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Occupational lung diseases result from worker exposure in occupational settings to unhealthy environments and agents, such as silica dust, antigens, coal dust, washed coal/mixed dust, asbestos, and beryllium. Most of these conditions have long latency periods, with disease manifesting years after exposure. Approximately 1 million workers in the U.S. report occupational exposure-related illnesses, including respiratory diseases. We evaluated major occupational lung diseases via an extensive literature review and present here advances in diagnosing major occupational lung diseases, preventive strategies, and regulatory considerations for maintaining a healthy workforce. We include the widely studied occupational lung diseases asbestosis, coal workers' pneumoconiosis and all other pneumoconioses, silicosis, byssinosis, malignant mesothelioma, hypersensitivity pneumonitis, and work-related asthma. The chemistry and physical properties of exposed materials play a role in the severity and pathogenesis of most occupational lung diseases. Knowledge of clinical signs and symptoms of these diseases, exposure history, and consensus diagnostic tools and criteria are crucial for accurate diagnosis, early detection, management, and improved outcomes. Further, regulatory agencies and other interested parties need to develop new and improved surveillance strategies, exposure limits, and technological and industrial safety measures, as well as implement regulations to guide industries and provide recommendations to protect all workers and reduce disease burden. [ABSTRACT FROM AUTHOR]

Air pollution as a result of intensified anthropogenic activity leads to the elevated cases of respiratory diseases. One of them is occupational asthma, which is described in this study by ecological aetiology. The mechanism of action of pollutants (allergens) on the mast cells - structural elements of symbiotic adaptation between humanity, environment, and the Technosphere - is systematized. Human immunity is described symbiotically and homeostatically by the expression of Gibbs energy, which is the main energetic moment of this complex unit Noosphere-BiosphereTechnosphere. The pathophysiological mechanisms of asthma with the creation of the complexes “mast+IgE” are also described by the quantitative expression of Gibbs free energy. Regarding this expression, decisions can be made for the combating of high levels of pollutants in the atmosphere as well as regarding prophylactic and therapeutic measures. [ABSTRACT FROM AUTHOR]

Exposure to 4,4′-methylene diphenyl diisocyanate (MDI) in the workplace may lead to the development of occupational asthma (OA). However, the specific mechanism(s) by which MDI induces OA are poorly understood. Previous reports have demonstrated that MDI and MDI-glutathione (GSH) conjugate exposure downregulates endogenous human/murine (hsa/mmu)-microRNA(miR)-206-3p, resulting in the activation of mmu/hsa-miR-206-3p-regulated signaling pathways in macrophages. Circular RNAs (circRNAs) regulate many important biological processes by targeting endogenous miRs; however, whether MDI/MDI-GSH exposure may influence circRNA expressions is unknown. Several circRNAs have been identified that regulate hsa-miR-206-3p. We hypothesize that MDI-GSH conjugate exposure induces endogenous circRNA(s) to regulate hsa-miR-206-3p in macrophages. The expression of candidate hsa-miR-206-3p-binding circRNAs was determined from MDI-GSH conjugate-treated differentiated THP-1 macrophages using RT-qPCR. MDI-GSH exposures induced hsa_circ_0008726 and its host gene transcript DNAJB6, whereas other circRNA(s) examined were either not detected or unchanged. RNA-induced silencing complex-immunoprecipitation (RISC-IP) experiments confirm that hsa-miR-206-3p can bind to hsa_circ_0008726. The expressions of endogenous hsa-miR-206-3p, hsa-miR-206-3p-regulated KLF4, and KLF4-activated M2 macrophage-associated markers and chemokines were up-/down-regulated by transfection of hsa_circ_0008726 siRNAs or hsa_circ_0008726 overexpression plasmid in macrophages, respectively. These results suggest MDI-GSH exposure downregulates hsa-miR-206-3p via induction of endogenous hsa_circ_0008726/DNAJB6, resulting in the upregulation of hsa-miR-206-3p-mediated regulations in macrophages. [ABSTRACT FROM AUTHOR]

Objective: Respirator medical evaluations are an important component of occupational health practice. Concepts and practices were established 25-50 years ago. Method: We suggest analysis and discussion of three areas warranting update. Results: a) Shift from disease-based decisions to evaluating the following 12 specific domains: cardiopulmonary, sudden change in condition, thermal, work interference, exacerbating existing condition, donning/doffing, dermatologic, proper utilization, fit testing interference, cultural/religious, arms/legs, and subjective responses. Two distinct evaluation processes are advised--"algorithmic" for the frequent straightforward evaluations and "specialist" for the more complex. b) Acknowledging the importance of subjective responses and clarifying the underlying causes--external stimulus, sensation, perception, interpretation, acceptability, and emotional response. c) Optimizing the organizational structures by explicitly defining the scope of evaluations, modifying the sequencing of assessment, and specifying qualifications of clinicians performing assessments. Conclusions: Reassessing respirator medical evaluation methods is needed. [ABSTRACT FROM AUTHOR]

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Workplace exposure to diisocyanates like 4,4'-methylene diphenyl diisocyanate can cause occupational asthma (MDI-OA), and the underlying biological pathways are still being researched. Although uncertainty remains, evidence supports the hypothesis that dermal exposure to MDI plays an important role in the development of MDI-OA. Gene expression, proteomics, and informatics tools were utilised to characterise changes in expression of RNA and protein in cultured human HEKa keratinocyte cells following exposure to conjugates of MDI with glutathione (MDI-GSH). RT-qPCR analysis using a panel of 39 candidate primers demonstrated 9 candidate genes upregulated and 30 unchanged. HPLC-MS/MS analysis of HEKa cell lysate identified 18 540 proteins across all samples 60 proteins demonstrate statistically significant differential expression in exposed cells, some of which suggest activation of immune and inflammatory pathways. The results support the hypothesis that dermal exposures have the potential to play an important role in the development of MDI-OA. Furthermore, proteomic and gene expression data suggest multiple immune (adaptive and innate) and inflammatory pathways may be involved in the development of MDI-OA. [ABSTRACT FROM AUTHOR]

