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Conferencia Dr. Monsó. Congreso SEPAR Sevilla 2006. It is healthy to live and work on a farm?
Citation preview
It is healthy to live and workon a farm?
It is healthy to live and workon a farm?
E MonsóHospital Germans Trias i Pujol,
Badalona, Spain.
E MonsóHospital Germans Trias i Pujol,
Badalona, Spain.
ContentContent
• The hygiene hypothesis.
• Exposures and diseases.
• Farming in Europe.
• Enclosed workplaces:
– Greenhouses.
– Confinement buildings.
• The hygiene hypothesis.
• Exposures and diseases.
• Farming in Europe.
• Enclosed workplaces:
– Greenhouses.
– Confinement buildings.
HealthHealth
Hygiene hypothesis
• Early exposure to farmingenvironments is associated with a low incidence of asthma, due to a predominant Th1 inmunologicresponse.
Hygiene hypothesis
• Early exposure to farmingenvironments is associated with a low incidence of asthma, due to a predominant Th1 inmunologicresponse.
HealthHealth
ErnstErnst. AJRCCM 2000. AJRCCM 2000
HealthHealth
ErnstErnst. AJRCCM 2000. AJRCCM 2000
HealthHealth
ErnstErnst. AJRCCM 2000. AJRCCM 2000
HealthHealth
HealthHealth
IlliIlli. BMJ 2001. BMJ 2001
HealthHealth
IlliIlli. BMJ 2001. BMJ 2001
HealthHealth
IlliIlli. BMJ 2001. BMJ 2001
HealthHealth
DiseaseDiseaseBHR+asthma asthma
• Farmers 2.6(1.3-5.3) 1.7(1.0-3.0)• Agricultural workers 1.8(1.0-3.2) 1.4(1.0-2.0)• Spray painters ..... ....• Cleaners .... ....• Plastics .... ....• Textiles .... ....• ....
KogevinasKogevinas. . LancetLancet 1999;353:1701999;353:170
Work-related diseasesWork-related diseases
• Rinitis.• Asthma.• Organic dust toxic syndrome.• Silo filler’s disease.• Farmer’s lung disease.• Chronic bronchitis.• Lung infection.• COPD.
• Rinitis.• Asthma.• Organic dust toxic syndrome.• Silo filler’s disease.• Farmer’s lung disease.• Chronic bronchitis.• Lung infection.• COPD.
Work exposuresWork exposures
• Toxic gases– Ammonia, CO2, methane, Hydrogen sulfide, NO2, CO.
• Organic dust– Endotoxin, glucan, mycotoxin.
• Biologic agents– Bacteria, fungi, Mites.
• Inorganic dusts.• Chemicals.• Infectious microorganisms.
• Toxic gases– Ammonia, CO2, methane, Hydrogen sulfide, NO2, CO.
• Organic dust– Endotoxin, glucan, mycotoxin.
• Biologic agents– Bacteria, fungi, Mites.
• Inorganic dusts.• Chemicals.• Infectious microorganisms.
Work environmentsWork environments
• Field work.
• Confinement house.
• Silo.
• Greenhouse.
• Field work.
• Confinement house.
• Silo.
• Greenhouse.
Northamerican/European Study onFarmers’ Lung Health - Design
Northamerican/European Study onFarmers’ Lung Health - Design
• Cross-sectional study of the prevalenceof respiratory symptoms in Europeanand Californian farmers.
• Assessment of occupation and region-related risk factors for respiratorysymptoms.
• Cross-sectional study of the prevalenceof respiratory symptoms in Europeanand Californian farmers.
• Assessment of occupation and region-related risk factors for respiratorysymptoms.
Monsó E. Eur Respir J 2003
Work-related diseasesWork-related diseases
• Rinitis.• Asthma.• Organic dust toxic syndrome.• Silo filler’s disease.• Farmer’s lung disease.• Chronic bronchitis.• Lung infection.• COPD.
• Rinitis.• Asthma.• Organic dust toxic syndrome.• Silo filler’s disease.• Farmer’s lung disease.• Chronic bronchitis.• Lung infection.• COPD.
