Prevalence of respiratory symptoms in sheep breeders

Background: The European Farmers' Study has indicated that sheep farmers might be at risk for the development of respiratory symptoms.

Aims: To assess the prevalence of respiratory symptoms in sheep breeders and potential work related risk factors.

Methods: All sheep breeders listed in two regions of South Germany were asked to answer a mailed questionnaire on respiratory symptoms, work related respiratory symptoms (WRS), and details of farming. Overall, 325 sheep breeders keeping at least 10 sheep could be included in the survey (response rate 81.9%). The prevalences were compared to the results of the European Farmers' Study.

Results: Sheep breeders showed a significantly higher prevalence of asthma related symptoms (prevalence odds ratio (POR) 2.1, 95% CI 1.5 to 3.0), chronic phlegm (POR 4.0, 95% CI 2.8 to 5.9), and WRS (POR 1.7, 95% CI 1.3 to 2.2) after adjusting for age, gender, smoking habits, full time farming, and study centre. In the multiple logistic regression model the risk for asthma related symptoms was doubled in full time farmers (POR 2.3, 95% CI 1.2 to 4.3). The major predictor of WRS was full time farming (POR 1.6, 95% CI 0.93 to 2.7) and the use of chemical footbaths (POR 2.1, 95% CI 1.2 to 3.7).

Conclusions: Sheep breeders might be at high risk for the development of respiratory symptoms. These symptoms may be associated with work intensity and chemical exposure during work. Studies including objective measurements should be performed.

     

Prevalence of respiratory symptoms among female flight attendants and teachers

Background: Potential health effects of the indoor environment in office buildings and aircraft have generated considerable concern in recent years.

Aims: To analyse the prevalence of self reported respiratory symptoms and illnesses in flight attendants (FAs) and schoolteachers.

Methods: Data were collected as part of a study of reproductive health among female FAs. The prevalences of work related eye, nose, and throat symptoms, wheezing, physician diagnosed asthma, chest illness, and cold or flu were calculated and stratified by smoking status in 1824 FAs and 331 schoolteachers.

Results: FAs and teachers were significantly more likely to report work related eye (12.4% and 7.4 %, respectively), nose (15.7% and 8.1%), and throat symptoms (7.5% and 5.7%) than were other working women (2.9% eye, 2.7% nose, and 1.3% throat symptoms). FAs were significantly more likely than teachers and referent working women to report chest illness during the prior three years (32.9%, 19.3%, 7.2%, respectively). Both study groups were more likely to report five or more episodes of cold or flu in the past year than were other working women (10.2% of FAs, 8.2% of teachers, 2.3% of referents), and both groups were more likely to report wheezing than other working women (22.8% of FAs, 28.4% of teachers, 16.4% of referents). FAs were significantly less likely than teachers and other working women to report ever having been diagnosed with asthma (8.2%, 13.3%, 11.8%, respectively).

Conclusions: Overall, FAs and schoolteachers report a higher prevalence of work related upper respiratory symptoms, chest illness, and cold or flu than the general working population.

     

Prevalence and risk factors of occupational asthma among hairdressers in Turkey

This study was designed to evaluate the questionnaire-based prevalence and possible risk factors of occupational asthma among hairdressers in Turkey. We investigated occupational history and respiratory, ocular, dermal, and nasal symptoms using a standardized questionnaire, evaluated worksite pulmonary function tests, and performed allergen skin testing. We then determined asthma risk factors using age- and gender-adjusted logistic regression models. The prevalence of occupational asthma in hairdressers was 14.6%. The odds ratio for hairdressers in a high work intensity group was 3.6 (95% confidence interval, 1.2 to 10.9) with a significant dose-response trend (chi 2 trend = 4.875; P = 0.027). The odds ratio for occupational asthma among workers with atopy was 4.5 (95% confidence interval, 1.2 to 17.2). We also observed an excess risk of occupational asthma with allergic rhinitis and conjunctivitis. Occupational asthma did not differ among subgroups of hairdressers. We observed an important risk of occupational asthma among hairdressers. The most prominent risk factors were work intensity and atopy.     

