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1.
Handb Exp Pharmacol ; 268: 213-225, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34031758

RESUMO

Occupational allergies are among the most common recorded occupational diseases. The skin and the upper and lower respiratory tract are the classical manifestation organs. More than 400 occupational agents are currently documented as being potential "respiratory sensitizers" and new reported causative agents are reported each year. These agents may induce occupational rhinitis (OR) or occupational asthma (OA) and can be divided into high-molecular weight (HMW) and low-molecular weight (LMW) agents. The most common occupational HMW agents are (glycol)proteins found in flour and grains, enzymes, laboratory animals, fish and seafood, molds, and Hevea brasiliensis latex. Typical LMW substances are isocyanates, metals, quaternary ammonium persulfate, acid anhydrides, and cleaning products/disinfectants. Diagnosis of occupational respiratory allergy is made by a combination of medical history, physical examination, positive methacholine challenge result or bronchodilator responsiveness, determination of IgE-mediated sensitization, and specific inhalation challenge tests as the gold standard. Accurate diagnosis of asthma is the first step to managing OA as shown above. Removal from the causative agent is of central importance for the management of OA. The best strategy to avoid OA is primary prevention, ideally by avoiding the use of and exposure to the sensitizer or substituting safer substances for these agents.


Assuntos
Asma Ocupacional , Hipersensibilidade , Doenças Profissionais , Alérgenos , Animais , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Fatores de Risco
2.
Artigo em Inglês | MEDLINE | ID: mdl-34948791

RESUMO

Isocyanate, whose disease-inducing mechanism is poorly understood, with poor prognosis, is widely used. Asthma is the most frequent manifestation of prolonged exposure. We assessed the evolution of the incidence of isocyanate-induced occupational asthma over time. PubMed and Cochrane databases were systematically searched for studies published since 1990 that assessed the relationship between occupational exposure to isocyanates and asthma. We identified 39 studies: five retrospective cohort studies, seven prospective cohort studies, three of which were inception cohorts), seven observational cross-sectional studies, five literature reviews, two case series, and 13 registry studies. The incidence of occupational asthma secondary to isocyanate exposure has decreased from more than 5% in the early 1990s to 0.9% in 2017 in the United States. Despite the wide use of optimal collective and individual protection measures, the risk of occupational asthma has stabilized. Occupational asthma risk can be assessed with good sensitivity using self-questionnaires and pulmonary function tests. Occupational avoidance should be implemented as soon as possible after the first symptoms appear because the prognosis becomes increasingly poor with the persistence of exposure. It is now necessary to study specifically cutaneous sensitization to isocyanates and to define what protective equipment is effective against this mode of exposure.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Saúde do Trabalhador , Asma Ocupacional/induzido quimicamente , Asma Ocupacional/epidemiologia , Estudos Transversais , Humanos , Isocianatos/toxicidade , Exposição Ocupacional/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos
3.
Rev Mal Respir ; 38(9): 914-935, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34711451

RESUMO

Work-related asthma (WRA) accounts for 10-25% of all adult asthma. It therefore seems important to raise questions regarding an asthmatic's approach to occupational or job training activities. WRA takes on two forms: work-exacerbated asthma (WEA) and occupational asthma (OA), which encompasses different subtypes of heterogeneous mechanisms. It currently represents a major challenge for occupational medicine in terms of detailed diagnosis, social care, the economic repercussions for workers and employers and, last but not least, social insurance. This review aims to sensitize health care practitioners to the peculiarities of WRA management in routine practice. More specifically, prognosis depends on early diagnosis, medical care and work adjustment measures. WEA and OA are explained in detail in view of identifying causative agents and at-risk occupations and defining adapted medical strategy. Relevant lines of questioning and complementary exams are presented. In addition, the key role of the occupational physician, especially as regards recognition and identification of occupational disease, is underlined, the objective being to facilitate optimal professional and social management. In future studies, the key role of counseling and orientation mechanisms should be highlighted as means of preventing WRA occurrence.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Adolescente , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia
4.
J Bras Pneumol ; 47(4): e20200577, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406224

RESUMO

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.


