Asthma and Chronic Obstructive Pulmonary Disease Associated With Occupational Exposure in Dairy Farmers - Importance of Job Exposure Matrices.

AIM: To evaluate the prevalence of chronic respiratory symptoms, lung function impairment, and chronic obstructive respiratory diseases in dairy farmers. Our objective is to then examine their relation to exposure duration and to explore the usefulness of job exposure matrices as tools for exposure assessment, and predictors for respiratory health impairment. METHODS: A cross-sectional study was performed, including 83 dairy farmers (mean age: 52.6 ± 8.7 years; mean exposure duration: 23.7 ± 7.6 years) and 80 office workers as a control group (mean age: 52.7 ± 8.2 years) matched for age, smoking habits, and socioeconomic status. Methods of evaluating examined subjects included a questionnaire on respiratory symptoms in the last 12 months, spirometry and histamine challenge, as well as the use of job exposure matrices (JEM). RESULTS: Dairy farmers had a significantly higher prevalence of cough (38.5), phlegm (27.7%), and wheezing (21.7%), than controls (p < 0.05). All mean baseline spirometric parameters were lower in dairy farmers compared to the controls, but statistical significance was confirmed only for MEF25, MEF50, and MEF75% (p = 0.010, p = 0.001, and p = 0.004, respectively). The prevalence of bronchial hyperresponsiveness, asthma, and chronic obstructive pulmonary disease was higher in dairy farmers but without statistical significance. JEM were useful tools for exposure assessment and predictors of factors for asthma and COPD development. CONCLUSION: The results suggest that occupational exposure among crop farmers is associated with a higher prevalence of respiratory symptoms, lung function impairment, and a higher prevalence of chronic respiratory diseases. JEM showed good potential for farming exposure evaluation and promoted their applicability within the diagnostic algorithm focused on respiratory health assessment.

Exposure to environmental tobacco smoke in the workplace in Macedonia: where are we now?

To assess the prevalence and the level of exposure to environmental tobacco smoke (ETS) in the workplace after the enactment of the law restricting indoor smoking in Macedonia, we performed a cross-sectional, self-administered questionnaire study including 372 never-smoking workers recruited from six workplaces. We found a high prevalence of workers exposed to ETS in the workplace (27.4 %) with no significant difference between particular occupation groups. We found no significant difference in the prevalence of passive smokers in the workplace between this study and our study conducted before the law was enacted (31.5 % vs. 27.4 %, P=0.324). The prevalence of workers exposed to ETS for less than three hours a day was significantly lower than of passive smokers with longer exposure (28.4 % vs. 71.6 %, P=0.038). The prevalence of workers exposed to ETS from less than 10 cigarettes smoked by coworkers per day was lower than the prevalence of workers with higher exposure, but statistical significance was not reached (37.9 % vs. 62.1 %, P=0.087). Our findings indicate a high prevalence and a high level of exposure to ETS in the workplace, which calls for stricter adherence to smoking-free legislation or even the total ban of smoking in the workplace.

Work-related asthma in automobile spray painters: two case reports.

This report describes two patients who had developed asthma after working as automobile painters with isocyanate-based aerosol paint for two years or over. In both patients asthma was confirmed using the standard diagnostic procedure. One of the subjects was atopic. One was ex-smoker and the other had never smoked. Neither had a family history of asthma. The symptoms occurred after workplace exposure lasting two years in one patient and three in the other. As both reported work-relatedness of the symptoms, they underwent serial peak expiratory flow rate (PEFR) measurement and bronchoprovocation testing. Significant work-related changes in PEFR diurnal variations and in non-specific bronchial hyperresponsiveness (NSBH) were observed in one patient, suggesting allergic occupational asthma (OA), while the other patient was diagnosed work-exacerbated asthma (WEA). Our data confirm that spray painting is an occupation with increased risk of respiratory impairment and asthma.

Adverse effects in workers exposed to inorganic lead.