1. Occupational exposure to 4,4'-methylene diphenyl diisocyanate (MDI) is associated with occupational asthma (OA) development. Alveolar macrophage-induced recruitment of immune cells to the lung microenvironment plays an important role during asthma pathogenesis. Previous studies identified that MDI/MDI-glutathione (GSH)-exposure downregulates endogenous hsa-miR-206-3p/hsa-miR-381-3p. Our prior report shows that alternatively activated (M2) macrophage-associated markers/chemokines are induced by MDI/MDI-GSH-mediated Krüppel-Like Factor 4 (KLF4) upregulation in macrophages and stimulates immune cell chemotaxis. However, the underlying molecular mechanism(s) by which MDI/MDI-GSH upregulates KLF4 remain unclear. 2. Following MDI-GSH exposure, microRNA(miR)-inhibitors/mimics or plasmid transfection, endogenous hsa-miR-206-3p/hsa-miR-381-3p, KLF4, or M2 macrophage-associated markers (CD206, TGM2), and chemokines (CCL17, CCL22, CCL24) were measured by either RT-qPCR, western blot, or luciferase assay. 3. MDI-GSH exposure downregulates hsa-miR-206-3p/hsa-miR-381-3p by 1.46- to 9.75-fold whereas upregulates KLF4 by 1.68- to 1.99-fold, respectively. In silico analysis predicts binding between hsa-miR-206-3p/hsa-miR-381-3p and KLF4. Gain- and loss-of-function, luciferase reporter assays and RNA-induced silencing complex-immunoprecipitation (RISC-IP) studies confirm the posttranscriptional regulatory roles of hsa-miR-206-3p/hsa-miR-381-3p and KLF4 in macrophages. Furthermore, hsa-miR-206-3p/hsa-miR-381-3p regulate the expression of M2 macrophage-associated markers and chemokines via KLF4. 4. In conclusion, hsa-miR-206-3p/hsa-miR-381-3p play a major role in regulation of MDI/MDI-GSH-induced M2 macrophage-associated markers and chemokines by targeting the KLF4 transcript, and KLF4-mediated regulation in macrophages. [ABSTRACT FROM AUTHOR]

Purpose: Occupational asthma is commonly observed in bakers and confectioners. Endogenous and exogenous risk factors contribute to bakers' asthma. A heightened awareness of this and early diagnosis can be helpful in terms of prevention. The aim of the study was to identify a temporal relationship between the years of training, as well as possible technical, procedural, and individual risk factors for the development of flour-exposure related atopic symptoms such as rhinitis, cough, and rash in young professionals. Methods: 127 bakers and confectioner trainees were observed over a one-year period. Two questionnaires served as test instruments. It was investigated whether the rates of atopic symptoms change over the course of a school year and which conditions in the workplace could be responsible for this. Descriptive statistics were used to answer the research questions concerning flour exposure and symptom rates. The Pearson-Chi-Square test was used for testing statistical differences between different groups (e.g. year of training, working conditions). Results: An increase in rates of self-reported rhinitis, coughing, and rashes throughout the duration of traineeship was shown (e.g. rhinitis of bakers at work: 0% in the first year of training, 20% in the second and 33% in the third year of training). The installation of vapour extraction systems and low-dust transfer of baking agents led to fewer symptoms in the workplace (30% of participants with rhinitis symptoms worked with no installed vapour extraction systems). A medical history of atopy was positively correlated with the occurrence of symptoms. Conclusion: To prevent the development of asthma in bakers, methods to improve occupational health and safety should be developed. Creating low dust working conditions e.g., due to the use of vapour extraction systems should be considered. [ABSTRACT FROM AUTHOR]

Monique da Silva Pinto,1 Caroline de Oliveira Ribeiro,1 Paula Morisco de Sá,2 Hermano Albuquerque Castro,3 Thiago Prudente Bártholo,4 Agnaldo José Lopes,4 Pedro Lopes Melo1,5 1Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil; 2University of the Brazilian Air Force, Postgraduate Program in Operational Human Performance, Rio de Janeiro, Brazil; 3National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 4Pedro Ernesto University Hospital, Pulmonary Function Laboratory, State University of Rio de Janeiro, Rio de Janeiro, Brazil; 5State University of Rio de Janeiro, Laboratory of Clinical and Experimental Research in Vascular Biology, Rio de Janeiro, BrazilCorrespondence: Pedro Lopes Melo, Department of Physiology, State University of Rio de Janeiro, São Francisco Xavier Street, Maracanã, Rio de Janeiro, Brazil, Tel +55(21)2334-0705, Email plopes@uerj.brBackground: Asthma onset or worsening of the disease in adulthood may be associated with occupational asthma (OA) or work-exacerbated asthma (WEA). Oscillometry and respiratory modeling offer insight into the pathophysiology and contribute to the early diagnosis of respiratory abnormalities.Purpose: This study aims to compare the changes due to OA and WEA and evaluate the diagnostic accuracy of this method.Patients and Methods: Ninety-nine volunteers were evaluated: 33 in the control group, 33 in the OA group, and 33 in the WEA group. The area under the receiver operator characteristic curve (AUC) was used to describe diagnostic accuracy.Results: Oscillometric analysis showed increased resistance at 4 hz (R4, p< 0.001), 20 hz (R20, p< 0.05), R4-R20 (p< 0.0001), and respiratory work (p< 0.001). Similar analysis showed reductions in dynamic compliance (p< 0.001) and ventilation homogeneity, as evaluated by resonance frequency (Fr, p< 0.0001) and reactance area (p< 0.0001). Respiratory modeling showed increased peripheral resistance (p< 0.0001), hysteresivity (p< 0.0001), and damping (p< 0.0001). No significant changes were observed comparing OA with WEA in any parameter. For OA, the diagnostic accuracy analyses showed Fr as the most accurate among oscillometric parameters (AUC=0.938), while the most accurate from respiratory modeling was hysteresivity (AUC=0.991). A similar analysis for WEA also showed that Fr was the most accurate among traditional parameters (AUC=0.972), and hysteresivity was the most accurate from modeling (AUC=0.987). The evaluation of differential diagnosis showed low accuracy.Conclusion: Oscillometry and modeling have advanced our understanding of respiratory abnormalities in OA and WEA. Furthermore, our study presents evidence suggesting that these models could aid in the early diagnosis of these diseases. Respiratory oscillometry examinations necessitate only tidal breathing and are straightforward to conduct. Collectively, these practical considerations, coupled with the findings of our study, indicate that respiratory oscillometry in conjunction with respiratory modeling, may enhance lung function assessments in OA and WEA.Keywords: occupational asthma, work-exacerbated asthma, pulmonary function, forced oscillations, respiratory modeling, fractional order modeling

Respiratory sensitization is a complex immunological process eventually leading to hypersensitivity following re-exposure to the chemical. A frequent consequence is occupational asthma, which may occur after long latency periods. Although chemical-induced respiratory hypersensitivity has been known for decades, there are currently no comprehensive and validated approaches available for the prospective identification of chemicals that induce respiratory sensitization, while the expectations of new approach methodologies (NAMs) are high. A great hope is that due to a better understanding of the molecular key events, new methods can be developed now. However, this is a big challenge due to the different chemical classes to which respiratory sensitizers belong, as well as because of the complexity of the response and the late manifestation of symptoms. In this review article, the current information on respiratory sensitization related processes is summarized by introducing it in the available adverse outcome pathway (AOP) concept. Potentially useful models for prediction are discussed. Knowledge gaps and gaps of regulatory concern are identified. [ABSTRACT FROM AUTHOR]

