Occupations and exposure events in acute and subacute irritant-induced asthma.

BACKGROUND: Exposures leading to irritant-induced asthma (IIA) are poorly documented. METHODS: We retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000-2018. We classified the cases into acute (onset after single exposure) and subacute (onset after multiple exposures) IIA. We analysed in detail, occupations, causative agents and their air levels in the workplace, exposure events and the root causes of high exposure. RESULTS: Altogether 69 patients were diagnosed with IIA, 30 with acute and 39 with subacute IIA. The most common occupational groups were industrial operators (n=23, 33%), metal and machinery workers (n=16, 11%) and construction workers (n=12, 8%). Among industrial operators significantly more cases had subacute IIA than acute IIA (p=0.002). Forty cases (57%) were attributable to some type of corrosive acidic or alkaline chemical. Acute IIA followed accidents at work in different types of occupation, while subacute IIA was typical among industrial operators performing their normal work tasks under poor work hygiene conditions. The most common root cause was lack of information or false guidance in acute IIA (n=11, 36%) and neglect of workplace hygiene measures in subacute IIA (n=29, 74%). CONCLUSIONS: Accidents are the main causes of acute IIA, whereas subacute IIA can develop in normal work in risk trades with poor work hygiene. Airborne strong acids or bases seem to be the most important causative agents of acute and subacute IIA. The different risk profiles of acute and subacute IIA should be considered in the prevention and identification of the cases.

Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance.

A subset of adult-onset asthma patients attribute their symptoms to damp and moldy buildings. Symptoms of idiopathic environmental intolerance (IEI) may resemble asthma and these two entities overlap. We aimed to evaluate if a distinct clinical subtype of asthma related to damp and moldy buildings can be identified, to unravel its corresponding pathomechanistic gene signatures, and to investigate potential molecular similarities with IEI. Fifty female adult-onset asthma patients were categorized based on exposure to building dampness and molds during disease initiation. IEI patients (n = 17) and healthy subjects (n = 21) were also included yielding 88 study subjects. IEI was scored with the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Inflammation was evaluated by blood cell type profiling and cytokine measurements. Disease mechanisms were investigated via gene set variation analysis of RNA from nasal biopsies and peripheral blood mononuclear cells. Nasal biopsy gene expression and plasma cytokine profiles suggested airway and systemic inflammation in asthma without exposure to dampness (AND). Similar evidence of inflammation was absent in patients with dampness-and-mold-related asthma (AAD). Gene expression signatures revealed a greater degree of similarity between IEI and dampness-related asthma than between IEI patients and asthma not associated to dampness and mold. Blood cell transcriptome of IEI subjects showed strong suppression of immune cell activation, migration, and movement. QEESI scores correlated to blood cell gene expression of all study subjects. Transcriptomic analysis revealed clear pathomechanisms for AND but not AAD patients. Furthermore, we found a distinct molecular pathological profile in nasal and blood immune cells of IEI subjects, including several differentially expressed genes that were also identified in AAD samples, suggesting IEI-type mechanisms.

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

OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Prevalence of various environmental intolerances in a Swedish and Finnish general population.

OBJECTIVE: To determine the prevalence of various environmental intolerances (EIs), using several criteria in a Swedish and a Finnish general population. Ill-health attributed to low-level environmental exposures is a commonly encountered challenge in occupational and environmental medicine. METHODS: In population-based questionnaire surveys, the Västerbotten Environmental Health Study (Sweden) and the Österbotten Environmental Health Study (Finland), EI was inquired by one-item questions on symptom attribution to chemicals, certain buildings, or electromagnetic fields (EMFs), and difficulties tolerating sounds. The respondents were asked whether they react with central nervous system (CNS) symptoms or have a physician-diagnosed EI attributed to the corresponding exposures. Prevalence rates were determined for different age and sex groups and the Swedish and Finnish samples in general. RESULTS: In the Swedish sample (n = 3406), 12.2% had self-reported intolerance to chemicals, 4.8% to certain buildings, 2.7% to EMFs, and 9.2% to sounds. The prevalence rates for the Finnish sample (n = 1535) were 15.2%, 7.2%, 1.6%, and 5.4%, respectively, differing statistically significantly from the Swedish. EI to chemicals and certain buildings was more prevalent in Finland, while EI to EMFs and sounds more prevalent in Sweden. The prevalence rates for EI with CNS-symptoms were lower and physician-diagnosed EIs considerably lower than self-reported EIs. Women reported EI more often than men and the young (18-39 years) to a lesser degree than middle-aged and elderly. CONCLUSIONS: The findings reflect the heterogeneous nature of EI. The differences in EI prevalence between the countries might reflect disparities concerning which exposures people perceive harmful and focus their attention to.

