine headaches in patients with asthma. The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism; parental history, common genetic compounds and smoking may play role in this mechanism. The headaches in asthma patients, atopic symptoms and family history should be questioned, and clinicians should be careful about the presence of migraine.

Effect of early life exposure to air pollution on development of childhood asthma.

PubMed

Clark, Nina Annika; Demers, Paul A; Karr, Catherine J; Koehoorn, Mieke; Lencar, Cornel; Tamburic, Lillian; Brauer, Michael

2010-02-01

There is increasing recognition of the importance of early environmental exposures in the development of childhood asthma. Outdoor air pollution is a recognized asthma trigger, but it is unclear whether exposure influences incident disease. We investigated the effect of exposure to ambient air pollution in utero and during the first year of life on risk of subsequent asthma diagnosis in a population-based nested case-control study. We assessed all children born in southwestern British Columbia in 1999 and 2000 (n = 37,401) for incidence of asthma diagnosis up to 34 years of age using outpatient and hospitalization records. Asthma cases were age- and sex-matched to five randomly chosen controls from the eligible cohort. We estimated each individual's exposure to ambient air pollution for the gestational period and first year of life using high-resolution pollution surfaces derived from regulatory monitoring data as well as land use regression models adjusted for temporal variation. We used logistic regression analyses to estimate effects of carbon monoxide, nitric oxide, nitrogen dioxide, particulate matter asthma diagnosis. A total of 3,482 children (9%) were classified as asthma cases. We observed a statistically significantly increased risk of asthma diagnosis with increased early life exposure to CO, NO, NO2, PM10, SO2, and black carbon and proximity to point sources. Traffic-related pollutants were associated with the highest risks: adjusted odds ratio = 1.08 (95% confidence interval, 1.041.12) for a 10-microg/m3 increase of NO, 1.12 (1.071.17) for a 10-microg/m3 increase in NO2, and 1.10 (1.061.13) for a 100-microg/m3 increase in CO. These data support the hypothesis that early childhood exposure to air pollutants plays a role in development of asthma.

A descriptive study of work aggravated asthma.

PubMed

Goe, S K; Henneberger, P K; Reilly, M J; Rosenman, K D; Schill, D P; Valiante, D; Flattery, J; Harrison, R; Reinisch, F; Tumpowsky, C; Filios, M S

2004-06-01

Work related asthma (WRA) is one of the most frequently reported occupational lung diseases in a number of industrialised countries. A better understanding of work aggravated asthma (WAA), as well as work related new onset asthma (NOA), is needed to aid in prevention efforts. WAA and NOA in the United States were compared using cases reported to the National Institute for Occupational Safety and Health (NIOSH) from four state Sentinel Event Notification Systems for Occupational Risks (SENSOR) surveillance programmes for 1993-95. A total of 210 WAA cases and 891 NOA cases were reported. WAA cases reported mineral and inorganic dusts as the most common exposure agent, as opposed to NOA cases, in which diisocyanates were reported most frequently. A similar percentage of WAA and NOA cases still experienced breathing problems at the time of the interview or had visited a hospital or emergency room for work related breathing problems. NOA cases were twice as likely to have applied for workers' compensation compared with WAA cases. However, among those who had applied for worker compensation, approximately three-fourths of both WAA and NOA cases had received awards. The services and manufacturing industrial categories together accounted for the majority of both WAA (62%) and NOA (75%) cases. The risk of WAA, measured by average annual rate, was clearly the highest in the public administration (14.2 cases/10(5)) industrial category, while the risk of NOA was increased in both the manufacturing (3.2 cases/10(5)) and public administration (2.9 cases/10(5)) categories. WAA cases reported many of the same adverse consequences as NOA cases. Certain industries were identified as potential targets for prevention efforts based on either the number of cases or the risk of WAA and NOA.

A telehealth system for automated diagnosis of asthma and chronical obstructive pulmonary disease.

PubMed

Gurbeta, Lejla; Badnjevic, Almir; Maksimovic, Mirjana; Omanovic-Miklicanin, Enisa; Sejdic, Ervin

2018-05-18

This paper presents the development and real-time testing of an automated expert diagnostic telehealth system for the diagnosis of 2 respiratory diseases, asthma and Chronic Obstructive Pulmonary Disease (COPD). The system utilizes Android, Java, MATLAB, and PHP technologies and consists of a spirometer, mobile application, and expert diagnostic system. To evaluate the effectiveness of the system, a prospective study was carried out in 3 remote primary healthcare institutions, and one hospital in Bosnia and Herzegovina healthcare system. During 6 months, 780 patients were assessed and diagnosed with an accuracy of 97.32%. The presented approach is simple to use and offers specialized consultations for patients in remote, rural, and isolated communities, as well as old and less physically mobile patients. While improving the quality of care delivered to patients, it was also found to be very beneficial in terms of healthcare.

Determinants and impact of suboptimal asthma control in Europe: The INTERNATIONAL CROSS-SECTIONAL AND LONGITUDINAL ASSESSMENT ON ASTHMA CONTROL (LIAISON) study.

PubMed

Braido, Fulvio; Brusselle, Guy; Guastalla, Daniele; Ingrassia, Eleonora; Nicolini, Gabriele; Price, David; Roche, Nicolas; Soriano, Joan B; Worth, Heinrich

2016-05-14

According to the Global Initiative of Asthma, the aim of asthma treatment is to gain and maintain control. In the INTERNATIONAL CROSS-SECTIONAL AND LONGITUDINAL ASSESSMENT ON ASTHMA CONTROL (LIAISON) study, we evaluated the level of asthma control and quality of life (QoL), as well as their determinants and impact in a population consulting specialist settings. LIAISON is a prospective, multicentre, observational study with a cross-sectional and a 12-month longitudinal phase. Adults with an asthma diagnosis since at least 6 months, receiving the same asthma treatment in the 4 weeks before enrolment were included. Asthma control was assessed with the 6-item Asthma Control Questionnaire (ACQ) and QoL with the MiniAsthma Quality of Life Questionnaire (MiniAQLQ). Overall, 8111 asthmatic patients were enrolled in 12 European countries. Asthma control was suboptimal in 56.5 % of patients and it was associated with poorer asthma-related QoL, higher risk of exacerbations and greater consumption of healthcare resources. Variables associated with suboptimal control were age, gender, obesity, smoking and comorbidities. Major determinants of poor asthma control were seasonal worsening and persisting exposure to allergens/irritants/triggers, followed by treatment-related issues. The cross-sectional phase results confirm that suboptimal control is frequent and has a high individual and economic impact. The clinicaltrials.gov identifier is NCT01567280 .

Results of an asthma disease management program in an urban pediatric community clinic.

