Síntomas respiratorios en agentes civiles de tránsito expuestos a smog en Quito en el año 2021 / Respiratory symptoms in civil traffic police agents exposed to smog in Quito in 2021

INTRODUCCIÓN. Existe relación entre la exposición de contaminantes en el aire y problemas respiratorios que van desde síntomas leves en vías respiratorias altas hasta enfermedades que pueden comprometer la vida de los pacientes como: neumonía, enfermedad pulmonar obstructiva crónica y cáncer pulmonar. OBJETIVO. Registrar los síntomas respiratorios presentados por agentes civiles de tránsito expuestos a smog. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 3 458 y muestra de 454 participantes entre agentes civiles de tránsito, fiscalizadores de tránsito y personal administrativo de la Agencia Metropolitana de Tránsito en el año 2021, seleccionados por muestreo aleatorio simple estratificado para los dos grupos de participantes; se aplicó un sondeo digital basado en las encuestas: European Community Respiratory Health Survey y condiciones de trabajo. Para el análisis de datos se utilizó la herramienta EPI INFO, donde se realizó pruebas estadísticas bivariadas de Chi2 y análisis multivariado como regresiones logísticas crudas y ajustadas. RESULTADOS. Se observó que la población de trabajadores operativos en vía tuvo alrededor de dos veces más riesgo de desarrollar sibilancias en comparación a la población administrativa OR=2,1 (IC 95% 1,01­4,39); el personal operativo tuvo más del doble de riesgo de desarrollar bronquitis crónica versus la población administrativa OR=2,5 (IC 95% 1,14­5,73). Los resultados fueron ajustados mediante regresión logística con variables de condiciones de trabajo y salud (p=<0,05). CONCLUSIÓN. Se registró una relación significativa entre la contaminación ambiental por smog y enfermedades respiratorias a largo plazo.

INTRODUCTION. There is a relationship between exposure to air pollutants and respiratory problems ranging from mild upper respiratory symptoms to life-threatening diseases such as pneumonia, chronic obstructive pulmonary disease and lung cancer is evident. OBJECTIVE. To record the respiratory symptoms presented by civilian traffic officers exposed to smog. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 3 458 and sample of 454 participants among civilian traffic agents, traffic inspectors and administrative personnel of the Metropolitan Traffic Agency in the year 2021, selected by simple stratified random sampling for the two groups of participants; a digital survey was applied based on the European Community Respiratory Health Survey and working conditions. For data analysis, the EPI INFO tool was used, where bivariate Chi2 statistical tests and multivariate analysis such as crude and adjusted logistic regressions were performed. RESULTS. It was observed that the population of operational track workers had about twice the risk of developing wheezing compared to the administrative population OR=2,1 (95% CI 1,01-4,39); operational personnel had more than twice the risk of developing chronic bronchitis versus the administrative population OR=2,5 (95% CI 1,14­5,73). Results were adjusted by logist regression with working conditions and health variables (p=<0,05). CONCLUSION. There was a significant relationship between smog pollution and long-term respiratory diseases.

Work-related asthma / Asma relacionada ao trabalho

ABSTRACT Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.

RESUMO A asma relacionada ao trabalho (ART) é um acometimento com elevada prevalência na população adulta. A ART inclui a asma ocupacional (AO), desencadeada pela exposição a um agente presente em um determinado ambiente de trabalho, e a asma agravada ou exacerbada pelo trabalho (AA/ET), que acomete indivíduos com antecedentes de asma ou que iniciaram um quadro de asma concomitante, mas sem relação causal com o ambiente de trabalho. Estima-se que 16,0% e 21,5% da asma no adulto sejam AO e AA/ET, respectivamente. O elevado e crescente número de substâncias químicas usadas na produção industrial, no uso domiciliar ou em serviços é responsável pela incidência de asma associada à exposição a agentes químicos na vida adulta. Este artigo de revisão descreve os principais tipos de ART, os procedimentos para seu diagnóstico, tratamento e prevenção e as condutas frente ao diagnóstico. Nem sempre é fácil a distinção entre AO e AA/ET. A importância do diagnóstico (AO ou AA/ET e asma induzida por sensibilizantes ou irritantes) tem relação com a adoção de medidas de prevenção para evitar que novos indivíduos sejam expostos e que os acometidos apresentem agravamento da doença, utilizando tratamento precoce e fornecendo orientação sobre aspectos previdenciários e trabalhistas.

