| 61. |
- Blanc, P. D., et al.
(författare)
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The Occupational Burden of Nonmalignant Respiratory Diseases An Official American Thoracic Society and European Respiratory Society Statement
- 2019
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X. ; 199:11, s. 1312-1334
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases. RAHAM J L, 1986, Applied Pathology, V4, P138
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| 62. |
- Blanc, Paul D., et al.
(författare)
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The prevalence and predictors of respiratory-related work limitation and occupational disability in an international study
- 2003
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Ingår i: Chest. ; 124:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Work-related symptoms and disability due to respiratory disease are common and costly among working-age adults. To investigate this problem, we analyzed data on respiratory symptoms related to the workplace and occupational disability from the European Community Respiratory Health Survey (ECRHS). METHODS: The ECRHS is a population-based sample of adults aged 20 to 44, with oversampling of subjects with symptoms that are consistent with respiratory disease. We analyzed structured interviews from 17,567 subjects, of whom 15,039 were from a general random population sample and 2,528 were from the respiratory symptom oversample. We defined work-related respiratory symptoms as self-reported wheeze or chest tightness at work, and work-related respiratory disability as reported job change due to breathing difficulties at work. We used binary generalized linear modeling with a log link to estimate the risk of symptoms and disability. FINDINGS: Wheeze at work was reported in the general population sample by 1,552 subject (10%), ranging from 4 to 15% among the 16 countries analyzed. Work-related respiratory disability was reported by 540 subjects (4%), ranging from 1 to 8%. Reported workplace exposure to vapors, gases, dust, or fumes was associated with increased risk of respiratory symptoms at work (prevalence ratio [PR], 2.1; 95% CI 1.8-2.4) and work-related respiratory disability (PR, 3.4; 95% confidence interval [CI], 2.0 to 5.1). Workplace environmental tobacco smoke exposure was associated with symptoms (PR, 1.3; 95% CI, 1.2 to 1.5) but not with disability (PR, 1.1; 95% CI, 0.9 to 1.4). INTERPRETATION: These data indicated that work-related respiratory symptoms and disability vary widely in this international sample but, nonetheless, are associated with workplace exposures that could be addressed through preventive measures.
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| 63. |
- Bonde, Ellen, 1968, et al.
(författare)
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Dissociation of dysfunctional breathing and odour intolerance among adults in a general-population study.
- 2013
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Ingår i: The clinical respiratory journal. - 1752-699X. ; 7:2, s. 176-182
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many patients present with a mixture of respiratory problems such as shortness of breath, heavy breathing, coughing and odour intolerance. If these patients are diagnosed as asthma, it might sometimes be a false diagnosis. Concepts such as sensory hyperreactivity, hyperventilation, asthma-like symptoms, odour intolerance and dysfunctional breathing are used to refer to these patients. Non-respiratory symptoms such as headache, fatigue and bloating are sometimes also part of the clinical picture. Our aim was to use factor analysis to increase our understanding of breathing-related symptoms in a general-population frame. Methods: A respiratory questionnaire was answered by 10108 subjects in a general-population sample. Items aiming to identify individuals with breathing-related symptoms and asthma were included. We used factor analysis with Varimax rotation to extract discriminatory components (i.e. groups of symptoms), based on the questionnaire items. The aim was to find groups of items (factors) as distinct as possible, still allowing overlap and showing the importance of each item in the separated factor. Results: Five distinct factors were identified in the factor analysis, representing dysfunctional breathing, odour intolerance, asthma, bronchitis and a group with mixed symptoms, respectively. These five factors explained 55% of the variance. Conclusions: Based on our findings, we conclude that non-asthmatic breathing-related symptoms may be separated into at least two categories in a general population, odour intolerance and dysfunctional breathing. These two categories seem to be two distinct groups of subjects with breathing-related symptoms and may represent different clinical entities separated from asthma and bronchitis. Please cite this paper as: Bonde E, Andersson E, Brisman J, Eklöf M, Ringsberg KC and Torén K. Dissociation of dysfunctional breathing and odour intolerance among adults in a general-population study. Clin Respir J 2012; DOI: 10.1111/j.1752-699X.2012.00299.x.
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| 64. |
- Boudigaard, S. H., et al.
(författare)
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A follow-up study of occupational styrene exposure and risk of autoimmune rheumatic diseases
- 2020
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 77:2, s. 64-69
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Increased risk has been suggested for autoimmune rheumatic diseases following solvent exposure. The evidence for specific solvents is limited, and little is known about exposure-response relations. Styrene is an aromatic, organic solvent and the objective of this study was to analyse the association between occupational styrene exposure and autoimmune rheumatic diseases in men and women. Methods We followed 72 212 styrene-exposed workers of the Danish reinforced plastics industry from 1979 to 2012. We modelled full work history of styrene exposure from employment history, survey data and historical styrene exposure measurements. We identified cases in the national patient registry and investigated gender-specific exposure-response relations by cumulative styrene exposure for different exposure time windows adjusting for age, calendar year and educational level. Results During 1 515 126 person-years of follow-up, we identified 718 cases of an autoimmune rheumatic disease, of which 73% were rheumatoid arthritis. When adjusting for potential confounders and comparing the highest with the lowest styrene exposure tertile, we observed a statistically non-significantly increased risk of systemic sclerosis among women (incidence rate ratio (IRR)=2.50; 95% CI 0.50 to 12.50) and men (IRR=1.86; 95 % CI 0.50 to 7.00), based on 9 and 22 cases, respectively. Results were inconsistent for the other autoimmune rheumatic diseases examined. Conclusion This study suggests an association between occupational styrene exposure and systemic sclerosis in men as well as in women but based on few cases. This is a new finding and has to be replicated before conclusions can be drawn.
