[Guideline for the Diagnosis and Treatment of COPD Patients - Issued by the German Respiratory Society and the German Atemwegsliga in Cooperation with the Austrian Society of Pneumology]. / Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD).

This document is a revision of the guideline for diagnosis and treatment of COPD that replaces the version from 2007. A multitude of recent reports regarding risk factors, diagnosis, assessment, prevention and pharmacological as well as non-pharmacological treatment options made a major revision mandatory. The new guideline is based on the GOLD document taking into account specifics in Germany and Austria.

The relation between paracetamol use and asthma: a GA2LEN European case-control study.

Studies from the UK and USA suggest that frequent use of paracetamol (acetaminophen) may increase the risk of asthma, but data across Europe are lacking. As part of a multicentric case-control study organised by the Global Allergy and Asthma European Network (GA(2)LEN), it was examined whether or not frequent paracetamol use is associated with adult asthma across Europe. The network compared 521 cases with a diagnosis of asthma and reporting of asthma symptoms within the last 12 months with 507 controls with no diagnosis of asthma and no asthmatic symptoms within the last 12 months across 12 European centres. All cases and controls were selected from the same population, defined by age (20-45 yrs) and place of residence. In a random effects meta-analysis, weekly use of paracetamol, compared with less frequent use, was strongly positively associated with asthma after controlling for confounders. There was no evidence for heterogeneity across centres. No association was seen between use of other analgesics and asthma. These data add to the increasing and consistent epidemiological evidence implicating frequent paracetamol use in asthma in diverse populations.

A case-control study of the relation between plasma selenium and asthma in European populations: a GAL2EN project.

BACKGROUND: There is evidence that selenium levels are relatively low in Europe and may be falling. Low levels of selenium or low activity of some of the enzymes dependent on selenium have been associated with asthma. METHODS: The GA(2)LEN network has organized a multicentre case-control study in Europe to assess the relation of plasma selenium to asthma. The network compared 569 cases in 14 European centres with a diagnosis of asthma and reporting asthma symptoms in the last 12 months with 576 controls from the same centres with no diagnosis of asthma and no asthmatic symptoms in the last 12 months. RESULTS: All cases and controls were selected from the same population defined by age and place of residence. Mean plasma selenium concentrations among the controls ranged from 116.3 microg/l in Palermo to 67.7 microg/l in Vienna and 56.1 microg/l among the children in Oslo. Random effects meta-analysis of the results from the centres showed no overall association between asthma and plasma selenium [odds ratio (OR)/10 microg/l increase in plasma selenium: 1.04; 95% confidence interval (CI): 0.89-1.21] though there was a significantly protective effect in Lodz (OR: 0.48; 95% CI: 0.29-0.78) and a marginally significant adverse effect in Amsterdam (OR: 1.68; 95% CI: 0.98-2.90) and Ghent (OR: 1.35; 95% CI: 1.03-1.77). CONCLUSION: This study does not support a role for selenium in protection against asthma, but effect modification and confounding cannot be ruled out.

Occupational exposure to ultrafine particles in police officers: no evidence for adverse respiratory effects.