This paper describes a retrospective cohort study comparing 60 workers occupationally exposed to inorganic lead and 60 matched controls. All subjects were assessed using data obtained from a specially designed Questionnaire for lead exposure and toxic effects assessment, physical examination, spirometry, ECG, and laboratory tests including blood lead level (BLL) and biomarkers of lead toxic effects. Muscle pain, droopiness, and work-related nasal symptoms were significantly more frequent in lead workers. The prevalence of lung symptoms was higher in lead workers than in controls, but not significantly (20 % vs. 6.6 %, respectively). Mean values of BLL and delta-aminolevulinic acid (ALA) were significantly higher in lead workers. The activity of delta-aminolevulinic acid dehydratase (ALAD) in lead workers was significantly lower than in controls. Abnormal of BLL, ALAD, and ALA were more frequent in lead workers, with statistical difference for BLL and ALAD. Inverse correlation was found between BLL and ALAD, and positive correlation between BLL and age, years of employment, and years of exposure. Inverse correlation was found between ALAD and age, years of employment, years of exposure, blood pressure, alcohol consumption, and years of alcohol consumption. Changes in spirometry correlated inversely with BLL. A positive correlation was found between BLL and erythrocyte count and haemoglobin concentration, whereas it was inverse for ALAD and haemoglobin concentration. A significant difference was found for BLL and ALAD, with a very high odds ratio (14.64 and 7.23, respectively) and high relative risk (4.18 and 3.08, respectively). Our data have confirmed the association between occupational lead exposure and deviation in specific biological markers of lead effect and between the role of occupational exposure in the development of adverse effects.

Eosinophil Cationic Protein Concentrations among Crop and Dairy Farmers with Asthma.

OBJECTIVE: To assess the mean serum eosinophil cationic protein (s-ECP) concentrations among crop and dairy farmers and office controls, and further examine its relation to exposure duration, smoking habit, as well as presence or absence of asthma. METHODS: A cross-sectional survey was performed including examined group (EG), composed by agricultural workers (87 crop - EG1 and 83 dairy farmers - EG2), and control group (CG) composed by 80 office workers within the same enterprise. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed and smoking history. Evaluation of examined subjects also included lung function tests, diagnosis of asthma, and measurement of s-ECP as a marker of inflammation. RESULTS: The main finding of the present study is that s-ECP concentrations were raised in subjects with asthma independent of the smoking habit. The mean s-ECP concentrations were higher in subjects of EG1 and EG2 compared with those in CG, but without reaching statistical significance. Mean s-ECP concentrations were significantly higher among subjects in EG1 exposed more than 20 years, while mean s-ECP concentrations were non-significantly higher in subjects of EG2 exposed more than 20 years, compared to those exposed less than 20 years. Mean s-ECP concentrations were higher among smokers within all three groups, but without reaching statistical significance between smokers and non-smokers. Mean s-ECP concentrations were significantly higher in subjects with asthma within EG1 (P = 0.049) and EG2 (P = 0.040), but also within those in CG (P = 0.046). CONCLUSION: Data obtained suggest that airway inflammation is present in farmers with asthma, and s-ECP is an important biomarker in means of reflecting disease severity and prognosis among exposed workers.

Occupational asthma in subjects occupationally exposed to herbal and fruit tea dust.

We performed a cross-sectional study to detect occupational asthma (OA) in 63 subjects occupationally exposed to herbal and fruit tea dust and in 63 corresponding controls. The evaluation included a questionnaire, skin prick tests to workplace and common inhalant allergens, spirometry, and histamine challenge test. The evaluation of the work-relatedness of asthma in the exposed workers was based on serial peak expiratory flow rate (PEFR) measurements and bronchoprovocation tests. We found a higher prevalence of respiratory symptoms in the exposed workers, whereas spirometric parameters were significantly lower. The prevalence of sensitisation to allergens and of bronchial hyperresponsivenss (BHR) did not differ significantly between the groups. The prevalence of asthma was also similar in both groups (8.0 % vs. 6.4 %; P=0.540). Work-relatedness of symptoms was reported by all asthmatic tea workers and by no control with asthma. Significant work-related changes in PEFR diurnal variations and in non-specific BHR, suggesting allergic OA, were found in one tea worker with asthma (1.6 %). No specific workplace agent causing OA in the affected subject was identified. None of the tea workers with asthma met the criteria for medical case definition of the reactive airway dysfunction syndrome (RADS). Our data confirm workplace exposure to herbal and fruit tea dust as a risk factor for OA.

Bronchial hyperresponsiveness in women cooks and cleaners.

