What role for asbestos in idiopathic pulmonary fibrosis? Findings from the IPF job exposures case-control study.

Background: Asbestos has been hypothesised as the cause of the recent global increase in the incidence of 'idiopathic' pulmonary fibrosis (IPF). Establishing this has important diagnostic and therapeutic implications. The association between occupational asbestos exposure and IPF, and interaction with a common (minor allele frequency of 9% in European populations) genetic variant associated with IPF, rs35705950, is unknown.

Chronic Obstructive Pulmonary Disease and Breathlessness in Older Workers Predict Economic Inactivity. A Prospective Cohort Study.

There is an aspiration to retain increasing numbers of older workers in employment, and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes. We report the findings of the first longitudinal study of this issue.

Chronic obstructive pulmonary disease in Welsh slate miners.

Background: Exposure to respirable crystalline silica (RCS) causes emphysema, airflow limitation and chronic obstructive pulmonary disease (COPD). Slate miners are exposed to slate dust containing RCS but their COPD risk has not previously been studied.

Aims: To study the cumulative effect of mining on lung function and risk of COPD in a cohort of Welsh slate miners and whether these were independent of smoking and pneumoconiosis.

Obliterative bronchiolitis in fibreglass workers: a new occupational disease?

Rationale And Objectives: Obliterative bronchiolitis (OB) is a rare disease with a small number of established occupational aetiologies. We describe a case series of severe OB in workers making glass-reinforced plastics.

Methods: Workplace exposures were the likely cause after the independent diagnosis of OB in two workers laying up the fibreglass hulls of yachts; the second worker took over the job of the first after he left following a lung transplant.

Detergent protease exposure and respiratory disease: case-referent analysis of a retrospective cohort.

Objectives: To examine the relationship between protease exposure and respiratory disease in a cohort of detergent enzyme manufacturers.

Methods: Case-referent analysis of a cohort of employees working in a European detergent factory between 1989 and 2002. Cases with new lower or upper respiratory disease were ascertained by examination of occupational health records and matched to referents on date of first employment.

Early-life allergen exposure and atopy, asthma, and wheeze up to 6 years of age.

Rationale: Although it is widely assumed that the incidence of childhood respiratory allergies to common aeroallergens is directly related to allergen exposure in early life, few longitudinal studies have investigated this issue, and available data are scarce and mainly limited to high-risk groups.

Objectives: To assess, in a prospective manner and in a general population, the role of early life exposures to Der p1 and Fel d1 on the inception of sensitization and asthma.

Methods: Pregnant women and their children were recruited for the Asthma Multicentre Infant Cohort Study.

Defining occupational asthma and confirming the diagnosis: what do experts suggest?

Diagnosis of occupational asthma

Atopy and asthma in rural Poland: a paradigm for the emergence of childhood respiratory allergies in Europe.

Background: We hypothesized that, in south-west Poland, a 'rural' protective effect on atopy and respiratory allergies would be most pronounced among children but that at all ages would be stronger among those with a rural background.

Methods: A cross-sectional survey of the inhabitants (age >5 years, n = 1657) of Sobotka, a town of 4000 people in south-west Poland: and seven neighbouring villages. We measured and analysed responses to skin prick tests (atopy) and to a standard questionnaire (asthma and hayfever).

Recorded infections and antibiotics in early life: associations with allergy in UK children and their parents.

Background: It is suggested that the inverse relationship between allergic disease and family size reflects reduced exposure to early life infections, and that antibiotic treatment in childhood diminishes any protective effect of such infection.

Methods: A birth cohort study was undertaken in 642 children recruited before birth and seen annually until the age of 8 years. Reported infections and prescribed antibiotics by the age of 5 years were counted from GP records and comparisons were made with a previous study of their parents.

Early allergen exposure and atopic eczema.

Background: The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent-reported, doctor-diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen.

Asbestos-induced and smoking-related disease: apportioning pulmonary function deficit by using thin-section CT.

Purpose: To retrospectively correlate the extent of individual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-related parenchymal disease (asbestosis) and to test these findings in a subsequent group of patients whose CT scans were retrospectively identified.

Materials And Methods: This retrospective study had Institutional Review Board approval; informed consent was not required. The study included 133 individuals who had been exposed to asbestos.