Comparação entre fatores sociodemográficos e ocupacionais com sintomas respiratórios e pico de fluxo expiratório em trabalhadores de uma indústria de cerâmica do Sul do Brasil / Comparison between socio-demographic and occupational factors with respiratory symptoms and peak expiratory flow in workers of a ceramic industry in Southern Brazil

Objetivo: avaliar a prevalência dos sintomas respiratórios ocupacionais, pico de fluxo expiratório (PFE) e fatores associados em trabalhadores de uma indústria de cerâmica do sul do Brasil. Métodos: estudo transversal. Foram avaliados trabalhadores de uma indústria de cerâmica do Sul do Brasil. Como instrumentos de pesquisa, foram aplicados questionários relacionados a aspectos ocupacionais, sintomas respiratórios, hábitos tabágicos e medida do PFE. As variáveis sociodemográficas e ocupacionais foram comparadas com os sintomas respiratórios e PFE. Resultados: foram avaliados 151 trabalhadores, sendo, predominantemente, do sexo masculino (87,4%), com média (±DP) de idade de 30,4 (±8,4) anos e histórico de tabagismo em 23,8% dos participantes. Entre os sintomas respiratórios, 23% relataram tosse diária e noturna e dispneia, 21% confirmaram escarro durante o dia/noite, e apenas 7% referiram chiado ou sibilos. O PFE abaixo de 80% do previsto foi encontrado em 37,1% dos trabalhadores, com média (±DP) de 84(±16,7)%. Ao comparar os fatores ocupacionais com os desfechos, foi observado que o menor tempo de trabalho esteve relacionado à maior prevalência de tosse (p=0,024). Conclusão: os sintomas respiratórios mais prevalentes foram a tosse e a dispneia, seguidos por escarro e sibilância. Aproximadamente, 1/3 dos trabalhadores demonstraram PFE<80%. Contudo, a relação inversa entre tempo de trabalho e sintomas merece maior investigação.

Objective: To evaluate the prevalence of occupational respiratory symptoms, peak expiratory flow (PEF) and associated factors in workers from a ceramic industry in southern Brazil. Methods: Cross-sectional study. Workers from a ceramic industry in southern Brazil were evaluated. The research instruments were questionnaires related to occupational aspects, respiratory symptoms, smoking habits, and PEF measurements. Sociodemographic and occupational variables were compared with respiratory symptoms and PEF. Results: We evaluated 151 workers, predominantly male (87.4%), with a mean (±DP) age of 30.4 (±8.4) years and a history of smoking in 23.8% of participants. Among the respiratory symptoms, 23% reported daily and nocturnal cough and dyspnea, 21% confirmed sputum during the day / night, and only 7% reported wheezing. PEF below 80% of predicted was found in 37.1% of workers, with a mean (± DP) of 84 (± 16.7) %. When comparing the occupational factors with outcomes, it was observed that the shorter working time was related to higher cough prevalence (p=0.024). Conclusion: The most prevalent respiratory symptoms were coughing and dyspnea, followed by sputum and wheezing. Approximately 1/3 of workers showed PEF <80%. However, the inverse relationship between working time and symptoms merits further investigation.

Doença alérgica ocupacional: aspectos socioepidemiológicos em ambulatório especializado na cidade de São Paulo / Occupational allergic disease: socio-epidemiological aspects from a specialized outpatient clinic at the city of Sao Paulo

Introdução: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. Objetivos: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. Métodos: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. Resultados: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. Conclusões: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.