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| 65. |
- Boudigaard, S. H., et al.
(författare)
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Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: a nationwide cohort study
- 2021
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 50:4, s. 1213-1226
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exposure to respirable crystalline silica is suggested to increase the risk of autoimmune rheumatic diseases. We examined the association between respirable crystalline silica exposure and systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus and small vessel vasculitis. Methods: In a cohort study of the total Danish working population, we included 1 541 505 male and 1 470 769 female workers followed since entering the labour market 1979-2015. Each worker was annually assigned a level of respirable crystalline silica exposure estimated with a quantitative job exposure matrix. We identified cases of autoimmune rheumatic diseases in a national patient register and examined sex-specific exposure-response relations by cumulative exposure and other exposure metrics. Results: We identified 4673 male and 12 268 female cases. Adjusted for age and calendar year, men exposed to high levels of respirable crystalline silica compared with non-exposed showed increased incidence rate ratio (IRR) for the four diseases combined of 1.53 [95% confidence interval (CI): 1.39-1.69], for systemic sclerosis of 1.62 (1.08-2.44) and rheumatoid arthritis of 1.57 (1.41-1.75). The overall risk increased with increasing cumulative exposure attained since entering the workforce [IRR: 1.07 (1.05-1.09) per 50 mu g/m(3)-years]. Female workers were less exposed to respirable crystalline silica, but showed comparable risk patterns with overall increased risk with increasing cumulative exposure [IRR: 1.04 (0.99-1.10) per 50 mu g/m(3)-years]. Conclusions: This study shows an exposure-dependent association between occupational exposure to respirable crystalline silica and autoimmune rheumatic diseases and thus suggests causal effects, most evident for systemic sclerosis and rheumatoid arthritis.
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| 66. |
- Brisman, Jonas, 1954, et al.
(författare)
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Spirometric reference equations for Swedish adults
- 2017
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Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961. ; 37:6, s. 640-645
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Tidskriftsartikel (refereegranskat)abstract
- New spirometric reference equations for Swedish adults are required. Three different older sets of reference equations clinically used in Sweden have various drawbacks and the recently published 'The Global Lung Function 2012 (GLI) equations' have been shown not to be adequate for Swedish normal, healthy non-smokers. We have recently concluded that a piecewise linear model presented by Lubinski and Golczewski accurately describes the distribution of spirometric variables in a large Swedish random population sample. This piecewise linear model also offers the important advantage of implementing easily physiologically interpretable coefficients. The present study aimed at presenting piecewise linear reference equations for Swedish adults based on a random population sample of 6685 individuals aged 25-75years. Predicted normal values by the piecewise linear reference equations and lower limit normal (LLN) were compared with the three reference equations frequently used clinically in Sweden and the GLI equations. We found predicted normal values according to the present piecewise linear reference equations close to 100% predicted normal as expected, whereas the other equations either overestimated or underestimated normal subjects. Concerning LLN, the present equations, i.e. 1.645 x RSD, showed the least deviation from the expected 5% and, e.g., the GLI equations systematically identified too few subjects below LLN. We conclude that the present piecewise linear reference equations, based on a relatively large general population sample, ought to be considered for clinical use in Sweden. Application of 1.645 x RSD below predicted value gave an acceptably accurate LLN.
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| 67. |
- Brisman, Jonas, 1954, et al.
(författare)
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The incidence of respiratory symptoms in female Swedish hairdressers
- 2003
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Ingår i: American Journal of Industrial Medicine. - : Wiley. - 0271-3586. ; 44:6
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Tidskriftsartikel (refereegranskat)abstract
- Background Airway diseases in hairdressers are a concern. The objective of this investigation is to evaluate the risk for three respiratory symptoms, wheeze, dry cough, and nasal blockage, in hairdressers. Methods A questionnaire on respiratory symptoms, atopy, smoking, and work history was answered by 3,957 female hairdressers and 4,905 women from the general population as referents. Incidence rates (IR) and incidence rate ratios (IRRs)for the three symptoms were estimated. Results The IRs of all three studied symptoms were higher in the hairdressers compared with the referents. Smoking modified the effects of cohort affiliationfor all threesymptoms; the combined effect from hairdressing work and smoking was less than expected. In addition, the effect of cohort affiliation for wheeze was also modified by atopy, and the effect of cohort affiliation for nasal blockage was also modified by calendar year. Conclusions Hairdressing work was associated with increased incidences of respiratory symptoms. Smoking had a negative modifying effect.
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| 68. |
- Canova, C., et al.
