conferencia dr. monsó. •it is healthy to live and work on a farm? congreso separ sevilla 2006
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Conferencia Dr. Monsó. Congreso SEPAR Sevilla 2006. It is healthy to live and work on a farm?TRANSCRIPT
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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.
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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.
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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.
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HealthHealth
ErnstErnst. AJRCCM 2000. AJRCCM 2000
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HealthHealth
ErnstErnst. AJRCCM 2000. AJRCCM 2000
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HealthHealth
ErnstErnst. AJRCCM 2000. AJRCCM 2000
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HealthHealth
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HealthHealth
IlliIlli. BMJ 2001. BMJ 2001
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HealthHealth
IlliIlli. BMJ 2001. BMJ 2001
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HealthHealth
IlliIlli. BMJ 2001. BMJ 2001
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HealthHealth
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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
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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.
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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.
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Work environmentsWork environments
• Field work.
• Confinement house.
• Silo.
• Greenhouse.
• Field work.
• Confinement house.
• Silo.
• Greenhouse.
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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
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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.
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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
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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
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Respiratory Symptoms
0
5
10
15
20
25
30
Smoking Rhinitis Asthma Chronic bronchitis ODTS
%
CaliforniaEurope* *
** *
* p<.001* p<.001
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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
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Animal exposure
0
10
20
30
40
50
60
Swine Beef/Veal Dairy Poultry Sheep Rabbit
%
CaliforniaEurope
**
** **
** **
* p<.001* p<.001
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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
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Crop exposure
0
10
20
30
40
50
60
Grain Vegetables Tomatoes Root crops Oil plants Fruits Nuts Flowers
%
CaliforniaEurope
**
** **
****
**
**
**
* p<.001* p<.001
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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
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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) ------
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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)
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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)
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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)
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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
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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)
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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)
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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)
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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)
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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)
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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)
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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.
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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
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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
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Flower greenhouseFlower greenhouse
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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.
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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.
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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.
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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.
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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%).
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Population samplePopulation sample
GreenhouseGreenhouse areaarea
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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)
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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
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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
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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
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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
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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)
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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)
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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
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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.
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PigPig farmersfarmers -- LungLung functionfunction declinedecline
IversenIversen. ERJ 2000. ERJ 2000
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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)
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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
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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
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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
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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)
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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
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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
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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
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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.
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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.
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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.
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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
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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
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