BACKGROUND: Inhalation exposure to fine and ultrafine particles (UFPs) has been associated with respiratory diseases. However, little is known on the quality, threshold levels and concentration of these particles causing adverse health effects. METHODS: The impact of occupational exposure to submicrometer and UFPs was assessed in 30 healthy police shooting instructors by clinical investigation, self-assessment questionnaire, sputum and spirometry and compared to a control group. General laboratory chemistry parameters, circulating cytokines (interleukin [IL]-2, IL-4, IL-5, IL-6, IL-8, interferon-gamma [IFN-γ]), and granulocyte macrophage colony-stimulating factor (GM-CSF) in serum were measured. UFP exposure was recorded by Scanning Mobility Particle Sizer. RESULTS: Concentrations of submicrometer sized airborne particles (< 700 nm) measured between 3.34 × 105/cm3 and 7.58 × 105/cm3 at shooting sites, with highest concentrations found in the UFP range (< 100 nm). The size of the monodispersed particles ranged from 54.74 ± 16.25 nm to 98.19 ± 22.83 nm. Short term exposure (4 h) to high levels of UFPs caused an increase of IFN-γ in exposed subjects (p = 0.022). 24 h after exposure a significant decrease of IgG, albumin fibrinogen and factor VII was found. Neither directly after 4 h of high levels UFPs exposure nor 24 h after exposure subjective complaints or objective measurements indicating adverse respiratory effects in exposed subjects were found. CONCLUSIONS: No consistent indications for adverse respiratory or inflammatory effects directly following exposure and 24 h after exposure to high levels of UFPs in our study group were detected. However we showed the assessment of short-term exposure effects at a genuine occupational setting, which might is relevant when a risk assessment of high level occupational exposures to UFPs is considered.

Respiratory findings in workers employed in the brick-manufacturing industry.

We studied 233 male workers employed in two brick-manufacturing plants and 149 matched control workers. The mean age of the brick workers was 35 years, with a mean duration of employment in this industry of 16 years. The prevalence of chronic respiratory symptoms as well as acute symptoms during the work shift were recorded. Lung function was measured on Monday during the work shift by recording maximum expiratory flow-volume (MEFV) curves, from which the forced vital capacity (FVC), the one-second forced expiratory volume (FEV1) and flow rates at 50% and the last 75% of the FVC (FEF50, FEF75) were measured. The results of periodic chest roentgenograms were reviewed. There was a significantly higher prevalence of chronic cough (31.8%), chronic phlegm (26.2%), and chest tightness (24.0%) in exposed workers, compared with control workers (20.1%; 18.1%; 0%) (P < 0.05). This increased symptom frequency was also documented among nonsmokers studied by age and by length of employment, suggesting a work-related effect. Among work shift-related symptoms, high prevalences were noted for upper respiratory tract symptoms (e.g., dry throat, eye irritation, throat irritation). The measured FVC and FEV1 were significantly lower than predicted for brick workers and suggested a restrictive pattern. The mean FVC (as a percent of predicted) was 78.1% and FEV1 was 88.1%. The FEF50 and FEF25 were not significantly decreased. A multiple regression analysis with age, exposure, and smoking as predictors and lung function parameters as response variables showed a significant effect between exposure and FVC. Significant chest roentgenographic abnormalities were not documented. These findings of a restrictive lung function pattern in brick workers with normal chest roentgenograms may suggest early interstitial disease. Additionally, a bronchitic component, as suggested by the respiratory symptoms, may also be present.

[Bronchial reactivity after provocation of the nasal mucosa with histamine]. / Stanje reaktivnosti bronha nakon podrazivanja nosne sluznice histaminom.

Data on the relationship between nasal and bronchial reactivities are scarce. This study aimed at investigating a possible influence of the nasal provocation test on bronchial reactivity. Three groups of eleven subjects each were examined: patients suffering from allergic rhinitis with no clinical evidence of asthma, workers exposed to respiratory irritants complaining of occupational rhinitis and asthma, and healthy subjects. Non-specific bronchoprovocation was performed before and after nasal challenge with histamine. The bronchial challenge with histamine solutions (0.125 mg/ml and 128 mg/ml) was performed by the five-breath cumulative method (Chai H. et al. J Allergy Clin Immunol 1975;56:323-7). Non-specific nasal provocation was performed by spraying doubling concentrations of histamine (0.125 mg/ml-32 mg/ml) into both nostrils at three-minute intervals. The reaction was monitored by measurement of nasal inspiratory peak flow, nasal resistance, and nasal spirometry. The level of non-specific nasal reactivity was significantly lower in patients with allergic rhinitis than in the other two groups. The bronchial reactivity of the "rhinitis" group and of those occupationally exposed to irritants was significantly lower than among healthy subjects. An immediate and significant decrease in bronchial reactivity could be observed after nasal challenge in the group of healthy subjects as well as in workers exposed to irritants, but there was no significant change in bronchial reactivity among patients suffering from allergic rhinitis.

