Respiratory and Nasal Symptoms, Immunological Changes, and Lung Function in Industrial Bakers
Background: Several studies reported that occupational exposure in bakery may cause respiratory impairment in exposed workers.
Aim: To assess the respiratory effects and immunological changes of occupational exposure in industrial bakers.
Material and Methods: We performed a cross-sectional study including 43 industrial bakers (20 males and 23 females, aged 34-55 years) and an equal number of office workers, matched by sex, age and smoking status. Evaluation of examined subjects included completion of questionnaire, skin prick tests to common and work-related inhalant allergens, spirometry, and histamine challenge.
Results: We found higher prevalence of nasal symptoms in the last 12 months in bakers with significant difference for runny nose (P = 0.033). Prevalence of respiratory symptoms in the last 12 months was also higher in bakers and statistical significance was obtained for cough (P = 0.041) and phlegm (P = 0.023). We found similar prevalence of allergic sensitization to common inhalant allergens in both examined groups, while sensitization to wheat flour and meal flour was registered only among bakers. Measured spirometric parameters were lower in bakers with significant difference for MEF50 and MEF75 (P = 0.004, and P = 0.000, respectively). Prevalence of bronchial hyperresponsiveness (BHR) was non-significantly higher in bakers with significantly higher severity (P = 0.029).
Conclusion: Our findings confirm that occupational exposure in industrial bakers may lead to adverse respiratory effects and immunological changes in exposed workers.
OBJECTIVE: To evaluate the prevalence of respiratory symptoms, lung function and bronchial hyperresponsiveness in farmers, with emphasize to their severity and work-relatedness due occupational risk factors and farming characteristics. METHODS: A cross-sectional survey was performed including 60 cow breeders aged 21 to 65 years, compared to an equal number of agricultural farmers matched by age, job exposure duration, and smoking status. We have used a questionnaire to record the chronic respiratory symptoms, detailed work history, specific farming activities and tasks performed, and smoking history. Evaluation of examined subjects also included lung function spirometry tests, and bronchial hyperresponsiveness testing.
RESULTS: We found higher prevalence of work related respiratory symptoms in the last 12 months in cow breeders with significant difference for phlegm (P = 0.039), and wheezing (P = 0.026). Mean values of all spirometric parameters were lower in cow breeders, reaching significance for MEF50 (P = 0.001) and MEF75 (P = 0.000). Significant difference was found for mild bronchial hyperresponsiveness among cow breeders with job exposure of more than 15 years. The risk of developing work-related respiratory symptoms increased significantly with full-time farming, exposure to gases and vapors, and keeping more than 10 cows.
CONCLUSION: Our data suggest that workplace exposure in farmers may cause respiratory impairment which is closely related to its duration, characteristics, and intensity. The results suggest that cow breeders in general have higher rates of work-related respiratory symptoms and bronchial hyperresponsiveness than agricultural farmers, whereas their severity increases with an increase in frequency and duration of animal contact
Jordan Minov, Jovanka Karadzinska-Bislimovska, Tatjana Petrova, Kristin Vasilevska, Snezana Risteska-Kuc, Saso Stoleski and Dragan Mijakoski
Efficacy and Tolerability of Various Antimicrobial Regimens in the Treatment of Exacerbations of Chronic Bronchitis and Chronic Obstructive Pulmonary Disease in Outpatients
Objective. To compare the efficacy and tolerability of different antibiotics empirically administered for exacerbations of chronic bronchitis and chronic obstructive pulmonary disease (COPD).
Methods. We performed an observational, non-randomized, open-label study including 226 outpatients with exacerbations of chronic bronchitis and mild or moderate COPD, 123 males and 103 females, aged 24 to 81. All patients were followed up for 30 days, with an intermediate visits at 5 and 10 days at which they were asked about the duration of symptoms (increased expectoration, increased dyspnea and/or presence of purulent sputum) and the side-effects of the drug. Five antibiotic regimens were evaluated: amoxicillin/clavulanic acid 875 mg/125 mg twice daily for 10 days, cefuroxime 250 mg twice daily for 10 days, cefixime 400 mg once daily for 10 days, clarithromycin 500 mg twice daily for 10 days, and ciprofloxacin 500 mg twice daily for 10 days.