Physician diagnosed asthma,respiratory symptoms,and associations with workplace tasks among radiographers in Ontario,Canada

Background: Medical radiation technologists (MRTs) or radiographers have potential exposure to chemicals including sensitisers and irritants such as glutaraldehyde, formaldehyde, sulphur dioxide, and acetic acid.

Aims: To determine the prevalence of asthma and work related respiratory symptoms among MRTs compared with physiotherapists, and to identify work related factors in the darkroom environment that are associated with these outcomes.

Methods: As part of a two component study, we undertook a questionnaire mail survey of the members of the professional associations of MRTs and physiotherapists in Ontario, Canada, to ascertain the prevalence of physician diagnosed asthma, and the prevalence in the past 12 months of three or more of the nine respiratory symptoms (previously validated by Venables et al to be sensitive and specific for the presence of self reported asthma). Information on exposure factors during the past 12 months, such as ventilation conditions, processor leaks, cleanup activities, and use of personal protective equipment was also collected.

Results: The survey response rate was 63.9% among MRTs and 63.1% among physiotherapists. Most analyses were confined to 1110 MRTs and 1523 physiotherapists who never smoked. The prevalence of new onset asthma (since starting in the profession) was greater among never smoking MRTs than physiotherapists (6.4% v 3.95%), and this differed across gender: it was 30% greater among females but fivefold greater among males. Compared with physiotherapists, the prevalence of reporting three or more respiratory symptoms, two or more work related, and three or more work related respiratory symptoms in the past 12 months was more frequent among MRTs, with odds ratios (ORs) (and 95% confidence intervals) adjusted for age, gender, and childhood asthma, of 1.9 (1.5 to 2.3), 3.7 (2.6 to 5.3), and 3.2 (2.0 to 5.0), respectively. Analyses examining latex glove use indicated that this was not likely to account for these differences. Among MRTs, respiratory symptoms were associated with a number of workplace and exposure factors likely to generate aerosol or chemical exposures such as processors not having local ventilation, adjusted OR 2.0 (1.4 to 3.0); leaking processor in which clean up was delayed, 2.4 (1.6 to 3.5); floor drain clogged, 2.0 (1.2 to 3.2); freeing a film jam, 2.9 (1.8 to 4.8); unblocking a blocked processor drain, 2.4 (1.6 to 3.7); and cleaning up processor chemical spill, 2.8 (1.9 to 4.2). These outcomes were not associated with routine tasks unlikely to generate exposures, such as working outside primary workplace, loading film into processor, routine cleaning of processors, or removing processed film. Males reported that they carried out a number of tasks potentially associated with irritant exposures more frequently than females, consistent with the marked increase in risk for new onset asthma.

Conclusions: These findings suggest an increase of work related asthma and respiratory symptoms shown to denote asthma among MRTs, which is consistent with previous surveys. The mechanism is not known but appears to be linked with workplace factors and may involve a role for irritant exposures.

     

Prevalence and association of welding related systemic and respiratory symptoms in welders

Background: The prevalence of welding related respiratory symptoms coexisting with welding related systemic symptoms in welders is unknown.

Aims: To determine in a sample of welders the prevalence of coexisting welding related systemic symptoms indicative of metal fume fever (MFF) and welding related respiratory symptoms suggestive of occupational asthma (OA), and the strength and significance of any association between these two groups of symptoms.

Methods: A respiratory symptoms questionnaire, a systemic symptoms questionnaire, and a questionnaire on occupational history were administered by telephone to 351 of a sample of 441 welders (79.6%) from two cities in Québec, Canada.

Results: The co-occurrence of possible MFF (defined as having at least two symptoms of fever, feelings of flu, general malaise, chills, dry cough, metallic taste, and shortness of breath, occurring at the beginning of the working week, 3–10 hours after exposure to welding fumes) together with welding related respiratory symptoms suggestive of OA (defined as having at least two welding related symptoms of cough, wheezing, and chest tightness) was 5.8%. These two groups of symptoms were significantly associated (χ² = 18.9, p < 0.001).

Conclusion: There is a strong association between welding related MFF and welding related respiratory symptoms suggestive of OA. As such, MFF could be viewed as a pre-marker of welding related OA, a hypothesis that requires further investigation.