Assuntos
Asma Ocupacional , Doenças Profissionais , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Prevalência
5.
BMJ Open Respir Res ; 8(1)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34362763

RESUMO

INTRODUCTION: Occupational asthma (OA) accounts for one in six cases of adult-onset asthma and is associated with a large societal cost. Many cases of OA are missed or delayed, leading to ongoing exposure to the causative agent and avoidable lung function loss and poor employment-related outcomes. Enquiry about work-related symptoms and the nature of work by healthcare professionals (HCPs) is limited, evident in primary and secondary care. Potential reasons cited for this are time pressure, lack of expertise and poor access to specialists. AIM: To understand organisational factors and beliefs and behaviours among primary HCPs that may present barriers to identifying OA. METHODS: We employed a qualitative phenomenological methodology and undertook 20-45 min interviews with primary HCPs in West Midlands, UK. We used purposive and snowball sampling to include general practitioners (GPs) and practice nurses with a range of experience, from urban and rural settings. Interviews were recorded digitally and transcribed professionally for analysis. Data were coded by hand, and thematic analysis was undertaken and determined theoretically until themes were saturated. RESULTS: Eleven HCPs participated (eight GPs, three nurses). Four themes were identified that were considered to impact on identification of OA: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. OA-specific education had been inadequate at every stage of training and practice, and clinical exposure to OA had been generally limited. OA-specific beliefs varied, as did clinical behaviour with working-age individuals with asthma. There was a focus on diagnosis and treatment rather than attributing causation. Identified issues regarding organisation of asthma care were time constraints, lack of continuity, referral pressure, use of guidelines and templates, and external targets. CONCLUSION: Organisation and delivery of primary asthma care, negative OA-related beliefs, lack of formal education, and exposure to OA may all currently inhibit its identification.


Assuntos
Asma Ocupacional , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Pessoal de Saúde , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa , Encaminhamento e Consulta
6.
Occup Environ Med ; 78(9): 661-668, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34282040

RESUMO

BACKGROUND: We hypothesised that occupational exposures differently affect subtypes of adult-onset asthma. OBJECTIVE: We investigated potential relations between occupation and three subtypes of adult asthma, namely atopic asthma, non-atopic asthma and asthma-COPD overlap syndrome (ACOS). METHODS: This is a population-based case-control study of incident asthma among working-age adults living in Pirkanmaa Hospital District in Southern Finland. The determinant of interest was occupation at the time of diagnosis of asthma or the job that the subject had quit due to respiratory symptoms. Asthma was divided into three mutually exclusive subtypes on the basis of any positive IgE antibody (atopic and non-atopic asthma) and presence of persistent airways obstruction in spirometry (ACOS). We applied unconditional logistic regression analysis to estimate adjusted OR (aOR), taking into account gender, age and smoking. RESULTS: The following occupational groups showed significantly increased risk of atopic asthma: chemical industry workers (aOR 15.76, 95% CI 2.64 to 94.12), bakers and food processors (aOR 4.69, 95% CI 1.18 to 18.69), waiters (aOR 4.67, 95% CI 1.40 to 15.56) and those unemployed (aOR 3.06, 95% CI 1.52 to 6.17). The following occupations showed clearly increased risk of non-atopic asthma: metal workers (aOR 8.37, 95% CI 3.77 to 18.59) and farmers and other agricultural workers (aOR 2.36, 95% CI 1.10 to 5.06). Some occupational groups showed statistically significantly increased OR of ACOS: electrical and electronic production workers (aOR 30.6, 95% CI 6.10 to 153.35), fur and leather workers (aOR 16.41, 95% CI 1.25 to 215.85) and those retired (aOR 5.55, 95% CI 1.63 to 18.97). CONCLUSIONS: Our results show that different occupations are associated with different subtypes of adult-onset asthma.


Assuntos
Asma Ocupacional/etiologia , Adulto , Fatores Etários , Asma Ocupacional/classificação , Asma Ocupacional/epidemiologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/epidemiologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/etiologia , Estudos de Casos e Controles , Indústria Química , Fazendeiros , Feminino , Finlândia/epidemiologia , Indústria Alimentícia , Humanos , Masculino , Pessoa de Meia-Idade , Restaurantes , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Adulto Jovem
7.
Allergy Asthma Proc ; 42(1): 72-77, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33404390