[Skin reactivity to grass pollen and the mite Dermatophagoides pteronyssinus in the prick-test using 2 types of allergen preparations]. / Reaktivnost koze na polene trava i grinju Dermatophagoides pteronyssinus u prick-testu izvedenom sa dvije vrste alergenskih pripravaka.

The reliability of prick testing with allergen preparations produced in Yugoslavia was assessed by comparison to the internationally accepted ones (Pharmacia Diagnostica) of 100,000 BU activity. The following allergens were used: the mite Dermatophagoides pteronyssinus in 107 subjects, and grass pollens: Dactylis glomerata, Poa pratensis, Phleum pratense and Secale cereale in 39 subjects. The clinical significance of the response was assessed in relation to the skin reaction to the negative control solution and positive histamine control (in concentration of 1 mg/ml). The results indicate that the allergen extract of Dermatophagoides pteronyssinus (3000 PNU/ml) produced in Yugoslavia does not provoke skin reactions comparable to those provoked by the standardized extract of 100,000 BU in contrast to the grass pollen allergens, with the exception of Poa pratensis, which evokes equivalent skin reactions. Thus grass pollen allergens are reliable extracts and can be applied with good confidence in routine work. The need to set more rigorous criteria for assessing skin prick reactions, when domestic, unstandardized products are used, emerged as a result of this study.

[Bronchial reactivity during continuous and interrupted exposure to respiratory irritants]. / Reaktivnost bronha u toku kontinuirane ekspozicije respiratornim iritansima i izvan nje.

Evolution of bronchial reactivity was examined in a sample of aluminium potroom workers exposed to a variety of respiratory irritants in concentrations below the MAC values for Yugoslavia (hydrogen fluoride, particulate fluorides, sulphur dioxide). Lung function indices and bronchial reactivity were measured in 24 workers continuously employed in an aluminium plant and in nine workers who had ceased to work in the plant. Measurements took place over a two-year interval. A sustained level of bronchial reactivity was recorded in both examined groups regardless of occupational practice. Even in workers with dyspnoea and airway obstruction bronchial reactivity did not worsen in spite of continuous exposure. Avoidance of exposure to potroom fumes did not bring about any significant improvement of reactivity, moreover, bronchial reactivity deteriorated in one worker. Owing to discordance between spirometric values and bronchial reactivity, a follow-up of workers removed from harmful occupational exposure is suggested.

Follow-up of airway reactivity in potroom workers in relation to exposure.

Two groups of workers were studied: a) 24 workers with respiratory complaints--7 of whom were light and 4 borderline hyper-reactors--who continued to work on the electrolytic reduction of aluminium for up to two years; b) 30 workers with increased bronchial reactivity who ceased to work in potrooms for 3.7 years on average (range 2-11 years) because of respiratory complaints. Subjective respiratory complaints were recorded and a non specific bronchial reactivity test was performed one or two times during the follow-up period. A sustained level of airway reactivity was recorded in both groups of workers regardless of exposure conditions. In workers with dyspnoea and airway obstruction, bronchial reactivity did not worsen in spite of continued exposure. On the other hand cessation of exposure was not followed by normalization of bronchial reactivity. The potential role of atopy, smoking habits and length of previous exposure was analyzed. It appears that increased bronchial reactivity, once induced, has a tendency to persist. An improvement in subjective complaints may be expected after cessation of exposure.

Alpha 1-antitrypsin and lung function in cement workers.