Introduction The problem of transcoding is recurrent when researchers wish to link occupational data from cohorts to Job-Exposure Matrices (JEMs) which were not set up in the same classifications. The Occupational Asthma-specific JEM (OAsJEM) is a JEM developed for assessing exposure to agents known at risk for asthma for jobs coded with ISCO88 occupation classification. To apply the OAsJEM in the CONSTANCES cohort, in which jobs and industries were coded with French PCS2003 and NAF2008 classifications respectively, we developed a crosswalk to convert jobs from PCS2003 into ISCO88 classification. Methods This work was carried out by 2 skilled coders and 1 novice coder who have worked independently by using different tools and transcoding strategies defined a priori. Consensus meetings were organized with skilled coders to define the final crosswalk. This work was elaborated in 2 steps: (i) for 38 ISCO88 codes classified as potentially exposed to cleaning and disinfection products by the OAsJEM, and (ii) for all jobs from the ISCO88 classification. A comparison between the 3 initial coder's crosswalk proposals and the final crosswalk was made for the 38 ISCO codes in step (i). Results The final crosswalk provided 998 matches between the 482 4-digit PCS2003 codes, 308 4-digit ISCO88 codes, and 31 3-digit ISCO88 codes. Information regarding the NAF2008 industry classification was also used in some cases to improve the final crosswalk. For the selected 38 ISCO88 codes, the final crosswalk provided 110 combinations, but the number of proposed ISCO88–PCS2003 couples by each of the 3 coders varied greatly from 68 to 153. In addition, an important variability between the 3 coders were observed among the number of common combinations between the initial coder's proposals and the final crosswalk (from 47% to 78%). Discussion We have developed a crosswalk specifically for an application of the OAsJEM in population-based surveys using the PCS2003 occupation classification. The development of this crosswalk is of great interest for the use of OAsJEM on the data of the CONSTANCES cohort and on any other survey with occupational data coded according to the French classifications. This OAsJEM crosswalk could be used by other teams to evaluate occupational exposures known to be at risk of asthma from occupational calendars coded with French classifications. [ABSTRACT FROM AUTHOR]

Background: Work-related asthma (WRA) is often undiagnosed and underreported. The occupational asthma web application (OAKKU) has been created to assist in identifying asthmagens to find and manage WRA. However, it has language limitations and lacks a user guide. Objective: To develop an effective OAKKU web application user guide using participatory action research (PAR). Materials and Methods: The design of the present study was PAR. The study was conducted in two loops of PAR at two asthma clinics, with the eight participation of physicians, nurses, nurse assistants, and pharmacists. Data was collected through group meetings, brainstorming sessions, situational analysis, and real-time observation during work. Data analysis was carried out using content analysis and mean. Results: The results revealed challenges as the followings. Physicians lacked awareness due to the effectiveness of current treatments and difficulties in accessing information on asthmagens, coupled with limited time for searching. Although the OAKKU web application was developed and implemented, language barriers and complex search functions posed usability issues. To address these challenges, user guides were developed, and the OAKKU web application was translated into Thai, while search functionalities were simplified. Experimental results demonstrated high effectiveness, as evidenced by a usability test score of 4.88 out of 5 for ease of understanding and satisfaction. Additionally, the OAKKU web application significantly reduced search time. Conclusion: The OAKKU web application user guide, developed through PAR, significantly enhanced the OAKKU web application. These included improvements to incorporate Thai language supports and simplifies the search process, resulting in more effective searches. [ABSTRACT FROM AUTHOR]

Background: Long-haul truck drivers (LHTDs) face a number of occupational hazards. One such hazard is exposure to diesel engine exhaust (DEE). However, this concept has yet to be analyzed. To address this gap, a concept analysis was conducted to explore the effects of DEE in relation to lung cancer. Methods: Walker and Avant's eight-step concept analysis method was utilized: concept selection, analysis purpose, concept uses, defining attributes, model case, borderline case, antecedents and consequences, and empirical referents. PubMed, Scopus, and CINAHL databases were searched for relevant literature. Findings: Diesel engine exhaust was identified as a mixture of gases and particulates that are considered carcinogenic. Defining attributes of DEE for truckers include respiratory effects such as decreased peak flow and increased airway resistance leading to symptoms such as a phlegm-producing cough, eye and throat irritation, exacerbation of asthma symptoms, and allergic responses. The identified level of DEE exposure associated with these attributes is 75 μg EC/m3 for 1 to 2 hours daily or a long-term exposure of 10 μg EC/m3. The conceptual definition of DEE in truckers was illustrated by the attributes, antecedents, consequences, model case, and empirical referents. Conclusion: Lung cancer was identified as a significant consequence of occupational DEE exposure for LHTDs. This analysis highlights the need for future research to develop interventions that will safeguard truckers from the adverse health effects of DEE exposure. [ABSTRACT FROM AUTHOR]

Background Occupational short-latency respiratory disease (SLRD; predominantly asthma, rhinitis, hypersensitivity pneumonitis, and occupational infections) prevalence is difficult to determine but certain occupations may be associated with increased susceptibility. Aims This study aimed to examine which occupations and industries are currently at high risk for SLRD and determine their respective suspected causal agents. Methods SLRD cases reported to the SWORD scheme between 1999 and 2019 were analysed to determine directly standardized rate ratios (SRR) by occupation against the average rate for all other occupations combined. Results 'Bakers and flour confectioners' and 'vehicle spray painters' showed significantly raised SRR for SLRD in general, mostly due to occupational rhinitis (234.4; 95% CI 200.5–274.0) and asthma (63.5; 95% CI 51.5–78.3), respectively. Laboratory technicians also showed significantly raised SRR for occupational rhinitis (18.7; 95% CI 15.1–23.1), primarily caused by laboratory animals and insects. Metal machining setters and setter-operators showed increased SRR for occupational hypersensitivity pneumonitis (42.0; 95% CI 29.3–60.3), largely due to cutting/soluble oils. The occupation mostly affected by infectious disease was welding trades (12.9; 95% CI 5.7–29.3), mainly attributable to microbial pathogenicity. Conclusions This study identified the occupational groups at increased risk of developing an SLRD based on data recorded over a recent two-decade period in the UK. Occupational asthma and rhinitis were identified as the prevailing conditions and hypersensitivity pneumonitis as a potentially rising respiratory problem in the metalworking industry. [ABSTRACT FROM AUTHOR]

One of occupational illnesses is irritant-induced asthma (IIA), which IIA is a phenotype of asthma caused by the inhalation of irritant agents. The incidence of IIA is reported as 5-18% of occupational asthma cases. In some cases, it is challenging to differentiate IIA from work-exacerbated asthma (WEA) because no specific diagnostic tests can determine whether a person has asthma caused by exposure to irritants. In any case of suspected IIA, the diagnosis of asthma should be confirmed by spirometry demonstrating airflow limitation with significant bronchodilator response or nonspecific bronchial hyperresponsiveness (NSBHR) to methacholine/histamine. IIA Management is similar to asthma management, including bronchodilator therapy and inhaled and/or systemic corticosteroids. Several studies recommend treating asthma in adults and adolescents with short-acting beta-agonists (SABA), adding a controller in the form of inhaled corticosteroids (ICS) as needed to reduce the risk of severe exacerbations and to control symptoms. This type of controller can be given regularly every day, or ICS-formoterol can be given as needed to relieve symptoms in mild asthma. Prevention that can be done at IIA includes health promotion, special protection, early diagnosis and early treatment, limitation of disabilities, and rehabilitation. [ABSTRACT FROM AUTHOR]