MethodMethod• Target sample: All subjects who
participated in the studies onrespiratory health in farmers performedin Europe and California in the nineties.
• Random selection from census andcontact by mail, phone or home visit.
• Questionnaire on respiratory symptomsand occupation.
• Target sample: All subjects whoparticipated in the studies onrespiratory health in farmers performedin Europe and California in the nineties.
• Random selection from census andcontact by mail, phone or home visit.
• Questionnaire on respiratory symptomsand occupation.
Monsó E. Eur Respir J 2003
StatisticsStatistics• Association between respiratory
symptoms, occupation and regionassessed using logistic regression.
– 1) Occupational model created forevery respiratory symptom with socio-demographic factors and type offarming as independent variables.
–2) Regional model including region in every occupational model as a riskfactor.
• Association between respiratorysymptoms, occupation and regionassessed using logistic regression.
– 1) Occupational model created forevery respiratory symptom with socio-demographic factors and type offarming as independent variables.
–2) Regional model including region in every occupational model as a riskfactor.
Monsó E. Eur Respir J 2003
Respiratory Symptoms
0
5
10
15
20
25
30
Smoking Rhinitis Asthma Chronic bronchitis ODTS
%
CaliforniaEurope* *
** *
* p<.001* p<.001
Results 1aSociodemography and Symptoms
Results 1aSociodemography and Symptoms
California Europe pN 1839 7188 Age, mean (SD) 55 (13) 48 (13) <.001Gender(women), n (%) 181 (10) 1246 (17) <.001Current smoking, n (%) 212 (11) 1602 (22) <.001Former smoking, n (%) 600 (33) 1329 (18) <.001Rhinitis, n (%) 440 (24) 910 (12) <.001Asthma, n (%) 86 (5) 203 (3) <.001Chronic bronchitis, n (%) 80 (4) 770 (11) <.001ODTS, n (%) 50 (3) 877 (12) <.001
California Europe pN 1839 7188 Age, mean (SD) 55 (13) 48 (13) <.001Gender(women), n (%) 181 (10) 1246 (17) <.001Current smoking, n (%) 212 (11) 1602 (22) <.001Former smoking, n (%) 600 (33) 1329 (18) <.001Rhinitis, n (%) 440 (24) 910 (12) <.001Asthma, n (%) 86 (5) 203 (3) <.001Chronic bronchitis, n (%) 80 (4) 770 (11) <.001ODTS, n (%) 50 (3) 877 (12) <.001
Animal exposure
0
10
20
30
40
50
60
Swine Beef/Veal Dairy Poultry Sheep Rabbit
%
CaliforniaEurope
**
** **
** **
* p<.001* p<.001
Results 1bAnimal Exposure
Results 1bAnimal Exposure
California Europe p