(författare)
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The influence of sensitisation to pollens and moulds on seasonal variations in asthma attacks
- 2013
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 42:4, s. 935-945
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Tidskriftsartikel (refereegranskat)abstract
- No large study has described the seasonal variation in asthma attacks in population-based asthmatics in whom sensitisation to allergen has been measured. 2637 young adults with asthma living in 15 countries reported the months in which they usually had attacks of asthma and had skin-prick tests performed. Differences in seasonal patterns by sensitisation status were assessed using generalised estimating equations. Most young adults with asthma reported periods of the year when their asthma attacks were more common (range: 47% in Sweden to 86% in Spain). Seasonal variation in asthma was not modified by sensitisation to house dust mite or cat allergens. Asthmatics sensitised to grass, birch and Alternaria allergens had different seasonal patterns to those not sensitised to each allergen, with some geographical variation. In southern Europe, those sensitised to grass allergens were more likely to report attacks occurred in spring or summer than in winter (OR March/April 2.60, 95% CI 1.70-3.97; OR May/June 4.43, 95% CI 2.34-8.39) and smaller later peaks were observed in northern Europe (OR May/June 1.25, 95% CI 0.60-2.64; OR July/August 1.66, 95% CI 0.89-3.10). Asthmatics reporting hay fever but who were not sensitised to grass showed no seasonal variations. Seasonal variations in asthma attacks in young adults are common and are different depending on sensitisation to outdoor, but not indoor, allergens.
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| 69. |
- Carlsen, Hanne Krage, et al.
(författare)
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Exposure to traffic and lung function in adults: A general population cohort study
- 2015
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region. Design: Cross-sectional results from a cohort study. Setting: The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001-2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants' residential address to the nearest road with dense traffic (>10 000 vehicles per day) or very dense traffic (>30 000 vehicles per day). The exposure categories were: low (>500 m; reference), medium (75-500 m) or high (<75 m). Participants: The source population was a population-based cohort of adults (n=6153). The study population included 5441 participants of European descent with good quality spirometry and information about all outcomes and covariates. Outcome measures: Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at a clinical examination. The association with exposure was examined using linear regression adjusting for age, gender, body mass index, smoking status and education in all participants and stratified by sex, smoking status and respiratory health status. Results: We identified a significant dose-response trend between exposure category and FEV1 (p=0.03) and borderline significant trend for FVC (p=0.06) after adjusting for covariates. High exposure was associated with lower FEV1 (-1.0%, 95% CI -2.5% to 0.5%) and lower FVC (-0.9%, 95% CI -2.2% to 0.4%). The effect appeared to be stronger in women. In highly exposed individuals with current asthma or chronic obstructive pulmonary disease, FVC was lower (-4.5%, 95% CI -8.8% to -0.1%). Conclusions: High traffic exposure at the residential address was associated with lower than predicted FEV1 and FVC lung function compared with living further away in a large general population cohort. There were particular effects on women and individuals with obstructive disease.
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| 70. |
- Carlsen, Hanne Krage, et al.
(författare)
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Exposure to traffic-related particle matter and effects on lung function and potential interactions in a cross-sectional analysis of a cohort study in west Sweden.
- 2020
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 10:10
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the long-term effects of source-specific particle matter (PM) on lung function, effects of Surfactant Protein A (SP-A) and glutathione S-transferase (GST) genes GSTP1 and GSTT1 gene variants and effect modification by single-nucleotide polymorphism (SNP) genotype.Cohort study with address-based annual PM exposure assigned from annual estimates of size (PM10, PM2.5 and PMBC) and source-specific (traffic, industry, marine traffic and wood burning) dispersion modelling.Gothenburg, Sweden.The ADult-Onset asthma and NItric oXide Study had 6685 participants recruited from the general population, of which 5216 (78%) were included in the current study with information on all variables of interest. Mean age at the time of enrolment was 51.4 years (range 24-76) and 2427 (46.5%) were men.The primary outcome was forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Secondary outcome measures were effects and gene-environment interactions of SP-A and GSTT1 and GSTP1 genotypes.Exposure to traffic-related PM10 and PM2.5 was associated with decreases in percent-predicted (% predicted) FEV1 by -0.48% (95% CI -0.89% to -0.07%) and -0.47% (95% CI -0.88% to -0.07%) per IQR 3.05 and 2.47 µg/m3, respectively, and with decreases in % predicted FVC by -0.46% (95% CI -0.83% to -0.08%) and -0.47% (95% CI -0.83% to -0.10%). Total and traffic-related PMBC was strongly associated with both FEV1 and FVC by -0.53 (95% CI -0.94 to -0.13%) and -0.43% (95% CI -0.77 to -0.09%) per IQR, respectively, for FVC, and similarly for FEV1. Minor allele carrier status for two GSTP1 SNPs and the GSTT1 null genotype were associated with decreases in % predicted lung function. Three SP-A SNPs showed effect modification with exposure to PM2.5 from industry and marine traffic.PM exposure, specifically traffic related, was associated with FVC and FEV1 reductions and not modified by genotype. Genetic effect modification was suggested for industry and marine traffic PM2.5.
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