Outcome of occupational asthma after cessation of exposure: a systematic review.

Background: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease.

Methods: A systematic review of the published literature on the symptomatic and functional outcomes of occupational asthma was carried out after avoidance of exposure to the causative agent. Through a full search of electronic and bibliographic sources, original studies documenting complete recovery from asthma (n = 39,1681 patients) or improvement in non-specific bronchial hyper-responsiveness (NSBHR; n = 28,695 patients) were identified.

IFN gamma and CXCR-1 gene polymorphisms in idiopathic bronchiectasis.

Idiopathic bronchiectasis is a disease of chronic, bacterial lung infection, unresolving inflammation and progressive lung damage. Bronchiectasis can be associated with autoimmune diseases including ulcerative colitis. Defects of both innate and adaptive immunity have been proposed.

Interferon-gamma therapy in two patients with progressive chronic pulmonary aspergillosis.

Infection by Aspergillus species causes a wide spectrum of pulmonary disease in humans. In two patients with semi-invasive Aspergillus-induced lung disease, significantly reduced levels of interferon-gamma secretion by peripheral blood mononuclear cells were found after in vitro stimulation with the T-cell mitogen phytohaemagglutinin. Despite anti-fungal therapy, both patients exhibited progressive disease, and adjunctive interferon-gamma therapy was associated with significant clinical improvement.

The effects of farming and birth order on asthma and allergies.

A farm childhood is apparently protective in allergic disease, but studies of this issue in Europe have been confined to particular types of farming practice. This study addressed whether or not this effect was generalisable. A cross-sectional survey of 800 schoolchildren living in rural Crete was undertaken.

Supermarket baker's asthma: how accurate is routine health surveillance?

Background: Regular health surveillance is commonly recommended for workers exposed to occupational antigens but little is known about how effective it is in identifying cases.

Aims: To report one large company's surveillance and compare its findings with those of a standard cross-sectional survey in the same workforce.

Methods: A supermarket company with 324 in-store bakeries producing bread from raw ingredients conducted a three-stage health surveillance programme in around 3000 bakery employees.

Childhood atopy and allergic disease and skin test responses to environmental mycobacteria in rural Crete: a cross-sectional survey.

Background: Through its powerful immunoregulatory effects, infection with atypical mycobacteria may exert a protective effect on the development of childhood allergic disease.

Objective: To examine the relationship between childhood atopy or allergic disease and previous infection with four species of atypical mycobacteria.

Methods: Eight hundred and six children aged 8-18 years and living in rural Crete--most of whom had had previous BCG immunization--underwent skin prick testing with 10 aeroallergens; their parents completed a standardized questionnaire relating to allergic disease.

The changing distribution of occupational asthma: a survey of supermarket bakery workers.

In the UK, since the mid 1980s, supermarkets have accounted for an increasing volume of bread production. Occupational asthma among employees who produce bread from raw ingredients in supermarkets has not been previously investigated. A cross-sectional survey was undertaken involving 239 (71%) employees from 20 different supermarket bakeries.

Early allergen exposure, skin prick responses, and atopic wheeze at age 5 in English children: a cohort study.

Background: For many years it has been assumed that the risk of childhood respiratory allergies is related to allergen exposures in early life. There are, however, few prospective data in support. We aimed to examine this relationship in a representative cohort of children born in Ashford, Kent (UK).

New pregnancies and loss of allergy.

Background: Inverse associations between allergic disease and sibship have been consistently described and are frequently explained by purported lower rates of early infection among children from small families. Alternative explanations include the possibility that pregnancy itself determines maternal atopic status.

Objective: To test the hypothesis that atopy defined by skin prick test (SPT) declines with increasing numbers of pregnancies.

Asthma: environmental and occupational factors.

Asthma is in several ways a difficult disease to study. Generally arising in childhood, its pattern is often one of remission and relapse; at any point there are difficulties in translating its characteristic, clinical features into an operational definition. Geographical and temporal patterns in its distribution - whereby the disease appears to have increased in frequency in more 'westernised' countries -suggest strong environmental determinants in its causation although there are, too, undoubted and important genetic influences on both its incidence and presentation.