Search

Background. More than 400 agents have been documented as causing occupational asthma (OA). The list of low-molecular-weight (LMW) agents that have been identified as potential causes of OA is constantly expanding, emphasizing the need to continually update our knowledge by reviewing the literature. Objective. The objective of this paper was to identify all new LMW agents causing occupational asthma reported during the period 2000–2010. Methods. A Medline search was performed using the keywords occupational asthma, new allergens, new causes, and low-molecular-weight agents. Results. We found 39 publications describing 41 new LMW causal agents, which belonged to the following categories: drugs (n=12), wood dust (n=11), chemicals (n=8), metals (n=4), biocides (n=3), and miscellaneous (n=3). The diagnosis of OA was confirmed through SIC for 35 of 41 agents, peak expiratory flow monitoring for three (3) agents, and the clinical history alone for three (3) agents. Immunological tests provided evidence supporting an IgE-mediated mechanism for eight (8) (20%) of the newly described agents. Conclusion. This paper highlights the importance of being alert to the occurrence of new LMW sensitizers, which can elicit OA. The immunological mechanism is explained by a type I hypersensitivity reaction in 20% of all newly described LMW agents.

Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1-year integrated care (IC) programme comprising two components (patient-centred education+case management) would be effective in preventing COPD-related hospitalizations.This was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty-nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components: patient -centred education-involving three group sessions of self-management education that included one motivational interview and instruction in the use of a written action plan; and case management-involving scheduled follow-up visits with access to a call centre. The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD-related re-hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes.Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re-hospitalization over the follow-up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23-0.85). Subgroup analyses revealed that the IC programme prevented more COPD-related hospitalizations in women compared with men. There were no significant between-group differences in length of hospital stay or number of ED visits.An IC programme combining self-management education and case-management can decrease rates of COPD-related hospitalizations, particularly among women.

Purpose of review To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management. Recent findings IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA. Summary IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.

Summary Background Asthma has been associated with suicidal ideation (SI), though the mechanisms remain poorly understood. Some asthma medications (e.g., theophylline and beta-2 adrenergic agonists) have been shown to provoke feelings of anxiety, fear, and irritability, but their link to SI among asthmatics has not been examined, which was the purpose of the present study. Methods 664 adult asthma outpatient (39% male, M age = 49 ± 14.3) underwent a sociodemographic, psychiatric, and medical history interview. Patients reported asthma medication use, which was verified by chart review. All patients underwent spirometry and completed questionnaires including the beck depression inventory-II (BDI-II) which includes an item that assesses SI in the past two weeks. Results 11.5% of patients reported having SI in the past two weeks. After adjusting for age, sex, smoking, asthma severity, and depressive disorders, analyses indicated that theophylline use was associated with an increased likelihood of SI (OR = 2.67, 95% CI = 1.07–6.65). Sensitivity analyses including asthma control levels and benzodiazepine use as additional covariates did not alter this association (respectively: OR = 2.54, 95% CI = 1.04–6.37; OR = 2.71, 95% CI = 1.09–6.78), though adding cohabitation rendered it no longer statistically significant (OR = 2.34, 95% CI = 0.90–6.09). There were no associations between SI and LABA use. Conclusions Findings suggest that theophylline but not LABA use may be associated with an increased risk of SI among adult asthmatics independent of depressive disorders, asthma control levels, and asthma severity, but not cohabitation, suggesting that cohabitation may be important for SI in this population. Physicians should be cautious when prescribing theophylline or similar agents to asthmatics, and ensure adequate follow-up.

BACKGROUND AND OBJECTIVES: Asthma care in Canada and around the world persistently falls short of optimal treatment. To optimize care, a systematic approach to identifying such shortfalls or ‘care gaps’, in which all stakeholders of the health care system (including patients) are involved, was proposed.METHODS: Several projects of a multipartner, multidisciplinary disease management program, developed to optimize asthma care in Quebec, was conducted in a period of eight years. First, two population maps were produced to identify regional variations in asthma-related morbidity and to prioritize interventions for improving treatment. Second, current care was evaluated in a physician-patient cohort, confirming the many care gaps in asthma management. Third, two series of peer-reviewed outcome studies, targeting high-risk populations and specific asthma care gaps, were conducted. Finally, a process to integrate the best interventions into the health care system and an agenda for further research on optimal asthma management were proposed.RESULTS: Key observations from these studies included the identification of specific patterns of noncompliance in using inhaled corticosteroids, the failure of increased access to spirometry in asthma education centres to increase the number of education referrals, the transient improvement in educational abilities of nurses involved with an asthma hotline telephone service, and the beneficial effects of practice tools aimed at facilitating the assessment of asthma control and treatment needs by general practitioners.CONCLUSIONS: Disease management programs such as Towards Excellence in Asthma Management can provide valuable information on optimal strategies for improving treatment of asthma and other chronic diseases by identifying care gaps, improving guidelines implementation and optimizing care.