Background: Occupational diseases involving the immune system are considered as occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. Objectives: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. Methods: Descriptive and retrospective study of the medical records of patients diagnosed with OAD and cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. Results: A total of 72 patients exhibited OAD, with age from 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) remained in their job, 19 (26%) changed function, 7 (10%) changed work area, 7 (10%) were fired and 3 (4%) retired. Conclusions: In the present study, OAD prevailed in males and the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same function even after diagnosis.

Exposición a polvo de harina de trigo en panaderías de la Región Metropolitana / Bakers' exposure to wheat flour dust in Santiago, Chile

Wheat flour is a known sensitizer for humans. Bakers exposed to flour dust may develop occupational rhinitis and asthma. In Chile there is no current permissible limit for occupational exposure to wheat flour. To propose such a limit, 9 bakeries located in 6 districts of Santiago de Chile were evaluated, 6 bakeries were semi-industrial and 3 were small business. Twenty-eight environmental personal samples were obtained by standard sampling methods and they were analyzed at the Institute of Public Health of Chile. No significant differences were found (p = 0,2915, Kruskall-Wallis' test) between air concentrations of flour particles in the working environment of semi-industrial (geometric mean: MG = 0.88 mg/m³,geometric deviation: DEG = 2,68) and small business (MG = 1.39 mg/m³, DEG = 2,31). A permissible limit of wheat flour dust exposure is recommended.

Se conoce que la harina de trigo es un sensibilizador en seres humanos. Los panaderos expuestos a polvo de harina pueden desarrollar rinitis y asma ocupacional. En Chile actualmente no existe un límite permisible para la exposición ocupacional a polvo de harina. Con el objetivo de proponer un límite, fueron evaluadas 9 panaderías de 6 comunas de Santiago de Chile, de las cuales 6 fueron semi-industriales y 3 pequeñas. Un total de veintiocho muestras personales de aire fueron obtenidas según método estándar de muestreo y analizadas en el Instituto de Salud Pública de Chile. No se encontraron diferencias significativas (p = 0,2915, prueba de Kruskall-Wallis) en la concentración de partículas de harina en el ambiente de trabajo semi-industrial (media geométrica: MG = 0,88 mg/m³, desviación geométrica: DEG = 2,68) y en el de panaderías pequeñas (MG = 1,39 mg/m³, DEG = 2,31). En base a las observaciones realizadas se recomienda establecer un límite permisible de exposición para polvo de harina de trigo.

Asma ocupacional / Occupational asthma

El asma ocupacional (AO) es la enfermedad laboral más frecuente en los países industrializados y se estima que aproximadamente un 15% del asma del adulto puede ser de origen ocupacional. En los Estados Unidos se estima que el 5-15% de los casos de asma pueden tener un origen relacionado con el trabajo. Según lo evaluado en diferentes estudios, la proporción de casos nuevos de asma en el adulto que se deben a la exposición ocupacional se desconoce por la ausencia de programas efectivos de vigilancia epidemiológica de las enfermedades de trabajo. Las diferencias en el diseño de los estudios epidemiológicos, la definición de AO, el tipo de población y el país donde se realiza el estudio son algunas de las razones de estas discrepancias y de la dificultad de realizar comparaciones. El AO puede desarrollarse tanto por un mecanismo inmunológico como no inmunológico. En su desarrollo influyen el tipo de agente al que está expuesto el individuo, el nivel y modo de exposición y factores genéticos de susceptibilidad. Dado que el tratamiento de elección en el AO es retirar al paciente de la exposición a su ambiente laboral, el número de personas que puede requerir un cambio de trabajo y las consecuencias económicas para la sociedad son considerables así como el impacto social y económico por la incapacidad laboral tanto temporal como permanente que produce. Por dicho motivo, una historia clínica detallada y personalizada de asma en el individuo juega un papel relevante, aportando conocimientos sobre los posibles desencadenantes (aeroalérgenos, irritantes ambientales), visualizando al trabajador in situ o inmerso en su lugar de trabajo y permitiendo comprender las diferentes situaciones suscitadas. Casi todos los agentes que llevan a otras enfermedades ocupacionales respiratorias también pueden causar asma laboral. Por consiguiente, son menos prevalentes los trabajos sin exposición de riesgo, y considerando que se trata de una patología muy frecuente y en incremento en países industrializados, deberían tomarse medidas preventivas eficaces.(AU)