Cervical and lumbar pain and radiological degeneration among fighter pilots: a systematic review and meta-analysis.

To assess the associations of acceleration force indicators (aircraft type and flight hours) with cervical and lumbar pain and radiological degeneration among fighter pilots. The PubMed, Embase, Scopus and Web of Science databases were searched until October 2013. Twenty-seven studies were included in the review and 20 in the meta-analysis. There were no differences in the prevalence of neck pain (pooled OR=1.07, 95% CI 0.87 to 1.33), cervical disc degeneration (OR=1.26, CI 0.81 to 1.96), low back pain (OR=0.80, CI 0.47 to 1.38) or lumbar disc degeneration (OR=0.87, CI 0.67 to 1.13) between fighter pilots and helicopter or transport/cargo pilots. Moreover, the prevalence of cervical (OR=1.14, CI 0.61 to 2.16) or lumbar (OR=1.05, CI 0.49 to 2.26) disc degeneration did not differ between fighter pilots and non-flying personnel. Most studies did not control their estimates for age and other potential confounders. Among high-performance aircraft pilots, exposure to the highest G-forces was associated with a higher prevalence of neck pain compared with exposure to lower G-forces (pooled OR=3.12, CI 2.08 to 4.67). The studies on the association between flight hours and neck pain reported inconsistent findings. Moreover, looking back over the shoulder (check six) was the most common posture associated with neck pain. Fighter pilots exposed to high G-forces may be at a greater risk for neck pain than those exposed to low G-forces. This finding should be confirmed with better control for confounding. Awkward neck posture may be an important factor in neck pain among fighter pilots.

Asthma related to workplace dampness and impaired work ability.

PURPOSE: To examine the long-term effects on work ability among patients previously diagnosed with occupational asthma (OA) or work-exacerbated asthma (WEA) or symptoms in relation to workplace dampness. METHODS: A questionnaire follow-up was used to study 1,098 patients (of whom 87 % were female) examined because of a suspected occupational respiratory disease caused by building dampness and mold. Self-rated work ability and early withdrawal from work were the two outcomes of the study. As determinants, we investigated the influence of the asthma diagnosis given in the initial examinations (OA or WEA), the number of persistent indoor air symptoms, and the psychosocial factors at work. RESULTS: With a mean follow-up of 7.8 years, 40 % of the OA patients, under 65 years of age, were outside worklife versus 23 % of the WEA patients and 15 % of the patients with only upper respiratory symptoms at baseline. The diagnosis of OA was associated with a nearly sixfold risk for early withdrawal from work in a comparison with a reference group with upper respiratory symptoms. A perceived poor social climate at work and poor experiences with supervisory co-operation were associated with impaired work ability outcomes. Those with multiple, long-term indoor air symptoms considerably more often perceived their work ability to be poor when compared with those with less significant symptoms. CONCLUSIONS: Adverse work ability outcomes are associated with asthma in relation to workplace dampness. The study raises the need for effective preventive measures in order to help workers with indoor air symptoms sustain their work ability.

[Work aggravated asthma]. / Tyon pahentama astma.

One out of five working persons with asthma has work-related respiratory symptoms. When exploring the symptoms of a working-age patient it is essential to survey the job description and working conditions. Early intervention in the factors aggravating the respiratory symptoms will decrease morbidity, maintain working capacity and improve the quality of life. Occupational health service and the employer play a central role in identifying and decreasing the exposure factors in the working environment as well as in patient guidance for asthma therapy and protecting from the stimuli. The working capacity of an asthmatic person can be improved by applying vocational rehabilitation.

[Irritant-induced asthma]. / Ärsytyksen aiheuttama astma.