This work was undertaken to provide a basis for determining the type of assistance young women living with breast cancer would find useful. In-depth interviews were conducted with 28 women diagnosed with breast cancer before the age of 45 years about their experiences with breast cancer. They ranged in age from 28 to 42 years at the time of diagnosis. Three overarching themes emerged from the analysis--"everything depends on acting now," "everything is out of sync," and "cancer invaded my whole life." These women shared perspectives similar to those of older women, but also held perspectives unique to being young, with young families and busy career lives. Many found services did not match their requirements and they urged the creation of services tailored to their unique needs.

The diagnosis of occupational asthma can be made by exposing workers to the relevant agent either in a hospital laboratory through specific inhalation challenges (SICs) or in the workplace. As suggested by several authors, workers with negative laboratory SIC can be monitored at the workplace under supervision. The present study aims to assess the frequency of, and identify factors associated with, a positive workplace reaction in workers with negative SIC in the laboratory. The results of workplace challenges were examined in 99 workers who underwent negative SIC between 1994 and 2004. A positive reaction either in the SIC or in the workplace was defined as a sustained fall in forced expiratory volume in one second of > or =20%. In total, 22 (22.2%) workers showed positive responses at the workplace. These subjects more often had increased baseline methacholine responsiveness (90.5 versus 67.6%). They also underwent more days of SIC testing (4.9 versus 3.3 days) and were exposed more often to two or more agents (56 versus 28.4%) and for a longer period of time (363.3 versus 220.4 min) in the laboratory. The present study illustrates the usefulness of workplace monitoring of airway function in the investigation of occupational asthma and identifies factors that are more often associated with a positive reaction.

There is growing evidence linking psychological stress to atopic disease, particularly asthma. Anxiety sensitivity, which is the fear of anxiety-related symptoms, may be particularly important in the study of anxiety and atopic disease. The present study examined the association between atopy and anxiety sensitivity in adult asthmatics. A total of 217 asthma patients who had undergone standard pulmonary function and allergen skin prick testing were included. Participants completed the Anxiety Sensitivity Index, Penn State Worry Questionnaire, Type D Personality Scale-16 and Beck Depression Inventory-II on the day of their asthma clinic visit. Total Anxiety Sensitivity Index score was found to be significantly higher in atopic (M = 17.15, SE = .9) versus non-atopic (M = 12.68, SE = 1.5) asthmatics, independent of age, sex, smoking status, asthma severity, asthma duration, and anxiolytic medication use (F = 6.11, p = .014). There was no evidence for a significant association between any of the other questionnaire scores and atopic status.

Background: Psychiatric disorders are highly prevalent in patients with COPD. In general, psychiatric disorders are more common in women than in men. The extent to which women with COPD suffer from greater psychiatric and psychological morbidity is not known. The present cross-sectional study evaluated the prevalence of mood and anxiety disorders, levels of psychological distress, and quality of life in 62 women and 54 men with documented, stable COPD. Methods: All patients (n 116) underwent a sociodemographic and medical history interview, followed by a structured psychiatric interview and standard spirometry. Patients also completed a battery of questionnaires measuring psychological distress and quality of life. Results: The overall prevalence of psychiatric disorders was 49%. Significantly more women than men met the diagnostic criteria for anxiety disorders (56% vs 35%), and a trend for greater levels of major depression in women was found (18% vs 7%). Women had significantly higher anxiety sensitivity and depressive symptoms compared to men but did not report more limitations in psychological functioning. Women also reported being less confident in their ability to control respiratory symptoms, and more daily physical limitations compared to men, despite having comparable COPD severity, dyspnea scores, and exacerbation rates. Conclusions: Results indicate that psychiatric disorders are at least three times higher in COPD patients compared to the general population, and nearly two times higher in women than in men. Women also have greater psychological distress, worse perceived control of symptoms, and greater functional impairment. Greater efforts should be made to identify and treat psychiatric disorders in COPD patients, particularly in women. (CHEST 2007; 132:148–155)