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 IlA patients completed a follow-up questionnaire a median of eight (interquartile range 4-11 ) years after asthma diag- nosis. We compared their results with those of 43 low-molecular-weight (LMW) sensitizer-induced occupational astlima (OA) patients and those of 206 adult- onset asthmatics in the general population. Results: Of the I IA patients, 40% re- ported 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= 4.8395% CI: 1.51-15.47).Most ofthe IIA patients' outcomes were inferior to those ofthe adult-onset asthmatics in the general population. Conclusions: HA prognosis appeared poor but resembled that of LMW-induced OA [ABSTRACT FROM AUTHOR]

The article discusses the development of an integrated care pathway for occupational pulmonary diseases. Occupational pulmonary diseases are a global issue, and it can be challenging to determine the causal link between exposure and disease. The care pathway consists of five steps, including medical consultation, an in-depth assessment of occupational history, standard diagnostic work-up, counseling, and follow-up. The pathway aims to improve early detection, organization of care, and collaboration between healthcare providers and occupational health professionals. The ultimate goal is to prevent and treat work-related pulmonary diseases effectively. [Extracted from the article]

This article discusses the establishment of a novel severe asthma canine model for research on respiratory intervention therapies. The researchers aimed to create a large animal model of asthma that closely mimics the clinical signs and features of severe asthma in humans. They exposed adult beagles to Toluene diisocyanate (TDI) via aerosol inhalation and observed pronounced asthma clinical signs, airway inflammation, and remodeling. The model also demonstrated the efficacy of respiratory intervention therapy. This model provides a valuable tool for studying the mechanisms and effectiveness of interventional pulmonological therapies for severe asthma. [Extracted from the article]

The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms. The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents. Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents. [ABSTRACT FROM AUTHOR]

The inhalation of hard metal may produce various respiratory manifestations including upper respiratory tract irritation, asthma, hypersensitivity pneumonia (HP), and a particular form of interstitial lung disease. Co is the main cause of the adverse health outcomes in hard metal workers. A particular form of interstitial lung disease, called hard metal lung disease (HMLD) includes giant cell interstitial pneumonia (GIP) and pulmonary fibrosis. Clinical and radiologic features of GIP resemble those of HP. In patients with HMLD, pulmonary fibrosis showing usual interstitial pneumonia (UIP) pattern is found. It is unclear that GIP progresses to severe fibrosis showing UIP pattern if the exposure to hard metal is not stopped. Follow-up CT scans suggest that GIP dose not progress to fibrosis showing UIP pattern. GIP and hard metal induced pulmonary fibrosis may be two different representations resulting from exposure to hard metal. Under current diagnostic criteria, both GIP and pulmonary fibrosis with UIP pattern are included.Cobalt exposure can occur inhalation, ingestion, and dermal routes. There is knowledge regarding the importance of cobalt ions skin absorption in relation to absorption via the respiratory tract in cobalt exposure. Co ions skin absorption can be considered as the reason that cases of hard metal workers’ asthma and HMLD occur more often at the wet area than at the dry area.

Background: Change in asthma burden attributed to specific environmental risk factor has not been evaluated. Objective: We aimed to explore the age, period, and cohort effects on asthma burden attributable to smoking and occupational asthmagens in different socio-demographic index (SDI) regions and the region and sex disparities. Methods: Risk factor-specific asthma deaths and disability-adjusted life years (DALYs) rates were extracted from Global Burden of Disease study 2019, estimated by standard Combined Cause of Death Model and DisMod-MR 2.1 modeling tool. Age-period-cohort analysis was conducted to decompose age, period, and cohort effects on asthma burden. Results: Smoking- and occupational asthmagens-related asthma deaths and DALYs rates dropped by > 45% during 1990–2019. In 2019, Africa, South and Southeast Asia had higher asthma burden than other regions. Male had higher asthma burden than female. Among nearly all age groups, low-middle SDI region had the highest smoking-related asthma burden, and low SDI region had the highest occupational asthmagens-related asthma burden. Inverse "V" shaped trend was observed in the above regions with increasing age. For smoking-related asthma deaths and DALYs rates, the most significant improvement of period rate ratio (RR) occurred in high SDI region, decreased from 1.67 (1.61, 1.74) to 0.34 (0.33, 0.36) and 1.61 (1.57, 1.66) to 0.59 (0.57, 0.61), respectively, as well as the cohort effect on smoking-related asthma burden. For occupational asthmagens-related asthma deaths and DALYs rates, the most sharply decrease of period and cohort RR appeared in the high and high-middle SDI regions. Low SDI region showed least progress in period and cohort RR of smoking- and occupational asthmagens-linked asthma burden. Conclusion: Smoking- and occupational asthmagens-related asthma burden sharply decreases, but region and sex disparities exist. Policy makers from low SDI region should reinforce tobacco control and prioritize workplace protection. [ABSTRACT FROM AUTHOR]

Exposure to laboratory animal allergens has been a significant cause of IgE-mediated allergic symptoms and occupational asthma (OA). Mice are the predominant species used in medical and scientific facilities. We have previously published a review of our air monitoring data of mouse and rat major allergens (mus m 1 and rat n 1) expressible in ng·m−3 from 2005–2016. We have now reassessed all this largely United Kingdom (UK) air monitoring data from 2005–2022, which include 77% and 47% additional mouse and rat results, respectively. Where possible, we have categorized the results to specific tasks and areas to identify those associated with higher exposures and explored temporal trends in exposure together with an estimation of the annual incidence of OA in 2005 and 2018. A downward shift in mouse results for personal samples was apparent from 2014, with evidence of a decrease in the 90th percentile, but both personal and static rat samples confoundingly showed an apparent increase from 2017. Activities of "cage changing", "cage cleaning", and "cage washing, dirty side" suggested substantial personal exposures in some facilities, while "bedding dumping" and "cage scraping" suggested generally high exposures, albeit modified by any respiratory protective equipment worn. Individually ventilated cages reduce exposure, but filter changing/cleaning can still lead to high exposures. Exposure from experimental and husbandry duties were generally lower, but in some facilities activities where animals are handled outside of cages can cause significant exposures. The reduction in personal exposure to the predominant species is consistent with an estimated 55% decrease in the UK annual incidence rate of OA in 2018 from 2005. The data may help facilities to improve exposure control by identifying higher risk activities, benchmarking their own monitoring data and help further reduce the risk of sensitization and subsequent allergic respiratory ill-health. [ABSTRACT FROM AUTHOR]