PubMed

Newcomb, Patricia

2006-07-01

Asthma is increasing in incidence, but adherence to national diagnosis and treatment guidelines is poor. The Children's Asthma Management Program (CHAMP) was designed and implemented by nurse practitioners to address the problem of inconsistent asthma management. This is an outcome-based evaluation of a novel asthma management program in which practitioners created a structured mechanism for implementing national evidence-based asthma treatment guidelines. Children who completed the program experienced an 85% decrease in hospitalizations for asthma, 87% decrease in emergency room visits for asthma, and 71% decrease in acute office visits for asthma exacerbations. Patients may benefit from microsystem structures intentionally designed to facilitate implementation of evidence-based guidelines.

The combined diagnosis of allergic and irritant contact dermatitis in a retrospective cohort of 1000 consecutive patients with occupational contact dermatitis.

PubMed

Schwensen, Jakob F; Menné, Torkil; Johansen, Jeanne D

2014-12-01

The diagnosis of combined allergic and irritant contact dermatitis is an accepted subdiagnosis for hand dermatitis, and it is often considered in a patient with contact dermatitis, a positive and relevant patch test result, and wet work exposure. We therefore hypothesize that it is arbitrary for wet work exposure to be taken into consideration in a patient with newly diagnosed relevant contact allergy. Furthermore, an overestimation of the diagnosis will probably occur if the criteria for wet work exposure are applied correctly, as many occupations have an element of wet work. To find the statistically expected number of combined allergic and irritant contact dermatitis cases in 1000 patients, and to evaluate the diagnostic criteria for the diagnosis. One thousand consecutive patients with occupational contact dermatitis from a hospital unit in Denmark were assessed. The expected number of cases with the diagnosis of combined allergic and irritant contact dermatitis was 0.33%, as compared with the observed number of 6.4%. Females occupied in wet occupations were often diagnosed with combined allergic and irritant contact dermatitis (p < 0.005). The diagnosis of combined allergic and irritant contact dermatitis should be used critically to avoid misclassification, and possible criteria for the diagnosis are proposed. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome: Doubled Costs Compared with Patients with Asthma Alone.

PubMed

Gerhardsson de Verdier, Maria; Andersson, Maria; Kern, David M; Zhou, Siting; Tunceli, Ozgur

2015-09-01

Patients with asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) have more rapid disease progression and more exacerbations than do those with either condition alone. Little research has been performed, however, in these patients. The objective was to summarize the health care utilization, costs, and comorbidities of patients with uncontrolled asthma and patients with ACOS. This retrospective analysis used medical and pharmacy claims from large commercial health plans. The study included patients 6 years or older with a diagnosis of asthma and one or more asthma exacerbation (index event). Patients were classified as having asthma alone or ACOS, and the two groups were matched for age, sex, region, index year, index month, and health plan type. Outcomes included rates of comorbid disease, health care utilization, and costs during the 12 months before and after the index exacerbation. Among the matched patients with asthma (6,505 ACOS; 26,060 without COPD), mean annual all-cause health care costs were twice as high as for patients with ACOS ($22,393 vs. $11,716; P < 0.0001). Asthma-related costs, representing 29% of total costs, were nearly twice as high among patients with ACOS ($6,319 vs. 3,356; P < 0.0001). Cost differences were driven by large differences in the proportions of patients with an inpatient hospitalization (34.0% vs. 14.6%; P < 0.0001) or emergency department visit (29.6% vs. 19.9%; P < 0.0001). Nearly all prespecified comorbid conditions were more prevalent in the ACOS group. Patients with asthma and COPD had nearly double the health care costs as did patients with asthma without COPD. The overall disease profile of patients with asthma should be considered when managing patients, rather than treating asthma as a solitary condition. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[National Disease Management Guideline for Asthma: recommendations and evidence for "asthma prevention" issues].

PubMed

Berdel, Dietrich; Buhl, Roland; Dierkesmann, Rainer; Niebling, Wilhelm; Schultz, Konrad; Ukena, Dieter; Worth, Heinrich; von Wichert, Peter; Ollenschläger, Günter; Kopp, Ina

2006-01-01

The National Disease Management Program (NDM Program) represents the basic content of structured, cross-sectoral healthcare. In particular, the NDM Program is directed towards coordinating different disciplines and areas of healthcare. The recommendations are developed through interdisciplinary consensus of the scientific medical societies on the basis of the best available evidence. Within this scope the scientific medical societies concerned with the prevention, diagnosis, therapy and rehabilitation of asthma consented upon a National Disease Management Guideline for Asthma in 2005. Among other things, the following cornerstones of asthma prevention were agreed upon: Breastfeeding and non-smoking were suggested as primary prevention measures for (expectant) parents. With respect to secondary prevention, recommendations have been made for allergen avoidance, active/passive smoking and immunotherapy. Regarding tertiary prevention, position statements on vaccination and specific immunotherapy are developed. The present paper presents both the original texts of the recommendations and the evidence underlying them.

The GINA asthma strategy report: what's new for primary care?

PubMed

Reddel, Helen K; Levy, Mark L

2015-07-30

The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and National Heart Lung and Blood Institute to develop a global strategy for managing and preventing asthma. GINA reports, now funded independently through the sale of GINA products, have provided the foundation for many national guidelines. They are prepared by international experts from primary, secondary and tertiary care, and are annually updated following a review of evidence. In 2014, a major revision of the GINA report was published, that took into account advances in evidence not only about asthma and its treatment, but also about how to improve implementation of evidence-based recommendations in clinical practice. This paper summarises key changes relevant to primary care in the new GINA report. A noticeable difference is the report's radically different approach, now clinically-focussed, with multiple practical tools and flow charts to improve its utility for busy frontline clinicians. Key changes in recommendations include a new, diagnosis-centred definition of asthma; more detail about how to assess current symptom control and future risk; a comprehensive approach to tailoring treatment for individual patients; expanded indications for commencing inhaled corticosteroids; new recommendations for written asthma action plans; a new chapter on diagnosis and initial treatment of patients with asthma-COPD overlap syndrome; and a revised approach to diagnosing asthma in preschool children. The 2014 GINA report (further updated in 2015) moved away from a 'textbook' approach to provide clinicians with up-to-date evidence about strategies to control symptoms and minimise asthma risk, in a practical, practice-centred format.

Cough during infancy and subsequent childhood asthma.

