Indoor mold levels and current asthma among school-aged children in Saskatchewan, Canada.

Current knowledge regarding the association between indoor mold exposures and asthma is still limited. The objective of this case-control study was to investigate the relationship between objectively measured indoor mold levels and current asthma among school-aged children. Parents completed a questionnaire survey of health history and home environmental conditions. Asthma cases had a history of doctor-diagnosed asthma or current wheeze without a cold in the past 12 months. Controls were age- and sex-matched to cases. Vacuumed dust samples were collected from the child's indoor play area and mattress. Samples were assessed for mold levels and quantified in colony-forming units (CFU). Sensitization to mold allergens was also determined by skin testing. Being a case was associated with family history of asthma, pet ownership, and mold allergy. Mold levels (CFU/m2 ) in the dust samples of children's mattress and play area floors were moderately correlated (r = 0.56; P < 0.05). High mold levels (≥30 000 CFU/m2 ) in dust samples from play [adjusted odds ratio (aOR) = 2.6; 95% CI: 1.03-6.43] and mattress (aOR) = 3.0; 95% CI: 1.11-8.00) areas were significantly associated with current asthma. In this study high levels of mold are a risk factor for asthma in children.

Farm Exposures and Allergic Disease Among Children Living in a Rural Setting.

OBJECTIVES: The purpose of this study was to examine the association between farm exposures and asthma and allergic disease in children while also highlighting the experiences of non-farm rural children. METHODS: This was a cross-sectional analysis of data collected from across the province of Saskatchewan, Canada in 2014. Surveys were completed by parents of 2275 rural dwelling children (farm and non-farm) aged 0 to 17 years within 46 rural schools. Questionnaires were distributed through schools for parents to complete. RESULTS: Asthma prevalence was 7.6%, of which 29.5% of cases were allergic. After adjustment for potential confounders, home location (farm vs non-farm) and other farm exposures were not associated with asthma and asthma phenotypes. Those who completed farm safety education were more likely to have asthma (11.7% vs. 6.7%; p = .001) compared to children without asthma. In sub-analyses among 6-12-year-old children, boys were more likely to have asthma (non-allergic) and use short-acting beta-agonists compared to girls. Doing farm work in the summer was associated with an increased risk of asthma [adjusted OR (aOR) = 1.71 (1.02-2.88); p = .041]. Doing routine chores with large animals was associated with an increased risk of asthma [aOR = 1.83 (1.07-3.15); p = .027] and allergic asthma [aOR = 2.37 (95%CI = 1.04-5.40); p = .04]. CONCLUSION: The present study showed that the prevalence of asthma and asthma phenotypes were similar between farm and non-farm rural children. There did not appear to be differential involvement in farming activities between those with and without asthma although those with asthma had more training suggesting possible attempts to mitigate harm from farm exposures.

Operator and Potential Exposure to Hydrogen Sulfide: A Study of the British Columbia Dairy Industry.

Hydrogen Sulfide (H2S) is produced in manure storage facilities and released during manure agitation. Exposure to this gas presents health risks to workers at daily exposure of greater than 10 parts per million (ppm). Exposure levels on BC dairy farms are unknown. The aim of this study was to document peak H2S exposure levels to operators and bystanders during manure agitation on British Columbia dairy farms to determine if action levels were exceeded. Farms were evaluated at two time points during manure agitation. Both operator exposure and potential exposure sampling were undertaken. Peak hydrogen sulfide levels were measured and categorized as greater than or less than the ceiling level (10 ppm) and action level (5 ppm). Associations between H2S levels above the ceiling level and farm factors were assessed. Measures were recorded at 43 dairy farms with 91 total measures recorded. Action levels were exceeded in 30% of operator measures and 64% of potential exposure measures while 20% of operator and 53% of potential peak H2S measures exceeded 10 ppm. Manure storage facilities were evenly distributed between indoor and outdoor locations with under-barn (43%) and outdoor storage (47%) most common. Sawdust was the most prominent bedding type (65%). Tractor operated propeller was the most common type of agitation equipment (62%). Manure temperature remained a significant predictor in the multivariate model for operator peak exposure. Exposure to H2S above the action level commonly occurs on BC Dairy farms. Given that Worksafe BC requires exposure control plans for H2S levels above 5 ppm, and that on dairy farms, measures of operator and potential H2S exposures were recorded above these levels, best practices to reduce potential H2S exposure are necessary to reduce possible operator and bystander exposure.