The aim of this cross-sectional study was to assess the prevalence and characteristics of bronchial hyperresponsiveness (BHR) in 43 women cleaners (aged 26 to 57) and 37 women cooks (aged 29 to 55) and compare them with 45 controls (women office workers aged 27 to 58). The evaluation of all subjects included a questionnaire, skin prick tests to common aeroallergens, spirometry, and histamine challenge (PC20 < or = 8 mg mL(-1)). We found higher BHR prevalence in cleaners and cooks than in office workers (30.2 % and 29.7 %, vs. 17.7 %, respectively), but statistical significance was not reached. The prevalence of mild and moderate to severe BHR was similar in all groups. Borderline BHR prevalence was significantly higher in cleaners than in controls (16.2 % vs. 6.6 %, P=0.032) whereas the difference was on the verge of significance in cooks (13.5 % vs. 6.6 %, P=0.081). Moderate to severe BHR was strongly associated with positive family history of asthma and atopy in all groups. Mild BHR was significantly associated with daily smoking in cleaners (P=0.031) and cooks (P=0.021), as well as with the duration of exposure in cleaners (P=0.038). Borderline BHR was closely related to daily smoking and duration of exposure in both cleaners and cooks. Our findings indicate an important role of workplace exposure in borderline BHR development, as well as the significant effect of smoking on mild BHR development in women cleaners and cooks.

C-Reactive Protein Concentrations Among Crop and Dairy Farmers with Stable Chronic Obstructive Pulmonary Disease.

AIM: To assess the mean serum C-reactive protein concentrations among farmers and office controls, and further examined its relation to exposure duration, smoking habit, as well as presence or absence of COPD. METHODS: A cross-sectional survey was performed including examined group (EG), composed of agricultural workers (87 crop - EG1 and 83 dairy farmers - EG2), and control group (CG) composed by 80 office workers. Evaluation of subjects included a questionnaire on chronic respiratory symptoms, lung function tests, COPD diagnostics, and measurement of CRP serum concentrations. RESULTS: Serum CRP concentrations were raised in stable COPD patients independent of smoking habit or exposure duration. The mean CRP serum concentrations were higher in the subjects of EG1 and EG2 compared with those in CG, but without statistical significance. This count for mean CRP serum concentrations in subjects of EG1 and EG2 exposed more than 20 years and for those in smokers in all three groups as well. The mean CRP serum concentrations were significantly higher in subjects with COPD within EG1 (P=0.049) and EG2 (P=0.040), while those in CG were not. CONCLUSION: Data obtained suggest that systemic inflammation is present in farmers with COPD and CRP is an important biomarker in COPD in means of reflecting disease severity and prognosis of exposed farmers.

Exacerbations in COPD Patients with Bronchiectasis.

There is evidence that coexisting bronchiectasis (BE) in patients with chronic obstructive pulmonary disease (COPD) aggravates the course of the disease. In this study, we aimed to evaluate the frequency and severity of bacterial exacerbations in COPD patients with BE. The frequency and duration of bacterial exacerbations treated in a 12-month period, as well as the duration of the exacerbation-free interval, were evaluated in 54 patients with COPD (Group D) who were diagnosed and assessed according to official recommendations. In 27 patients, BE was diagnosed by high-resolution computed tomography (HRCT), whereas an equal number of COPD patients who were confirmed negative for BE by HRCT, served as controls. We found a significantly higher mean number of exacerbations in a 12-month period in COPD patients with BE (2.9 ± 0.5), as compared to their mean number in controls (2.5 ± 0.3) (p = 0.0008). The mean duration of exacerbation, i.e. the mean number of days elapsed before complete resolution of the symptoms or their return to the baseline severity, was significantly longer in COPD patients with BE as compared to their mean duration in controls (6.9 ± 1.8 vs. 5.7 ± 1.4; p = 0.0085). In addition, the mean exacerbation-free interval expressed in days, in patients with COPD with BE, was significantly shorter than in COPD patients in whom BE were excluded (56.4 ± 17.1 vs. 67.2 ± 14.3; p = 0.0149). Overall, our findings indicate that coexisting BE in COPD patients may lead to more frequent exacerbations with a longer duration.

Exercise-induced bronchoconstriction in textile and agricultural workers and in bakers.