RESUMO

Background: Baker's asthma (BA) is one of the most common causes of occupational asthma. Prevalence of BA varies from 3 to 24% in various studies; however, in our country, there are not enough data on its prevalence. Objective: The aim of this study was to evaluate wheat flour sensitivity and to determine the rate of BA in workers at a large bread factory in Ankara. Methods: All steps of the study were carried out in the workplace by the research team who made regular visits to the bread factory. A questionnaire was used to determine the presence of respiratory symptoms and its relation with the occupation. Skin-prick tests and specific immunoglobulin E measurements were performed. Pulmonary function tests and specific inhalation challenges (SIC) were performed to confirm the BA diagnosis. Results: A total of 162 workers (women/men, 3/159; mean ±standard error age, 38.25 ± 7.8 years) were included in the study. Of the 99 workers who described symptoms, 88 (88.8%) had nasal and 57 (57.5%) had lower respiratory symptoms. Sensitivity to wheat flour was present in 23 of the workers (14.2%) among all the workers. Among all the workers, seven (4.32%) were diagnosed with BA and SICs were positive in four (2.46%). Conclusion: Wheat sensitivity was high among the bakers who were exposed to wheat flour; however, the prevalence of BA was quite lower than the previous data in the literature.


Assuntos
Alérgenos/imunologia , Asma Ocupacional/imunologia , Triticum/imunologia , Adulto , Asma Ocupacional/epidemiologia , Pão , Feminino , Farinha , Humanos , Imunoglobulina E/sangue , Masculino , Instalações Industriais e de Manufatura , Pessoa de Meia-Idade , Prevalência , Testes de Função Respiratória , Turquia/epidemiologia
8.
Curr Opin Allergy Clin Immunol ; 21(2): 110-113, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332925

RESUMO

PURPOSE OF REVIEW: The purpose of this review was to list all new confirmed cases of immunological occupational asthma (IOA) described between mid-2014 and April 2020. RECENT FINDINGS: Several new agents, both of high and low molecular weight, have been identified in the last 6 years as potential respiratory sensitizers being able to induce immunological occupational asthma. This review confirms that new causes of IOA are still identified regularly, particularly in subjects exposed to high molecular agents, in the food industry (farming, pest control, food processing), pharmaceutical industry (antibiotics, various drugs) and cosmetic environment (dyes, powders). SUMMARY: It stressed the need for clinicians to stay alert and suspect occupational asthma in any adult with new onset asthma or newly uncontrolled asthma.


Assuntos
Asma Ocupacional , Exposição Ocupacional , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Indústria Alimentícia , Humanos , Doenças Profissionais , Exposição Ocupacional/efeitos adversos
9.
Occup Environ Med ; 78(2): 112-116, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32855346

RESUMO

OBJECTIVES: Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved. METHODS: Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010-2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models. RESULTS: The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95% CI 1.0 to 5.5 and OR 3.4, 95% CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected. CONCLUSIONS: Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms.


Assuntos
Alérgenos/imunologia , Farinha , Doenças Profissionais/epidemiologia , Doenças Profissionais/imunologia , Exposição Ocupacional/efeitos adversos , Adulto , Asma Ocupacional/epidemiologia , Asma Ocupacional/imunologia , Estudos Transversais , Dermatite/epidemiologia , Dermatite/imunologia , Poeira/imunologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Prevalência , Rinite/epidemiologia , Rinite/imunologia , Triticum/imunologia
10.
Rev Mal Respir ; 37(9): 710-721, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33069502

RESUMO

INTRODUCTION: Screening for occupational asthma is should still be promoted. In order to improve the efficiency of any educational intervention we need to evaluate the patient's knowledge of the disease. OBJECTIVES: The aims were to evaluate objectively the knowledge level of Tunisian asthmatic patients concerning occupational asthma using a self-questionnaire in Arabic Tunisian dialect, then to conduct a validation process of the questionnaire. METHODS: We followed De Vellis's rules during all stages of redaction of the self-questionnaire. It contained 18 items allocated in 4 dimensions: knowledge about asthma; knowledge about occupational asthma; prognosis of occupational asthma; prevention of occupational asthma. A pre-test was conducted on 18 asthmatic patients to assess the clarity and comprehensibility of all the questions. The questionnaire was then applied to 107 asthmatic patients. RESULTS: The statistical analysis proved the discrimination value in 14 of the 18 items. The internal consistency of the questionnaire was demonstrated by a KR20 index of 0.731. Factorial analysis of the principal components showed the reliability of the questionnaire and of its uni-dimensional structure. The statistical findings proved the positive correlation between the mean scores of all its dimensions. CONCLUSIONS: Using this questionnaire in daily practice should inform health care providers about the level of knowledge of occupational asthma in the targeted population and improve the effectiveness of any further educational intervention.