Swine, n (%) 40 (2) 2337 (32) <.001Beef/Veal, n (%) 381 (21) 3987 (55) <.001Dairy, n (%) 136 (7) 4037 (56) <.001Poultry, n (%) 89 (5) 692 (10) <.001Sheep, n (%) 105 (6) 522 (7) <.05Rabbit, n (%) 8 (1) 212 (3) <.001One or more, n (%) 584 (32) 6009 (84) <.001
California Europe p
Swine, n (%) 40 (2) 2337 (32) <.001Beef/Veal, n (%) 381 (21) 3987 (55) <.001Dairy, n (%) 136 (7) 4037 (56) <.001Poultry, n (%) 89 (5) 692 (10) <.001Sheep, n (%) 105 (6) 522 (7) <.05Rabbit, n (%) 8 (1) 212 (3) <.001One or more, n (%) 584 (32) 6009 (84) <.001
Crop exposure
0
10
20
30
40
50
60
Grain Vegetables Tomatoes Root crops Oil plants Fruits Nuts Flowers
%
CaliforniaEurope
**
** **
****
**
**
**
* p<.001* p<.001
Results 1cCrop Exposure
Results 1cCrop Exposure
California Europe pGrain, n (%) 180 (10) 3754 (52) <.001Vegetables, n (%) 63 (3) 943 (13) <.001Tomatoes, n (%) 82 (5) 516 (7) <.001Root crops, n (%) 59 (3) 1801 (25) <.001Oil plants, n (%) 47 (3) 1235 (17) <.001Fruits/berries, n (%) 878 (47) 563 (8) <.001Nuts, n (%) 490 (26) 287 (4) <.001Flowers, n (%) 89 (5) 311 (4) <.001
California Europe pGrain, n (%) 180 (10) 3754 (52) <.001Vegetables, n (%) 63 (3) 943 (13) <.001Tomatoes, n (%) 82 (5) 516 (7) <.001Root crops, n (%) 59 (3) 1801 (25) <.001Oil plants, n (%) 47 (3) 1235 (17) <.001Fruits/berries, n (%) 878 (47) 563 (8) <.001Nuts, n (%) 490 (26) 287 (4) <.001Flowers, n (%) 89 (5) 311 (4) <.001
Results 2aRisk factors-Animal farming
Results 2aRisk factors-Animal farming
Adjusted OR (95CI)Rhinitis Asthma
Swine 0.65 (0.56-0.76) ------Beef/Veal 1.13 (0.97-1.31) ------Dairy 0.55 (0.47-0.64) 0.80 (0.62-1.03)Poultry 1.30 (1.06-1.60) 1.90 (1.34-2.68)Sheep ------ ------Rabbit 1.27 (0.88-1.85) ------
Adjusted OR (95CI)Rhinitis Asthma
Swine 0.65 (0.56-0.76) ------Beef/Veal 1.13 (0.97-1.31) ------Dairy 0.55 (0.47-0.64) 0.80 (0.62-1.03)Poultry 1.30 (1.06-1.60) 1.90 (1.34-2.68)Sheep ------ ------Rabbit 1.27 (0.88-1.85) ------
Results 2bRisk factors-Animal farming
Results 2bRisk factors-Animal farming
Adjusted OR (95CI)Chron. bronchitis ODTS
Swine 1.22 (1.03-1.43) ------
Beef/Veal ----- 0.76 (0.64-0.90)
Dairy ----- 1.32 (1.11-1.57)
Poultry ----- 1.25 (0.99-1.59)
Sheep 1.27 (0.98-1.66) 1.31 (1.01-1.69)
Rabbit 1.68 (1.13-2.50) 1.89 (1.30-2.75)
Adjusted OR (95CI)Chron. bronchitis ODTS
Swine 1.22 (1.03-1.43) ------
Beef/Veal ----- 0.76 (0.64-0.90)
Dairy ----- 1.32 (1.11-1.57)
Poultry ----- 1.25 (0.99-1.59)
Sheep 1.27 (0.98-1.66) 1.31 (1.01-1.69)
Rabbit 1.68 (1.13-2.50) 1.89 (1.30-2.75)
Results 2cRisk factors-Crop farming
Results 2cRisk factors-Crop farming
Adjusted OR (95CI)Rhinitis Asthma