PubMed

Oren, E; Rothers, J; Stern, D A; Morgan, W J; Halonen, M; Wright, A L

2015-09-01

Wheezing in infancy has been associated with subsequent asthma, but whether cough similarly influences asthma risk has been little studied. We sought to determine whether prolonged cough and cough without cold in the first year of life are associated with childhood asthma. Participants in the Infant Immune Study, a non-selected birth cohort, were surveyed 7 times in the first 9 months of life regarding the presence of wheeze and cough. Cough for more than 28 days was defined as prolonged. Parents were asked at 1 year if the child ever coughed without a cold. Asthma was defined as parental report of physician diagnosis of asthma, with symptoms or medication use between 2 and 9 years. Logistic regression was used to assess adjusted odds for asthma associated with cough characteristics. A total of 24% (97) of children experienced prolonged cough and 23% (95) cough without cold in the first 9 months, respectively. Prolonged cough was associated with increased risk of asthma relative to brief cough (OR 3.57, CI: 1.88, 6.76), with the risk being particularly high among children of asthmatic mothers. Cough without cold (OR 3.13, 95% CI: 1.76, 5.57) was also independently associated with risk of childhood asthma. Both relations persisted after adjustment for wheeze and total IgE at age 1. Prolonged cough in infancy and cough without cold are associated with childhood asthma, independent of infant wheeze. These findings suggest that characteristics of cough in infancy are early markers of asthma susceptibility, particularly among children with maternal asthma. © 2015 John Wiley & Sons Ltd.

Cough During Infancy and Subsequent Childhood Asthma

PubMed Central

Oren, Eyal; Rothers, Janet; Stern, Debra A.; Morgan, Wayne J.; Halonen, Marilyn; Wright, Anne L.

2015-01-01

OBJECTIVES Wheezing in infancy has been associated with subsequent asthma, but whether cough similarly influences asthma risk has been little studied. We sought to determine whether prolonged cough and cough without cold in the first year of life are associated with childhood asthma. METHODS Participants in the Infant Immune Study, a non-selected birth cohort, were surveyed 7 times in the first 9 months of life regarding presence of wheeze and cough. Cough for more than 28 days was defined as prolonged. Parents were asked at 1 year if the child ever coughed without a cold. Asthma was defined as parental report of physician diagnosis of asthma, with symptoms or medication use between 2–9 years. Logistic regression was used to assess adjusted odds for asthma associated with cough characteristics. RESULTS 24% (97) of children experienced prolonged cough and 23% (95) cough without cold in the first 9 months, respectively. Prolonged cough was associated with increased risk of asthma relative to brief cough (OR 3.57, CI: 1.88, 6.76), with the risk being particularly high among children of asthmatic mothers. Cough without cold (OR 3.13, 95% CI: 1.76, 5.57) was also independently associated with risk of childhood asthma. Both relations persisted after adjustment for wheeze and total IgE at age 1. CONCLUSIONS AND CLINICAL RELEVANCE Prolonged cough in infancy and cough without cold are associated with childhood asthma, independent of infant wheeze. These findings suggest that characteristics of cough in infancy are early markers of asthma susceptibility, particularly among children with maternal asthma. PMID:26011047

Screening for asthma in Cantonese-speaking immigrant children

PubMed Central

Greenfield, Robyn O; Lee, Angela C; Tang, Roland; Brugge, Doug

2005-01-01

Background Asthma prevalence among Chinese immigrant children is poorly understood and attempts to screen these children have produced varied outcomes. We sought to learn how to improve screening for asthma in Chinese immigrant children. Methods Children (n = 152) were administered the Brief Pediatric Asthma Screen in either Cantonese or English, they then viewed and reacted to a video showing people wheezing and subsequently took a pulmonary function test. Results The diagnosed asthma prevalence for our study population was 27.0%, with another 5.3% having possible undiagnosed asthma. Very few children had spirometry findings below normal. In multivariate analysis, being native born (p = 0.002) and having a family history of asthma (p = 0.003) were statistically associated with diagnosis of asthma. After viewing the video, 35.6% of respondents indicated that the images differed from their conception of wheezing. Of four translations of the word "wheeze" no single word was chosen by a majority. Conclusion Our findings suggest that asthma diagnoses are higher for Chinese children who were born in the US suggesting that desegregation of data might reveal at risk subpopulations. Care needs to be taken when diagnosing asthma for Cantonese speakers because of the centrality of the word wheeze and the challenges of translation. PMID:15904513

Screening for asthma in Cantonese-speaking immigrant children.

PubMed

Greenfield, Robyn O; Lee, Angela C; Tang, Roland; Brugge, Doug

2005-05-17

Asthma prevalence among Chinese immigrant children is poorly understood and attempts to screen these children have produced varied outcomes. We sought to learn how to improve screening for asthma in Chinese immigrant children. Children (n = 152) were administered the Brief Pediatric Asthma Screen in either Cantonese or English, they then viewed and reacted to a video showing people wheezing and subsequently took a pulmonary function test. The diagnosed asthma prevalence for our study population was 27.0%, with another 5.3% having possible undiagnosed asthma. Very few children had spirometry findings below normal. In multivariate analysis, being native born (p = 0.002) and having a family history of asthma (p = 0.003) were statistically associated with diagnosis of asthma. After viewing the video, 35.6% of respondents indicated that the images differed from their conception of wheezing. Of four translations of the word "wheeze" no single word was chosen by a majority. Our findings suggest that asthma diagnoses are higher for Chinese children who were born in the US suggesting that desegregation of data might reveal at risk subpopulations. Care needs to be taken when diagnosing asthma for Cantonese speakers because of the centrality of the word wheeze and the challenges of translation.

An algorithmic approach for the treatment of severe uncontrolled asthma

PubMed Central

Zervas, Eleftherios; Samitas, Konstantinos; Papaioannou, Andriana I.; Bakakos, Petros; Loukides, Stelios; Gaga, Mina

2018-01-01

A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers. The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options. PMID:29531957

Challenges in the management of exercise-induced asthma.

PubMed

Storms, William

2009-05-01

Exercise and physical activity are common triggers of symptoms in patients with asthma, although some individuals - especially athletes - may have symptoms with exercise alone. Exercise-induced bronchospasm (EIB) describes airway hyper-reactivity that is observed following exercise in a patient who is not otherwise diagnosed with asthma; exercise-induced asthma (EIA) describes airway hyper-reactivity associated with exercise in a patient who has persistent asthma. Specific challenges affecting both the diagnosis and treatment of these conditions are discussed in this review. The past decade has seen substantial advances in our understanding of EIA and EIB, including new guidelines on their management. With appropriate therapy, all patients with exercise-related symptoms should be able to reach their desired level of performance.

The relationship between the Leicester cough questionnaire, eosinophilic airway inflammation and asthma patient related outcomes in severe adult asthma.