Assuntos
Asma Ocupacional , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Adulto , Idoso , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/terapia , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/estatística & dados numéricos , Tunísia/epidemiologia , Adulto Jovem
11.
Toxicol Ind Health ; 36(11): 876-884, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32862785

RESUMO

The anonymized data of an epidemiology study on incidence of toluene diisocyanate (TDI)-related occupational asthma in three US-based TDI production facilities have been reanalyzed to identify where to best focus exposure reduction efforts in industrial practice to reduce the risk of sensitization to TDI. Since the induction of sensitization has sometimes been attributed to cumulative exposure, this relationship was examined first. Gross cumulative exposure values (i.e. not taking into account whether respiratory protection was used or not) and net cumulative exposure values (i.e. accounting for the use of respiratory protection) per participant were calculated based on the duration of their study participation and the average time-weighted average value of the exposure group to which they belonged. These two sets of cumulative exposure data were compared with asthma incidence using logistic regression. Incidence was zero among workers who rarely come into contact with open plant systems (e.g. during maintenance or spills). Notwithstanding, no statistically significant relationship between asthma incidence and either gross or net cumulative exposure could be determined. This is shown to be consistent with the results of several other epidemiology studies on TDI-related occupational asthma. In conclusion, cumulative exposure values are not a good indicator of the risk of developing TDI-related occupational asthma.


Assuntos
Poluentes Ocupacionais do Ar/análise , Asma Ocupacional/epidemiologia , Indústria Química , Exposição Ocupacional/análise , Tolueno 2,4-Di-Isocianato/análise , Relação Dose-Resposta a Droga , Humanos , Modelos Logísticos , Saúde do Trabalhador , Fatores de Tempo , Estados Unidos/epidemiologia
12.
Toxicol Ind Health ; 36(11): 885-891, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32945732

RESUMO

The anonymized data of an epidemiology study on the incidence of toluene diisocyanate (TDI)-related occupational asthma in three US-based TDI production facilities have been reanalyzed to identify where to best focus exposure reduction efforts in industrial practice in order to reduce the risk of sensitization to TDI. In Part I, it was demonstrated that cumulative exposure is not a good indicator of the risk of developing TDI-related occupational asthma. In this Part II, an alternative model was developed based on net exposure parameters (i.e. samples taken when no respiratory protection was used). A statistically significant relationship was determined between asthma incidence and the frequency of exposure to TDI levels indicative of peak events that are expressed as time-weighted average-8 (TWA-8) values greater than 3 ppb during which no respiratory protection was used. This relationship suggests a threshold to induction of TDI-related asthma. The findings also highlight the importance of a comprehensive program for controlling workplace atmosphere in the plant by technical measures (e.g. selection of equipment, cleaning procedures) and controlling exposure by organizational measures and situational awareness (e.g. training, use of in-the-field direct reading indicators) during high potential exposure scenarios (e.g. line breaking, spills) to encourage or enforce the appropriate use of respiratory protection.


Assuntos
Poluentes Ocupacionais do Ar/análise , Asma Ocupacional/epidemiologia , Indústria Química , Máscaras , Exposição Ocupacional/análise , Tolueno 2,4-Di-Isocianato/análise , Asma Ocupacional/prevenção & controle , Relação Dose-Resposta a Droga , Humanos , Modelos Logísticos , Saúde do Trabalhador , Fatores de Tempo , Estados Unidos/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-32599814

RESUMO

Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.


Assuntos
Asma Ocupacional , Hiper-Reatividade Brônquica , Hipersensibilidade , Doenças Profissionais , Exposição Ocupacional , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Humanos , Exposição Ocupacional/efeitos adversos , Testes Cutâneos
14.
Artigo em Chinês | MEDLINE | ID: mdl-32629574