Irritant-induced asthma is a rare disease, usually being caused by an accidental or other exceptionally strong exposure to substances irritating the respiratory passages. High-dose inhaled corticosteroid medication is immediately started at the emergency call service. If severe exposure is suspected, it is important to monitor the patient at least for a couple of days in hospital. Immediately after the acute stage diagnostic investigations are carried out, including a metacholine or histamine challenge test, since demonstration of airway hyperreactivity is of diagnostic and prognostic significance. The asthma may remain permanent.

Long-Term Impairment From Irritant-Induced Occupational Asthma.

OBJECTIVE: The aim of the study is to assess the long-term physical condition, health-related quality of life, employment, and work ability of irritant-induced asthma (IIA) patients. METHODS: Forty-three IIA patients completed a follow-up questionnaire a median of eight (interquartile range 4-11) years after asthma diagnosis. We compared their results with those of 43 low-molecular-weight (LMW) sensitizer-induced occupational asthma (OA) patients and those of 206 adult-onset asthmatics in the general population. RESULTS: Of the IIA patients, 40% reported depressive symptoms. Of the <65-year-olds, 56% were employed, of whom 39% assessed their work ability as limited. IIA patients had more difficulty climbing several flights of stairs than LMW-induced OA patients (70% vs 47%, OR = 4.83 95% CI: 1.51-15.47). Most of the IIA patients' outcomes were inferior to those of the adult-onset asthmatics in the general population. CONCLUSIONS: IIA prognosis appeared poor but resembled that of LMW-induced OA.

Clinical Characteristics of Irritant-Induced Occupational Asthma.

BACKGROUND: Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete. OBJECTIVES: To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. METHODS: This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. RESULTS: Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting ß-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). CONCLUSIONS: Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.

Prolonged exposure to damp and moldy workplaces and new-onset asthma.

PURPOSE: Epidemiological evidence shows that indoor dampness is associated with respiratory symptoms, the aggravation of preexisting asthma, and the development of new-onset asthma. Follow-up studies indicate that symptoms compatible with asthma constitute risk factors for the future development of asthma. The aims of the study were (1) to assess whether asthma-like symptoms (cough, dyspnea, and wheeze) that occur in relation to exposure to damp and moldy work environments lead to the later development of asthma and (2) to assess the importance of continued exposure to indoor dampness and molds at work in the development of asthma. METHODS: We followed 483 patients with asthma-like symptoms related to damp workplaces but without objective evidence of asthma in baseline examinations. The development of asthma and present work conditions were established with the use of a questionnaire 3-12 years later. RESULTS: A total of 62 patients (13%) reported having developed asthma during the study period. Continued exposure to a damp or moldy environment was associated with a more than fourfold increase in the risk of asthma (odds ratio 4.6, 95% confidence interval 1.8-11.6). Working in a non-remediated environment at follow-up was the strongest risk factor for developing asthma. The remediation of damp buildings seemed to be associated with a decrease in the risk of asthma. CONCLUSIONS: The results indicate that exposure at work to dampness and molds is associated with the occurrence of new-onset asthma. Exposed workers suffering from asthma-like symptoms represent a risk group for the development of asthma. The risk appears especially high if the exposure continues. Due to inherent weaknesses of patient series, the findings need corroborative studies.

New-onset adult asthma in relation to damp and moldy workplaces.

OBJECTIVE: Damp and moldy indoor environments aggravate pre-existing asthma. Recent meta-analyses suggest that exposure to such environments may also induce new-onset asthma. We assessed the probability of molds being the cause of asthma in a patient series examined because of respiratory symptoms in relation to workplace dampness and molds. METHODS: Altogether 694 such patients had been clinically assessed between 1995 and 2004. According to their histories, they had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms. The investigations had included specific inhalation challenge (SIC) tests with mold extracts and serial peak expiratory flow (PEF) recordings. Using internationally recommended diagnostic criteria for occupational asthma (OA), we categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). The clinical details of 258 patients were analyzed, and their levels of microbial exposure were evaluated. RESULTS: The agreement between the serial PEF recordings and SIC tests (both being either positive or negative) was 56%. In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. At 6 months, the follow-up examinations of 136 patients with probable OA showed that the symptoms were persistent, and no improvement in spirometry was noted despite adequate treatment. Only 58% of the patients had returned to work. CONCLUSIONS: Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.

Perceived indoor air quality and psychosocial work environment in office, school and health care environments in Finland.