The high burden of asthma appears to be related to poor asthma control. Although previous studies have reported associations between depressive disorders (DDs) and anxiety disorders (ADs) and worse asthma control and quality of life, the relative impact of these disorders on asthma control and quality of life has not been explored. This study evaluated the relative impact of having a DD and/or AD on asthma control and quality of life.Five hundred four consecutive adults with confirmed, physician-diagnosed asthma underwent a brief, structured psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control and asthma-related quality of life were assessed using the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). All patients underwent standard spirometry.Thirty-one percent of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (8% had DD only, 12% had AD only, and 11% had both). Analyses revealed independent effects for DDs on total ACQ scores (p0.01), and for DDs and ADs on total AQLQ scores and all four AQLQ subscales (p0.05). There were no interaction effects.Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are associated with worse asthma control. Interestingly, having both a DD and an AD did not confer additional risk for worse asthma control or quality of life. Physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control and quality of life.

The present study assessed the usefulness of key items obtained from a clinical "open" questionnaire prospectively administered to 212 subjects, referred to four tertiary-care hospitals for predicting the diagnosis of occupational asthma (OA). Of these subjects, 72 (34%) were diagnosed as OA (53% with OA due to high-molecular-weight agents) according to results of specific inhalation challenges, and 90 (42%) as non-OA. Wheezing at work occurred in 88% of subjects with OA and was the most specific symptom (85%). Nasal and eye symptoms were commonly associated symptoms. Wheezing, nasal and ocular itching at work were positively, and loss of voice negatively associated with the presence of OA in the case of high-, but not low molecular-weight agents. A prediction model based on responses to nasal itching, daily symptoms over the week at work, nasal secretions, absence of loss of voice, wheezing, and sputum, correctly predicted 156 out of 212 (74%) subjects according to the presence or absence of OA by final diagnosis. In conclusion, key items, i.e. wheezing, nasal and ocular itching and loss of voice, are satisfactorily associated with the presence of occupational asthma in subjects exposed to high-molecular-weight agents. Therefore, these should be addressed with high priority by physicians. However, no questionnaire-derived item is helpful in subjects exposed to low-molecular-weight agents.

Summary Background Achieving good asthma control has become the major goal of asthma treatment. Studies have reported a high rate of psychiatric disorders among asthma patients, though the impact of these disorders on asthma control and quality of life remains unexplored. This study evaluated the prevalence of psychiatric disorders in 406 adult asthma patients, and associations between psychiatric status, levels of asthma control, and asthma-related quality of life. Methods Consecutive asthma patients presenting to the asthma clinic underwent a brief, structured psychiatric interview, completed the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ), and reported the frequency of bronchodilator use in the past week. All patients underwent standard pulmonary function testing. Results A total of 34% \( n = 136 \) of patients had one or more psychiatric diagnosis, including major depression (15%), minor depression (5%), dysthymia (4%), panic disorder (12%), generalized anxiety disorder (5%), and social phobia (4%). Though there were no differences in pulmonary function, patients with versus without psychiatric disorders had worse ACQ and AQLQ scores and reported greater bronchodilator use, independent age, sex and asthma severity. Conclusions Results suggest that psychiatric disorders are prevalent among asthmatics and are associated with worse asthma control and quality of life. Physicians should be aware of the potential risk of poorer asthma control and functional impairment in this population.

There is a recent trend in the social sciences--predominantly among researchers engaged with qualitative methodologies--to translate research finding into artistic and narrative forms. In this paper, we describe our work in translating finding about the experiences of men with prostate cancer and their spouses into a dramatic production, No Big Deal? We then report upon, and provide commentary about data from interviews with health professionals who attended a performance.Health professionals (N = 26) were interviewed within 2 weeks of attending a performance of No Big Deal? and again 6 months later (N = 23).After attendance at the performance, many study participants reported (at both interview times): new awareness or understanding about the issues facing prostate cancer patients; reinforcements of their positive attitudes and behaviors in relation to patients; an increased sense of connection with ill people; and plans to alter their clinical practices to better meet patient needs.Narrative and dramatic forms are viable ways to communicate vital information about the possibilities for professionals to be helpful to patients--and they are the wave of the future for educational and dissemination practices.

