Within- and between-person variability of exhaled breath condensate pH and NH4+ in never and current smokers

SummaryRecent studies have suggested that the collection of exhaled breath condensate (EBC) may be a viable method in occupational field studies to sample secretions of the lower airway because it is simple to perform and non-invasive. However, there are unresolved questions about whether certain laboratory conditions may influence the analysis of EBC biomarker measurements. A total of 12 subjects performed 116 EBC tests. The effect of short and long-term sample storage and sample volume on two biomarkers of acid stress, pH and NH4+, in EBC were investigated and did not significantly influence either marker measurement after argon deaeration. We also investigated the variability and the effect of smoking on the biomarkers by collecting six samples each from five adult never smokers and five adult current smokers over a period of 1 month (n=60 total). For pH, the within-person and between-person variability was larger in current smokers compared to never smokers. Similar results were found for NH4+. Cigarette packs smoked per day now was also associated with both pH (p=0.01) and NH4+ (p=0.04) using mixed effects regression analysis. The variability and smoking results suggest that repeated measurements of EBC pH and NH4+ from the same individual may accurately predict the biological state of the airways of current smokers when compared to never smokers

A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

<p>Abstract</p> <p>Background</p> <p>The term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes.</p> <p>Methods</p> <p>A review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).</p> <p>Results</p> <p>Of the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.</p> <p>Conclusions</p> <p>Without more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.</p

Impact of the Spanish Smoking Law on Exposure to Second-Hand Smoke and Respiratory Health in Hospitality Workers: A Cohort Study

A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban

Quantification of ETS exposure in hospitality workers who have never smoked

<p>Abstract</p> <p>Background</p> <p>Environmental Tobacco Smoke (ETS) was classified as human carcinogen (K1) by the German Research Council in 1998. According to epidemiological studies, the relative risk especially for lung cancer might be twice as high in persons who have never smoked but who are in the highest exposure category, for example hospitality workers. In order to implement these results in the German regulations on occupational illnesses, a valid method is needed to retrospectively assess the cumulative ETS exposure in the hospitality environment.</p> <p>Methods</p> <p>A literature-based review was carried out to locate a method that can be used for the German hospitality sector. Studies assessing ETS exposure using biological markers (for example urinary cotinine, DNA adducts) or questionnaires were excluded. Biological markers are not considered relevant as they assess exposure only over the last hours, weeks or months. Self-reported exposure based on questionnaires also does not seem adequate for medico-legal purposes. Therefore, retrospective exposure assessment should be based on mathematical models to approximate past exposure.</p> <p>Results</p> <p>For this purpose a validated model developed by Repace and Lowrey was considered appropriate. It offers the possibility of retrospectively assessing exposure with existing parameters (such as environmental dimensions, average number of smokers, ventilation characteristics and duration of exposure). The relative risk of lung cancer can then be estimated based on the individual cumulative exposure of the worker.</p> <p>Conclusion</p> <p>In conclusion, having adapted it to the German hospitality sector, an existing mathematical model appears to be capable of approximating the cumulative exposure. However, the level of uncertainty of these approximations has to be taken into account, especially for diseases with a long latency period such as lung cancer.</p