Results. The clinical success rate, defined as a complete resolution or a return of the symptoms to the baseline severity, in the groups receiving amoxicillin/clavulanic acid, cefuroxime, cefixime, clarithromycin, and ciprofloxacin was 68.9%, 75.0%, 73.5%, 72.7%, and 77.1%, respectively. The mean time to relief of symptoms varied from 6.8 days with amoxicillin/clavulanic acid to 6.1 days with cefuroxime. Relapse within the first month was registered in the group receiving clarithromycin and ciprofloxacin (3.1% and 2.6%, respectively). The prevalence of the adverse events varied from 10.4% with ciprofloxacin, following by 8.9% for amoxicillin/clavulanic acid, 7.5% for cefixime, 6.8% with clarithromycin to 6.1% with cefuroxime.
Conclusion. Our findings suggest high efficacy and safety of all studied regimens in the treatment of exacerbations of chronic bronchitis and COPD.
Jovanka Karadzinska-Bislimovska, Jordan Minov, Dragan Mijakoski, Sasho Stoleski and Sasho Todorov
Brucellosis as an Occupational Disease in the Republic of Macedonia
Brucellosis, a bacterial disease caused by species of the genus Brucella, is an important zoonosis and recognized as an occupational disease. A high risk of infection with Brucella is associated with certain workplaces related to direct contact with infected animals or their products. Infection may occur by inhalation of infectious aerosols, conjunctival contamination, skin contamination, contact with laboratory cultures and tissue samples, and accidental injection of live vaccines.
Brucellosis is included as an occupational disease in the Macedonian List of Occupational Diseases, and diagnosis and verification of the occupational diseases, according to the national medical criteria, are realized at the Occupational Health Institute of R. Macedonia. According to the official health statistics, in the last two decades in Macedonia as an endemic region, a high incidence of human brucellosis has been registered, with more than 300 reported cases per year. In spite of a possible high occupational risk of infection with Brucella sp in the confirmed cases of disease, during 2008-09 just 12 cases of brucellosis (6 stockmen, 5 veterinarians and an agronomist) were confirmed as an occupational disease. These data suggest that human brucellosis is underdiagnosed and underreported as an occupational disease at national level.
An adequate management of brucellosis with a multidisciplinary approach should provide more accurate reported data in occupational epidemiology in the country.
There is a need to strengthen joint actions within the health care system, to promote an intersectoral collaboration and to support the successful realization of national control programme at the community level.
Jordan Minov, Jovanka Karadžinska-Bislimovska, Kristin Vasilevska, Snežana Risteska-Kuc and Sašo Stoleski
Effects of Passive Smoking at Work on Respiratory Symptoms, Lung Function, and Bronchial Responsiveness in Never-Smoking Office Cleaning Women
This cross-sectional study compares respiratory symptoms, lung function, and bronchial responsiveness between 27 office cleaning women exposed to environmental tobacco smoke at work and 57 unexposed controls. The age range of both groups was 24 to 56 years, and none of the women had ever smoked. Information on respiratory symptoms, cleaning work history, and passive smoking in the workplace were obtained with a questionnaire. The subjects also took a skin prick test to common inhalant allergens, a lung function test, and a histamine challenge. Despite smoking restriction in indoor environments, we found a high prevalence of passive smokers in the workplace (32.1 %). In these subjects we found a significantly higher prevalence of wheezing with breathlessness (25.9 % vs. 8.8 %; P=0.036), wheezing without cold (25.9 % vs. 7.0 %; P=0.016), and breathlessness after effort (29.6 % vs. 8.8 %; P=0.014) than in control subjects. Objective measurements showed a significantly lower MEF25 (53.6 % vs. 63.7 %; P=0.001) and a significantly higher prevalence of borderline bronchial hyperresponsiveness (22.2 % vs. 7.0 %; P=0.044) in the passive smokers in the workplace. This study provides evidence of adverse respiratory effects in office cleaning women associated with passive smoking in the workplace. Our findings support a stricter implementation of the current national law to protect respiratory health of all workers.
Jordan Minov, Jovanka Karadžinska-Bislimovska, Kristin Vasilevska, Snežana Risteska-Kuc and Sašo Stoleski
Work-Related Asthma in Automobile Spray Painters: Two Case Reports
This report describes two patients who had developed asthma after working as automobile painters with isocyanate-based aerosol paint for two years or over. In both patients asthma was confirmed using the standard diagnostic procedure. One of the subjects was atopic. One was ex-smoker and the other had never smoked. Neither had a family history of asthma. The symptoms occurred after workplace exposure lasting two years in one patient and three in the other. As both reported work-relatedness of the symptoms, they underwent serial peak expiratory flow rate (PEFR) measurement and bronchoprovocation testing. Significant work-related changes in PEFR diurnal variations and in non-specific bronchial hyperresponsiveness (NSBH) were observed in one patient, suggesting allergic occupational asthma (OA), while the other patient was diagnosed work-exacerbated asthma (WEA). Our data confirm that spray painting is an occupation with increased risk of respiratory impairment and asthma.