Modelling of the relationship between chemical structure and toxicological end-points offers a quick and efficient means of hazard prediction using a computer.1 Agius et al have developed and validated a quantitative structure-activity relationship (QSAR) model to predict the potential of low molecular weight (LMW) organic agents to cause asthma due to sensitisation, as determined by the hazard index (HI).2–5 Using a cut-point HI of 0.5, it has demonstrated a sensitivity of 79% and a specificity of 93%4 with a high negative predictive value (91–100%) suggesting that the use of such a HI could play a …

Breast cancer patients' utilisation of supportive care has been understudied. In this paper, results from a population-based survey are used to assess the role of physicians and nurses in providing supportive care to women. Participants for this study were women with histologically confirmed invasive breast cancer diagnosed 23-36 months prior to contact about the study, who were randomly selected from the Ontario Cancer Registry. Patients for whom a physician approved contact were sent a survey questionnaire. There were two follow-up mailings. The survey included items related to patients' perceptions of supportive care involvement of oncologists, surgeons, family physicians and nurses. Among 1,119 eligible patients, 65% returned completed questionnaires. A total of 72% of these women reported having talked with an oncologist about one or more supportive care issues; 78% with a surgeon; 73% with a family physician; and 45% with a nurse. Factors linked to seeking supportive care from physicians and/or nurses included: younger age, working status, higher education, additional health insurance beyond that provided by government, higher household income, and receiving chemotherapy. Results indicate that physicians and nurses were providing important supportive care to most women with breast cancer. In a health care context where specialised supportive care services (e.g. help from dietitians, psychologists, social workers) are often unavailable or difficult to access, supportive care remains largely a responsibility of medical and nursing professionals. Even brief interventions may make an important difference to how patients deal with their illness over time.

This paper reports on the results of a survey of utilization of professional supportive care services by women with breast cancer, and on patterns of differential service utilization by sub-groups of patients. Study participants were women with invasive breast cancer diagnosed 23-36 months prior to contact about the study, and randomly selected from the Ontario Cancer Registry. From among 1,119 eligible women sent survey questionnaires, 731 returned completed questionnaires (65%). A total of 31% of respondents reported accessing one or more of the following professionals: social worker, psychologist, psychiatrist, dietitian, physiotherapist. Among those who responded to a question about whether they would have liked specific services, 34% reported that there was at least one professional supportive care service they would have liked to use, but were unable to access. Factors shown to be related to greater utilization of services included: younger age, higher household income, employed or student status, private health insurance coverage, and having received chemotherapy. Overall, there was a surprisingly low utilization of professional specialized supportive care services among women with breast cancer. Policy implications include finding strategies to better inform cancer patients about existing services, and ensuring that a core set of services are available to all patients.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking the nurse's opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies quite likely will influence the response to the patient's inquiries. This article represents the findings of interviews with 20 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses who were interviewed emphasized that information regarding unconventional therapies needs to be available readily for both patients and health care professionals. Other themes identified in the interviews included the following: Various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open, and a place should be found for unconventional therapies. The interviewees saw a clearly defined role for nurses regarding unconventional therapies.

purpose: In this article, the authors describe the experiences of men with prostate cancer and their spouses between diagnosis and surgery. description: As part of a longitudinal qualitative study, semistructured interviews were held with 34 prostate cancer patients who were waiting for surgery. Separate interviews were held with their spouses. results: Six main components of experience were evident from the analysis of transcripts related to the presurgery period: 1) the news of a diagnosis of prostate cancer came initially as a shock for both partners, the impact of which lessened over time; 2) the new reality of illness necessitated readdressing the marital relationship, most often resulting in a sense of renewed connection and commitment; 3) the illness crisis precipitated a search for information to guide decisions about treatment; 4) there was a need for couples to decide who to inform about the cancer diagnosis and how much to say about it; 5) couples attempted to seek a semblance of normality in their lives, especially after treatment decisions had been made; and 6) despite attempts to minimize the potential impact of upcoming surgery, anxiety was typically experienced at least intermittently by one or both partners. clinical implications: Physicians, nurses, social workers, and other health professionals need to facilitate attempts by the patient to gather and synthesize information. Cancer specialists can play a positive role in reducing distress in couples, and, thus, the attention of the specialists to communication issues is critical. The strain of waiting for surgery must be considered when treatment recommendations are made; watchful waiting protocols require further study from a psychological perspective. Clinicians need to be alert to the balance between being positive and carrying on as normal, and acknowledging and dealing with the distress that arises.