RESUMO

Objective: To analyze the direct economic burden of occupational asthma patients and provide economic basis for the government to rationally allocate health resources. Methods: In September 2019, colleted the case data of 53 patients diagnosed with occupational asthma who were hospitalized in our hospital from December 2008 to December 2018, and analyze the impact of gender, age, diagnosis time, ducation level, allergen type to the length of stay, hospitalization cost, medical technology diagnosis and treatment costs, western medicine costs, average daily hospitalization costs and other indicators. Results: The average length of hospitalization for occupational asthma patients was (38.7±8.1) days, and the average hospitalization cost was 14743 yuan, of which medical technology diagnosis and treatment costs, western medicine costs, and comprehensive medical service costs accounted for the top three, 42.5% (331977/781369) , 32.0% (249942/781369) , 19.6% (153268/781369) respectively. Hospitalization days for occupational asthma patients has decreased significantly in 2014-2018 (P<0.05) . There were no significant differences in hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs for occupational asthma patients caused by different allergens (isocyanates, persulfates and phthalic anhydrides) (P>0.05) . Hospitalization days, hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs of patients with moderate occupational asthma were significantly higher than those of mild patients (P<0.05) . Conclusion: Early detection of occupational asthma patients and early intervention can reduce the economic burden on patients and society.


Assuntos
Asma Ocupacional/epidemiologia , Efeitos Psicossociais da Doença , Asma Ocupacional/economia , Custos de Cuidados de Saúde , Hospitalização , Humanos
15.
J Allergy Clin Immunol Pract ; 8(10): 3311-3321, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32653647

RESUMO

There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Rinite , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Humanos , Imunoglobulina E , Estudos Longitudinais , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Rinite/diagnóstico , Rinite/epidemiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32627764

RESUMO

Work-related asthma (WRA) includes heterogeneous conditions, which have in common (i) symptoms and signs compatible with asthma and (ii) a relationship with exposures in the workplace. The types of WRA described in this review are distinguished by their etiology, comprising of work-exacerbated asthma (WEA), irritant-induced asthma (IIA), and immunologic occupational asthma (OA). There have been significant advances in the definition and characterization of the different forms of WRA by international panels of experts. The present review provides a comprehensive and updated view of the current knowledge on causes and phenotypes of WRA. Health care practitioners should consider WRA in any case of adult asthma, given that one fifth of workers with asthma report symptoms of WEA and it has been estimated that OA represents 10% to 25% of asthma in adulthood. The information provided in this review will facilitate the physician in the recognition of the different forms of WRA, since it has been established that five categories of agents are responsible for at least 60% of WEA cases and seven groups of agents are the cause of 70% of immunologic OA. In addition, there is agreement that IIA can be elicited not only by a single massive irritant exposure, but also by low/moderate repeated irritant exposures.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Fenótipo , Adulto , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Humanos , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Local de Trabalho
17.
Ann Work Expo Health ; 64(8): 817-825, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32491156

RESUMO

OBJECTIVES: The processing of seafood (fish and shellfish) for human consumption can lead to health consequences, including occupational asthma (OA). Several non-UK studies have reported both respiratory outcomes and airborne levels of major allergens in seafood processing. However, there is a paucity of such evidence in the UK land-based seafood processing sector, which employs some 20 000 workers. METHODS: University of Manchester's Surveillance of Work-related and Occupational Respiratory Disease (SWORD) reporting system has been interrogated over the period 1992-2017 to define the incidence rate of OA cases that can be ascribed to the UK land-based processing sector, and the seafood species implicated. Airborne allergen monitoring data undertaken at Health and Safety Executive's laboratory from 2003 to 2019 have also been collated. RESULTS: The estimated annual OA incidence rate in seafood processors was 70 [95% confidence intervals (CIs) 48.9, 91.1] per 100 000 workers compared with 2.9 (95% CIs 2.8, 3.1) in 'all other industries'. The annual calculated percentage trend in OA (1992-2017) was -8.1% (95% CIs -15.9, 0.4) in seafood processing showing a similar trend to 'all other industries' (mean -7.0%; 95% CIs -7.8, -6.1). Prawns and salmon/trout were notably implicated by SWORD as causative species related to OA. There is a general paucity of available UK airborne allergen monitoring data, particularly concerning processing salmon or trout. Available airborne monitoring for salmon parvalbumin in seven processors ranged between the limit of detection and 816 ng m-3 (n = 64). Available air monitoring levels of the major shellfish allergen (tropomyosin) during processing of crabs and prawns ranged between 1 and 101 600 ng m-3 (n = 280), highlighting that high levels of exposure can occur. CONCLUSIONS: These data show an excess incidence of OA in the UK seafood processing industry during 1992-2017, with limited airborne monitoring data for the processing of prawn, crab, and salmon suggesting that significant exposure to major seafood allergens can occur in this industry. Further investigation of current levels of respiratory ill-health and the sources of allergen exposure are warranted.