PubMed

Natarajan, Sushiladevi; Free, Robert C; Bradding, Peter; McGarvey, Lorcan; Siddiqui, Salman

2017-03-04

Severe asthma is characterised by a variety of symptoms, which include chronic cough, however the mechanisms responsible for cough reflex hypersensitivity in asthma remain poorly elucidated. Current asthma patient-related outcome instruments such as the six-point Juniper Asthma Control Score (ACQ-6) and Asthma Quality of Life Questionnaire (AQLQ) were not primarily designed to capture cough and its related morbidity in asthma. The Leicester Cough Questionnaire (LCQ) is a patient-related outcome instrument designed to capture the health-related quality of life associated with cough. To date the LCQ has not been evaluated in a severe asthma population. We evaluated 262 extensively characterised adult patients with severe asthma attending the Leicester Severe Asthma Service. All patients had a clinician diagnosis of asthma and objective physiological evidence and met the ATS/ERS criterion for servere asthma. In all patients we evaluated a) the LCQ distribution and b) the relationships between the LCQ and ACQ-6, AQLQ, airway inflammation in sputum. The LCQ demonstrated the following properties; mean: 15.0, standard deviation: 4.54, median: 15.48, and range: 11.6-19.2. We found a moderate correlation between LCQ and ACQ-6 (r = - 0.605, p < 0.0001) and a LCQ and AQLQ (r = 0.710, p < 0.0001). There was no relationship between LCQ and log 10 sputum percentage eosinophils (%). A proportion of patients with severe asthma have a significant degree of cough-related morbidity that appears independent of eosinophilic airway inflammation and is not captured fully by existing asthma patient-reported outcome instruments. Our preliminary findings suggest that further research is now required to validate the LCQ and its responsiveness in severe asthma populations to capture cough-related morbidity and response to specific interventions.

[Increasing prevalence of asthma in school children--ISAAC study (International Study of Asthma and Allergies in Children)].

PubMed

Lis, Grzegorz; Breborowicz, Anna; Cichocka-Jarosz, Ewa; Swiatły, Aleksandra; Głodzik, Izabela; Gazurek, Dorota; Sobkowiak, Paulina; Alkiewicz, Jerzy; Pietrzyk, Jacek J

2003-01-01

The aim of the study was to assess changes in asthma prevalence between 1994/1995 (study I) and 2001/2002 (study II). Standardized ISAAC questionnaire was used. Randomly assigned population of school children 6-7 and 13-14 yrs of age was surveyed in Kraków and Poznań. The prevalence of wheezing ever increased significantly in group 6-7 yrs of age from 25.5% to 28.6% in Krakow and from 17.3% to 27.6% in Poznań, respectively in study I and study II. The similar rise was found in group 13-14 yrs of age in Krakow from 14.6% to 21.6%, in Poznań from 17.1% to 22.2%. In both age groups and in both centers the number of children with established asthma diagnosis increased: in group 6-7 yrs of age in Krakow from 4.0% to 5.8%, in Poznań from 1.3% to 5.9%; in group 13-14 yrs of age in Krakow from 2.3% to 6.8%, in Poznań from 2.0% to 5.2%. Analysis of current symptoms (in the last year) confirmed increasing prevalence of wheezing, wheezing after exercise and night cough in Poznań in both age group, in Krakow only in older children. In younger children in Kraków significant difference concerned only wheezing after exercise. The most frequent symptom reported by children was nocturnal cough in the last year. The prevalence of the asthma symptoms and established asthma diagnosis increased during last 7 years. However significant number of children presenting asthma symptoms remains still underdiagnosed.

Occupational asthma after exposure to azodicarbonamide: report of four cases.

PubMed Central

Normand, J C; Grange, F; Hernandez, C; Ganay, A; Davezies, P; Bergeret, A; Prost, G

1989-01-01

Azodicarbonamide (Chemical Abstract Service Registry No 123.77.3) is an organic low molecular weight agent used for blowing and foaming plastics. Finely ground azodicarbonamide can be a pulmonary and sometimes a cutaneous acute sensitiser. Four cases of work related asthma are reported. PMID:2920144

Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012.

PubMed

Stocks, S Jill; McNamee, Roseanne; van der Molen, Henk F; Paris, Christophe; Urban, Pavel; Campo, Giuseppe; Sauni, Riitta; Martínez Jarreta, Begoña; Valenty, Madeleine; Godderis, Lode; Miedinger, David; Jacquetin, Pascal; Gravseth, Hans M; Bonneterre, Vincent; Telle-Lamberton, Maylis; Bensefa-Colas, Lynda; Faye, Serge; Mylle, Godewina; Wannag, Axel; Samant, Yogindra; Pal, Teake; Scholz-Odermatt, Stefan; Papale, Adriano; Schouteden, Martijn; Colosio, Claudio; Mattioli, Stefano; Agius, Raymond

2015-04-01

The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Smoke-free legislation and hospitalizations for childhood asthma.

PubMed

Mackay, Daniel; Haw, Sally; Ayres, Jon G; Fischbacher, Colin; Pell, Jill P

2010-09-16

Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental tobacco smoke. The aim of our study was to determine whether the ban on smoking in public places in Scotland, which was initiated in March 2006, influenced the rate of hospital admissions for childhood asthma. Routine hospital administrative data were used to identify all hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. A negative binomial regression model was fitted, with adjustment for age group, sex, quintile of socioeconomic status, urban or rural residence, month, and year. Tests for interactions were also performed. Before the legislation was implemented, admissions for asthma were increasing at a mean rate of 5.2% per year (95% confidence interval [CI], 3.9 to 6.6). After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children. There were no significant interactions between hospital admissions for asthma and age group, sex, urban or rural residence, region, or quintile of socioeconomic status. In Scotland, passage of smoke-free legislation in 2006 was associated with a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke. (Funded by NHS Health Scotland.)

RANDOMISED ASPIRIN ASSIGNMENT AND RISK OF ADULT-ONSET ASTHMA IN THE WOMEN'S HEALTH STUDY

PubMed Central

Kurth, Tobias; Barr, R. Graham; Gaziano, J. Michael; Buring, Julie E.

2008-01-01

Rationale Randomised data in men showed a small but significant reduction in risk of adult-onset asthma among those assigned to aspirin. Results from an observational study in women suggest that frequent use of aspirin decreased the risk of adult-onset asthma. Randomised data in women are lacking. Objective To test the effect of 100 mg of aspirin on alternate days or placebo on the risk of adult-onset asthma in the Women's Health Study. Methods Post-hoc analyses from a randomised, double-blind, placebo-controlled clinical trial of aspirin and vitamin E in apparently healthy US women with no indication or contraindication to aspirin therapy and free of a history of asthma at study entry. Measurements Female health professionals could self-report an asthma diagnosis on yearly questionnaires. Results Among 37,270 women without reported history of asthma prior to randomisation and during 10 years of follow-up, there were 872 new reports of asthma diagnosis in the aspirin group and 963 in the placebo group (hazard ratio=0.90; 95% confidence interval=0.82−0.99; P=0.027). This apparent 10% lower relative risk of incident adult-onset asthma among those assigned to aspirin was significantly modified by body mass index, indicating no effect among women with a body mass index of ≥30 kg/m2. There was no significant effect modification by age, smoking status, exercise levels, postmenopausal hormone use, or randomised vitamin E assignment. Conclusions In this large, randomised clinical trial of apparently healthy adult women, assignment of 100 mg of aspirin on alternate days reduced the relative risk of newly reported diagnosis of asthma. PMID:18339679

The asthma knowledge and perceptions of older Australian adults: implications for social marketing campaigns.