Occupational exposure to the most widely used monomeric diisocyanate (dNCO), 4,4'-methylene diphenyl diisocyanate (MDI), may lead to the development of occupational asthma (OA). Alveolar macrophages with alternatively activated (M2) phenotype have been implicated in allergic airway responses and the pathogenesis of asthma. Recent in vivo studies demonstrate that M2 macrophage-associated markers and chemokines are induced by MDI-exposure, however, the underlying molecular mechanism(s) by which this proceeds is unclear. Following MDI exposure (in vivo and in vitro) M2 macrophage-associated transcription factors (TFs), markers, and chemokines were determined by RT-qPCR, western blots, and ELISA. Expression of M2 macrophage-associated TFs and markers including Klf4/KLF4, Cd206/CD206, Tgm2/TGM2, Ccl17/CCL17, Ccl22/CCL22, and CCL24 were induced by MDI/MDI-GSH exposure in bronchoalveolar lavage cells (BALCs)/THP-1 macrophages. The expression of CD206, TGM2, CCL17, CCL22, and CCL24 are upregulated by 3.83-, 7.69-, 6.22-, 6.08-, and 1.90-fold in KLF4-overexpressed macrophages, respectively. Endogenous CD206 and TGM2 were downregulated by 1.65-5.17-fold, and 1.15-1.78-fold, whereas CCL17, CCL22, and CCL24 remain unchanged in KLF4-knockdown macrophages. Finally, MDI-glutathione (GSH) conjugate-treated macrophages show increased chemotactic ability to T-cells and eosinophils, which may be attenuated by KLF4 knockdown. Our data suggest that MDI exposure may induce M2 macrophage-associated markers partially through induction of KLF4. [ABSTRACT FROM AUTHOR]

The effects of occupational isocyanate exposure range from asthma and contact dermatitis to neurotoxicity and cancer. Respiratory sensitization due to orthopedic cast application has been well documented. This study aims to compare the safety of standard-of-care fiberglass casts and a novel waterproof cast alternative by measuring the amount of isocyanate released during off-gassing over time. A 3D-printed arm simulator with comparable casing material amounts was placed in a sealed chamber. An isocyanate-sensing color-changing (SafeAir) tag was used to measure the levels of toxic exposure. Triplicate trials were conducted across all time periods (15 min, 1 h, and 24 h) and conditions. The bare arm simulator and freshly opened tags served as negative controls. Normalized pixel intensity indexes and isocyanate release estimates in ppb were derived from ImageJ-analyzed SafeAir tag photos. Fiberglass casts exhibited greater isocyanate release than both the waterproof alternative (p = 0.0002) and no-cast controls (p = 0.0006), particularly at 24 h. The waterproof alternative and no-cast control did not statistically differ (p = 0.1603). Therefore, the waterproof alternative released less isocyanate than the fiberglass casts. Waterproof cast alternatives may be safer than fiberglass by limiting medical professionals' exposure to toxic isocyanates and, thus, decreasing their risk of suffering occupational asthma. [ABSTRACT FROM AUTHOR]

Resumen: El asma es una enfermedad inflamatoria crónica que afecta alrededor del 5% de la población mundial y genera unos elevados costes sociosanitarios. Para un manejo adecuado de la enfermedad es necesario un correcto diagnóstico, basado en medidas objetivas de la afectación funcional, así como el control de los síntomas y la valoración del riesgo futuro de exacerbaciones.Se ha estimado que un 18% de los pacientes asmáticos en Europa occidental tienen asma grave y aproximadamente el 50% de ellos cuentan con un mal control. La gravedad del asma se establece en función de las necesidades mínimas de tratamiento de mantenimiento para alcanzar el control. Las guías de práctica clínica de asma recomiendan clasificar a los pacientes graves en asma alérgica (T2); asma eosinofílica (T2) y asma no T2 con el fin de establecer el tratamiento más adecuado.En las últimas décadas se han desarrollado nuevas terapias biológicas que pueden aplicarse según el fenotipo y el endotipo del asma, lo que permite hacer un tratamiento selectivo y personalizado. Estos fenotipos y endotipos pueden modificarse a lo largo del tiempo y por ello, la identificación de biomarcadores capaces de predecir la gravedad, el curso de la enfermedad y la respuesta a un determinado tratamiento parece imprescindible. En el asma se han estudiado una gran cantidad de biomarcadores, pero hasta ahora solo algunos pueden usarse fácilmente en la práctica clínica habitual. La aplicación de las tecnologías ómicas (epigenómica, genómica, transcriptómica, proteómica, metabolómica, lipidómica, etc.) que sirvan para este fin, todavía se encuentran en fase de investigación. Abstract: Asthma is a chronic inflammatory disease that affects about 5% of the world's population and generates high health and social costs. Proper management of the disease requires a correct diagnosis, based on objective measures of functional impairment, as well as symptom control and assessment of the future risk of exacerbations.It has been estimated that 18% of asthma patients in Western Europe have severe asthma and approximately 50% of them have poor control. The severity of asthma is established based on the minimum maintenance treatment needs to achieve control. Asthma clinical practice guidelines recommend classifying severe patients into allergic asthma (T2); eosinophilic asthma (T2) and non-T2 asthma in order to establish the most appropriate treatment.In recent decades, new biological therapies have been developed that can be applied according to the phenotype and endotype of asthma, allowing for selective and personalized treatment. These phenotypes and endotypes can change over time and therefore, the identification of biomarkers capable of predicting the severity, the course of the disease and the response to a given treatment seems essential. A large number of biomarkers have been studied in asthma, but so far only a few can be readily used in routine clinical practice. The application of omics technologies (epigenomics, genomics, transcriptomics, proteomics, metabolomics, lipidomics, etc.) for this purpose is still in the research phase.

Multiple respiratory hazards have been identified in the cannabis cultivation and production industry, in which occupational asthma and work-related exacerbation of preexisting asthma have been reported. An employee working in a Massachusetts cannabis cultivation and processing facility experienced progressively worsening work-associated respiratory symptoms, which culminated in a fatal asthma attack in January 2022. This report represents findings of an Occupational Safety and Health Administration inspection, which included a worksite exposure assessment, coworker and next-of-kin interviews, medical record reviews, and collaboration with the Massachusetts Department of Public Health. Respiratory tract or skin symptoms were reported by four of 10 coworkers with similar job duties. Prevention is best achieved through a multifaceted approach, including controlling asthmagen exposures, such as cannabis dust, providing worker training, and conducting medical monitoring for occupational allergy. Evaluation of workers with new-onset or worsening asthma is essential, along with prompt diagnosis and medical management, which might include cessation of work and workers' compensation when relation to work exposures is identified. It is important to recognize that work in cannabis production is potentially causative. [ABSTRACT FROM AUTHOR]

Background The current knowledge about occupational allergic diseases among greenhouse workers is scant. Aims To describe greenhouse workers' occupational allergic diseases. Methods We identified 28 greenhouse workers with occupational allergic diseases in 2002–2020 by conducting a systematic search in the patient register of the Finnish Institute of Occupational Health. All the patients worked in tomato- or cucumber-growing greenhouses and showed immunoglobulin-E-mediated sensitization to occupational agents. Specific inhalation challenges or workplace peak expiratory flow monitoring confirmed occupational asthma (OA), nasal allergen challenges confirmed occupational rhinitis (OR) and open skin tests confirmed occupational contact urticaria (OCU). Results Most patients had more than one occupational disease and were sensitized to several workplace agents. Tomato plants were the most common cause of occupational diseases and induced 22 allergic diseases in 14 patients. Cucumber plants caused occupational diseases in 10 patients (3 OA, 7 OR and 6 OCU). The pest control mite Amblyseius swirskii and a mixture of parasitic wasps Encarsia formosa and Eretmocerus eremicus both induced two OA cases. Three patients had an occupational disease caused by storage mites and three others had a work-related systemic reaction to a bumblebee sting. Conclusions The greenhouse workers typically suffered from several occupational allergic diseases and were sensitized to cultivated plants, various pest control organisms and storage mites. All these can cause OA and OR, but in this study, OCU was only induced by cultivation plants. Cucumber plant is a novel cause of OA and OR, and A. swirskii is a novel cause of OA. [ABSTRACT FROM AUTHOR]