Grain 1.13 (1.00-1.29) ------Vegetables 0.77 (0.61-0.97) 0.52 (0.32-0.83)Tomatoes 0.77 (0.57-1.04) ------Root crops ------ 1.28 (0.94-1.75)Oil plants ------ ------Fruits/berries 1.30 (1.10-1.54) ------Nuts 1.23 (1.00-1.51) ------Flowers 1.29 (0.98-1.70) 1.71 (1.06-2.77)
Adjusted OR (95CI)Rhinitis Asthma
Grain 1.13 (1.00-1.29) ------Vegetables 0.77 (0.61-0.97) 0.52 (0.32-0.83)Tomatoes 0.77 (0.57-1.04) ------Root crops ------ 1.28 (0.94-1.75)Oil plants ------ ------Fruits/berries 1.30 (1.10-1.54) ------Nuts 1.23 (1.00-1.51) ------Flowers 1.29 (0.98-1.70) 1.71 (1.061.71 (1.06--2.77)2.77)
Results 2dRisk Factors-Crop Farming
Results 2dRisk Factors-Crop Farming
Adjusted OR (95CI)Chron. bronchitis ODTS
Grain 1.42 (1.21-1.67) 2.15 (1.82-2.53)Vegetables ------ ------Tomatoes ------ ------Root crops ------ 1.51 (1.28-1.77)Oil plants 1.49 (1.22-1.81) 1.66 (1.39-1.98)Fruits/berries 0.90 (0.72-1.12) 0.81 (0.64-1.01)Nuts 0.55 (0.40-0.77) ------Flowers 1.67 (1.22-2.27) 1.75 (1.29-2.38)
Adjusted OR (95CI)Chron. bronchitis ODTS
Grain 1.42 (1.21-1.67) 2.15 (1.82-2.53)Vegetables ------ ------Tomatoes ------ ------Root crops ------ 1.51 (1.28-1.77)Oil plants 1.49 (1.22-1.81) 1.66 (1.39-1.98)Fruits/berries 0.90 (0.72-1.12) 0.81 (0.64-1.01)Nuts 0.55 (0.40-0.77) ------Flowers 1.67 (1.22-2.27) 1.75 (1.29-2.38)
ResultsRisk Factors-Farming
ResultsRisk Factors-Farming
Crops Animals
Grain SwineVegetables Beef/VealTomatoes DairyRoot crops PoultryOil plants SheepFruits/berries RabbitsNutsFlowers
Crops Animals
Grain SwineVegetables Beef/VealTomatoes DairyRoot crops PoultryOil plants SheepFruits/berries RabbitsNutsFlowers
Results 4aEurope-California . Regional risk factors
Results 4aEurope-California . Regional risk factors
Non-smokers Adjusted OR (95CI)Sociodemograph. Occupational mod.
Rhinitis 0.56 (0.47- 0.65) 0.58 (0.47-0.71)Asthma 0.96 (0.68- 1.35) 0.95 (0.67-1.35)Chronic Br. 4.19 (3.08- 5.70) 3.61 (2.64-4.95)ODTS 7.93 (5.76-10.93) 4.14 (2.81-6.09)
Non-smokers Adjusted OR (95CI)Sociodemograph. Occupational mod.
Rhinitis 0.56 (0.47- 0.65) 0.58 (0.47-0.71)Asthma 0.96 (0.68- 1.35) 0.95 (0.67-1.35)Chronic Br. 4.19 (3.08- 5.70) 3.61 (2.64-4.95)ODTS 7.93 (5.76-10.93) 4.14 (2.81-6.09)
Results 4bEurope-California . Regional risk factors
Results 4bEurope-California . Regional risk factors
Smokers Adjusted OR (95CI)Sociodemograph. Occupational m.
Rhinitis 0.70 (0.47- 1.05) 0.68 (0.42-1.12)Asthma 1.92 (0.85- 4.37) 1.41 (0.68-3.27)Chronic Br. 2.82 (1.76- 4.53) 1.73 (1.05-2.86)ODTS 9.88 (4.23-23.10) 3.96 (1.65-9.51)
Smokers Adjusted OR (95CI)Sociodemograph. Occupational m.