Assuntos
Asma Ocupacional , Exposição Ocupacional , Animais , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Manipulação de Alimentos , Humanos , Exposição Ocupacional/efeitos adversos , Alimentos Marinhos , Reino Unido/epidemiologia
18.
J Allergy Clin Immunol Pract ; 8(10): 3277-3282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32561498

RESUMO

Phenotypic differences and similarities in the spectrum of occupational asthma (OA) subtypes reflect the underlying mechanisms of the diverse forms of the disease, and these phenotypes provide information as to diagnostic steps and approaches to management. In large part, the phenotype reflects the existence of immunologic mechanisms and the presence or absence of a specific IgE-antibody response to a work sensitizer. However, further differences occur between OA from high- and low-molecular-weight sensitizers (chemical sensitizers), which potentially might be relevant for nonoccupational asthma. Chemical sensitizers cause a specific response that is more likely to be a late asthmatic response and specific IgE can be identified only in a minority. Irritant-induced asthma is most easily recognized when it occurs with 1 or more high-level respiratory irritant exposure(s) but is also possible with chronic low-level exposures as in cleaners, farmers, and woodworkers, as suggested from epidemiologic studies. OA chronic obstructive pulmonary disease overlap is more common in older patients and with OA from low-molecular-weight sensitizers. Removal from exposure to the causative agent is currently advised for those with OA from sensitization: further studies with omalizumab and other biologic agents are needed to determine whether these might allow return to the same exposure.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Idoso , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Humanos , Irritantes , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Fenótipo
19.
Workplace Health Saf ; 68(10): 491-500, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32364022

RESUMO

Background: Although nurses are well described as being at risk of work-related asthma, certified nurse aides (CNAs) are understudied. Using a statewide registry in Texas, we measured prevalence and risk factors for work-related asthma and bronchial hyperresponsiveness (BHR) symptoms among CNAs. Methods: For this cross-sectional study, a questionnaire was mailed to a random sample of CNAs (n = 2,114) identified through the Texas Department of Aging and Disability Services registry, working in health care during 2016-2017, to collect data on job history, asthma symptoms, and sociodemographics. Two outcomes were defined: (a) new-onset asthma (NOA) after entry into the health care field and (b) BHR-related symptoms. Job exposures to cleaning compounds and tasks were assigned using an externally coded CNA-specific job-exposure matrix. Logistic regression modeling was used to measure associations between cleaning exposures and the two asthma outcomes. Findings: The final sample consisted of 413 CNAs (response rate 21.6%). The prevalence of NOA and BHR symptoms were 3.6% and 26.9%, respectively. In adjusted models, elevated odds for BHR symptoms were observed for patient care cleaning (odds ratio [OR] = 1.71, 95% confidence interval [CI] = [0.45, 6.51]), instrument cleaning (OR = 1.33, 95% CI = [0.66, 2.68]), building-surface cleaning (OR = 1.39, 95% CI = [0.35, 5.60]), exposure to glutaraldehyde/orthophthalaldehyde (OR = 1.33, 95% CI = [0.66, 2.68]), and latex glove use during 1992-2000 (OR = 1.62, 95% CI = [0.84, 3.12]). There were too few NOA cases to warrant meaningful regression analysis. Conclusion/Application to Practice: Although not statistically significant, we observed elevated odds of BHR symptoms among nurse aides, associated with cleaning exposures, suggesting this is an at-risk group of health care professionals for work-related respiratory disease, meriting further study.


Assuntos
Asma Ocupacional/epidemiologia , Hiper-Reatividade Brônquica/epidemiologia , Assistentes de Enfermagem/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Adulto , Asma Ocupacional/etiologia , Hiper-Reatividade Brônquica/etiologia , Estudos Transversais , Desinfetantes/efeitos adversos , Feminino , Glutaral/efeitos adversos , Humanos , Látex/efeitos adversos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Prevalência , Fatores de Risco , Inquéritos e Questionários , Texas/epidemiologia , o-Ftalaldeído/efeitos adversos
20.
Occup Environ Med ; 77(9): 617-622, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32404531

RESUMO

OBJECTIVE: We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life. METHODS: We used the nationally representative Panel Study of Income Dynamics (1968-2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life. RESULTS: The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18-65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk. CONCLUSION: Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.


Assuntos
Asma/epidemiologia , Exposição Ocupacional/efeitos adversos , Ocupações , Adulto , Asma Ocupacional/epidemiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
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