Occupational asthma (OA) is the most common occupational disease in industrialized countries and it is estimated that approximately 15% of adult asthma may be of occupational origin. In the United States, it is estimated that 5-15% of asthma cases can have a work-related origin.As evaluated in different studies, the proportion of new cases of asthma in adults that are due to occupational exposure is unknown by the absence of effective epidemiological surveillance programs of occupational diseases.The differences in the design of epidemiological studies, the definition of OA, the type of population and the country where the study is conducted are some of the reasons for these discrepancies and the difficulty of making comparisons. The OA can be developed by an immune mechanism so as not immune. In its development influence the type of agent that is exposed individual, level and mode of exposure and genetic susceptibility factors. Since the treatment of choice in the OA is to remove the patient from exposure to their work environment, the number of people who may require a change of job and economic consequences for society are significant and the social and economic impact of both permanent and temporary incapacity produced.For this reason, a detailed and personalized medical history of asthma in the individual plays an important role, providing insights into possible triggers (airborne allergens, environmental irritants), visualizing the worker in situ or immersed in his workplace and allowing understand the different situations arising.Almost all the agents that lead to other occupational respiratory diseases can also cause occupational asthma. Therefore, works without risk exposure are less prevalent, and considering that this is a very common disease andis increasing in industrialized countries, effective preventive measures should be taken.(AU)

Enfermedades respiratorias ocupacionales / Occupational pulmonary diseases

Las enfermedades ocupacionales son aquellas producidas directamente por el ejercicio de la profesión. Estas se encuentran reguladas por la Ley 16.744 y son de cargo de prestadores de servicios denominados habitualmente mutuales. En este artículo se describen los principales aspectos epidemiológicos, fisiopatológicos, clínicos, de criterios diagnósticos y principios terapéuticos, de cuatro enfermedades respiratorias, las más relevantes en el medio nacional: Silicosis, asma, enfermedades por asbesto y enfermedades por hipobaria.

Occupational diseases are those produced directly by work activities. In Chile, occupational diseases are regulated by the law 16.744 and the service providers are called, mutualidades. In this paper is described epidemiology, physiopathology, clinical aspects, diagnostic criteria and therapeutic principles of the four most important occupational respiratory diseases in Chile: Silicosis, occupational asthma, asbestos diseases and altitude sickness.

Bronquiolite associada à exposição a aroma artificial de manteiga em trabalhadores de uma fábrica de biscoitos no Brasil / Bronchiolitis associated with exposure to artificial butter flavoring in workers at a cookie factory in Brazil

OBJETIVO: Relatar quatro casos de bronquiolite decorrente de exposição a aroma artificial de manteiga em uma fábrica de biscoitos no Brasil. MÉTODOS: Descrevemos os achados clínicos, espirométricos e tomográficos nos quatro pacientes, assim como achados de biópsia pulmonar em um dos pacientes. RESULTADOS: Os quatro pacientes eram homens jovens, não fumantes, e desenvolveram obstrução persistente ao fluxo aéreo (relação VEF1/CVF reduzida e VEF1 de 25-44% do previsto) após 1-3 anos de exposição a diacetil, sem a utilização de equipamentos de proteção individual, em uma fábrica de biscoitos. A TCAR mostrou achados indicativos de bronquiolite. Em um paciente, a biópsia pulmonar cirúrgica mostrou bronquiolite obliterante associada a células gigantes. CONCLUSÕES: A bronquiolite decorrente de exposição a flavorizantes artificiais deve ser considerada em trabalhadores com obstrução ao fluxo aéreo no Brasil.

OBJECTIVE: To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil. METHODS: We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. RESULTS: All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. CONCLUSIONS: Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.