PubMed

Evers, Uwana; Jones, Sandra C; Caputi, Peter; Iverson, Don

2013-06-01

The purpose of this research is to gain an understanding of the asthma perceptions of older adults and identify gaps in their asthma knowledge. In regional New South Wales, Australia, a stratified, random sample of 4066 adults, aged 55 years and over, both with and without an asthma diagnosis, completed a survey based on the Health Belief Model about asthma knowledge and perceptions. Almost half of the sample had experienced symptoms of breathlessness in the past four weeks. Breathlessness was a predictor of lower health ratings and poorer mood. Older adults reported low susceptibility to developing asthma. The sample demonstrated poor knowledge of key asthma symptoms including shortness of breath, tightness in the chest and a cough at night. There is a general lack of asthma awareness in this age group. This could result in not seeking medical help, and thus a reduced quality of life. Older adults should be made aware of key symptoms and the prevalence of asthma in the older adult population, and be empowered to take control of their respiratory health. Audience segmentation for an intervention should be based on recent experience of breathlessness and asthma diagnosis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The relationship between migraine headache and asthma features.

PubMed

Dirican, Nigar; Demirci, Seden; Cakir, Munire

2017-06-01

Migraine and asthma are comorbid chronic disorders with episodic attacks thought to involve inflammatory and neurological mechanisms. The objective of the present study is to investigate the relationship of asthma features between the asthma patients with migraine and those without migraine headache. A cross-sectional study was conducted from October 2015 to June 2016. Physician-diagnosed asthma patients aged 18 years and above were included. Demographic data, pulmonary function test and treatment of asthma were recorded. Asthma control was assessed using the asthma control test (ACT) and asthma control questionnaire (ACQ). The diagnosis of migraine was made by the neurologist with face-to face examinations based on the International Classification of Headache Disorders, third edition beta (ICHD-III-beta) criteria. Data about the age at onset, frequency of headache attacks, duration of headache attack, the presence of aura, and severity of headache were recorded. The severity of headache was evaluated using visual analogue scale (VAS). Overall 121 asthma patients were included in this study. Migraine was found to be present in 32 (26.4%) of patients. No statistically significant difference was found between asthma group and asthma with migraine groups in terms of pulmonary function test parameters. The mean ACT score in asthma with migraine patients group was significantly lower than the asthma groups. Morever, in the group asthma with migraine, a negative significant correlations were found between ACT scores with VAS scores. This study demonstrates that migraine headache may be associated with poor asthma control. On the other hand, it should not be forgotten that ACT is a subjective test and can be affected from by many clinical parameters.

A descriptive analysis of asthma in the U.S. Navy Submarine Force.

PubMed

Sims, J R; Tibbles, P M; Jackman, R P

1999-12-01

The U.S. Navy Submarine Force offers a unique opportunity to study asthma because of the relative socioeconomic and physical homogeneity of the population and the closed environment occupational exposure. Currently, asthma is disqualifying from submarine service, which results in a significant loss of experienced personnel. We performed a retrospective analysis of 119 U.S. Navy submariner disqualification packages for asthma between 1989-1993. We found a 0.16% annual period prevalence of asthma in the active duty enlisted Atlantic Fleet Submarine Force. Two groups of asthma disqualifications were identified with a significant increase above their proportional representation in the fleet: enlisted personnel (p < 0.01) and submarine recruits (p < 0.0001). The proportion of African-American personnel also had a tendency toward increased asthma disqualification (p < 0.08). There were no differences in prevalence of asthma between crews of ballistic missile submarines or fast attack submarines. Asthma risk factors reported in the civilian literature (childhood history of asthma, family history of asthma and non-drug allergies) were highly represented in our study (41%, 46% and 68% of submariners, respectively). Most disqualified submariners had "mild" asthma based on the diagnostic work-up. The methacholine challenge test appeared to carry a disproportionate diagnostic weight despite its low specificity. Although the period prevalence of asthma is low in the U.S. Navy Submarine Force, submariners disqualified for asthma have similar historical and ethnic risk factors as the civilian population.

Air pollution and asthma severity in adults

PubMed Central

Rage, Estelle; Siroux, Valérie; Künzli, Nino; Pin, Isabelle; Kauffmann, Francine

2009-01-01

Objectives There is evidence that exposure to air pollution affects asthma, but the effect of air pollution on asthma severity has not been addressed. The aim was to assess the relation between asthma severity during the past 12 months and home outdoor concentrations of air pollution. Methods Asthma severity over the last 12 months was assessed in two complementary ways among 328 adult asthmatics from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) examined between 1991 and 1995. The 4-class severity score integrated clinical events and type of treatment. The 5-level asthma score is based only on the occurrence of symptoms. Nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) concentrations were assigned to each residence using two different methods. The first was based on the closest monitor data from 1991–1995. The second consisted in spatial models that used geostatistical interpolations and then assigned air pollutants to the geo-coded residences (1998). Results Higher asthma severity score was significantly related to the 8-hour average of ozone during April-September (O3-8hr) and the number of days (O3-days) with 8-hour ozone averages above 110 μg.m−3 (for a 36-day increase, equivalent to the inter quartile range, in O3-days, odds ratio (95% confidence interval) 2.22 (1.61–3.07) for one class difference in score). Adjustment for age, sex, smoking habits, occupational exposure, and educational level did not alter results. Asthma severity was unrelated to NO2. Both exposure assessment methods and severity scores resulted in very similar findings. SO2 correlated with severity but reached statistical significance only for the model based assignment of exposure. Conclusions The observed associations between asthma severity and air pollution, in particular O3, support the hypothesis that air pollution at levels far below current standards increases asthma severity. PMID:19017701

New-onset asthma after exposure to the steam system additive 2-diethylaminoethanol. A descriptive study.