To assess the prevalence and the characteristics of exercise-induced bronchoconstriction (EIB) in subjects occupationally exposed to organic dusts we performed a cross-sectional study including 152 exposed subjects (67 textile workers, 42 agricultural workers, and 43 bakers) and 72 unexposed controls. Evaluation of exposed and unexposed subjects included a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise challenge tests (ECT). The EIB prevalence found in textile workers was 8.9 %, in agricultural workers 7.1 %, in bakers 6.9 %, and in office workers 5.5 %. The highest bronchial reaction to exercise was found in ECT-positive agricultural workers (26.1+/-6.9), followed by textile workers (25.2+/-7.4), bakers (23.0+/-5.8), and office workers (21.8+/-4.4). EIB was significantly associated with atopy and positive family history of asthma in all exposed groups. EIB was significantly associated with smoking duration in textile workers (P=0.039) and agricultural workers (P=0.027). Bronchial reaction to exercise was significantly greater in smoking than in non-smoking textile (P=0.045) and agricultural workers (P=0.032). Our data suggest that the combination of daily smoking and workplace exposure to certain types of organic dusts could contribute to EIB development and severity.

Exercise-induced bronchoconstriction and exercise-induced respiratory symptoms in workers exposed to tea dust.

Assuming that airborne particles and pollutants are important contributing factors in the development of exercise-induced bronchoconstriction (EIB), we performed a case-control study including 63 tea workers (36 men and 27 women, aged 36-55, duration of employment 3-30 years) and an equal number of office workers, matched by sex and age. Exercise-induced respiratory symptoms were recorded in a questionnaire. Skin prick tests, spirometry, as well as exercise and histamine challenge were carried out. Environmental measurements were performed on site during the work shifts. The prevalence of self-reported exercise-induced respiratory symptoms and EIB did not differ significantly between the exposed and control group (41.6% vs 36.8%, and 6.4% vs 4.8%, respectively). In both exposed and control workers, EIB was strongly linked to asthma (P < 0.01). In the exposed workers it was significantly associated with positive family history of asthma (P < 0.01) and positive family history of atopies (P < 0.05), whereas in the exposed smokers it was significantly related to smoking duration (P < 0.05). Bronchial reaction to exercise in the exposed smokers was significantly greater than in control smokers (P < 0.05). Self-reported exercise-induced respiratory symptoms were weakly associated with EIB, with a large proportion of false positive and a low proportion of false negative results in both groups.

Chronic Respiratory Symptoms and Lung Function in Agricultural Workers - Influence of Exposure Duration and Smoking.

INTRODUCTION: Job exposure in agricultural workers often leads to respiratory impairment. AIM: To assess the influence of exposure duration and smoking on chronic respiratory symptoms and ventilatory capacity in agricultural workers. METHODS: A cross-sectional study covered 75 agricultural workers, compared with an equal number of office workers matched by age, exposure duration and smoking status. Standardized questionnaire was used to obtain data on chronic respiratory symptoms, job and smoking history. Lung functional testing was performed by spirometry. RESULTS: The prevalence of respiratory symptoms was higher in agricultural workers, with significant difference for cough (P = 0.034), and dyspnea (P = 0.028). Chronic respiratory symptoms among agricultural workers were significantly associated with duration of exposure (P < 0.05) and daily smoking (P < 0.01), as well as with daily smoking in controls (P < 0.01). The average values of spirometric parameters in exposed workers were significantly different for MEF50 (P = 0.002), MEF75 (P = 0.000), and MEF25-75 (P = 0.049). Obstructive changes in small airways in exposed workers were strongly related to exposure duration (P < 0.05) and smoking (P < 0.01). Agricultural workers with job exposure more than 15 years had more expressed adverse respiratory symptoms and lung function decline. CONCLUSION: The results confirmed the influence of agricultural exposure and daily smoking on chronic respiratory symptoms and airflow limitation, primarily targeting the small airways.

Course of COPD Assessment Test (CAT) Scores During Bacterial Exacerbations of Chronic Obstructive Pulmonary Disease Treated in Outpatient Setting.