Background: Risk factors for the severity of occupational asthma (OA) are often attributed to occupational exposure. However, some recent epidemiological data suggest a link with obesity. The study aimed to analyze the relationship between obesity and the severity of (OA) assessed by non-specific bronchial provocation. Materials and Methods: We conducted an epidemiological descriptive retrospective study including patients who were referred to the Occupational Medicine Department of Farhat Hached University Hospital of Sousse, for (OA) and who have completed a non-specific bronchoprovocation test to metacholine. Results: Our population consisted of 131 cases of (OA) with a female predominance. The average BMI was 27.34 ±5.30 kg. Obesity was observed in 29.8% of cases. The non-specific metacholine bronchial provocation test revealed an average dose of PD20 at 750.4 ±656.3 µg. Severe (OA) was observed in (35.1%). After univariate analysis, obesity in asthmatics had a significant association with age (p<0.001), marital status (p=0.005), average professional seniority (p<0.001), the evolution of complaints (p=0.035) and abnormal initial spirometry (p=0.044). As for the severity of (OA), the univariate analytical study did not show a significant link with obesity (p=0.68). Conclusion: The association between obesity and OA is not an easy task and should be made using more accurate tools to measure body fat percentage. The preventive role of the occupational physician is essential in factories in order to make more prudent decisions when employing workers with a high BMI in high-risk occupations. Hence the importance of regular monitoring of weight in workers exposed to asthmatics during periodic examinations. [ABSTRACT FROM AUTHOR]

Purpose of Review: Occupational rhinitis is an underdiagnosed disease with significant morbidity and implications in the workplace. Multiple factors associated with this disease continue to pose a challenge to investigators. This review aims to summarize recent literature in occupational rhinitis, including classifications, pathogenesis, diagnosis, and treatment, as well as the impact of occupational rhinitis on individuals. Additionally, it identifies areas in need of further research and investigation. Recent Findings: We highlight current research on the association between occupational rhinitis and occupational asthma and the role of immunotherapy in this disease. Discussion includes the impact of social trends on workers and the wider consequences of occupational rhinitis including decreased work productivity, absenteeism, and socioeconomic burden. Summary: Occupational rhinitis remains a challenging disease entity due to the numerous potential causative factors, reduced recognition, morbidity in asthma, and therapeutic limitations. Additional research is needed to better identify disease predictors and develop effective management strategies. [ABSTRACT FROM AUTHOR]

Objective: We discussed health problems encountered during the wind turbine production process and occupational diseases that may arise. Risk factors for occupational asthma are discussed. Methods: This is a case-control study. The workers, who had been referred to the Occupational Diseases outpatient clinic between August 2018 and January 2021, were evaluated. Exposure histories and laboratory, functional, and radiological findings of patients diagnosed with occupational diseases were presented. The exposure and functional properties of cases with occupational asthma and normal workers are compared. Results: A total of 154 workers had were evaluated. All the workers were male, the mean age was 34.6+-6.9, median working time was 60 months and latency period was 36 months. The rates of occupational diseases such as occupational asthma, pneumoconiosis, and allergic contact dermatitis were 19.5% (n=30), 0.6% (n=1), and 5.8% (n=9), respectively. The patients with occupational asthma were younger (29.6+-4.63 vs. 37.3+-6.43). Working time- duration of exposure was lower [36 months (24-51) vs. 72 months (48-84)]. Conclusion: Wind turbines, which reduce the carbon footprint and are used to obtain sustainable energy, may have unsustainable health effects on employees during the production process.

Occupational asthma triggered by inhaling fish-derived aerosols is estimated to affect 2–8% of exposed individuals. This primarily affects workers in the fish processing industry. Fishmongers, rarely experience this issue, as recent research found no significant difference in asthma rates compared to a control group. We report the case of a fishmonger who presented with a 1-year history of rhinoconjunctivitis and asthma. The patient attributed these symptoms to his occupational exposure within the fish market environment, which worsened in the cold storage warehouse. Symptoms improved during holidays. Diagnosis involved skin-prick tests, sIgE (ImmunoCAP-specific IgE) measurements, and bronchial challenge tests, confirming occupational asthma from fish bioaerosol exposure. Parvalbumins, common fish proteins, share structural similarities, leading to cross-reactivity in fish allergy sufferers. In this case, sensitivity to rGad c1 (cod parvalbumin) was identified as the primary trigger for the patient's asthma, and responsible for sensitizations observed across various tested fish species. [ABSTRACT FROM AUTHOR]

Objective To investigate the adverse effects of low-concentration isocyanate exposure on airway inflammation and lung function and to explore the application of fractional exhaled nitric oxide (FeNO) in occupational health examinations of isocyanate-exposed workers. Methods From 2016 to 2017, a total of 192 workers exposed to isocyanates were selected as the exposure group, and 91 with similar age and gender composition (office and/or logistics personnel) without any exposure to occupational hazards (as references) were studied. Monitoring data of airborne isocyanate concentration in workplaces in the past 5 years were collected. The basic information of all workers was collected, and their lung function, FeNO, and salbutamol bronchial dilation tests were performed. The differences in various indicators among these two groups of workers were compared. Results The airborne isocyanate concentration in workplaces over the past 5 years was significantly lower than the national occupational exposure limit. The forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) of the exposed workers were higher than those of the reference group, while FEV1/FVC was lower than that of the reference group, and the differences were statistically significant (P < 0.001). There was no significant difference in FeNO levels between the exposed workers and the reference workers (P > 0.05). The FEV1/FVC ratio was higher in the exposed workers with exposure time < 7 years than workers with exposure time≥ 7 years (P < 0.05), while there was no significant difference in FeNO levels between these two groups (P > 0.05). There was no significant difference in various indicators of lung function among different workers grouped according to the FeNO levels (P > 0.05). Among 192 exposed workers, 13 had FeNO levels higher than 50 ppb (1 ppb = 1 × 10-9), and among 9 workers receiving bronchial dilation tests 3 workers were positive. Conclusions FEV1/FVC could better reflect the adverse effect of isocyanate, a type of asthmagens, on lung function. FeNO levels cannot indicate the occupational low -level isocyanate exposure, while positive changes shown by bronchial dilation tests in exposed populations occur earlier than changes in lung function. The combination of FeNO measurement and bronchial dilation tests could have certain predictive value for diagnosing and screening occupational asthma. [ABSTRACT FROM AUTHOR]