OBJECTIVES: The study examined the extent and prevalence of perceived indoor environment-related (IE-related) symptoms environmental complaints and psychosocial work environmental factors in Finnish office, school and health care environments. MATERIAL AND METHODS: The data were collected from non-industrial workplaces (N = 455) in 2011-2012 and 2015-2017 using the Finnish Institute of Occupational Health's Indoor Air Questionnaire (IA Questionnaire). Suspicion of IE-related problems was reported in 59% of workplaces. The data consisted of 28 826 employees' responses. RESULTS: The employees reported symptoms and environmental discomfort in office environments less often than in school or health care environments. The most often reported IE-related complaints were stuffy air (39% of respondents), dry air (34%) and insufficient ventilation (33%). The most often reported symptoms were irritation of the nose (27% of respondents), irritation of the eyes (26%), and hoarse or dry throat (24%). The results showed differences between the perceived IE in office, school and health care environments. CONCLUSIONS: Compared to earlier findings, the most often perceived IE-related symptoms and complaints have increased in Finnish health care environments. The office employees' perceptions of psychosocial work environment remained fairly unchanged whereas health care personnel more often assessed their psychosocial environment as positive compared to previous reports. Instead of exact reference values, comparing the results of IA Questionnaires with the distributions and mean values of the results of this study may be more informative for those striving to solve IE-related problems. The presented distribution and mean values of perceived symptoms, environmental complaints and psychosocial work environment might help to relate the results to other workplaces. This, in turn, might increase the understanding that IA Questionnaire results are influenced by many factors. The results presented can be used as new reference material when interpreting the results of IA Questionnaires in office, school and health care environments. Int J Occup Med Environ Health. 2020;33(4):479-95.

Psychosocial treatments for employees with non-specific and persistent physical symptoms associated with indoor air: A randomised controlled trial with a one-year follow-up.

OBJECTIVE: Persistent physical symptoms (PPS) associated with indoor air without an adequate pathophysiological- or environmental-related explanation may lead to work disability and decreased health-related quality of life (HRQoL). We attempted to assess the effect of cognitive behavioural therapy (CBT) for PPS and also psychoeducation (PE) on these symptoms involving disability. METHOD: The intention-to-treat (ITT) sample included 52 employees recruited from an occupational healthcare service randomised as either controls undergoing treatment as usual (TAU) or TAU enhanced with CBT or PE. The primary outcome was HRQoL measuring the severity of symptoms and restrictions in everyday life caused by them. Secondary outcomes included depressive, anxiety and insomnia symptoms, and intolerance to environmental factors, assessed at baseline and at 3-, 6- and 12-month follow-ups. RESULTS: At the 12-month follow-up assessment point, no statistically significant differences between treatments emerged following adjustment for gender, age, and HRQoL before the waiting period in the ITT analysis [F(2,46)=2.89, p=.07]. The secondary analysis revealed a significant improvement in HRQoL in the combined intervention group as compared with controls [F(1,47)=5.06, p=.03, g=0.41]. In total, 15% of participants dropped out during follow-up. CONCLUSIONS: The results suggest that CBT for PPS or PE might not have a robust effect on HRQoL in PPS associated with indoor air, but the study did not achieve the planned power. Despite difficulties during the recruitment process, the final dropout rates remained low, and participants positively evaluated CBT, suggesting that it represents an acceptable treatment to them. Trial status This study was registered at the ClinicalTrials.gov registry (NCT02069002).

Healthy people in healthy premises: the Finnish Indoor Air and Health Programme 2018-2028.

Clean and fresh indoor air supports health and well-being. However, indoor air can contain pollutants that can cause a variety of symptoms and reduce well-being. Individual exposure agents can also increase the risk of certain diseases. Finns have taken major steps to improve the quality of indoor air for several decades. The primary focus of these activities has been the prevention and reduction of exposure to poor indoor air quality through guidance and regulation directing remediation of damaged buildings. Nevertheless, reported symptoms related to poor indoor air quality are common in Finland. In addition to exposure to indoor air pollutants, this may be partly due to the lively public discussion on the health risks caused by poor indoor air quality, conflicting views between experts, and mistrust towards public authorities, building owners and builders. Because of the scale of the indoor air problems in Finland, people's needs for reliable information and support, and the major costs involved, there is a call for new evidence-based methods, perspectives and solutions. Therefore, the Finnish Institute for Health and Welfare initiated the Finnish Indoor Air and Health Programme 2018-2028 together with a number of collaborators and stakeholders. The primary, long-term objective of the programme is to reduce hazards to health and well-being linked to indoor environments in Finland. To fulfill this objective, the programme will focus on the promotion of human health and well-being, the prevention of hazards, improved communication and engage the whole health-care sector to manage better patients´ symptoms and complaints. The 10-year Finnish Indoor Air and Health Programme consists of four areas that aim (1) to increase understanding of the effects of indoor environments on health and well-being; (2) to develop the management of problems linked to indoor environments; (3) to improve the treatment and working and functional capacity of people with symptoms and illnesses; and (4) to strengthen the competence in matters related to indoor environments. The progress of the programme and reaching the predefined, quantitative goals will be monitored throughout the programme.