INTRODUCTION: COPD Assessment Test (CAT) is an 8-items questionnaire for assessment of health status in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To evaluate the course of CAT scores during bacterial exacerbations of COPD treated in outpatient setting. METHODS: We performed an observational, prospective study including 81 outpatients (57 males and 24 females, aged 43 to 74 years) with bacterial exacerbation of COPD. All participants completed CAT at initial visit (i.e. at the time of diagnosis of exacerbation and beginning of its treatment), 10 and 30 days after initial visit. Mean scores of each item, as well as the overall mean score, at these time points were compared. RESULTS: The mean scores for each CAT question at initial visit varied from 2.6 to 3.5, whereas the mean scores for each CAT question 10 days after initial visit varied from 1.7 to 2.6. We registered significant reduction of the mean overall CAT score 10 days after initial visit as compared to its value at initial visit of 6.9 ± 2.7 points (16.8 vs 23.7; P < 0.001). The mean scores for each CAT question 30 days after initial visit varied from 1.3 to 2.4. We registered reduction of mean overall CAT score 30 days after initial visit as compared to its score 10 days after initial visit of 2.9 ± 1.2 points (13.9 vs 16.8; P < 0.005). The mean overall CAT score 30 days after initial visit was reduced for 9.8 ± 4.5 points as compared to its value at initial visit (13.9 vs 23.7; P < 0.001). CONCLUSION: We found significant improvement in the patient's health status during recovery from exacerbation as compared to their health status at the time of exacerbation confirming the CAT as an effective tool to measure health status in patients with COPD.

Chronic obstructive pulmonary disease in never-smoking dairy farmers.

INTRODUCTION: Work-related chronic obstructive pulmonary disease (COPD) represents a considerable part of the disease burden globally. OBJECTIVE: To assess the COPD prevalence and characteristics in never-smoking dairy farmers. MATERIALS AND METHODOLOGY: We have conducted a cross-sectional study with 75 male dairy farmers aged 26 to 59 years, and compared them with equivalent number of male office workers similar by age, and duration of employment. Data on chronic respiratory symptoms, job history and daily activities were obtained by questionnaire. Lung functional testing of the examined subjects included baseline spirometry, and bronchodilator reversibility measurement. RESULTS: Dairy farmers showed higher prevalence of overall respiratory symptoms, but significant difference was noticed for cough, phlegm, and dyspnea. Dairy farmers had more prevalent work-related respiratory symptoms, being significant for overall symptoms, cough, and phlegm. The mean baseline values of spirometric parameters were lower in dairy farmers, but significance was reported for FEV1/FVC%, MEF50, MEF75, and MEF25-75. Dairy farmers had significantly higher COPD prevalence than office controls (10.7% vs 2.7%, P = 0,049). Dairy farmers and office controls showed significant association between COPD and age over 45 years. Dairy farmers had a significant association between COPD and employment duration of over 20 years (P = 0.023), but also between COPD and work-related chronic respiratory symptoms (P = 0.041). CONCLUSION: The study findings favor the cause-effect association between job exposure to respiratory hazards, and development of persistent airway obstruction among dairy farmers.

Exercise-related respiratory symptoms and exercise-induced bronchoconstriction in industrial bakers.

In order to assess prevalence and characteristics of exercise-related respiratory symptoms (ERRS) and exercise-induced bronchoconstriction (EIB) in industrial bakery, the authors performed a cross-sectional study including 57 bakers and an equal number of office workers studied as a control. Evaluation of examined subjects included completion of a questionnaire, skin prick tests to common inhalant and occupational allergens, spirometry, and exercise and histamine challenge. The authors found a similar prevalence of ERRS and EIB in both bakers and controls. EIB was significantly associated with atopy, asthma, family history of asthma, and positive histamine challenge in either group, whereas in bakers it was closely related to sensitization to occupational allergens (p = .032). Bronchial reaction to exercise was significantly higher in bakers with EIB (25.7% vs 19.2%; p = .021). These findings suggest that occupational exposure in industrial bakery may accentuate bronchoconstrictive response to exercise.

Smoking among Macedonian workers five years after the anti-smoking campaign.