Workers on dairy farms face exposures to organic dusts and endotoxin. At the same time, a number of studies of farmers have reported a lower prevalence of asthma in farmworkers compared to persons without farm contact. The "hygiene hypothesis" suggests that early life exposures on farms could be protective against allergic disease and asthma. Such protective relationships are less well studied in adult farm workers. A cross-sectional analysis of respiratory function and allergy status was performed in a sample of dairy farm workers (n = 42) and community controls (n = 40). Measures of respiratory status (spirometry, exhaled nitric oxide FeNO, self-reported symptoms) and levels of total and bovine-specific IgE were compared between the groups. Prevalence of self-reported asthma and most respiratory symptoms was similar in the two groups, with the exception of increased report of dyspnea among dairy workers. In the dairy workers, level of lung function was not reduced and FeNO was not increased. In unadjusted and adjusted models, dairy work was not associated with reduced lung function or increased airway inflammation. Mean IgE levels did not differ significantly between workers and controls, but elevated bovine-specific IgE was detected only among dairy workers, with an apparent association between elevated bovine IgE and increased FeNO. While dairy workers did not demonstrate increased asthma prevalence compared to controls, sensitization to bovine antigen in several workers appeared to be associated with airway inflammation. Occupational health programs for dairy workers should consider the risk of animal allergy as part of respiratory health protection efforts. [ABSTRACT FROM AUTHOR]

Introduction: Occupational asthma (OA) is a type of Work-Related Asthma characterised by variable airflow limitation and/or inflammation due to causes and conditions attributable to a particular occupational environment, and not to stimuli encountered outside the workplace. There is an increasing need to extend the depth of knowledge of OA to better manage this condition, especially among food industry workers who are affected by it. Objective: This systematic review aimed to determine the factors associated with occupational asthma among food industry workers by electronically collecting articles from two databases (Medline and Scopus). Methods: This systematic review was prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) updated guideline. Two independent reviewers screened the titles and abstracts of the collected data, which were then stored in Endnote20 based on the inclusion and exclusion criteria. The included articles have been critically appraised to assess the quality of the studies using the Mixed Methods Appraisal Tool (MMAT). Result: The search yielded 82 articles from Medline and 85 from SCOPUS, resulting in 167 unique hits. Only 22 articles have been included in the full-text assessment following a rigorous selection screening. Of the 22 articles identified, five were included in the final review. Several factors were found to have contributed to occupational asthma among food industry workers. They were classified into two categories: (1) work environment-related factors; and (2) individual factors. Conclusion: Several work environment and individual-related factors were found to be associated with OA among food industry workers. A better understanding of the development of the disease and its potential risk factors is needed because it can affect worker's quality of life. Pre-employment and periodic medical surveillance should be conducted to assess and detect any possible risk of developing occupational asthma among workers. [ABSTRACT FROM AUTHOR]

Respiratory allergy and asthma to laboratory animals are common and preventable using engineering, administrative, and work practice controls, along with PPE (including reparatory protection) and tracked using medical surveillance. In this 10-year follow-up national survey of prevention practices, wide variation in practices, controls, and medical surveillance persisted. Objective: Laboratory animal allergy (LAA) is common and preventable. This study provides a 10-year update on LAA prevention programs in the United States and the effect of COVID-19 on prevention practices. Methods: An electronic survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. Results were compared with the prior survey. Results: A total of 141 institutions employing 58,224 laboratory animal workers responded. Results were similar to the prior survey with wide variation in practices. Medical surveillance increased (58%–71%), but N95 respirator use decreased (17%–13%). As before, only 25% of institutions knew their LAA incidence and prevalence rates. COVID-19 had a small time-limited effect on personal protective equipment use. Conclusions: Universal use of evidence-based practices and improved medical surveillance would provide greater worker protection from LAA. [ABSTRACT FROM AUTHOR]

The association between breathing sounds and respiratory health or disease has been exceptionally useful in the practice of medicine since the advent of the stethoscope. Remote patient monitoring technology and artificial intelligence offer the potential to develop practical means of assessing respiratory function or dysfunction through continuous assessment of breathing sounds when patients are at home, at work, or even asleep. Automated reports such as cough counts or the percentage of the breathing cycles containing wheezes can be delivered to a practitioner via secure electronic means or returned to the clinical office at the first opportunity. This has not previously been possible. The four respiratory sounds that most lend themselves to this technology are wheezes, to detect breakthrough asthma at night and even occupational asthma when a patient is at work; snoring as an indicator of OSA or adequacy of CPAP settings; cough in which long-term recording can objectively assess treatment adequacy; and crackles, which, although subtle and often overlooked, can contain important clinical information when appearing in a home recording. In recent years, a flurry of publications in the engineering literature described construction, usage, and testing outcomes of such devices. Little of this has appeared in the medical literature. The potential value of this technology for pulmonary medicine is compelling. We expect that these tiny, smart devices soon will allow us to address clinical questions that occur away from the clinic. [ABSTRACT FROM AUTHOR]

Background: Work‐related asthma (WRA) is the most prevalent occupational respiratory disease, and it has negative effects on socioeconomic standing, asthma control, quality of life, and mental health status. Most of the studies on WRA consequences are from high‐income countries; there is a lack of information on these effects in Latin America and in middle‐income countries. Methods: This study compared socioeconomic, asthma control, quality of life, and psychological outcomes among individuals diagnosed with WRA and non‐work‐related asthma (NWRA) in a middle‐income country. Patients with asthma, related and not related to work, were interviewed using a structured questionnaire to assess their occupational history and socioeconomic conditions, and with questionnaires to assess asthma control (Asthma Control Test and Asthma Control Questionnaire‐6), quality of life (Juniper's Asthma Quality of Life Questionnaire), and presence of anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Each patient's medical record was reviewed for exams and use of medication, and comparisons were made between individuals with WRA and NWRA. Results: The study included 132 patients with WRA and 130 with NWRA. Individuals with WRA had worse socioeconomic outcomes, worse asthma control, more quality‐of‐life impairment, and a higher prevalence of anxiety and depression than individuals with NWRA. Among individuals with WRA, those who had been removed from occupational exposure had a worse socioeconomic impact. Conclusions: Consequences on socioeconomic, asthma control, quality of life, and psychological status are worse for WRA individuals when compared with NWRA. [ABSTRACT FROM AUTHOR]

Work-related dysphonia in subjects with occupational asthma is associated with neutrophilic airway inflammation Keywords: dysphonia; neutrophilic inflammation; occupational asthma EN dysphonia neutrophilic inflammation occupational asthma 1 4 4 05/29/23 20230501 NES 230501 DATA AVAILABILITY STATEMENT Research data are not shared. The baseline clinical features and sputum cell counts of the subjects with and without dysphonia as well as the univariate associations with dysphonia are detailed in Table 1. [Extracted from the article]