The relationship between the serum concentration of alpha 1-antitrypsin (AAT), the concentration of dust at the workplace and lung function abnormalities was examined in 48 male workers occupationally exposed to cement dust. Measurements were performed in all subjects and included ventilatory volumes (FVC, FEV1), airway resistance (Raw), static lung volumes (RV, FRC, TLC), transfer factor for CO and AAT serum concentration. The relationship between lung function, smoking, respirable cement dust exposure, and AAT serum concentration was investigated by the method of multiple linear regression. A statistically significant correlation was observed between AAT blood concentration and respirable dust exposure. The contribution of respirable dust exposure to the description of AAT concentration was positive as was the contribution of Raw. The contributions of transfer CO, smoking and RV/TLC ratio were negative. All the variables considered accounted for approximately 30% of the total variability of the AAT concentration. To conclude, in cement workers the higher AAT serum concentration which is associated with a loss of lung function, and higher respirable cement dust concentration may be part of the defence mechanism against the potential proteolytic activity occurring in occupational dust exposure.

[Physical stress and bronchial hyperreactivity in aluminum-processing workers]. / Fizicko opterecenje i bronhijalna hiperreaktivnost radnika u proizvodnji aluminija.

A possible impact of physical load on the degree of bronchial hyperreactivity was studied in actual working conditions among the workers in an aluminium electrolysis plant. Respiratory irritants present in the working environment were also determined. The study was conducted in two groups of workers: one, of 34 workers who had been previously categorized as having respiratory symptoms and the other, of 19 control workers without symptoms. Both groups were matched by age, height, weight and years of service in the plant. All workers underwent a progressive submaximum exercise test of 300-600-900 kpm/min load on a bicycle ergometer. Simultaneously a continuous monitoring of heart function was performed. Heart rate, blood pressure and lung function parameters: FVC, FEV1, PEF, MEF25, MEF50, MEF75 and FEV1/FVC% ratio were measured before and 18 minutes after exercise. The results of the study showed that physical load and concurrent exposure to respiratory irritants had no impact on bronchial hyperreactivity in either group of workers. However, the exercise test demonstrated the existence of appreciable individual differences within the two groups.

[Immunologic and respiratory findings in workers on a pig farm]. / Imunoloski i respiratorni nalazi radnika u svinjogojstvu.

The prevalence of respiratory symptoms and ventilatory capacity in relation to immunological status were studied in 32 swine workers and in 39 controls. A large number of swine workers reacted to antigen of swine hair (34%) and to swine confinement antigen (28%) but also to other antigens such as animal food (78%), and corn flour (37%). Control workers showed comparable prevalence in their reaction to these antigens (17%, 25%, 51%, 25%). Increased IgE serum level was determined in three swine workers (9.4%) and in one control worker (2.6%). Swine workers with positive skin tests demonstrated significantly larger acute reductions in FEF50 and FEF25 than those with negative skin tests (P less than 0.01). The ventilatory capacity data measured before shift in swine workers with positive skin tests were significantly lower than the predicted normal values. Swine confinement antigen caused a dose-related contraction of guinea pig smooth muscle in vitro. Our data indicate that non-immunological reactions may be partly responsible for the acute and/or chronic changes in respiratory function.

[Immunologic reaction and ventilatory function in hemp-processing workers]. / Imunoloske reakcije i ventilacijske funkcije radnika na preradi konoplje.

The relationship between immunological status and respiratory function was studied in 42 hemp workers and in 49 control workers. The highest prevalence of positive skin tests was recorded for a mixture of hemp and flax (64%), followed by flax (48%), hemp on a combining machine (41%), hemp on a carding machine (38%), hemp on spinning and weaving machines (33%), and hemp on a softening machine (20%). The prevalence of positive skin tests in control workers was smaller and varied from 21 to 5%. Increased IgE was found in 35.7% of the hemp workers and in 5.0% of the controls (P less than 0.05). Hemp workers with positive skin tests had a significantly higher prevalence of chronic respiratory symptoms than those with negative skin tests. Acute ventilatory capacity reductions did not differ in respect to the immunological status. An extract of hemp dust caused a constriction of an isolated guinea pig tracheal smooth muscle in vitro. Our data suggest that hemp dust as well as producing an immunological effect may exert an irritant effect on the respiratory system in exposed textile workers.