     

Emergency hospital admission for pain in palliative patients: A crucial role for general practitioners

Abstract

Introduction: In previous papers we analysed the incidence of wheezing in young children living near the iron and steel factory in C?l?ra?i, and in a control region (Rose?i) without industrial air pollution. Research question: Is industrial air pollution exposure during the first years of life a risk factor for the presence of asthmatic symptoms in children at school age? Methods: We assessed the prevalence of asthma symptoms using the ISAAC short form questionnaire for children aged 6–7 years, and measured the FEV1 and PEF in the children of both municipalities (297 children in C?l?ra?i, i.e. the exposed cohort, and 237 in Rose?i, i.e. the non-exposed cohort). Results: We found an OR of 7.2 (95% CI: 3.6–14.3) for affirmative answers to at least one of ISAAC questions for children living in C?l?ra?i compared to the children in Rose?i. The numbers of affirmative answers to all but one of the ISAAC questions were significantly higher in C?l?ra?i. The main result remained robust after adjusting for a series of co-variables using multiple logistic regression analysis (OR 14.8; 95% CI: 4.8–46.1). There was a strong relation between early life wheezing and asthma symptoms at school age (OR 9.0; 95%CI: 3.4–23.5).

Conclusion: Children, who had been living near an iron and steel factory during their early years, are still at increased risk for asthma symptoms at school age.     

Work organisation and unintentional sleep: results from the WOLF study

Background: Falling asleep at work is receiving increasing attention as a cause of work accidents.

Aims: To investigate which variables (related to work, lifestyle, or background) are related to the tendency to fall asleep unintentionally, either during work hours, or during leisure time.

Methods: 5589 individuals (76% response rate) responded to a questionnaire. A multiple logistic regression analysis of the cross sectional data was used to estimate the risk of falling asleep.

Results: The prevalence for falling asleep unintentionally at least once a month was 7.0% during work hours and 23.1% during leisure time. The risk of unintentional sleep at work was related to disturbed sleep, having shift work, and higher socioeconomic group. Being older, being a woman, and being a smoker were associated with a reduced risk of unintentionally falling asleep at work. Work demands, decision latitude at work, physical load, sedentary work, solitary work, extra work, and overtime work were not related to falling asleep at work. Removing "disturbed sleep" as a predictor did not change the odds ratios of the other predictors in any significant way. With respect to falling asleep during leisure time, disturbed sleep, snoring, high work demands, being a smoker, not exercising, and higher age (>45 years) became risk indicators.

Conclusion: The risk of involuntary sleep at work is increased in connection with disturbed sleep but also with night work, socioeconomic group, low age, being a male, and being a non-smoker.

     

Prevalence and onset of rhinitis and conjunctivitis in subjects with occupational asthma caused by trimellitic anhydride (TMA)

Individuals with occupational asthma may also report symptoms of rhinitis or conjunctivitis. The objective of this study was to investigate the prevalence of rhinitis and conjunctivitis in subjects with occupational asthma as a result of trimellitic anhydride (TMA). Additionally, we wanted to evaluate the onset of rhinitis and conjunctivitis symptoms as compared with the occupational asthma symptoms. In a case series design, we studied 25 consecutive employees with TMA-induced asthma; each of them had participated in an annual surveillance program in which they were queried about rhinitis, conjunctivitis, and other respiratory symptoms. Twenty-two of the 25 (88%) reported rhinitis symptoms whereas 17 of the 25 (68%) reported conjunctivitis symptoms. In 17 of the 22 (77%) individuals with rhinitis and asthma, the rhinitis symptoms preceded the asthma symptoms. In 14 of the 17 (82%) individuals with conjunctivitis, those symptoms preceded the asthma symptoms. In summary, symptoms of rhinitis and conjunctivitis are common in subjects with occupational asthma because of TMA and often precede the respiratory symptoms.     