PubMed

Gadon, M E; Melius, J M; McDonald, G J; Orgel, D

1994-06-01

Through a leak in the steam heating system, the anticorrosive agent 2-diethylaminoethanol was released into the air of a large office building. Irritative symptoms were experienced by most of the 2500 employees, and 14 workers developed asthma within 3 months of exposure. This study was undertaken to review clinical characteristics of these asthmatics. Environmental exposure monitoring data and medical records were reviewed. Seven of 14 cases were defined as "confirmed" and 7 of 14 as "suspect," using the National Institute for Occupational Safety and Health surveillance case definition of occupational asthma. Spirometry was positive in 4 of 14 of the cases and peak flow testing in 10 of 14. Three cases were diagnosed on the basis of work-related symptoms and physical examination alone. The study suggests that acute exposure to the irritating steam additive 2-diethylaminoethanol was a contributing factor in the development of clinical asthma in this population.

Association between asthma and family size between 1977 and 1994.

PubMed

Rona, R J; Hughes, J M; Chinn, S

1999-01-01

Several recent reports show a negative association between asthma and family size or birth order, but this association was not detected in data collected between 10 and 30 years ago. This study compared the association between sibship size and asthma in three surveys using the same methodology in 1977, 1985/86, and 1993/94. Cross sectional comparison of the 1977, 1985/86, and 1993/94 surveys. Study areas in England and Scotland. Parents of children between 5 to 11 years in England and Scotland were asked about asthma and bronchitis attacks in the last 12 months, and wheeze in their child. Approximately 9000 children participated in each of the surveys. The overall association between asthma, defined as asthma attacks or wheeze, and total number of siblings was not significant (p = 0.22), but an only child had a higher prevalence of asthma than children with siblings (OR 0.87 95% CI 0.76 to 0.98). The interaction between year of survey and sibship size on asthma was not significant (p = 0.36). There was no association between asthma and birth order. A significant interaction between social class and year of survey on asthma was detected (p = 0.004). In the 1993/94 survey children whose fathers had a semi or unskilled manual occupation had a higher prevalence of asthma (16%) than children whose fathers belonged to other social classes (13%). This study provides only marginal support for a change over time of the association between sibship size and asthma. Based on recent reports the nature of the exposure agent that may explain the association remains controversial. This study suggests a disproportionate increase of asthma in lower social classes.

The association between gastro-oesophageal reflux disease and asthma: a systematic review.

PubMed

Havemann, B D; Henderson, C A; El-Serag, H B

2007-12-01

Gastro-oesophageal reflux disease (GORD) has been linked to a number of extra-esophageal symptoms and disorders, primarily in the respiratory tract. This systematic review aimed to provide an estimate of the strength and direction of the association between GORD and asthma. Studies that assessed the prevalence or incidence of GORD in individuals with asthma, or of asthma in individuals with GORD, were identified in Medline and EMBASE via a systematic search strategy. Twenty-eight studies met the selection criteria. The sample size weighted average prevalence of GORD symptoms in asthma patients was 59.2%, whereas in controls it was 38.1%. In patients with asthma, the average prevalence of abnormal oesophageal pH, oesophagitis and hiatal hernia was 50.9%, 37.3% and 51.2%, respectively. The average prevalence of asthma in individuals with GORD was 4.6%, whereas in controls it was 3.9%. Pooling the odds ratios gave an overall ratio of 5.5 (95% CI 1.9-15.8) for studies reporting the prevalence of GORD symptoms in individuals with asthma, and 2.3 (95% CI 1.8-2.8) for those studies measuring the prevalence of asthma in GORD. One longitudinal study showed a significant association between a diagnosis of asthma and a subsequent diagnosis of GORD (relative risk 1.5; 95% CI 1.2-1.8), whereas the two studies that assessed whether GORD precedes asthma gave inconsistent results. The severity-response relationship was examined in only nine studies, with inconsistent findings. This systematic review indicates that there is a significant association between GORD and asthma, but a paucity of data on the direction of causality.

Work, obesity, and occupational safety and health.

PubMed

Schulte, Paul A; Wagner, Gregory R; Ostry, Aleck; Blanciforti, Laura A; Cutlip, Robert G; Krajnak, Kristine M; Luster, Michael; Munson, Albert E; O'Callaghan, James P; Parks, Christine G; Simeonova, Petia P; Miller, Diane B

2007-03-01

There is increasing evidence that obesity and overweight may be related, in part, to adverse work conditions. In particular, the risk of obesity may increase in high-demand, low-control work environments, and for those who work long hours. In addition, obesity may modify the risk for vibration-induced injury and certain occupational musculoskeletal disorders. We hypothesized that obesity may also be a co-risk factor for the development of occupational asthma and cardiovascular disease that and it may modify the worker's response to occupational stress, immune response to chemical exposures, and risk of disease from occupational neurotoxins. We developed 5 conceptual models of the interrelationship of work, obesity, and occupational safety and health and highlighted the ethical, legal, and social issues related to fuller consideration of obesity's role in occupational health and safety.

Occupational and environmental lung disease.

PubMed

Seaman, Danielle M; Meyer, Cristopher A; Kanne, Jeffrey P

2015-06-01

Occupational and environmental lung disease remains a major cause of respiratory impairment worldwide. Despite regulations, increasing rates of coal worker's pneumoconiosis and progressive massive fibrosis are being reported in the United States. Dust exposures are occurring in new industries, for instance, silica in hydraulic fracking. Nonoccupational environmental lung disease contributes to major respiratory disease, asthma, and COPD. Knowledge of the imaging patterns of occupational and environmental lung disease is critical in diagnosing patients with occult exposures and managing patients with suspected or known exposures. Copyright © 2015 Elsevier Inc. All rights reserved.

[Association between unplanned pregnancy and adolescence onset asthma].

PubMed

Vázquez-Nava, Francisco; Gil-Lara, Bertoldo; Cruz-Torres, Leoncio; Vázquez-Rodríguez, Carlos F; Vázquez-Rodríguez, Eliza M; Felizardo-Ávalos, Jorge; Llanes-Castillo, Arturo; Córdova-Fernández, José A

2013-01-01

The association between asthma and pregnancy has been documented previously. The relationship between unplanned pregnancy and onset asthma in adolescence has not been studied. To determine the association between unplanned pregnancy and adolescence onset asthma. A cross-sectional study was done gathering information about asthma, unplanned pregnancy, family atopy and active or passive smoking in 3,130 adolescents aged 13-19 years. Asthma diagnosis was established through a selfquestionnaire based on the International Study of Asthma and Allergy in Childhood. Odds ratios for asthma were determined using logistic regression model and chi-squared test. Mean age of the participants was 16.37 ± 1.93 years. The prevalence of active smoking was 16.1%, of passive smoking 40% and of family atopy 9.8%. From the pregnant adolescents (785), 59.5% reported had planned not to have a child before pregnancy. Prevalence of wheezing during the year prior to the study was 9.3% and of wheezing during the pregnancy 2%. The prevalence of adolescence onset asthma was 5.4%. The age of initiation of asthma in the adolescence was 14.75 ± 1.60 years. The analysis showed that unplanned pregnancy has a slight risk for the development of asthma during adolescence. (Crude OR=1.03; CI 95% 1.02-1.05; p=0.000). Unplanned pregnancy, family atopy, active smoking and smoking friends are associated with the onset-asthma in the adolescence.