Rhinitis 0.70 (0.47- 1.05) 0.68 (0.42-1.12)Asthma 1.92 (0.85- 4.37) 1.41 (0.68-3.27)Chronic Br. 2.82 (1.76- 4.53) 1.73 (1.05-2.86)ODTS 9.88 (4.23-23.10) 3.96 (1.65-9.51)
Results 5a - EuropeChronic bronchitis and indoor work
Results 5a - EuropeChronic bronchitis and indoor work
Chronic bronchitisODTS Adjusted OR (95CI)
yes noNon-smokers 28% 7% 5.17 (4.21- 6.34)Smokers 40% 11% 4.28 (3.01- 6.10)
Chronic bronchitisODTS Adjusted OR (95CI)
yes noNon-smokers 28% 7% 5.17 (4.21- 6.34)Smokers 40% 11% 4.28 (3.01- 6.10)
Results 5b - EuropeChronic bronchitis and indoor work
Results 5b - EuropeChronic bronchitis and indoor work
Chronic bronchitisConfinement building Adjusted OR (95CI)
yes noNon-smokers 11% 8% 1.58 (1.27- 1.96)Smokers 18% 11% 1.98 (1.46- 2.68)
Chronic bronchitisConfinement building Adjusted OR (95CI)
yes noNon-smokers 11% 8% 1.58 (1.27- 1.96)Smokers 18% 11% 1.98 (1.46- 2.68)
Results 5c - EuropeChronic bronchitis and indoor work
Results 5c - EuropeChronic bronchitis and indoor work
Chronic bronchitisgreenhouse Adjusted OR (95CI)
yes no
Non-smokers 15% 9% 1.59 (1.02- 2.48)Smokers 14% 15% 0.98 (0.45- 2.12)
Chronic bronchitisgreenhouse Adjusted OR (95CI)
yes no
Non-smokers 15% 9% 1.59 (1.02- 2.48)Smokers 14% 15% 0.98 (0.45- 2.12)
Results 6aNon-smoking animal farmers
Results 6aNon-smoking animal farmers
n=112Former smoking, n (%) 28 (25.0)Chronic bronchitis, n (%) 36 (32.1)
in former smokers, n (%) 6 (5.4)in never smokers, n (%) 30 (26.8)
Chronic bronchitis+COPD, n (%) 11 (10.7)in former smokers, n (%) 3 (11.1)in never smokers, n (%) 8 (10.5)
n=112Former smoking, n (%) 28 (25.0)Chronic bronchitis, n (%) 36 (32.1)
in former smokers, n (%) 6 (5.4)in never smokers, n (%) 30 (26.8)
Chronic bronchitis+COPD, n (%) 11 (10.7)in former smokers, n (%) 3 (11.1)in never smokers, n (%) 8 (10.5)
Conclusions - 1Conclusions - 1
• The prevalence of chronic bronchitisand ODTS is higher in European than in Californian farmers.
• The high prevalence of chronicbronchitis and ODTS in Europeanfarmers depends on the type offarming practiced in the region and ismainly related to work inside animal confinement buildings.
• The prevalence of chronic bronchitisand ODTS is higher in European than in Californian farmers.
• The high prevalence of chronicbronchitis and ODTS in Europeanfarmers depends on the type offarming practiced in the region and ismainly related to work inside animal confinement buildings.
BackgroundBackground
The European Farmers’ Studydemonstrated that the cultivation offlowers and ornamental plants is a riskfactor for bronchial asthma and workinginside greenhouses increases this risk.
The European Farmers’ Studydemonstrated that the cultivation offlowers and ornamental plants is a riskfactor for bronchial asthma and workinginside greenhouses increases this risk.
Monsó E. Am J Respir Crit Care Med 2000; 162: 1246Monsó E. Am J Respir Crit Care Med 2000; 162: 1246
European Farmers’ StudyEuropean Farmers’ Study
5.4% asthma prevalence in flower growers
OR (95%CI) for asthma
Flower growing 2.1 (1.1-3.9)
Greenhouse work 2.1 (0.9-4.5)
farmers with other cultivations as the reference
5.4% asthma prevalence in flower growers
OR (95%CI) for asthma
Flower growing 2.1 (1.1-3.9)
Greenhouse work 2.1 (0.9-4.5)
farmers with other cultivations as the reference
Monsó E. Am J Respir Crit Care Med 2000; 162: 1246Monsó E. Am J Respir Crit Care Med 2000; 162: 1246
Flower greenhouseFlower greenhouse
AimAim
To determine the prevalence and theetiology of occupational asthma in cropfarmers cultivating flowers and/orornamental plants inside greenhouses.
To determine the prevalence and theetiology of occupational asthma in cropfarmers cultivating flowers and/orornamental plants inside greenhouses.
Method - 1Method - 1Target populationTarget population
•Determination of a representativesubsample from the population ofgreenhouse flower and/or ornamental plant growers who participated in theEuropean Farmers’ Study.
•Selection of a random sample of 40 growers from this subsample for thepresent study.
•Determination of a representativesubsample from the population ofgreenhouse flower and/or ornamental plant growers who participated in theEuropean Farmers’ Study.
•Selection of a random sample of 40 growers from this subsample for thepresent study.