Respiratory symptoms and diseases among construction painters

Objective: To study the self-reported prevalence of respiratory symptoms and diseases among construction painters and estimate the potential risk for this group compared with a representative group of carpenters sharing the construction work environment but without significant exposure to paint. Methods: A questionnaire study was conducted on 1,000 male Finnish construction painters and 1,000 carpenters (mean response rate 60.5%). Symptoms and diseases of the respiratory tract were studied, by logistic regression modelling, in relation to occupation and duration of painting experience. Age, atopy and smoking habits were taken into account. Results: The painters reported more asthma-like, rhinitis, laryngeal and eye symptoms than the carpenters [odds ratio (OR) 1.4–1.8]. The difference in the prevalence of asthma between the occupations was not statistically significant, but the painters with 1–10 years of painting experience had a threefold risk of asthma compared with the carpenters. Chronic bronchitis was linked to painting occupation [OR 1.9, 95% confidence interval (CI) 1.2–3.0] and to the duration of exposure; OR (CI) for over 30 years of painting was 2.2 (1.2–4.0). Occupation was not associated with allergic rhinitis or conjunctivitis. Conclusions: The results indicate a higher risk for respiratory symptoms and chronic bronchitis among construction painters than among carpenters.     

Occupational asthma in New Zealanders: a population based study.

OBJECTIVES: To examine the effect of occupation on respiratory symptoms in a randomly selected adult population aged 20-44 years. METHODS: It is based on the phase II sampling of the New Zealand part of the European Community respiratory health survey. 1609 people (63.9% response rate) completed a detailed respiratory questionnaire. Of those responding, 1174 (73%) underwent skin tests and 1126 (70%) attended to undergo methacholine bronchial challenge. Current occupation was recorded and a previous occupation was also recorded if it had led to respiratory problems. 21 occupational groups were used for analysis for the five definitions of asthma wheezing in the previous 12 months; symptoms related to asthma; bronchial hyperresponsiveness (BHR); BHR with wheezing in the previous 12 months; and BHR with symptoms related to asthma. RESULTS: Prevalence odds ratios (ORs) were significantly increased for farmers and farm workers (OR 4.16, 95% confidence interval (95% CI) 1.33 to 13.1 for the combination of wheezing and BHR). Increased risks of prevalence of asthma were also found for laboratory technicians, food processors (other than bakers), chemical workers, and plastic and rubber workers. Workers had also been divided into high and low risk exposure categories according to relevant publications. The prevalence of wheezing was greater in the high risk group (OR 1.57, 95% CI 0.83 to 2.95) than in the low risk group. Atopy was associated with asthma, but the prevalence of atopy did not differ significantly between occupational exposure groups. The attributable risk of wheezing that occurred after the age of 15 years and that was estimated to be due to occupational exposure (based on the defined high risk group) was 1.9%, but this increased to 3.1% when farmers and food processors (other than bakers) were also included in the high risk group. CONCLUSIONS: This population based study has identified certain occupations significantly associated with combinations of asthmatic symptoms and BHR.     

Risk factors for recurrent wheezing in children under 13 years old in the South of Brazil]

OBJECTIVE: To study the prevalence of and major factors associated with recurrent wheezing in children younger than 13 years of age in the urban area of Rio Grande, in the state of Rio Grande do Sul, Brazil. METHODS: The presence of recurrent wheezing was investigated in a cohort as part of a cross-sectional study that was begun in 1997 that focused on the morbidity from respiratory diseases in children then between 0 and 5 years of age. During home visits in 2004 a standardized questionnaire given by trained interviewers was used to obtain information concerning the family's socioeconomic and living conditions, maternal care during pregnancy and delivery, and children's current and previous morbidity patterns. The statistical analysis included the calculation of the odds ratio (OR) and 95% confidence interval (95% CI), with nonconditional logistic regression adjustment for potential confounding factors, according to a predefined hierarchical model. RESULTS: Of the 775 children studied in 1997, 685 were located in 2004 (loss of 11.6%). In this group, the prevalence of recurrent wheezing at the time of the interview was 27.9%. After adjustment, the risk factors were: current rhinitis (OR=45.7; 95% CI: 24.2 to 86.5), use of wood stove for cooking (OR=2.7; 95% CI: 1.4 to 4.9), child's history of acute respiratory infection (OR=2.1; 95% CI: 1.3 to 3.5), bottle feeding (OR=2.1; 95% CI: 1.1 to 3.8), history of asthma in siblings (OR=1.9; 95% CI: 1.2 to 3.2), maternal history of asthma (OR=1.8; 95% CI: 1.1 to 2.9), and fewer than six prenatal medical consultations (OR=1.6; 95% CI: 1.1 to 2.4). Paternal schooling<9 years was a protective factor against recurrent wheezing (OR=0.6; 95% CI: 0.4 to 0.9). CONCLUSIONS: These results suggest that the management of recurrent wheezing and asthma must consider checking for and simultaneously treating rhinitis. The measures to minimize the effects of recurrent wheezing should include educational and treatment programs focusing on asthma.     