Caution: Reptile pets shuttle grasshopper allergy and asthma into homes.

PubMed

Jensen-Jarolim, Erika; Pali-Schöll, Isabella; Jensen, Sebastian A F; Robibaro, Bruno; Kinaciyan, Tamar

2015-01-01

The numbers of reptiles in homes has at least doubled in the last decade in Europe and the USA. Reptile purchases are increasingly triggered by the attempt to avoid potentially allergenic fur pets like dogs and cats. Consequently, reptiles are today regarded as surrogate pets initiating a closer relationship with the owner than ever previously observed. Reptile pets are mostly fed with insects, especially grasshoppers and/or locusts, which are sources for aggressive airborne allergens, best known from occupational insect breeder allergies. Exposure in homes thus introduces a new form of domestic allergy to grasshoppers and related insects. Accordingly, an 8-year old boy developed severe bronchial hypersensitivity and asthma within 4 months after purchase of a bearded dragon. The reptile was held in the living room and regularly fed with living grasshoppers. In the absence of a serological allergy diagnosis test, an IgE immunoblot on grasshopper extract and prick-to-prick test confirmed specific sensitization to grasshoppers. After 4 years of allergen avoidance, a single respiratory exposure was sufficient to trigger a severe asthma attack again in the patient. Based on literature review and the clinical example we conclude that reptile keeping is associated with introducing potent insect allergens into home environments. Patient interviews during diagnostic procedure should therefore by default include the question about reptile pets in homes.

Emotionally Triggered Asthma and its Relationship to Panic Disorder, Ataques de Nervios, and Asthma-Related Death of a Loved One in Latino Adults

PubMed Central

Vazquez, Karinna; Sandler, Jonathan; Interian, Alejandro; Feldman, Jonathan M.

2016-01-01

Objective Research has demonstrated high comorbidity between asthma and panic disorder (PD). Less is known about the relationship between asthma and the Latino cultural idiom of distress of ataques de nervios, as well as the role that psychosocial stressors play. The current study tested the hypotheses that Latino asthma patients who experience PD, ataques de nervios, and/or asthma-related death of a loved one endorse greater psychological triggers of asthma, greater perceived impact of asthma triggers, and greater difficulty controlling such triggers than do those without these conditions. Methods Data originated from an interview conducted prior to a randomized controlled trial in which 292 Latino adults with self-reported asthma were recruited from outpatient clinics in the Bronx, NY. The PRIME-MD Patient Health Questionnaire (PHQ) was used to screen for PD symptoms, while the Structured Clinical Interview for DSM-IV (SCID-I) was used to confirm diagnosis of PD. Lifetime history of ataques de nervios and asthma-related death of a loved one were based upon self-report. Asthma triggers were examined using the Asthma Trigger Inventory (ATI). Results PD, ataques de nervios, and asthma-related death of a loved one each predicted a higher frequency of psychological asthma triggers, controlling for gender and comorbid medical conditions. Participants with PD also reported greater impact of asthma triggers than those without PD, while no significant differences in perceived control were observed. Conclusion Providers should screen for PD, ataques de nervios, and asthma-related death of a loved one in Latino asthma patients, given their observed association with emotionally triggered asthma. PMID:28107897

RItA: The Italian severe/uncontrolled asthma registry.

PubMed

Maio, S; Baldacci, S; Bresciani, M; Simoni, M; Latorre, M; Murgia, N; Spinozzi, F; Braschi, M; Antonicelli, L; Brunetto, B; Iacovacci, P; Roazzi, P; Pini, C; Pata, M; La Grasta, L; Paggiaro, P; Viegi, G

2018-03-01

The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, and inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care. Four hundred and ninety three adult patients from 27 Italian centers (recruited in 2011-2014) were analyzed. Mean age was 53.8 years. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40 years); the mean age for asthma symptoms onset was 30.2 years and for asthma diagnosis 34.4 years. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, and 16.0% oral corticosteroids. Mean FEV 1 % pred of 75.1%, median values of 300/mm 3 of blood eosinophil count, 323 kU/L of serum total IgE, and 24 ppb of FENO were shown. Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), and allergic conjunctivitis (30.2%). 55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, and 7.3% hospitalizations. Factors associated with exacerbation risk were obesity (OR, 95% CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30-borderline), nasal polyps (1.86, 0.88-3.89-borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67-borderline), and anti-IgE use in a protective way (0.26, 0.12-0.53). Comparisons to severe asthma multicenter studies and available registries showed data consistency across European and American populations. An international effort in the implementation of SUA patients' registries could help to better understand the clinical features and to manage severe asthma, representing a non-negligible socioeconomic burden for health services. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Presence of Headache and Migraine in Asthma Patients

PubMed Central

Turan, Muzaffer Onur; Susuz, Çiğdem Çelik; Turan, Pakize Ayşe

2017-01-01

OBJECTIVES Migraine is a diseases characterized with severe headaches, with neurological and systemic findings. The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders, parental history and migraine in asthma patients. MATERIAL AND METHODS A total of 288 asthma outpatients, who had the diagnosis by an early or late test of reversibility showing a reversible airway obstruction according to hospital database were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department and investigated about the presence of migraine. The diagnosis of migraine headache was made if patients fulfilled the International Headache Society (IHS) criteria. RESULTS 60.4% of patients described a headache. There were 94 patients (32.6%) with headaches meeting the IHS criteria for migraine. Only 12 patients had migraine with aura. There were atopic symptoms in 86.8% of patients. According to parental history, there were asthma in 47.9%, atopic symptoms in 39.6% and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headaches (65.3%) “p=0.007”. The prevalence of migraine was significantly high in patients with parental atopic symptoms (54%) “p=0.002”. Multiple logistic regression analysis identified that gender, parental history of asthma, allergia and migraine, and smoking were independent risk factors for presence of migraine in asthmatics. CONCLUSION There is a high prevalence of migraine headaches in patients with asthma. The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism; parental history, common genetic compounds and smoking may play role in this mechanism. The headaches in asthma patients, atopic symptoms and family history should be questioned, and

Takotsubo cardiomyopathy: A known unknown foe of asthma.

