Asthma in damp indoor work environments

Indoor dampness and mold are associated with adverse respiratory health effects, of which asthma is the most frequently diagnosed disease. Respiratory and non-specific symptoms related to building dampness are usually transient, but persistent symptoms appear to be common for some persons, even despite building repairs or a change to an alternative work environment. The study assessed methods for diagnosing occupational asthma induced by indoor dampness and mold. A retrospective analysis of a group of patients examined at the Finnish Institute of Occupational Health in 1995-2004 was conducted. All of the examined 2200 workers had respiratory symptoms related to workplace dampness. According to this study, serial PEF monitoring is an applicable method in the clinical evaluation of occupational asthma induced by indoor dampness. An individual exposure assessment can be based on descriptions of the extent and location of the moisture and mold damage in the building structures and on microbial measurements. Specific IgE-mediated sensitization to molds occurs, but in a small proportion of cases only. Mechanisms of dampness-related asthma remain largely unknown. The patients were followed-up with a questionnaire survey 3-12 years after the baseline examinations. The results suggest that, for workers with work-related asthma-like symptoms occurring in relation to indoor dampness and molds at work, continuing to work in such environments creates a risk for developing asthma. Preventive measures to avoid further exposure seem to be relevant in order to prevent the development of asthma. In practice, such measures would involve the remediation of moisture and mold damage or the relocation of workers to a non-moisture damaged environment. Follow-up at occupational health services is recommended for patients with respiratory symptoms related to workplace dampness. In addition, the long-term effects on the quality of life and work ability of these workers were evaluated. Patients diagnosed with occupational asthma had worse outcomes than did patients with non-occupational asthma or only respiratory symptoms without asthma at the baseline. A perceived poor social climate at work and poor experiences with the supervisor s cooperation at an early stage of symptoms were determinants for impaired self-assessed work ability and early withdrawal from work. In addition, multiple, persistent, indoor-air symptoms at the time of the follow-up increased the risk of poor self-assessed work ability. The results are in accordance with the widely recognized fact that the causes of disability are multifactorial and are not associated with medical conditions only. More apt measures, for example, early support and workplace management practices concerning work ability, are required.Työpaikan kosteus- ja homevaurioiden on osoitettu olevan yhteydessä haitallisiin hengitystievaikutuksiin, joista yleisin sairaus on astma. Tavallisesti hengitystie- ja yleisoireet menevät ohi, kun rakennuksen vauriot korjataan. Osalla potilaista oireet pitkittyvät rakennuksen korjaustoimenpiteistä tai työpisteen vaihdosta huolimatta. Väitöskirjan tavoitteena oli arvioida ja kehittää kosteusvaurioympäristöstä aiheutuvan ammattiastman diagnostiikkaa. Tutkimusaineistona oli 2 200 Työterveyslaitoksella ammattitautiepäilyn takia vuosina 1995-2004 tutkittua potilasta, joilla oli ollut työpaikan kosteusvaurioon liittyviä hengitystieoireita. Tutkimuksessa todettiin, että altistumisen arvioinnin perusteena voidaan käyttää tietoja työpaikan kosteus- ja homevaurioiden laajuudesta ja sijainnista sekä mikrobimäärityksiä. PEF-työpaikkaseuranta todettiin käyttökelpoiseksi työkaluksi ammattiastman diagnostiikassa, kun sitä verrattiin spesifisiin hengitysteiden altistuskokeisiin homeuutteilla. IgE-välitteistä homeherkistymistä havaittiin esiintyvän vain osalla ammattiastmapotilaista. Potilaille tehtiin 3-12 vuoden kuluttua Työterveyslaitoksen tutkimusten jälkeen seurantakysely, jossa tutkittiin kosteusvaurioympäristössä ilmenevien astmankaltaisten oireiden merkitystä astman riskitekijänä. Jos nykyisessäkin työpaikassa oli kosteusvaurio, astmariski oli yli nelinkertainen verrattuna niihin vastaajiin, jotka ilmoittivat, ettei työpaikassa ole kosteusvaurioita. Entisissä, korjaamattomissa kosteusvauriotiloissa työskentelyyn liittyi merkittävä astman kehittymisen riski. Tutkimustulokset viittaavat siihen, että kosteusvaurioiden korjaamisella tai oireilevan työntekijän siirtämisellä pois kosteusvaurioituneista tiloista voidaan vaikuttaa astmariskiin. Työterveyshuollon seuranta on tarpeen työntekijöille, joilla on kosteusvaurioympäristöön liittyviä hengitystieoireita. Kyselyllä selvitettiin myös työpaikan kosteusvaurioihin liittyvän astman pitkäaikaisvaikutuksia elämänlaatuun ja työkykyyn. Ammattiastmaa sairastavilla elämänlaatu ja työkyky olivat huonompia kuin muilla tutkituilla. Huonoksi koettu esimiehen toiminta ja huonoksi koettu työilmapiiri aikaisemmassa kosteusvauriotyöpaikassa olivat yhteydessä alentuneisiin työkyvyn indikaattoreihin. Myös mitä enemmän pitkittyneitä sisäilmaoireita seurannassa ilmoitettiin, sitä huonommaksi työkyky koettiin. Tulokset sopivat aikaisempaan tietoon, että työkyvyn alenemisen syyt koostuvat monesta tekijästä eivätkä johdu pelkästään terveydellisistä syistä. Työkyvyn tukemiseksi tarvitaan varhaisia ja aikaisempaa tehokkaampia toimia työpaikalla ja työterveyshuollossa