[Respiratory function in fur-processing workers]. / Ventilacijska funkcija radnika u preradi krzna.

Forty women employed as furriers in the fur processing industry and a group of 31 control workers were examined. A higher prevalence of chronic respiratory symptoms was found among the furriers than among the controls. The differences were statistically significant for chronic cough and sinusitis (P less than 0.01). The highest prevalence in furriers was found for chronic cough (50%), sinusitis (30%), followed by dyspnea (25%), nasal catarrh (20%) and occupational asthma (5%). A large number of workers complained of acute symptoms during work shift. Statistically significant mean acute reductions in ventilatory capacity over the workshift were recorded for FVC (-4.1%), FEV1 (-5.2%) and FEV50 (-6.3%). The furriers demonstrated significantly lower mean measured pre-shift values for FVC and FEV25 (P less than 0.05) when compared with the predicted. Pre-shift administration of 40 mg of Intal considerably diminished acute ventilatory capacity over the work shift.

[Respiratory diseases, symptoms and ventilatory function in workers involved in processing food for livestock]. / Respiratorne bolesti, simptomi i ventilacijske funkcije radnika u preradi hrane za stoku.

The prevalence of chronic and acute respiratory symptoms and ventilatory capacity were studied in a group of 71 workers employed in animal food processing. A control group of 55 unexposed workers was also included in the study. A significantly higher prevalence for most of the chronic respiratory symptoms was found among the exposed than among control workers. Exposed smokers had a significantly higher prevalence of chronic cough, chronic phlegm, chronic bronchitis and chest tightness than control smokers. The values for FVC, FEV1 and FEF50 measured in the exposed workers were significantly lower in comparison to predicted normal lung function values. In smokers all the measured parameters of ventilatory capacity were significantly lesser than predicted. For non-smokers only FVC and FEV1 were below normal. Our data indicate that occupational exposure to animal food may cause the development of acute and chronic respiratory symptoms and impairment of ventilatory capacity.

[Respiratory symptoms and ventilatory function of the lungs in wool textile industry workers]. / Respiracijski simptomi i ventilacijska funkcija pluca radnica u tekstilnoj industriji na preradi vune.

Subjects in the study were 158 female wool textile workers and 87 control non-exposed workers. Respiratory symptoms were assessed by means of a questionnaire. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on Monday before and after the work shift. Forced vital capacity (FVC), one-second forced expiratory volume (FEV1) and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on MEFV curves. Significantly higher prevalences of all chronic respiratory symptoms were recorded in exposed than in control workers (P < 0.01). Exposure to wool dust caused significant across shift reductions of ventilatory capacity varying from 2.0 to 9.1%. Those reductions were similar in textile workers exposed to wool for more than 10 years showed similar across shift reductions of ventilatory capacity tests as those with shorter exposure. Smokers and non-smokers had similar acute and chronic lung function changes. In a larger number of wool workers FEF50 and FEF25 were below 70% of predicted normal values. Bronchoprovocation testing with wool dust extract did not demonstrate correlation with respiratory impairment. Our data suggest that dust exposure in wool textile mills may be associated with the development of chronic respiratory symptoms and impaired lung function.

[Immunologic status, respiratory symptoms and ventilatory function in fur processing workers]. / Imunoloski status, respiratorni simptomi i ventilacijske funkcije radnica na preradi krzna.

A group of 54 women employed in the fur processing industry and a control group of 31 non-furriers were examined. The highest prevalence of positive immediate skin reactions to antigen from animal hair was found for marten (10%), followed by fox and lamb (7%), mink (5%) and chinese lamb, domestic fox and chinese calf (2%). Precipitating antibodies were demonstrated for lamb (17%), astrakhan (14%), mink, domestic fox and for skunk (12%), chinese lamb (10%), and chinese calf (7%). Increased total IgE was found in 9.5% of the furriers. Chronic respiratory symptoms were more prevalent among workers with positive skin tests and positive precipitins than among those with negative tests. The prevalence of the acute symptoms was higher among workers with precipitins than in those without them. There was no such relationship between the symptoms and the results of skin tests. Acute reductions of ventilatory capacity over the work shift occurred in workers with positive precipitins but not in those with positive skin tests. Our study suggests that furriers can develop acute and chronic respiratory difficulties frequently associated with specific indicators of atopy.

