L'asthme chez les personnels hospitaliers et de ménage

Plus de 400 substances ont été identifiées comme pouvant intervenir dans l’asthme professionnel. Parmi les métiers exposés figurent ceux liés au nettoyage, notamment en milieu hospitalier, milieu dans lequel l’exposition professionnelle aux désinfectants ou aux produits de nettoyage est d’autant plus élevée que ces substances permettent de prévenir la survenue d’infections nosocomiales

Utilisation de Codes-Barres pour évaluer les expositions aux produits de nettoyage - COBANET: Utilisation de Codes-Barres pour évaluer les expositions professionnelles ou domestiques aux produits de nettoyage et de désinfection – Étude de faisabilité

National audienceLes produits d’entretien contiennent de nombreuses substances irritantes ou sensibilisantes qui peuvent provoquer de l’asthme selon des mécanismes encore peu connus. Bien que des associations aient été mises en évidence entre l’utilisation régulière de ces produits et l’apparition de l’asthme, les agents chimiques en cause n’ont pas été clairement identifiés. Pour améliorer l’évaluation des expositions en minimisant les effets de biais, la piste proposée dans le projet COBANET serait d’évaluer l’utilisation des produits de nettoyage et de désinfection en France à partir de leurs codes‐barres

EGEA Collection: A Biobank Devoted to Asthma and Asthma-related Phenotypes

The Epidemiological study on the Genetics and Environment of Asthma (EGEA) is a 20-year cohort including cases with asthma (n = 388), their first degree relatives (n = 1244) and population-based controls (n = 415) recruited in the early 90’s from five French cities. Participants were extensively characterized regarding environment and respiratory health, and a specific effort was made to trace and bank biological samples (ISO 9001 certification since 2006). Access to data and samples is opened to researchers wishing to develop new scientific collaborative programs. The survey has already led to more than a hundred papers with almost one third in collaboration with national and international teams.</p

Ability of ecological deprivation indices to measure social inequalities in a French cohort

Background: Despite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort. Methods: We assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS. Results: The analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively). Conclusion: FDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations

Asthma control in severe asthma and occupational exposures to inhalable asthmagens

INTRODUCTION: Work-related asthma accounts for ≥25% of asthma in working-age populations, though the relationship between work exposures and symptoms is frequently missed, leading to poor health and employment outcomes. We hypothesised that inhalable exposures at work are associated with poor asthma control in severe asthma (SA).METHODS: We searched the Birmingham (UK) Regional NHS SA Service clinical database (n=1453 records; 1 March 2004 to 1 March 2021) and undertook a cross-sectional study using baseline data collected at diagnosis. We included all employed patients aged 16-64 with documented current occupation (n=504), and collected socio-demographic, general health and asthma-specific data, including Asthma Control Questionnaire 7 (ACQ7) score. The Occupational Asthma Specific Job-Exposure Matrix (OAsJEM) was employed to determine the likelihood of exposure to respiratory sensitisers, irritants, cleaning agents and detergents; associations between exposures and ACQ7 were investigated using binary and multinomial regression.RESULTS: Frequently reported occupations were care assistants (7%) and nurses (6%); 197/504 (39%) patients were exposed to an asthmagen, including respiratory sensitisers (30%), airway irritants (38%) and cleaning products/disinfectants (29%). ACQ7 score was available for 372/504 (74%) patients, of whom 14% had adequate control (ACQ7=0-1.5). After adjustment for major confounders there were no significant associations between inhaled asthmagens and ACQ7 score (either as binary or multinomial outcomes).CONCLUSION: JEM-determined workplace exposures to inhaled asthmagens are not associated with asthma control in SA; 29-39% of patients may have current exposure to workplace asthmagens. Routine collection of lifetime occupational data including current job role and level of exposure, in the national asthma registry, would give further insights into this relationship.</p