Ympäristöherkkyyden hoidon ja kuntoutuksen järjestäminen Suomessa

Ympäristöherkkyys voi aiheuttaa merkittävää kärsimystä ja haittaa. Useat suomalaiset ja eurooppalaiset tahot, mukaan lukien Euroopan parlamentti, ovat esittäneet, että ympäristöherkkyyteen tulisi kiinnittää aiempaa enemmän huomiota. Sosiaali- ja terveysministeriön ympäristöherkkyysverkosto on todennut, että ympäristöherkkyyden tunnistusta terveydenhuollossa tulee parantaa ja hoitomalleja kehittää. Sosiaali- ja terveysministeriön toimeksiannosta Työterveyslaitoksella on laadittu ehdotus (2016) ympäristöherkkyyden hoidon ja kuntoutuksen järjestämisestä Suomessa

Asthma diagnosed in late adulthood is linked to work disability and poor employment status

Background: Age at asthma onset is associated with severity and outcomes of the disease. Objective: We studied if age at asthma diagnosis is related to employment and outcomes in working career. Patients and methods: A questionnaire was sent to 2613 adults with asthma in Tampere, Finland, and a follow-up questionnaire was sent after six years. Asthmatics were divided into groups based on their employment status: working full-time or work disability. Logistic regression was used to study the association of age at asthma diagnosis with employment status at baseline and with the risk of exiting full-time work during follow-up period. Results: In cross-sectional analysis, asthma diagnosed in late adulthood (50 + years) was associated with higher OR for having work-disability compared to childhood onset asthma (OR [95% CI] 3.60 [1.43-9.06]). During follow-up, asthma diagnosed in late adulthood was associated with higher OR for exiting full time work compared to childhood-onset asthma (OR 10.87 [3.25-36.40]). Conclusions: Asthma diagnosed in late adulthood is a higher risk for poor employment than asthma diagnosed earlier in life. Adult-onset of asthma is an important factor in view of work ability and early rehabilitation procedures.Peer reviewe

Employment status and changes in working career in relation to asthma : a cross-sectional survey

Background: Asthmatics confront inconveniences in working life that make it more difficult to pursue a sustainable career, such as unemployment and work disability. Ways of dealing with these inconveniences may be career changes. More needs to be known about the backgrounds and consequences of career changes among asthmatics, especially their relation to asthma or a change in asthma symptoms. The aim of this study was to compare earlier career changes of adults with asthma who are working full time to those who have drifted away from active working life because of work disability, unemployment or early retirement. The frequency of having changed tasks, work place or occupation, whether the changes had been driven by asthma and furthermore, whether the changes had affected their asthma symptoms were investigated. Methods: In this population-based survey study, all patients with reimbursement rights for asthma aged 20-65 years in the city of Tampere (total population 190,000), Finland (n = 2613) were recruited. The questionnaire was sent in October 2000 and the response rate was 79%. The questionnaire included questions e.g. on changing tasks, work place and occupation, whether these changes were driven by asthma or associated with change of asthma symptoms. The respondents were divided into four groups: working full-time, work disability, unemployed and retired due to age. We applied ANOVA with Dunnet's post-test (variances were not equal between the groups) for a continued variable age and Chi-squared tests for categorical variables. Logistic regression models were built using unemployed vs. full-time work or work disability vs. full-time work as an outcome variable. A p-value of Results: Adults with asthma working full time had more often made changes in their career, but not as often driven by asthma as those with current work disability. The reason for changing work place compared to full-time workers (24.9%) was more often mainly or partly due to asthma among those with work disability (47.9%, p <0.001) and the unemployed (43.3%, p = 0.006). Of those who made career changes because of asthma, a major proportion (over 67%) reported relief in asthma symptoms. Changing tasks (OR 5.8, 95% CI 1.9-18.0, for unemployment vs. full-time work), work place (OR 2.8, 95% CI 1.1-7.0, for work disability vs. full-time work and OR 2.6, 95% CI 1.3-5.4, for unemployment vs. full-time work) or occupation (OR 2.7, 95% CI 1.2-6.0, for unemployment vs. full-time work) mainly because of asthma was associated with an elevated risk for undesirable employment status even after adjusting for age, gender, smoking and professional status. Conclusions: Career changes that were made mainly because of asthma were associated with undesirable employment status in this study. However, asthma symptoms were relieved after career changes especially among those who reported asthma to be the reason for the change. In addition to proper treatment and counselling of asthma patients towards applicable area of work or study, it may be beneficial to support early career changes in maintaining sustainable working careers among adults with asthma.Peer reviewe