NO2, as a marker of air pollution, and recurrent wheezing in children: a nested case-control study within the BAMSE birth cohort

Aims: To investigate the association between air pollution, including with NO₂, and recurrent wheezing during the first two years of life.

Methods: A birth cohort (BAMSE) comprised 4089 children, for whom information on exposures, symptoms, and diseases was available from parental questionnaires at ages 2 months, and 1 and 2 years. NO₂ was measured during four weeks in and outside the dwellings of children with recurrent wheezing and two age matched controls, in a nested case-control study (540 children).

Results: Conditional logistic regression showed an OR of 1.60 (95% CI 0.78 to 3.26) among children in the highest quartile of outdoor NO₂ exposure in relation to those in the lowest quartile, adjusted for potential confounders. The corresponding OR for indoor NO₂ was 1.51 (95% CI 0.81 to 2.82). An interaction with environmental tobacco smoke (ETS) was indicated with an OR of 3.10 (95% CI 1.32 to 7.30) among children exposed to the highest quartile of indoor NO₂ and ETS. The association between NO₂ and recurrent wheezing appeared stronger in children who did not fulfil the criteria for recurrent wheezing until their second year.

Conclusions: Although the odds of increased recurrent wheezing are not statistically significantly different from one, results suggest that exposure to air pollution including NO₂, particularly in combination with exposure to ETS, increases the risk of recurrent wheezing in children.

     

Occupational and Environmental Risk Factors for Asthma in Rural Communities in China

Abstract

Respiratory allergens such as dust, gases/fumes, and hay smoke, which are frequently present in agricultural settings, can cause or aggravate asthma. The purpose of this study was to examine the relationships between occupational and environmental exposures and asthma in Chinese rural communities. The study population consisted of 28,946 people 15 years old or older, living in rural areas of Anhui province, China. A modified Mandarin translation of the ATS-DLD questionnaire was administered by trained interviewers to request information about exposures to specific occupational/environmental agents and respiratory disorders. In Huaining, the prevalence of wheezing was 3.8% for men; 2.1% for women; the prevalence of asthma was 1.6% for men; 1.8% for women. In Zongyang, the prevalence of wheezing was 2.7% for men; 1.9% for women; the prevalence of asthma was 1.7% for men; 1.2% for women. With control for potential confounders such as gender, age, residential area, education level, and smoking status, the pooled adjusted odds ratios (ORs) of wheezing and asthma for the group exposed to wood/hay smoke were 1.36 (95% CI: 1.14–1.61) and 1.27 (95% CI: 1.021.58), respectively. For coal-stove users, the pooled adjusted ORs were 1.47 (95% CI: 1.091.98) for wheezing and 1.51 (95% CI: 1.05–2.17) for asthma. After stratification of the subjects by dust type, the estimated ORs for wheezing were 1.58 (95% CI: 1.02–2.44) among the group exposed to inorganic dust and 3.03 (95% CI: 1.25–7.33) among the group exposed to metal dust. Asthma was not shown to be significantly associated with any specific dust type. Findings of the present study are consistent with previously reported adverse respiratory health effects related to occupational/environmental exposures to wood/hay smoke and dust, and indicate the need for further occupational disease surveillance in rural communities.     

Self reported respiratory symptoms and diseases among hairdressers.