Assessment of endotoxin levels in the home and current asthma and wheeze in school-age children.

UNLABELLED: The relationship between household endotoxin and asthma in children is not clear. To further investigate the relationship between sources of endotoxin and childhood asthma, we conducted a case-control study of children with and without asthma and examined their more frequent household exposures in the home. Children ages 6-13 years with current asthma (n = 70) or wheeze only (n = 19) were sex and age matched (+/-1 year) to 107 controls. Play area and mattress dust were collected for endotoxin analysis. Atopic status was determined by skin prick testing for allergies. A family size of >4 per household was associated with higher endotoxin levels (EU/mg) in the bed dust (P < 0.05). Passive smoking (P < 0.05) and the presence of a cat were associated with higher levels of endotoxin in mattress dust. Endotoxin levels in either the play dust or the bed dust did not differ between cases and controls. Within atopic cases, those with higher endotoxin loads (EU/m2) in bed or play areas were more likely to miss school for chest illness (P < 0.05). In this study, household endotoxin is not a risk factor for current asthma overall but may be associated with increased severity in children with atopic asthma. PRACTICAL IMPLICATIONS: This study did not find that household sources of endotoxin were associated with asthma. However, within atopic asthmatics, asthma severity (as measured by a history of being kept home from school because of a chest illness in the past year) was associated with higher levels of endotoxin in dust from the child's bed. There is a need to further investigate the nature of the relationship between household endotoxin and asthma severity in children which could lead to better management of childhood asthma.

Total dust and endotoxin in poultry operations: comparison between cage and floor housing and respiratory effects in workers.

OBJECTIVE: The objective of this study was to assess respiratory outcomes and environmental exposure levels of workers in cage-housed and floor-housed poultry operations. METHODS: Poultry operations were evaluated for total dust, endotoxin, and ammonia, and respiratory symptoms and lung function tests of workers were conducted. RESULTS: Workers in floor-housed poultry operations had significantly greater exposures to total dust and ammonia, whereas workers from cage-housed poultry operations reported greater frequency of current and chronic symptoms overall and significantly greater current and chronic phlegm (39% vs 18% and 40% vs 11%, respectively). Endotoxin concentration (EU/mg) was a significant predictor (P = 0.05) of chronic phlegm for all poultry workers. CONCLUSIONS: Greater endotoxin concentration in the presence of significantly lower total dust, in conjunction with greater respiratory symptoms in workers from cage-housed poultry operations, as compared with workers from floor-housed poultry operations, appears to indicate that differences in environmental exposures may impact respiratory outcomes of workers.

Positive human health effects of wearing a respirator in a swine barn.

STUDY OBJECTIVES: A study was conducted to evaluate the acute health effects of wearing an N-95 disposable respirator in a swine confinement facility. DESIGN: A crossover trial design was used in the study. SETTING: The study was carried out at the research facilities of the Centre for Agricultural Medicine, the Royal University Hospital, and the Prairie Swine Centre Inc, Saskatoon, Saskatchewan, Canada. PARTICIPANTS: Twenty-one nonsmoking healthy male subjects with no previous swine barn exposure participated in the study. INTERVENTIONS: The subjects participated in a laboratory session (baseline day), a 4-h exposure in a traditional swine room wearing the respirator (intervention day), and a 4-hour exposure in a traditional swine room without a respirator (nonintervention day). MEASUREMENTS: Lung function, methacholine challenge tests, blood counts, nasal lavage, and cytokines in serum and nasal lavage fluid. RESULTS: Mean (+/- SE) shift change in FEV(1), from preexposure to postexposure, was highest on nonintervention day (-8.1+/-1.01%) and was significantly different from intervention day (0.32+/-0.62%; p<0.0001) and baseline day (1.57+/-0.51%; p<0.0001). Similar patterns were observed in the mean values of the provocative concentration of a substance (methacholine) causing a 20% fall in FEV(1) (nonintervention day, 130.4+/-36.9 mg/mL; intervention day, 242.0+/-38.0 mg/mL; and baseline day, 328.0 mg/mL +/-34.1 mg/mL). Significant increases in serum neutrophil levels and nasal cell counts were observed on the nonintervention day in comparison to the baseline and intervention days. Significant increases also were found in the levels of cytokines interleukin (IL)-6 and IL-8 in nasal lavage fluid and in the levels of IL-6 in serum for the nonintervention day in comparison to the other 2 days. CONCLUSIONS: The results demonstrate that an N-95 disposable respirator can help to significantly reduce acute negative health effects in subjects not previously exposed to a swine barn environment.