Correlates of employment status in individuals with asthma : a cross-sectional survey

Background: This study aims to elucidate factors that among adults with asthma are associated with working full-time. Methods: This cross-sectional survey of 2613 working-age adults with asthma included questions on asthma history, symptoms and use of asthma medication, socioeconomic factors and health behavior. Full-time workers were compared to groups according to employment status: unemployed, work disability and retired due to age. Results: Adults with asthma working full time were younger and more often nonmanual workers, experienced less asthma symptoms, used less asthma medication and smoked less than subjects with work disability. After adjusting for age, gender, smoking and professional status, having frequent symptoms of asthma during last month was associated with an increase in the risk of unemployment (OR 2.3, 95% CI 1.3-4.2) and with an increase in the risk of work disability (OR 4.4, 95% CI 2.3-8.2). Conclusions: Among adults with asthma, full-time work was associated with younger age, less symptomatic asthma despite of less medication, nonmanual work and less smoking. Having more severe symptoms of asthma was associated with undesirable employment status such as unemployment or work disability. Possibilities to change from manual to nonmanual work may be important in preventing work disability and early exit from work.Peer reviewe

Asthma trigger perceptions are associated with work disability

Objective: To study the association between perceptions of various triggers of asthma and employment status. Methods: A questionnaire was administered to all those adults living in the city of Tampere, Finland, who were entitled to special reimbursement for asthma medication by the Social Insurance Institution (n = 2613). The response rate was 79%. The study population (n = 1657) consisted of individuals who worked full-time (n = 967), were unemployed (n = 197), had all-cause work disability (n = 334), or were retired due to old age (n = 159). Given a list of potential asthma triggers, the respondents were asked how often (never/sometimes/often) the trigger caused or worsened their asthma symptoms during leisure time. Results: After adjusting for background variables (age, sex, smoking, and professional status), frequency of asthma symptoms, and the use of asthma medication during the last year, any individual trigger identified as asthma-relevant was associated with having work disability (vs. working full-time). The highest odds ratio (OR) was found for vehicle exhaust (OR 5.0, CI 2.2-11.4). We found similar but less consistent associations between asthma trigger perceptions and unemployment. No elevated ORs were found regarding asthma trigger perceptions for old-age retirement. Conclusions: Perceptions of asthma triggers are associated with all-cause work disability. Our findings suggest that asthmatics have excess trigger perceptions that are not explained by asthma alone. Asthmatics need to be informed that inaccurate trigger perceptions may develop, and how they are induced, because unnecessary trigger avoidance may interfere with work life.Peer reviewe

PERCEIVED INDOOR AIR QUALITY AND PSYCHOSOCIAL WORK ENVIRONMENT IN OFFICE, SCHOOL AND HEALTH CARE ENVIRONMENTS IN FINLAND

Objectives: The study examined the extent and prevalence of perceived indoor environment-related (IE-related) symptoms environmental complaints and psychosocial work environmental factors in Finnish office, school and health care environments. Material and Methods: The data were collected from non-industrial workplaces (N = 455) in 2011-2012 and 2015-2017 using the Finnish Institute of Occupational Health's Indoor Air Questionnaire (IA Questionnaire). Suspicion of IE-related problems was reported in 59% of workplaces. The data consisted of 28 826 employees' responses. Results: The employees reported symptoms and environmental discomfort in office environments less often than in school or health care environments. The most often reported IE-related complaints were stuffy air (39% of respondents), dry air (34%) and insufficient ventilation (33%). The most often reported symptoms were irritation of the nose (27% of respondents), irritation of the eyes (26%), and hoarse or dry throat (24%). The results showed differences between the perceived IE in office, school and health care environments. Conclusions: Compared to earlier findings, the most often perceived IE-related symptoms and complaints have increased in Finnish health care environments. The office employees' perceptions of psychosocial work environment remained fairly unchanged whereas health care personnel more often assessed their psychosocial environment as positive compared to previous reports. Instead of exact reference values, comparing the results of IA Questionnaires with the distributions and mean values of the results of this study may be more informative for those striving to solve IE-related problems. The presented distribution and mean values of perceived symptoms, environmental complaints and psychosocial work environment might help to relate the results to other workplaces. This, in turn, might increase the understanding that IA Questionnaire results are influenced by many factors. The results presented can be used as new reference material when interpreting the results of IA Questionnaires in office, school and health care environments.Peer reviewe