OBJECTIVES: Hairdressers are exposed to many irritative and allergenic substances capable of causing occupational respiratory symptoms and diseases. The self reported prevalence of respiratory symptoms and diseases was studied, and the risks among hairdressers compared with saleswomen was estimated. METHODS: A cross sectional prevalence study of respiratory symptoms and diseases was carried out among hairdressers and supermarket saleswomen, with a computer assisted telephone interview method (CATI). The study population comprised all the female hairdressers and supermarket saleswomen aged 15-54 years in the Helsinki metropolitan area, Finland. Disproportionate random samples of female hairdressers and sales-women were drawn from the trade union membership registers. The interviews were carried out between February and April 1994. A response rate of 80.5% (355/440) was obtained for hairdressers and 82.2% (583/709) for saleswomen. Atopy, smoking, chronic illnesses, type of work, working hours, working conditions, personal and professional use of hair products, and the use of personal protective devices were assessed. The outcome variables were self reported symptoms of the upper and lower respiratory tract. These were used to define chronic bronchitis, and asthma, laryngitis, and allergic rhinitis diagnosed by a physician. RESULTS: There was a considerable difference in the prevalence of chronic bronchitis; 6.8% in hairdressers versus 1.9% in saleswomen. The odds ratio (OR) adjusted for age, smoking, and atopy for chronic bronchitis indicated an increased risk of chronic bronchitis (OR 4.8, 95% confidence interval (95% CI) 2.2 to 10.1). No association was found between work as a hairdresser and asthma, laryngitis, and allergic rhinitis. Also the prevalence of rhinitis, rhinitis with eye symptoms, cough with phlegm, dyspnoea, and dyspnoea accompanied by cough was increased among hairdressers. The corresponding adjusted risk ORs were 1.7 (95% CI 1.3 to 2.3) for rhinitis, 1.9 (95% CI 1.4 to 2.6) for rhinitis with eye symptoms, 1.4 (CI 1.1 to 1.9) for cough with phlegm, 1.5 (95% CI 1.0 to 2.2) for dyspnoea, and 1.6 (95% CI 1.0 to 2.7) for dyspnoea with cough. CONCLUSIONS: Our results indicate an increased prevalence of upper and lower respiratory symptoms among hairdressers. Allergenic and irritative chemicals in hairdressing are likely candidates explaining the difference found between the hairdressers and controls. Work related reasons should be considered when a hairdresser presents with airway symptoms. Preventive actions are needed to improve the working conditions and personal protection.     

Factores asociados al asma en los niños y adolescentes de la zona rural de Navarra (España)

Objectives

To determine the factors associated with asthma and asthma-related symptoms in children and adolescents in rural areas of Navarre (Spain).

Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study.

BACKGROUND: Remarkable overlap exists in symptoms between asthma and chronic obstructive pulmonary disease (COPD), and the symptoms of the patients with mild asthma are often falsely thought to be caused by smoking. The objective of the study was to determine the prevalence of doctor-diagnosed asthma, asthmatic symptoms and doctor-diagnosed COPD in an adult population. The prevalence and relation to asthma of aspirin intolerance, nasal polyposis, allergic rhinitis and smoking habits were also examined. METHODS: Postal questionnaire survey of a population-based random sample (4300) of adult women and men aged 18-65 years served by the P?ij?t-H?me Central Hospital in southern Finland (a region with 208 000 inhabitants) was performed. RESULTS: The non-response-adjusted prevalence (Drane's linear method) of doctor-diagnosed asthma was 4.4% (95% CI: 3.3-5.5%) and of COPD 3.7% (95% CI: 2.7-4.8%). The prevalence of allergic rhinitis was 37.3% (95% CI: 33.3-41.2%), and of overall aspirin intolerance 5.7% (95% CI: 4.4-7.1%). The observed prevalence of aspirin intolerance causing shortness of breath or attacks of asthma was 1.2% and it was higher in patients with doctor-diagnosed asthma than without (8.8% versus 0.8%, relative risk [RR] = 11.4, P < 0.0001), and higher in those with allergic-like rhinitis than without (2.6% versus 0.3%, RR = 7.7, P < 0.0001). The prevalence of nasal polyposis was 4.3% (95% CI : 2.8-5.8%). CONCLUSIONS: The current prevalence of doctor-diagnosed asthma among adults is 4.4%, and allergic rhinitis, nasal polyposis and aspirin intolerance are associated with an increased risk of asthma. There is also association between aspirin-induced asthma and allergic-like rhinitis.     

Evidence based guidelines for the prevention, identification, and management of occupational asthma

Background: Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010.

Aim: The guidelines aim to improve the prevention, identification, and management of occupational asthma by providing evidence based recommendations on which future practice can be based.