PubMed

Kotsiou, Ourania S; Douras, Alexandros; Makris, Demosthenes; Mpaka, Nikoleta; Gourgoulianis, Konstantinos I

2017-10-01

Patients with uncontrolled asthma are at a greater risk of asthma attacks requiring emergency room visits or hospital admissions. Takotsubo cardiomyopathy is potentially a significant complication in a course of status asthmaticus. We describe a 43-year-old female patient who presented with status asthmaticus that was further complicated with takotsubo cardiomyopathy. Recognizing apical ballooning syndrome is challenging in patients with a history of respiratory disease because the symptoms of the last entity may complicate the diagnostic approach. It is difficult to distinguish clinically apical ballooning syndrome from the acute airway exacerbation itself. Both asthma and takotsubo cardiomyopathy share the same clinical presentation with dyspnea and chest tightness. In our patient, the electrocardiographic abnormalities, the rapidly reversible distinctive characteristics of echocardiography, and the modest elevation of serum cardiac biomarkers levels, in combination with the presence of a stress trigger (severe asthma attack), strongly supported the diagnosis of broken heart syndrome. Clinicians should re-evaluate asthma management and be aware of the complications associated with asthma attacks such as stress-induced cardiomyopathy.

[Risk factors for asthma in children in Hefei, China].

PubMed

Xiong, Mei; Ni, Chen; Pan, Jia-Hua; Wang, Qiang; Zheng, Li-Lin

2013-05-01

To investigate the risk factors for asthma in children in Hefei, China and to provide a strategy for asthma control in this region. A total of 400 children with a confirmed diagnosis of asthma, as well as 400 children of comparable age, sex, living environment, and family background, who had no respiratory diseases, were selected for a case-control study. A survey questionnaire survey was completed for all children. The obtained data were subjected to univariate and multivariate logistic regression analysis to determine the risk factors for asthma. The logistic regression analysis showed that a family history of allergy, allergic rhinitis, infantile eczema, no breastfeeding, air-conditioning and passive smoking were the risk factors for asthma in children, with odds ratios of 9.63, 7.56, 4.58, 2.16, 1.73, and 1.55 respectively. In order to reduce the incidence of asthma, we should advocate breast feeding, promote outdoor activities, keep ventilation natural, prevent passive smoking and cure allergic rhinitis.

[Secondary and tertiary prevention of allergic asthma in children].

PubMed

Rancé, F; Deschildre, A; Bidat, E; Just, J; Couderc, L; Wanin, S; Weiss, L

2010-12-01

Asthma is a disease of the lung epithelial barrier, most often associated with allergy in children. Asthma and allergy are two distinct diseases, but the phenotypic expression of asthma depends on atopic status. A better definition of phenotypes of asthma would result in better targeting of prevention and treatment modalities. Secondary prevention aims to prevent the onset of asthma and the acquisition of new sensitizations in sensitized children. Studies concerning allergen avoidance are insufficient to reach a definitive conclusion and antihistamines have not been shown to be effective. The results for specific immunotherapy suggest a benefit to prevent transition from allergic rhinitis to asthma and the onset of new sensitizations. Tertiary prevention aims to reduce symptoms in children with an existing allergic asthma diagnosis. The avoidance of known respiratory allergens will only be effective in combination with management of the whole environment. Specific immunotherapy has a real place, in combination with background therapy. It should be used according to guidelines in appropriately treated patients. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Occupational contact dermatitis.

PubMed

Lushniak, Boris D

2004-01-01

The dermatologist should be aware of the many facets of occupational skin diseases, which can be caused by physical, chemical, and biological insults. The most common manifestation of occupational skin diseases is contact dermatitis (both irritant and allergic). Three factors point out the importance of occupational skin diseases as diseases that have a public health impact: 1) occupational skin diseases are common; 2) they often have a poor prognosis; and 3) they result in a noteworthy economic impact for society and for an individual. They are also diseases amenable to public health interventions. Specific industries and exposures may put a worker at risk of occupational contact dermatitis. The accuracy of the diagnosis of occupational contact dermatitis is related to the skill level, experience, and knowledge of the medical professional who makes the diagnosis and confirms the relationship with a workplace exposure. Prevention of occupational contact dermatitis is important, and a variety of prevention strategies are available.

Occupational neurology.

PubMed Central

Feldman, R. G.

1987-01-01

The nervous system is vulnerable to the effects of certain chemicals and physical conditions found in the work environment. The activities of an occupational neurologist focus on the evaluation of patients with neurological disorders caused by occupational or environmental conditions. When one is making a differential diagnosis in patients with neurological disorders, the possibility of toxic exposure or encounters with physical factors in the workplace must not be overlooked. Central to an accurate clinical diagnosis is the patient's history. A diagnosis of an occupational or environmental neurological problem requires a careful assessment of the clinical abnormalities and confirmation of these disabilities by objective tests such as nerve conduction velocity, evoked potentials, electroencephalogram, neuropsychological batteries, or nerve biopsy. On the basis of information about hazards in the workplace, safety standards and environmental and biological monitoring can be implemented in the workplace to reduce the risks of undue injury. Clinical manifestations of headache, memory disturbance, and peripheral neuropathy are commonly encountered presentations of the effects of occupational hazards. Physicians in everyday clinical practice must be aware of the signs and symptoms associated with exposure to possible neurotoxins and work methods. Occupational and environmental circumstances must be explored when evaluating patients with neurologic disorders. PMID:3577214

Asthma - what to ask the doctor - adult

MedlinePlus

... I have a fire in my fireplace or wood-burning stove? What sort of changes do I ... 42. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management ...

Does treatment of paradoxical vocal fold movement disorder decrease asthma medication use?

PubMed

Kramer, Scott; deSilva, Brad; Forrest, L Arick; Matrka, Laura

2017-07-01

To determine whether diagnosis and treatment of paradoxical vocal fold movement disorder (PVFMD) leads to decreased asthma medication use. Secondary objectives include determining initial rate of asthma medication use, characterizing symptom improvement, and correlating with pulmonary function testing (PFT). Prospective observational study. Patients newly diagnosed with PVFMD at a single institution were recruited to participate. Medication questionnaires were completed at the initial visit, at the first return visit for therapy, and at 6 months. PFTs were reviewed when available. Sixty-six patients were recruited; the study was closed early because findings reached significance. Fifty-six patients (85%) were taking asthma medication at presentation. Forty-four patients presented with PFTs, and two-thirds were normal. Forty-two patients completed follow-up questionnaires; 79% decreased asthma medication use (P < .001), and 82% reported symptom improvement. Seventy-seven percent of patients participated in therapy and 23% did not, with equal rates of decrease in asthma medication use between these groups. Outcomes did not vary based on PFT pattern (i.e., obstructive vs. nonobstructive, P = .75). Diagnosis and treatment of PVFMD lead to a decline in asthma medication use. This decrease occurred alongside symptom improvement and irrespective of PFT findings. Use of asthma medication in this patient population is high, at 85%. 4. Laryngoscope, 127:1531-1537, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Managing Asthma in Primary Care: Putting New Guideline Recommendations Into Context

PubMed Central