Toimintakykyä rajoittava sisäilmaoireisto

Työterveyslaitos sai Terveyden ja hyvinvoinnin laitokselta toimeksiannon arvioida sisäilmasta vakavasti sairastuneiden määrää ja miten sisäilmaongelmista kärsivät ihmiset ovat saaneet hoitoa tai sosiaalietuuksia ja miten heidän työkykyään on pyritty edistämään ml. sen, millaisia kuntoutustoimia on tehty tai on suunnitteilla. Tavoitteena oli koota käytettävissä oleva tieto ja kuvata tämänhetkiset käytännöt. Julkisen keskustelun perusteella ei ole selvää, mitä tarkoitetaan, kun puhutaan sisäilmasta vakavasti sairastuneista. Sisäympäristön altisteet ja olosuhteet voivat selittää ohimeneviä oireita, jotka korjaantuvat, kun olosuhteet saatetaan kuntoon. Luvussa 2 kuvattu lyhyesti sisäilmaan liittyvät terveysvaikutukset. On ihmisiä, joilla on rakennusten sisäilmaongelmiin liittyen invalidisoivia, toimintakykyä pitkäaikaisesti rajoittavia oireita. Oireet ilmenevät tietyissä sisäympäristöissä, ja oireet väistyvät, kun henkilö ei oleskele kyseisissä rakennuksissa. Tällaista oirekokonaisuutta ei selitä mikään lääketieteellinen sairaus, kuten astma. Vakavasti toimintakykyä rajoittavassa oireilussa on kyse pitkäaikaisesta oireilu- ja reaktioherkkyydestä rakennuksissa, töissä, kotona tai muualla, joissa ei ole merkittäviä puutteita sisäilman laadussa. Pitkäaikainen oireiluherkkyys ympäristötekijöille on jatkumo lievästä sietokyvyn heikentymisestä invalidisoivaan toimintakykyä heikentävään oireistoon. Tämän vuoksi havainnot ja arviot esiintyvyydestä vaihtelevat sen mukaan, miten oireiluherkkyyttä kysytään. Pitkäaikainen oireiluherkkyys näkyy terveydenhuollossa, esimerkiksi työterveyshuollossa. Se näkyy myös ammattitautitutkimuksiin sisäilmaongelmien (kosteusvauriot) vuoksi lähetetyillä työntekijöillä. Silloin kun oireisto rajoittaa työllistymistä, ilmiö näkyy TE-toimistossa asioinnin yhteydessä, ja kun oireisto aiheuttaa ongelmia asumisessa, haetaan apua sosiaalipalveluista. Kuntoutusta järjestävillä tahoilla, Kelassa ja työeläke- ja tapaturmavakuutusjärjestelmässä, sisäilmaan liittyvä toimintakyvyn heikkeneminen on tunnettu ilmiö. Selvitimme joko kyselyllä tai haastattelemalla, mitä tukitoimia on tehty ja miten vakava oireilu näkyy työterveyshuollossa, TE-toimistoissa, sosiaalitoimessa ja sosiaalivakuutusjärjestelmässä sekä keskisuuren kaupungin henkilöstöhallinnon näkökulmasta (luku 4)

Clinical Characteristics of Irritant-Induced Occupational Asthma

BACKGROUND: Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (HA) is incomplete. OBJECTIVES: To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. METHODS: This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. RESULTS: Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting beta-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. HA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). HA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). CONCLUSIONS: Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.Peer reviewe

Environmental Intolerance, Symptoms and Disability Among Fertile-Aged Women

The purpose was to study the prevalence of environmental intolerance (EI) and its different manifestations, including behavioral changes and disability. Fertile-aged women (n = 680) of the Kuopio Birth Cohort Study were asked about annoyance to 12 environmental factors, symptoms and behavioral changes. We asked how much the intolerance had disrupted their work, household responsibilities or social life. We chose intolerance attributed to chemicals, indoor molds, and electromagnetic fields to represent typical intolerance entities. Of the respondents, 46% reported annoyance to chemicals, molds, or electromagnetic fields. Thirty-three percent reported symptoms relating to at least one of these three EIs, 18% reported symptoms that included central nervous system symptoms, and 15% reported behavioral changes. Indicating disability, 8.4% reported their experience relating to any of the three EIs as at least "somewhat difficult", 2.2% "very difficult" or "extremely difficult", and 0.9% "extremely difficult". Of the latter 2.2%, all attributed their intolerance to indoor molds, and two thirds also to chemicals. As the number of difficulties increased, the number of organ systems, behavioral changes and overlaps of the three EIs also grew. EI is a heterogeneous phenomenon and its prevalence depends on its definition. The manifestations of EI form a continuum, ranging from annoyance to severe disability.Peer reviewe