Methods: The literature was searched systematically using Medline and Embase for articles published in all languages up to the end of June 2004. Evidence based statements and recommendations were graded according to the Royal College of General Practitioner's star system and the revised Scottish Intercollegiate Guidelines Network grading system.

Results: A total of 474 original studies were selected for appraisal from over 2500 abstracts. The systematic review produced 52 graded evidence statements and 22 recommendations based on 223 studies.

Discussion: Evidence based guidelines have become benchmarks for practice in healthcare and the process used to prepare them is well established. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification, and management of occupational asthma, based on and using the best available medical evidence. The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed for the early identification of symptoms, including occupational rhinitis, with additional functional and immunological tests where appropriate. Effective management of workers suspected to have occupational asthma involves the identification and investigation of symptoms suggestive of asthma immediately they occur. Those workers who are confirmed to have occupational asthma should be advised to avoid further exposure completely and early in the course of their disease to offer the best chance of recovery.

     

Characteristics of work related asthma: results from a population based survey

Objectives

Many risk factors for asthma have been investigated, one of which is the workplace. Work related asthma is a frequently reported occupational respiratory disease yet the characteristics which distinguish it from non‐work related asthma are not well understood. The purpose of this study was to examine differences between work related and non‐work related asthma with respect to healthcare use and asthma control characteristics.

Methods

Data from the Massachusetts Behavioral Risk Factor Surveillance System for 2001 and 2002 were used for this analysis. Work related status of asthma was determined by self‐report of ever having been told by a physician that asthma was work related. Healthcare measures evaluated were emergency room visits and physician visits for worsening asthma and for routine care. Characteristics of asthma control evaluated were frequency of asthma symptoms, asthma attacks, difficulty sleeping, and asthma medication usage in the last 30 days and limited activity in the past 12 months.

Results

The prevalence of lifetime and current asthma in Massachusetts were 13.0% and 9.2%, respectively. Approximately 6.0% (95% CI 4.8 to 7.3) of lifetime and 6.2% (95% CI 4.7 to 7.8) of current asthma cases were work related. In the past 12 months, individuals with work related current asthma were 4.8 times (95% CI 2.0 to 11.6) as likely to report having an asthma attack, 4.8 times (95% CI 1.8 to 13.1) as likely to visit the emergency room at least once, and 2.5 times (95% CI 1.1 to 6.0) as likely to visit the doctor at least once for worsening asthma compared to individuals with non‐work related asthma.

Conclusions

Work related asthma is associated with increased frequency of asthma attacks and use of healthcare services. A better understanding of factors that contribute to differences in healthcare use and asthma control is needed to improve prevention and control strategies for individuals suffering from the disease.     

Occupational mortality in British commercial fishing, 1976-95

Aims: To establish the causes and circumstances of all deaths occurring at work or related to work among fishermen in British commercial fishing between 1976 and 1995.

Methods: A retrospective study, based on official mortality files, with a population of 440 355 fishermen-years at risk.

Results: Of 616 deaths in British fishing, 454 (74%) were due to accidents at work, and 394 (87%) of these fishermen drowned. A total of 270 accidents were caused by casualties to vessels and 184 by personal accidents. There was no significant decline in the fatal accident rate, 103.1 per 100 000 fishermen-years, between 1976 and 1995. The fatal accident rate was 52.4 times higher (95% CI 42.9 to 63.8) than for all workers in Great Britain during the same period, and this relative risk increased through the 1980s up to 76.6 during 1991–95. Relative risks with the construction (12.3) and manufacturing (46.0) industries were higher than 5 and 20 respectively, during 1959–68. Trawlers foundering in adverse weather was the most frequent cause of mortality from casualties to vessels (115 deaths), and 82 of 145 personal accidents at sea arose during operations involving trawling nets.

Conclusions: When compared with shore based industries, fishing remains at least as hazardous as before. Prevention should be aimed, most importantly, at the unnecessary operation of small vessels and trawling net manoeuvres in hazardous weather and sea conditions. Other measures should focus on preventing falls overboard, reducing fatigue, a more widespread use of personal flotation devices, and improvements in weather forecast evaluation.