Occup Environ Med

OBJECTIVES: Asthma has significant occupational consequences. The objective of our study was to investigate the links between asthma and the career path, taking into account gender and age at asthma onset. METHODS: Using cross-sectional data collected at inclusion in the French CONSTANCES cohort in 2013-2014, we studied the links between each career path indicator (number of job periods, total duration of employment, numbers of part-time jobs and work interruptions due to unemployment or health issues, employment status at inclusion) on the one hand, and current asthma and asthma symptom score in the last 12 months on the other hand, as reported by the participants. Multivariate analyses were performed separately for men and women using logistic and negative binomial regression models adjusted for age, smoking status, body mass index and educational level. RESULTS: When the asthma symptom score was used, significant associations were observed with all of the career path indicators studied: a high symptom score was associated with a shorter total duration of employment as well as a greater number of job periods, part-time jobs and work interruptions due to unemployment or health issues. These associations were of similar magnitude in men and women. When current asthma was used, the associations were more pronounced in women for some career path indicators. CONCLUSION: The career path of asthmatic adults is more often unfavourable than that of those without asthma. Efforts should be made to support people with asthma in the workplace, in order to maintain employment and facilitate the return to work.La cohorte CONSTANCES - Infrastructure épidémiologique ouverte pour la recherche et la surveillanc

The Role of Socioeconomic Status in the Association of Lung Function and Air PollutionA Pooled Analysis of Three Adult ESCAPE Cohorts

Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO2. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO2 associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function

Associations between Nitric Oxide Synthase Genes and Exhaled NO-Related Phenotypes according to Asthma Status

International audienceBACKGROUND: The nitric oxide (NO) pathway is involved in asthma, and eosinophils participate in the regulation of the NO pool in pulmonary tissues. We investigated associations between single nucleotide polymorphisms (SNPs) of NO synthase genes (NOS) and biological NO-related phenotypes measured in two compartments (exhaled breath condensate and plasma) and blood eosinophil counts. METHODOLOGY: SNPs (N = 121) belonging to NOS1, NOS2 and NOS3 genes were genotyped in 1277 adults from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA). Association analyses were conducted on four quantitative phenotypes: the exhaled fraction of NO (Fe(NO)), plasma and exhaled breath condensate (EBC) nitrite-nitrate levels (NO2-NO3) and blood eosinophils in asthmatics and non-asthmatics separately. Genetic heterogeneity of these phenotypes between asthmatics and non-asthmatics was also investigated. PRINCIPAL FINDINGS: In non-asthmatics, after correction for multiple comparisons, we found significant associations of Fe(NO) levels with three SNPs in NOS3 and NOS2 (P ≤ 0.002), and of EBC NO2-NO3 level with NOS2 (P = 0.002). In asthmatics, a single significant association was detected between Fe(NO) levels and one SNP in NOS3 (P = 0.004). Moreover, there was significant heterogeneity of NOS3 SNP effect on Fe(NO) between asthmatics and non-asthmatics (P = 0.0002 to 0.005). No significant association was found between any SNP and NO2-NO3 plasma levels or blood eosinophil counts. CONCLUSIONS: Variants in NO synthase genes influence Fe(NO) and EBC NO2-NO3 levels in adults. These genetic determinants differ according to asthma status. Significant associations were only detected for exhaled phenotypes, highlighting the critical relevance to have access to specific phenotypes measured in relevant biological fluid

Étude de l’asthme chez les personnels hospitaliers et de ménage: Rôle des expositions professionnelles ou domestiques aux produits de nettoyage et de désinfection dans l’asthme

L’asthme professionnel représente 5 à 10 % des asthmes en France. Il est défini comme « un asthme déclenché ou aggravé par une substance inhalée sur les lieux du travail ». Plus de 400 substances ont été identifiées comme pouvant intervenir dans l’asthme professionnel, parmi lesquelles : l’ammoniac, l’eau de javel, le formaldéhyde, etc. Parmi les métiers exposés figurent ceux liés au nettoyage, notamment en milieu hospitalier, milieu dans lequel l’exposition professionnelle aux désinfectants ou aux produits de nettoyage est d’autant plus élevée que ces substances permettent de prévenir la survenue d’infections nosocomiales. Si les données montrent une augmentation progressive des nouveaux cas d’asthme professionnel, le rôle des produits chimiques dans le déclenchement de l’asthme n’est pas encore très clair. Le projet de recherche « NETA » (2009-2013) traite de l’exposition aux produits de nettoyage et aux désinfectants en milieu hospitalier et de son lien avec l’asthme