[Immunologic status, respiratory symptoms and ventilatory function in soybean-processing workers]. / Imunoloski status, respiratorni simptomi i ventilacijske funkcije radnika na preradi soje.

Immunological and respiratory findings were studied in a group of 19 male soy-bean workers. A group of 31 control workers were examined for the prevalence of respiratory symptoms and 20 control workers were included in the immunological study. All soy-bean workers had positive immediate skin reaction to soy-bean dust, 18 to soy antigen after separation from oil, three to lecithin antigen and only one to soy oil. Only three soy-bean workers had increased levels of specific IgE. Among 20 control workers, 19 reacted to soy-bean dust, 20 to soy after separation of oil and none to soy oil. One demonstrated increased specific IgE. The prevalence of chronic respiratory symptoms was considerably higher in exposed than in control workers, being statistically different for dyspnea (P less than 0.01). The statistically significant acute reductions in ventilatory capacity were particularly pronounced for FEF50 (-4.7%) and FEF25 (-9.4%). The mean ventilatory capacity values before shift on Monday were significantly lower than those on the following Friday for FVC, FEF50 and FEF25. There was no difference in ventilatory capacity between soy-bean workers with positive and those with negative skin tests to house dust or between those with increased and those with normal IgE serum levels. A water soluble extract of soy-bean dust was also assayed in organ bath containing guinea pig trachea. This model showed the extract to be highly reactive causing a dose-related constriction of airway smooth muscle. Our data suggest that immunologic sensitization to soy-bean products is very frequent. In addition to possible humoral contribution to respiratory disorders, soy dust seems to directly affect airway smooth muscle.

[Ventilatory capacity and respiratory symptoms in hemp-processing workers]. / Ventilacijski kapacitet i respiratorni simptomi radnika na preradi konoplje.

The prevalence of respiratory symptoms and changes in ventilatory capacity were studied in 84 female (mills A and B) and 27 male hemp workers employed in textile mills. Forty-nine women and 30 men from a non-dusty industry served as controls. A significantly higher prevalence of almost all chronic respiratory symptoms was found in exposed female workers compared to controls. For men the differences were significant for nasal catarrh and sinusitis. A high prevalence of byssinosis was found among female workers in both mills (A = 47.8%); B = 57.9%) as well as in male workers (66.7%). Statistically significant acute across work shift reductions in ventilatory capacity were found for all measurements in female and male hemp workers (P greater than 0.01) varying from 7.1% for FEV1 to 15.1% for FEF50. Measured Monday baseline values before the work shift were significantly lower than expected for hemp workers being particularly reduced for FEF25 and FEF50. The data suggest that exposure to hemp dust is a major risk factor for the development of occupational lung disease.

[Comparative study of respiratory changes in female workers exposed to organic aerosols]. / Komparativno ispitivanje respiratornih poremecaja radnika eksponiranih organskim aerosolima.

The prevalence of acute and chronic respiratory symptoms and ventilatory capacity were studied in 314 women and 119 men exposed to some organic aerosols. The prevalence of all chronic respiratory symptoms was significantly higher in exposed than in control workers. A large number of exposed workers complained of acute symptoms which develop during work shift. There were statistically significant acute reductions of all ventilatory capacity tests, particularly FEF50 and FEF25. Comparison of measured ventilatory capacity with predicted normal values indicated obstructive ventilatory capacity changes located mostly in smaller airways. Our data suggest that exposure to organic aerosols may contribute to the development of chronic obstructive lung disease.