This review addresses the need for a framework to increase the consistency, objectivity and transparency in the regulatory assessment of respiratory sensitisers and associated uncertainties. Principal issues are considered and illustrated through a case study (with methyl methacrylate). In the absence of test methods validated for regulatory use, formal documentation of the weight-of-evidence for hazard classification both at the level of integration of individual studies within lines of evidence and across a broad range of data streams was agreed to be critical for such a framework. An integrated approach is proposed to include not only occupational studies and clinical evidence for the regulatory assessment of respiratory sensitisers, but also information on structure and physical and chemical factors, predictive approaches such as structure activity analysis and in vitro and in vivo mechanistic and toxicokinetic findings. A weight-of-evidence protocol, incorporating integration of these sources of data based on predefined considerations, would contribute to transparency and consistency in the outcome of the assessment. In those cases where a decision may need to be taken on the basis of occupational findings alone, conclusions should be based on transparent weighting of relevant data on the observed prevalence of occupational asthma in various studies taking into account all relevant information including the range and nature of workplace exposures to the substance of interest, co-exposure to other chemicals and study quality. [ABSTRACT FROM AUTHOR]

Objectives The definition of work-related Asthma (WRA) has changed in recent years and new etiologies and agents have been identified. The aim of this study is to describe the main causal agents of WRA in France in the period 2001–2018 in the main work sectors. Methods Data were collected from the French national network of occupational health surveillance and prevention [Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)], Data between 2001 and 2018 with at least a probable or certain association with one occupational agent, were included. Results Work sectors with more cases OF WRA included personal service activities (10.6%), food industry (10.2%) and healthcare activities (7.6%). WRA cases were most frequently related to flour (10%), quaternary ammoniums compounds (5.3%), isocyanates (5.1%) and cleaning products (4.8%). Conclusion Occupational exposure to specific agents capable of causing WRA is still present, and four agents represent more than 25% of the cases. Actions to prevent respiratory exposure are still relevant. [ABSTRACT FROM AUTHOR]

Although serum S100A9 and CLP levels may be elevated in asthma, neither is superior to serum periostin levels in the assessment of asthma control for this mixt group of patients with asthma. Keywords: asthma control; biomarker; calprotectin; periostin; S100A9 EN asthma control biomarker calprotectin periostin S100A9 455 458 4 04/18/23 20230401 NES 230401 Key Messages Serum S100A9 and periostin levels were elevated in patients with asthma compared with the controls. [Extracted from the article]

Background: Occupational exposure to allergens in the baking industry is well documented. Two workers employed in the industrial baking industry for more than 30 and 17 years respectively presented with symptoms suggestive of asthma, preceded by conjunctivitis and rhinitis. Their symptoms were worse during exposure to flour dust in the front-end areas of the bakery, particularly the mixing and dough-making areas, and were relieved by the avoidance of exposure to flour dust. Methods: The clinical assessment of the workers included an evaluation of their respiratory function using spirometry with a bronchodilator challenge. Serial peak-flow (PEF) monitoring over four weeks was conducted and included periods at and away from work. A work effect index (WEI) was generated from the PEF data using the OASYS® software to assess the work-relatedness of symptoms. An immunological assessment included the detection of atopy using skin-prick tests (SPTs) to common aeroallergens and the detection of specific IgE to baking allergens, including wheat and rye flour, and fungal α-amylase. Results: Occupational rhinitis (OR) and asthma (OA) associated with sensitisation to wheat, rye and fungal α-amylase was diagnosed in both workers. The diagnosis was based on the clinical presentation of work-related symptoms, diurnal variation in PEF exceeding 20% and elevated specific IgE to wheat (290 kU/L and 2.02 kU/L), rye (92.8 kU/L and 1.40 kU/L) and fungal α-amylase (3.53 kU/L and >100 kU/L). The serial PEF analysis of Worker 1 revealed a WEI of 3.71, whereas Worker 2's PEF data were suboptimal for analysis. The workplace visit confirmed inadequate risk mitigation of baking allergen exposure; and exposure to high flour-dust levels (5-16 mg/m³) in the mixing area was confirmed by a recent hygiene survey. Conclusion: These cases of baker's asthma and allergy highlight the persistent role of inadequate exposure-control measures in industrial bakeries. Specific South African exposure standards for flour-dust allergens are needed to prevent the development of allergic diseases such as asthma and to mitigate the risk in bakery workers. [ABSTRACT FROM AUTHOR]

Diisocyanates are a group of chemicals widely used in different industrial applications. The critical health effects related to diisocyanate exposure are isocyanate sensitisation, occupational asthma and bronchial hyperresponsiveness (BHR). Industrial air measurements and human biomonitoring (HBM) samples were gathered in specific occupational sectors to examine MDI, TDI, HDI and IPDI and the respective metabolites from Finnish screening studies. HBM data can give a more accurate picture of diisocyanate exposure, especially if workers have been exposed dermally or used respiratory protection. The HBM data were used for conducting a health impact assessment (HIA) in specific Finnish occupational sectors. For this purpose, exposure reconstruction was performed on the basis of HBM measurements of TDI and MDI exposures using a PBPK model, and a correlation equation was made for HDI exposure. Subsequently, the exposure estimates were compared to a previously published dose–response curve for excess BHR risk. The results showed that the mean and median diisocyanate exposure levels and HBM concentrations were low for all diisocyanates. In HIA, the excess risk of BHR from MDI exposure over a working life period was highest in the construction and motor and vehicle industries and repair sectors, resulting in estimated excess risks of BHR of 2.0% and 2.6%, and 113 and 244 extra BHR cases in Finland, respectively. Occupational exposure to diisocyanates must be monitored because a clear threshold for DI sensitisation cannot be established. [ABSTRACT FROM AUTHOR]

Abstract Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of respiratory tract inflammation, originally designated to identify eosinophilic airway inflammation and to predict steroid response. The main field of application of this biomarker is asthma, but FeNO has also been used for other allergic and non-allergic pulmonary disorders such as chronic obstructive pulmonary disease, hypersensitivity pneumonitis and interstitial lung disease. A substantial part of respiratory diseases are related to work, and FeNO, a safe and easy measure to conduct, is a potential valid examination in an occupational setting. This systematic review assesses the value of measuring FeNO related to three types of airborne exposures: allergens, irritants, and respiratory particles inhaled during occupational activities. The review covers results from longitudinal and observational clinical studies, and highlights the added value of this biomarker in monitoring effects of exposure and in the diagnostic criteria of occupational diseases. This review also covers the possible significance of FeNO as an indicator of the efficacy of interventions to prevent work-related respiratory diseases. Initially, 246 articles were identified in PUBMED and SCOPUS. Duplicates and articles which covered results from the general population, symptoms (not disease) related to work, non-occupational diseases, and case reports were excluded. Finally, 39 articles contributed to this review, which led to the following conclusions: a) For occupational asthma there is no consensus on the significant value of FeNO for diagnosis, or on the magnitude of change needed after specific inhalation test or occupational exposure at the workplace. There is some consensus for the optimal time to measure FeNO after exposure, mainly after 24 h, and FeNO proved to be more sensitive than spirometry in measuring the result of an intervention. b) For other occupational obstructive respiratory diseases, current data suggests performing the measurement after the work shift. c) For interstitial lung disease, the evaluation of the alveolar component of NO is probably the most suitable.