[Work underlying respiratory symptoms?]. / Työkö hengitystieoireiden taustalla?

Every medical practitioner attending working-aged patients will encounter patients, whose respiratory symptoms are associated with work. Most commonly such symptoms constitute irritational symptoms of the respiratory passages or exacerbation of a disease such as asthma. Connection of the symptoms with work can easily be screened at the surgery visit with brief questions. In cases of suspected occupational disease, investigations by a specialized clinic are needed. Sometimes exclusion of occupational disease is required, before a decision can be made that the symptoms are caused by nonspecific stimuli. Even if the patient does not have an occupational disease, collaboration with occupational health services may prove fruitful.

Asthma diagnosed in late adulthood is linked to work disability and poor employment status.

BACKGROUND: Age at asthma onset is associated with severity and outcomes of the disease. OBJECTIVE: We studied if age at asthma diagnosis is related to employment and outcomes in working career. PATIENTS AND METHODS: A questionnaire was sent to 2613 adults with asthma in Tampere, Finland, and a follow-up questionnaire was sent after six years. Asthmatics were divided into groups based on their employment status: working full-time or work disability. Logistic regression was used to study the association of age at asthma diagnosis with employment status at baseline and with the risk of exiting full-time work during follow-up period. RESULTS: In cross-sectional analysis, asthma diagnosed in late adulthood (50 + years) was associated with higher OR for having work-disability compared to childhood onset asthma (OR [95% CI] 3.60 [1.43-9.06]). During follow-up, asthma diagnosed in late adulthood was associated with higher OR for exiting full time work compared to childhood-onset asthma (OR 10.87 [3.25-36.40]). CONCLUSIONS: Asthma diagnosed in late adulthood is a higher risk for poor employment than asthma diagnosed earlier in life. Adult-onset of asthma is an important factor in view of work ability and early rehabilitation procedures.

Health-related quality among life of employees with persistent nonspecific indoor-air-associated health complaints.

OBJECTIVE: Nonspecific health complaints associated with indoor air are common in work environments. In some individuals, symptoms become persistent without an adequate explanation. The aim was to study factors that associate with the health-related quality of life (HRQoL) of employees with persistent, nonspecific indoor-air-related symptomatology. METHODS: We present baseline results of a randomized controlled trial of interventions targeted on the HRQoL of the employees with indoor-air-associated nonspecific symptoms. The main participant-inclusion criterion was the presence of persistent indoor-air-related multiorgan symptoms with no known pathophysiological or environment-related explanation. As a comparison for participants´ HRQoL (n = 52) we used data from the general-population Health 2011 study (BRIF8901) including information on subjects matched to the participants´ working status and age and subjects with asthma, anxiety or depressive disorder, or other chronic conditions with work disability. RESULTS: The participants showed greater and a clinically significant impairment of HRQoL [M = 0.83, SE = 0.013] than individuals from the general population [M = 0.95, SE = 0.001, p < .001, Hedges´ g = 2.33] and those with asthma [M = 0.93, SE = 0.005, p < .001, Hedges´ g = 1.46], anxiety and depressive disorder [M = 0.89, SE = 0.006, p < .001, Hedges´ g = 0.73], or a chronic condition with work disability [M = 0.91, SE = 0.003, p < .001, Hedges´ g = 1.11]. Prevalent symptoms of depression, anxiety, and insomnia and poor recovery from work were associated with a poor HRQoL. CONCLUSIONS: Individuals with nonspecific indoor-air-associated symptoms have a poorer HRQoL than individuals in the general population with a globally burdensome disease. Psychological distress associated with a poor HRQoL should be considered in the making of decisions about the treatment of these patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02069002.