Accelerated lung function decline in swine confinement workers.

We conducted a longitudinal study to determine the annual rate decline in pulmonary function measurements in male swine confinement workers. For comparison, a grain farming group and a nonfarming rural-dwelling control group were also chosen for the longitudinal study. Two hundred seventeen swine confinement workers, 218 grain farmers, and 179 nonfarming control subjects had valid pulmonary function measurements at the baseline observation conducted in 1990 to 1991 and at the second observation conducted in 1994 to 1995. The swine confinement workers were younger (mean age=38.3+/-11.7 [SD] years) than the nonfarming control subjects (42.6+/-10.4 years) and the grain farmers (44.5+/-11.9 years). When stratified by age, nonfarming control subjects had the lowest mean annual rate decline in FEV1 and FVC in all age categories. The swine confinement workers had the largest annual rate decline in FEV1 and FVC, and this was most obvious in the middle age categories. After controlling for age, height, smoking, and baseline pulmonary function, swine confinement workers had excess annual decline of 26.1 mL in FEV1 (p=0.0005), 33.5 mL in FVC (p=0.0002), and 42.0 mL/s in forced expiratory flow between 25% and 75% of FVC (FEF[25-75%]) (p=0.02) over nonfarming control subjects. Grain farmers had excess annual decline of 16.4 mL in FEV1 (p=0.03), 26.7 mL in FVC (p=0.002), and 11.2 mL/s in FEF(25-75%) (p=0.38) over control subjects. These findings suggest that workers engaged in the swine industry and grain farmers appear prone to accelerated yearly losses in lung function and may therefore be at risk for the future development of chronic airflow limitation.

Predictors of longitudinal changes in pulmonary function among swine confinement workers.

OBJECTIVE: To determine predictors of longitudinal changes in pulmonary function in swine confinement workers. DESIGN: Longitudinal study conducted from November 1989 to June 1991 and January 1994 to May 1995. SETTING: Swine confinement workers in Saskatchewan. PARTICIPANTS: Forty-two swine confinement workers who were studied in 1989/90 and studied again in 1994/95. RESULTS: Of 98 male swine confinement workers (mean age SD 36.3 11.1 years) studied at baseline, 42 were studied again five years following. Complete information on baseline across-shift pulmonary function (preshift forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], and every 2 h FEV1 and FVC during the shift), and five-year follow-up pulmonary function (with FEV1 and FVC) were available on all 42 subjects. Mean across-shift changes (preshift measurement to last measurement of the day) at baseline were -159. 8 61.7 mL in FEV1 and -35.3 65.6 mL in FVC. Mean annual rate change between baseline and follow-up for FEV1 was -53.9 61.7 mL/year and for FVC -48.9 71.6 mL/year. After adjusting for age, height, smoking and hours spent in the barn, the baseline across-shift change in FEV1 and FVC was a significant predictor of annual rate change in FEV1 (P=0.01) and FVC (P=0.02), respectively. To determine the effects of indoor air quality on longitudinal lung function decline, indoor air environmental measurements were analysed. Complete information on respiratory health and indoor air quality was available on 34 of the 42 subjects. Assessment of indoor environment of swine barns included a summer and winter measurement for airborne dust, gases and endotoxin levels. After adjusting for age, height, smoking, ammonia and hours spent in the barn, the endotoxin level (Eu/mg)was a significant predictor of annual rate change for FEV1 but not FVC. CONCLUSIONS: These results suggest that shift change is an important predictor of longitudinal changes in lung function in swine confinement workers and that endotoxin exposures may mediate annual decline in FEV1 in these workers.

Respiratory response to endotoxin and dust predicts evidence of inflammatory response in volunteers in a swine barn.