Method - 2Method - 2MeasurementsMeasurements
• Greenhouse characteristics• Air contaminants.• Symptoms and occupational exposure.• Spirometry and reversibility testing. • Workplace bronchial provocation
challenge for subjects reportingwheezing and/or asthma last year.
• Skin testing with workplace allergens.
• Greenhouse characteristics• Air contaminants.• Symptoms and occupational exposure.• Spirometry and reversibility testing. • Workplace bronchial provocation
challenge for subjects reportingwheezing and/or asthma last year.
• Skin testing with workplace allergens.
Method - 3Method - 3Skin testingSkin testing
•Common allergens (Dermatophagoides, mixed trees, mixed grass, mixed graminae, Parietaria, cat and dog hair).
•Workplace allergens:
• Moulds: Alternaria, Cladosporium, Aspergillusand Penicillium.
• Flowers: Gladiolus, Hyacintus, Narcissus, Solidago, Chrysantemum and Heliantus.
• Spider mite.
•Common allergens (Dermatophagoides, mixed trees, mixed grass, mixed graminae, Parietaria, cat and dog hair).
•Workplace allergens:
• Moulds: Alternaria, Cladosporium, Aspergillusand Penicillium.
• Flowers: Gladiolus, Hyacintus, Narcissus, Solidago, Chrysantemum and Heliantus.
• Spider mite.
Results - 1Results - 1Population samplePopulation sample
•73/85 greenhouse flower and/orornamental plant growers participating in the European Farmers’ Study worked in Spain (86%) and were the targetpopulation.
•39 growers from the random sample of40 subjects from the target populationparticipated in the study (97.5%).
•73/85 greenhouse flower and/orornamental plant growers participating in the European Farmers’ Study worked in Spain (86%) and were the targetpopulation.
•39 growers from the random sample of40 subjects from the target populationparticipated in the study (97.5%).
Population samplePopulation sample
GreenhouseGreenhouse areaarea
Results - 2Results - 2Sociodemography and symptomsSociodemography and symptoms
Age, m (SD) 48.6 (10.2)Gender (m/f) 35/4Smoking, n (%) 18 (46.2)Flower growers, n (%) 25 (64.1)Ornamental plant growers, n(%) 14 (35.9)Wheezing last year, n (%) 12 (30.8)Nasal allergies last year, n(%) 12 (30.8)Asthma attacks last year, n (%) 3 (7.7)
Age, m (SD) 48.6 (10.2)Gender (m/f) 35/4Smoking, n (%) 18 (46.2)Flower growers, n (%) 25 (64.1)Ornamental plant growers, n(%) 14 (35.9)Wheezing last year, n (%) 12 (30.8)Nasal allergies last year, n(%) 12 (30.8)Asthma attacks last year, n (%) 3 (7.7)
Greenhouse air contamination by moulds
0
10
20
30
40
50
60
70
80
90
100
% o
f ob
serv
atio
ns
Cladosp. Penicil. Botryu. Acremon. Asperg. Alternar. Geotric. Other Non-ident.
82
46
31
18 15 13
36
18
44
Results - 3Results - 3
1
1,5
2
2,5
3
3,5
4
4,5
0 30 60 90 120 150 180 210 240 270 300 330 360
Minutes
FEV
1 (
L)
Control day Greenhouse day
*
*
* Decline FEV1 >20%
Workplace bronchial challenge - 1
1
1,5
2
2,5
3
3,5
4
4,5
0 30 60 90 120 150 180 210 240 270 300 330 360
Minutes
FEV
1 (
L)
Control day Greenhouse day
* ** Decline FEV1 >20%
Workplace bronchial challenge - 2
1
1,5
2
2,5
3
3,5
4
4,5
0 30 60 90 120 150 180 210 240 270 300 330 360
Minutes
FEV
1 (
L)
Control day Greenhouse day
*
* Decline FEV1 >20%
Workplace bronchial challenge - 3
Results - 4Results - 4Occupational asthma and sensitizationOccupational asthma and sensitization
n (%)
atopy (n=38) 16 (42.1)
current asthma 5 (12.8)
- occupational 3 (7.7)
- non-occupational 2 (5.1)
n (%)
atopy (n=38) 16 (42.1)
current asthma 5 (12.8)
- occupational 3 (7.7)
- non-occupational 2 (5.1)
Results - 4Results - 4Sensitization to workplace allergensSensitization to workplace allergens
n=38 n (%)
moulds 7 (18.4)
flowers 8 (21.1)
spider mite 2 (5.3)
one or more allergens 13 (34.2)
n=38 n (%)
moulds 7 (18.4)
flowers 8 (21.1)
spider mite 2 (5.3)
one or more allergens 13 (34.2)
Sensitization to workplace allergen 13/38 (34.2)
Occupational asthma 3/39 (7.7)
Sensitization to moulds (2)/ flowers (2)
Occupational asthma
- Sensitized to workplace allergens 3/13 (23.1)
- Non-sensitized to workplace allergens 0/25 (0.0)
Etiology of occupational asthma
Prevalences n (%)
Results - 5
Conclusions - 2Conclusions - 2•One third of the greenhouse flowerand/or ornamental plant growers are sensitized to workplace moulds and/orflowers.