Pretjerana bronhalna reaktivnost u kuharica i čistača

The aim of this cross-sectional study was to assess the prevalence and characteristics of bronchial hyperresponsiveness (BHR) in 43 women cleaners (aged 26 to 57) and 37 women cooks (aged 29 to 55) and compare them with 45 controls (women office workers aged 27 to 58). The evaluation of all subjects included a questionnaire, skin prick tests to common aeroallergens, spirometry, and histamine challenge (PC20≤8 mg mL-1). We found higher BHR prevalence in cleaners and cooks than in office workers (30.2 % and 29.7 %, vs. 17.7 %, respectively), but statistical significance was not reached. The prevalence of mild and moderate to severe BHR was similar in all groups. Borderline BHR prevalence was significantly higher in cleaners than in controls (16.2 % vs. 6.6 %, P=0.032) whereas the difference was on the verge of significance in cooks (13.5 % vs. 6.6 %, P=0.081). Moderate to severe BHR was strongly associated with positive family history of asthma and atopy in all groups. Mild BHR was significantly associated with daily smoking in cleaners (P=0.031) and cooks (P=0.021), as well as with the duration of exposure in cleaners (P=0.038). Borderline BHR was closely related to daily smoking and duration of exposure in both cleaners and cooks. Our findings indicate an important role of workplace exposure in borderline BHR development, as well as the significant effect of smoking on mild BHR development in women cleaners and cooks.Svrha je ovoga presječnog ispitivanja bila utvrditi prevalenciju i značajke pretjerane bronhalne reaktivnosti (engl. bronchial hyperresponsiveness, krat. BHR) u profesionalnih čistačica (43 ispitanice u dobi od 26 do 57 godina) i kuharica (37 ispitanica u dobi od 29 do 55 godina). Kontrolna skupina obuhvatila je 45 uredskih radnica u dobi od 27 do 58 godina. Ocjena izloženih i kontrolnih ispitanica obuhvatila je upitnik, skin prick testove na uobičajene inhalacijske alergene, spirometriju te histaminski test (PC20 ≤8 mg mL-1). ^istačice odnosno kuharice iskazale su veću prevalenciju BHR-a od kontrolnih uredskih radnica (30,2 % odnosno 29,7 % prema 17,7 %), ali ona nije bila statistički značajna. Sve su skupine iskazale podjednaku prevalenciju umjerenog i snažnog BHR-a. Prevalencija graničnoga BHR-a bila je značajno viša u čistačica negoli u kontrole (16,2 % naprema 6,6 %, P=0,032), a na rubu statističke značajnosti bila je i razlika između kuharica i kontrole (13,5 % prema 6,6 %, P=0,081). Umjeren odnosno snažan BHR u svih je skupina bio značajno povezan s obiteljskom povijesti astme i atopija. Blagi BHR značajno je povezan sa svakodnevnim pušenjem u čistačica (P=0,031) i kuharica (P=0,021), a u čistačica i s trajanjem izloženosti (P=0,038). Granični BHR je i u čistačica i u kuharica povezan sa svakodnevnim pušenjem i trajanjem profesionalne izloženosti. Naši podaci upućuju na važnu ulogu profesionalne izloženosti u nastanku graničnoga BHR-a te na značajan utjecaj pušenja na nastanak blagoga BHR-a u profesionalnih čistačica i kuharica

Exposure in grain elevators: are we measuring the relevant agent? (presentation)

The objectives of this study were to: measure dust, endotoxin and glucan levels; record readily available "determinants of exposure" data; compare exposure levels, determinants of exposure; and evaluate significance of results for future studies and for prevention.Environmental Health (SOEH), School ofOccupational and Environmental Hygiene, School ofMedicine, Faculty ofPopulation and Public Health (SPPH), School ofUnreviewedFacultyOthe

Combined exposure to dog and indoor pollution: incident asthma in a high-risk birth cohort

The impact of single exposures on asthma development is better understood than the effect of multiple exposures. The objective of the present study was to evaluate the effect of combined early exposure to dog allergen (Can-f1) plus indoor nitrogen dioxide (NO₂) or environmental tobacco smoke (ETS) on asthma and bronchial hyperreactivity (BHR) in a high-risk birth cohort. We also aimed to assess atopy's impact on the effects of these exposures. Peri-birth ETS exposure was measured using cord blood cotinine (CCot). During year 1, atopy, NO₂, Can-f1, and urinary cotinine (UCot) were measured. At 7 yrs of age, 380 children were assessed for asthma and BHR. Exposure effects were determined using stepwise multiple linear regression. Co-exposure to elevated Can-f1 and NO₂, or Can-f1 and ETS (CCot), increased risk for asthma, relative to having neither such exposure (OR 4.8 (95% CI 1.1-21.5) and 2.7 (1.1-7.1), respectively); similar risks resulted when substituting dog ownership for allergen. Atopy increased asthma and BHR risk associated with several exposures; notably, atopy with elevated UCot, relative to atopy without such exposure, increased risk of BHR (OR 3.1 (95% CI 1.1-8.6)). In a high-risk birth cohort, early co-exposure to Can-f1 and NO₂ or ETS increased the risk of incident asthma. Atopy increased the risk of asthma and BHR associated with ETS.link_to_OA_fulltex