BACKGROUND: It has been shown that exposure in intense exposure in swine barn facilities is associated with increased respiratory symptoms and reduction in pulmonary functions. This study investigated if systemic response could be predicted by FEV(1) response following swine barn exposure. METHODS: Naïve males were tested at baseline, low and high endotoxin and dust levels. Subjects were classified as "more responsive" (n = 9) or "less responsive" (n = 11) based on FEV(1) reduction following high endotoxin exposure. Health measures included pulmonary function testing, blood samples and nasal lavage. Environmental samples were collected from the barn. RESULTS: White blood cells and blood lymphocytes at low exposure were significantly greater in those who were "more responsive" compared to those who were "less responsive". There was a significant increase in blood lymphocytes, serum IL6, total nasal lavage cells and nasal IL8 at high exposure among "more responsive" subjects compared to "less responsive" subjects. CONCLUSIONS: Respiratory response to high-level endotoxin and dust exposure predicts evidence of inflammatory response throughout a range of endotoxin and dust exposures.

Human health effects of dust exposure in animal confinement buildings.

Work in swine and poultry units is associated with exposure to significant levels of organic dust and endotoxins with the highest concentrations found in poultry houses, whereas values found in dairy and in cattle farming are much lower. Corresponding to this is an excess of work-related respiratory symptoms in swine farmers. A dose-response relationship exists between symptoms and number of working hours. Longitudinal studies have demonstrated an accelerated decline of lung function in swine farmers large enough to cause clinically significant disease in some farmers. Because of the large number of people needed in swine farming and the long working hours, swine farming has emerged as the major respiratory problem in farming. Experimental studies indicate that exposure has to be lowered substantially to avoid acute effects and longitudinal studies demonstrate that loss of lung function occurs in non-smoking swine farmers without respiratory symptoms and that accelerated decline in lung function occurs below endotoxin concentrations in dust (100 ng/m3) proposed as a safe threshold.

Occupational asthma in newly employed workers in intensive swine confinement facilities.

Respiratory symptoms, reductions in pulmonary function and increased bronchial responsiveness have been described in exposed workers and in naïve volunteers exposed to intensive swine production facilities. Typically, this occurs in persons who have been employed for a long duration or in previously unexposed, naïve volunteers. The current authors describe four cases, all female, who developed acute onset of wheezing and cough suggestive of asthma within weeks of commencing full-time employment in intensive swine production facilities. None of the workers were aware of any previous asthma, allergies or hay fever. All four employees reported improvement of symptoms on cessation of work in the facilities and consequent withdrawal from exposure. However, when seen at the respiratory clinic, cases 1 and 3 continued to be either mildly symptomatic or were taking medications with continued borderline airways responsiveness, as measured by methacholine challenge test up to 4 and 5 months, respectively, following work cessation. Case 2 continued to have symptoms for > or =3 months after work cessation. Only case 1, however, was seen at repeated visits in the respiratory clinic. One worker participated in a work re-entry trial and experienced profound coughing and chest tightness within an hour of entry, after which, the trial had to be terminated. Provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20) measured 5 h later was lower than pre-trial PC20. No acute exposure event was recorded in the workers prior to the onset of symptoms. To the current authors' knowledge, this is the first report of occupational asthma occurring in newly employed full-time intensive swine production workers after a short-term exposure and should raise awareness that previously unexposed workers may be at risk of developing what would appear to be long-term asthma after relatively short-term exposure.

Positive human health effects of dust suppression with canola oil in swine barns.

A crossover trial was conducted to evaluate the acute human health effects of a dust control technology in a swine confinement facility. Twenty lifetime nonsmoking male subjects, with no evidence of allergy or asthma and no previous swine barn exposure, participated in the study, which included a laboratory session (baseline), 5-h exposure in a swine room sprinkled with canola oil (treatment) and 5-h exposure in a traditional swine room (control). Mean values of inhalable dust concentrations and endotoxin levels in the control room were significantly greater than those observed in the treatment room. Mean shift changes in FEV1 from preexposure to end of exposure were 1.1% (standard error, 0.63%) on baseline day, -1.9% (0.63%) on treatment day, and -9.9% (1.12%) on control day; the differences in the shift changes were statistically significant. Mean value of methacholine concentration that reduced the FEV1 by 20% (PC20) in bronchoprovocation tests on baseline day was significantly different from that on treatment day (p = 0.04) and that on control day (p < 0.001). Significant increases were also observed in white blood cell counts and nasal lavage cell counts on the control day in comparison with the other two days. Blood neutrophil counts after control room exposure were twice those observed on baseline and after exposure to the treatment room. Significant differences were also observed in IL-1 beta, IL-6, and IL-8 nasal lavage cytokines and in IL-6 serum cytokine. These results suggest that the canola oil dust control method is effective in improving indoor air quality in swine barns and reducing acute health effects in naive healthy subjects.