•The cultivation of flowers and/orornamental plants inside greenhousescauses occupational asthma in almost 8%of the growers, through sensitization toworkplace antigens.
•One third of the greenhouse flowerand/or ornamental plant growers are sensitized to workplace moulds and/orflowers.
•The cultivation of flowers and/orornamental plants inside greenhousescauses occupational asthma in almost 8%of the growers, through sensitization toworkplace antigens.
PigPig farmersfarmers -- LungLung functionfunction declinedecline
IversenIversen. ERJ 2000. ERJ 2000
Method 1Method 1• Never-smoking subjects who participated in the
European Farmers’ Study and worked inside animal confinement buildings (n=105).
Age, mean (SD) 45.1 (11.7)Gender (women), n (%) 21 (20.0)Country
Denmark, n (%) 14 (13.3)Germany, n (%) 65 (61.9)Switzerland, n (%) 20 (19.0)Spain, n (%) 6 (5.7)
• Never-smoking subjects who participated in theEuropean Farmers’ Study and worked inside animal confinement buildings (n=105).
Age, mean (SD) 45.1 (11.7)Gender (women), n (%) 21 (20.0)Country
Denmark, n (%) 14 (13.3)Germany, n (%) 65 (61.9)Switzerland, n (%) 20 (19.0)Spain, n (%) 6 (5.7)
Method - 2Method - 2
MeasurementsMeasurements
• Symptoms and occupational exposure.• Spirometry and reversibility testing.• FEV1 variability in a work day.• Confinement building characteristics.• Air contaminants:
• Carbon dioxide• Ammonia• Dust• Endotoxin
• Symptoms and occupational exposure.• Spirometry and reversibility testing.• FEV1 variability in a work day.• Confinement building characteristics.• Air contaminants:
• Carbon dioxide• Ammonia• Dust• Endotoxin
Type of farmingPig, n (%) 82 (78.1)Beef/Veal, n (%) 32 (30.5)Dairy, n (%) 23 (21.9)Poultry, n (%) 33 (31.4)
Respiratory symptomsWheeze last year, n (%) 58 (55.2)Chronic bronchitis, n (%) 48 (45.7)Wheeze or chronic bronchitis, n (%) 72 (68.6)
Respiratory symptoms - animal farmers
FEV1%, m (SD) 98.5 (21.0)
COPD, n (%) ($) 18 (17.1)mild, n (%) 7 (6.7)moderate/severe, n (%) 11 (10.5)+respiratory symptoms, n (%) 18 (17.1)
FEV1 variability>10%, m (SD) 20 (19.0)increase, n (%) 7 (6.7)decline, n (%) 13 (12.3)
COPD and FEV1 variabilityvariability >10%, n (%) 4 (3.8)variab.>10% + wheeze, n(%) 4 (3.8)
Lung function - animal farmers
($) GOLD criteria
Confinement building
Area (m2 ) 168 (110-300)Temperature (ºC) 18.0 (15.7-20.0) Humidity (%) 81.3 (73.5-87.2)CO2 (ppm) 1500 (1000-2000)Ammonia (ppm) 10.0 (5.0-17.0) Total dust (mg/m3) 5.6 (2.3-9.4)Endotoxin (ng/m3) 85.9 (35.3-275.4)
Building characteristics - Air contaminants
expressed as median (interquartile range)
COPD, n (%)
≤median >median Crude OR(95%CI) p
Measurement
Area (m2 ) 10 (18.9) 8 (15.4) 0.78 (0.28-2.17) >0.25
Temperature (ºC) 8 (14.8) 10 (19.6) 1.40 (0.50-3.89) >0.25
Relative humidity (%) 7 (13.2) 11 (21.2) 1.76 (0.62-4.97) >0.25
COPD and building characteristics