Clinical Characteristics of Disability in Patients with Indoor Air-Related Environmental Intolerance.

BACKGROUND: Chronic nonspecific symptoms attributed to indoor nonindustrial work environments are common and may cause disability, but the medical nature of this disability is unclear. The aim was to medically characterize the disability manifested by chronic, recurrent symptoms and restrictions to work participation attributed to low-level indoor pollutants at workplace and whether the condition shares features with idiopathic environmental intolerance. METHODS: We investigated 12 patients with indoor air-related work disability. The examinations included somatic, psychological, and psychiatric evaluations as well as investigations of the autonomic nervous system, cortisol measurements, lung function, and allergy tests. We evaluated well-being, health, disability, insomnia, pain, anxiety, depression, and burnout via questionnaires. RESULTS: The mean symptom history was 10.5 years; for disabling symptoms, 2.7 years. Eleven patients reported reactions triggered mainly by indoor molds, one by fragrances only. Ten reported sensitivity to odorous chemicals, and three, electric devices. Nearly all had co-occurrent somatic and psychiatric diagnoses and signs of pain, insomnia, burnout, and/or elevated sympathetic responses. Avoiding certain environments had led to restrictions in several life areas. On self-assessment scales, disability showed higher severity and anxiety showed lower severity than in physician assessments. CONCLUSION: No medical cause was found to explain the disability. Findings support that the condition is a form of idiopathic environmental intolerance and belongs to functional somatic syndromes. Instead of endless avoidance, rehabilitation approaches of functional somatic syndromes are applicable.

Employment status and changes in working career in relation to asthma: a cross-sectional survey.

BACKGROUND: Asthmatics confront inconveniences in working life that make it more difficult to pursue a sustainable career, such as unemployment and work disability. Ways of dealing with these inconveniences may be career changes. More needs to be known about the backgrounds and consequences of career changes among asthmatics, especially their relation to asthma or a change in asthma symptoms. The aim of this study was to compare earlier career changes of adults with asthma who are working full time to those who have drifted away from active working life because of work disability, unemployment or early retirement. The frequency of having changed tasks, work place or occupation, whether the changes had been driven by asthma and furthermore, whether the changes had affected their asthma symptoms were investigated. METHODS: In this population-based survey study, all patients with reimbursement rights for asthma aged 20-65 years in the city of Tampere (total population 190,000), Finland (n = 2613) were recruited. The questionnaire was sent in October 2000 and the response rate was 79%. The questionnaire included questions e.g. on changing tasks, work place and occupation, whether these changes were driven by asthma or associated with change of asthma symptoms. The respondents were divided into four groups: working full-time, work disability, unemployed and retired due to age. We applied ANOVA with Dunnet's post-test (variances were not equal between the groups) for a continued variable age and Chi-squared tests for categorical variables. Logistic regression models were built using unemployed vs. full-time work or work disability vs. full-time work as an outcome variable. A p-value of <.05 was considered statistically significant. RESULTS: Adults with asthma working full time had more often made changes in their career, but not as often driven by asthma as those with current work disability. The reason for changing work place compared to full-time workers (24.9%) was more often mainly or partly due to asthma among those with work disability (47.9%, p < 0.001) and the unemployed (43.3%, p = 0.006). Of those who made career changes because of asthma, a major proportion (over 67%) reported relief in asthma symptoms. Changing tasks (OR 5.8, 95% CI 1.9-18.0, for unemployment vs. full-time work), work place (OR 2.8, 95% CI 1.1-7.0, for work disability vs. full-time work and OR 2.6, 95% CI 1.3-5.4, for unemployment vs. full-time work) or occupation (OR 2.7, 95% CI 1.2-6.0, for unemployment vs. full-time work) mainly because of asthma was associated with an elevated risk for undesirable employment status even after adjusting for age, gender, smoking and professional status. CONCLUSIONS: Career changes that were made mainly because of asthma were associated with undesirable employment status in this study. However, asthma symptoms were relieved after career changes especially among those who reported asthma to be the reason for the change. In addition to proper treatment and counselling of asthma patients towards applicable area of work or study, it may be beneficial to support early career changes in maintaining sustainable working careers among adults with asthma.