Jordan Minov, Jovanka Bislimovska-Karadzhinska, Tatjana Petrova, Kristin Vasilevska, Snezana Risteska-Kuc, Saso Stoleski and Dragan Mijakoski
Asthma Control Test™ in Assessment of Clinical Asthma Control
Background. The goal of asthma treatment is to achieve and maintain control of the disease.
Objective. To assess validity and reliability of Asthma Control Test™ (ACT) as a patient-based tool for quantifying the control of the disease in the subjects with persistent asthma.
Methods. A cross-sectional study including 396 subjects with persistent asthma drown from a population of treated patients was performed. Evaluation of the examined subjects included completion of the ACT, spirometry, and asthma specialist rating of control.
Results. The mean derived ACT score in all study subjects was 19.2±3.3. Prevalence of the study subjects with totally controlled (TC), well-controlled (WC) and not well-controlled (NWC) asthma by derived ACT score was 9.1%, 43.2% and 47.7%, respectively. Results from the spirometry showed that in 45% of the study subjects FEV1 value was less than 80%. Prevalence of the study subjects with TC, WC and NWC asthma by asthma specialist rating was 8.1%, 41.1% and 50.7%, respectively. A strong correlation between the derived ACT scores and asthma specialist rating of control was observed (r = 0.51, P = 0.000).
Conclusion. Our data confirm the usefulness of the ACT as a valid and reliable screening tool for asthma control.
Jovanka Karadžinska-Bislimovska, Jordan Minov, Sašo Stoleski, Dragan Mijakoski, Snežana Risteska-Kuc and Snežana Milkovska
Environmental and Occupational Health Risks Among Agricultural Workers Living in a Rural Community Near Petroleum Refinery and Motorway in Skopje Region
To assess health risks in agricultural workers associated with environmental exposure to pollutants released from a petroleum refinery and from traffic, we performed a cross-sectional study that included 119 randomly selected subjects divided in two groups. Group 1 included 60 agricultural workers living in a rural community near the petroleum refinery and a motorway overpass, whereas Group 2 consisted of 59 agricultural workers performing similar activities and living in a rural community with no exposure to industrial and traffic pollutants. Risk assessment included a questionnaire, blood pressure measurement, spirometry, laboratory tests, and toxicological analysis. The groups showed a similar prevalence of health problems, with exception of muscle pain in the extremities, headache, and fatigue, which were significantly more common in Group 1. Diastolic blood pressure was higher in Group 1, but not significantly (p=0.057). The same is true for blood carbon monoxide. Significantly higher in Group 1 were blood haemoglobin (p=0.001) and blood lead (p<0.001). Serum cholinesterase activity was similar in both groups. Our findings indicate the need of regular medical exams, ambient monitoring and environmental impact assessment in agricultural population in order to detect individuals at risk and to institute adequate preventive measures.
Saso Stoleski, Jordan Minov, Jovanka Karadzinska-Bislimovska and Dragan Mijakoski
OBJECTIVE: To assess the effect of job exposure and its duration on chronic respiratory symptoms and ventilatory capacity among agricultural workers.
METHODS: We performed a cross-sectional study including 120 agricultural workers aged 36 to 53 years, compared to an equal number of office workers matched by age, duration of workplace exposure and smoking status. A questionnaire was used to record the chronic respiratory symptoms, detailed job history, specific job activities and tasks performed, and smoking history. Evaluation of examined subjects also included functional lung testing by spirometry.
RESULTS: We found non-significantly higher prevalence of respiratory symptoms in the last 12 months in agricultural workers with significant difference for cough (P = 0.044), and wheezing (P = 0.031). Mean values of all spirometric parameters were lower in agricultural workers, being significantly different for MEF50 (P = 0.001) and MEF75 (P = 0.000). Adverse respiratory effects and lung function deterioration were more expressed in agricultural workers with duration of job exposure more than 20 years than in those exposed less than 20 years.
CONCLUSION: Our data suggest that workplace exposure in agricultural workers may lead to respiratory impairment which is close related to its duration.
Jovanka Karadžinska-Bislimovska, Jordan Minov, Snežana Risteska-Kuc, Sašo Stoleski and Dragan Mijakoski
Bronchial Hyperresponsiveness in Women Cooks and Cleaners
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.