To assess the efficacy of nationwide anti-smoking campaign, we compared the findings of a study on worker smoking performed in 2005 with our latest cross-sectional study completed in 2010. It included 753 randomly selected workers, of whom 126 office, 108 construction, 93 agricultural, 97 petroleum refinery, 114 textile, 117 food processing workers, and 98 cleaners. Information was collected with a self-administered questionnaire. The prevalence of current smokers among all workers was 35.4 %, ranging from 30.2 % in office workers to 43.5 % in construction workers. It did not significantly differ from the prevalence recorded in 2005 (35.4 % vs. 36.8 %, respectively; P=0.441). Mean pack-years smoked among all smokers was 12.4 ± 2.3, ranging from 10.9 in administrative workers to 13.7 in agricultural workers. We did not find any significant difference in the prevalence of current smokers between male and female workers and between workers aged less or more than 40 years, as well as between workers of higher and lower education. The prevalence of ex-smokers was 10.5 %, ranging from 8.4 % in construction workers to 12.1 % in administrative workers, whereas the prevalence of passive smokers was 29.1 %, ranging from 26.2 % in food processing workers to 32.9 % in agricultural workers. Our findings indicate that the prevalence of current and passive smokers has remained high regardless of the anti-smoking campaign and call for stricter implementation of anti-smoking regulations.

Exercise-induced bronchoconstriction and exercise-induced respiratory symptoms in nurses.

In order to assess prevalence and characteristics of exercise-induced respiratory symptoms (EIRSs) and exercise-induced bronchoconstriction (EIB) in health care workers, we performed a cross-sectional study including 48 female nurses from primary care settings and an equal number of female office workers studied as a control group. The evaluation of examined groups included completion of a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise and histamine challenge. We found a similar prevalence of EIRSs and EIB in both groups. EIB was closely related to asthma, atopy, family history of asthma, and positive histamine challenge in either group, while the association between EIB and daily smoking in nurses was of borderline statistical significance. Bronchial reaction to exercise was significantly higher in nurses than in controls with EIB. With the exception of exercise induced wheezing, EIRSs were weakly associated with EIB in both groups with a large proportion of false positive results.

Environmental and occupational health risks among agricultural workers living in a rural community near petroleum refinery and motorway in Skopje region.

To assess health risks in agricultural workers associated with environmental exposure to pollutants released from a petroleum refinery and from traffic, we performed a cross-sectional study that included 119 randomly selected subjects divided in two groups. Group 1 included 60 agricultural workers living in a rural community near the petroleum refinery and a motorway overpass, whereas Group 2 consisted of 59 agricultural workers performing similar activities and living in a rural community with no exposure to industrial and traffic pollutants. Risk assessment included a questionnaire, blood pressure measurement, spirometry, laboratory tests, and toxicological analysis. The groups showed a similar prevalence of health problems, with exception of muscle pain in the extremities, headache, and fatigue, which were significantly more common in Group 1. Diastolic blood pressure was higher in Group 1, but not significantly (p=0.057). The same is true for blood carbon monoxide. Significantly higher in Group 1 were blood haemoglobin (p=0.001) and blood lead (p<0.001). Serum cholinesterase activity was similar in both groups. Our findings indicate the need of regular medical exams, ambient monitoring and environmental impact assessment in agricultural population in order to detect individuals at risk and to institute adequate preventive measures.

Effects of passive smoking at work on respiratory symptoms, lung function, and bronchial responsiveness in never-smoking office cleaning women.

This cross-sectional study compares respiratory symptoms, lung function, and bronchial responsiveness between 27 office cleaning women exposed to environmental tobacco smoke at work and 57 unexposed controls. The age range of both groups was 24 to 56 years, and none of the women had ever smoked. Information on respiratory symptoms, cleaning work history, and passive smoking in the workplace were obtained with a questionnaire. The subjects also took a skin prick test to common inhalant allergens, a lung function test, and a histamine challenge. Despite smoking restriction in indoor environments, we found a high prevalence of passive smokers in the workplace (32.1 %). In these subjects we found a significantly higher prevalence of wheezing with breathlessness (25.9 % vs. 8.8 %; P=0.036), wheezing without cold (25.9 % vs. 7.0 %; P=0.016), and breathlessness after effort (29.6 % vs. 8.8 %; P=0.014) than in control subjects. Objective measurements showed a significantly lower MEF25 (53.6 % vs. 63.7 %; P=0.001) and a significantly higher prevalence of borderline bronchial hyperresponsiveness (22.2 % vs. 7.0 %; P=0.044) in the passive smokers in the workplace. This study provides evidence of adverse respiratory effects in office cleaning women associated with passive smoking in the workplace. Our findings support a stricter implementation of the current national law to protect respiratory health of all workers.