COPD, n/n total (%) Adjusted OR(95%CI)
CO2First quartile 5/29 (17.2) 1.00Second quartile 8/32 (25.0) 1.08 (0.34-3.43) Third quartile 4/20 (20.0) 0.54 (0.17-1.69)Fourth quartile 1/24 (4.2) 0.18 (0.02-1.44)
AmmoniaFirst quartile 3/28 (10.7) 1.00Second quartile 8/32 (25.0) 1.82 (0.48-7.00)Third quartile 3/21 (14.3) 0.86 (0.30-2.48)Fourth quartile 4/24 (16.7) 1.32 (0.35-4.89)
COPD and indoor contaminants - 1
n=76 COPD, n/n total (%) Adjusted OR(95%CI)
Total dustFirst quartile 1/17 (5.9) 1.00Second quartile 2/21 (9.5) 2.96 (0.34-25.98)Third quartile 2/19 (10.5) 3.70 (0.79-17.27)Fourth quartile 6/19 (31.6) 4.16 (1.01-17.14)
EndotoxinFirst quartile 1/19 (5.3) 1.00Second quartile 3/19 (15.8) 4.03 (0.46-35.52)Third quartile 3/18 (16.7) 1.98 (0.50-7.87)Fourth quartile 4/20 (20.0) 1.15 (0.23-5.59)
COPD and indoor air contaminants - 2
Conclusions - 3
•COPD in never-smoking farmers workinginside animal confinement buildings mayreach moderate severity.
•Indoor exposure to organic dust in theworkplace is related to COPD, and show a dose-response relationship.
•Endotoxin exposure is marginally related to COPD.
Final conclusionsFinal conclusions• The prevalence of chronic bronchitis is
higher in European than in Californianfarmers.
• Chronic bronchitis in Europe is relatedto work inside animal confinementareas and greenhouses.
• The prevalence of chronic bronchitis ishigher in European than in Californianfarmers.
• Chronic bronchitis in Europe is relatedto work inside animal confinementareas and greenhouses.
Final ConclusionsFinal Conclusions•One third of the greenhouse flowergrowers are sensitized to workplacemoulds and/or flowers.
•The cultivation of flowers insidegreenhouses causes occupational asthmain almost 8% of the growers, throughsensitization to workplace antigens.
•One third of the greenhouse flowergrowers are sensitized to workplacemoulds and/or flowers.
•The cultivation of flowers insidegreenhouses causes occupational asthmain almost 8% of the growers, throughsensitization to workplace antigens.
Final Conclusions
•COPD in never-smoking farmers working
inside confinement buildings is significant.
•Indoor exposure to organic dust in the
workplace is related to COPD
Epidemiología de la enfermedad
Epidemiología de la enfermedad
Ramón Magarolas Rosa ReinónSandra Cabrera Sandra AlonsoMarc Schenker Cathy SaikiKatja Radon Elena RiuDennis Nowak Martin IversenBrigitta Danuser Josep Morera
Hospital Germans Trias i Pujol, Badalona, SpainUniversity of California, Davis, California, USAI Poliklinik Arbeits-Umweltmedizin, Munchen, Germany
Ramón Magarolas Rosa ReinónSandra Cabrera Sandra AlonsoMarc Schenker Cathy SaikiKatja Radon Elena RiuDennis Nowak Martin IversenBrigitta Danuser Josep Morera
Hospital Germans Trias i Pujol, Badalona, SpainUniversity of California, Davis, California, USAI Poliklinik Arbeits-Umweltmedizin, Munchen, Germany