Nine focus groups for well, longer-term survivors of breast cancer were held in Ontario, Canada. Prevalent themes identified through analysis of focus group transcripts fell into two broad categories, one reflecting the context within which women seek information and the other reflecting the content of information desired and sought. Themes related to context included: the ongoing impact on women of their initial disease experience and continued uncertainty about possible recurrence; womens' lack of information and understanding about processes involved in developing medical knowledge; prevailing mistrust about the impact of cost curtailment policies; and, concerns related to how professional communication can aid or hinder the goal of obtaining information. Themes related to content issues included: follow-up protocols, tamoxifen, detecting signs of possible recurrence, prevention for daughters, neglected side effects of treatment, insurance, lifestyle, and unconventional therapies.

The popularity of unconventional therapies has grown dramatically in recent years. This paper reports on the results of a pilot study investigating the perspectives of physicians involved with cancer care regarding their reactions to this trend and their ways of trying to meet associated challenges. Nine oncologists, nine general practitioners, and one surgeon were interviewed over the telephone, employing open-ended questions. The physicians were unanimously interested in having information available about unconventional therapies. They also expressed a desire to be supportive of patient choices in this area, provided conventional therapy was not compromised. However, there was little interest in initiating communication about unconventional therapies, with most seeing such discussions as a poor use of their time. Suggestions for future research, as well as educational and policy strategies, are addressed.

Objective Aerobic exercise can improve cardiovascular fitness and does not seem to be detrimental to patients with asthma, though its role in changing asthma control and inflammatory profiles is unclear. The main hypothesis of the current randomised controlled trial is that aerobic exercise will be superior to usual care in improving asthma control. Key secondary outcomes are asthma quality of life and inflammatory profiles. Design A total of 104 sedentary adults with physician-diagnosed asthma will be recruited. Eligible participants will undergo a series of baseline assessments including: the asthma control questionnaire; the asthma quality-of-life questionnaire and the inflammatory profile (assessed from both the blood and sputum samples). On completion of the assessments, participants will be randomised (1:1 allocation) to either 12-weeks of usual care or usual care plus aerobic exercise. Aerobic exercise will consist of three supervised training sessions per week. Each session will consist of taking a short-acting bronchodilator, 10 min of warm-up, 40 min of aerobic exercise (50–75% of heart rate reserve for weeks 1–4, then 70–85% for weeks 5–12) and a 10 min cool-down. Within 1 week of completion, participants will be reassessed (same battery as at baseline). Analyses will assess the difference between the two intervention arms on postintervention levels of asthma control, quality of life and inflammation, adjusting for age, baseline inhaled corticosteroid prescription, body weight change and pretreatment dependent variable level. Missing data will be handled using standard multiple imputation techniques. Ethics and dissemination The study has been approved by all relevant research ethics boards. Written consent will be obtained from all participants who will be able to withdraw at any time. Results The result will be disseminated to three groups of stakeholder groups: (1) the scientific and professional community; (2) the research participants and (3) the general public. Registration Details ClinicalTrials.gov Identifier NCT00953342

Given the high estimated prevalence and financial burden of occupational asthma (OA),1 ,2 prevention is a major concern. However, in the absence of a regulatory screening protocol, the respiratory sensitising potential of a chemical is usually only apparent when it has caused a human case of OA. The purpose of primary prevention is to detect hazardous agents before the occurrence of the issue, in order to avoid exposure of workers.3 Agius et al 4 have developed and validated a computer based asthma hazard prediction model to predict the potential of low molecular weight (LMW) organic agents to cause asthma …

Study objective The duration of action of several new non-sedative antihistamine preparations as assessed by skin and bronchial reactivity to histamine has still not been well established. The aim of the study was to evaluate the duration of effect of loratadine (10 mg) and terfenadine (120 mg) administered once a day for one week on cutaneous and inhaled reactivity to histamine by comparison with a placebo. Subjects Twenty-four adult asthmatic subjects were included in a parallel group study that compared the duration of effect of two antihistamines and a placebo on cutaneous and inhaled reactivity to histamine. Study design Baseline cutaneous and inhaled reactivity (concentration causing a fall of 20 percent in FEV1 [PC20]) to histamine was obtained on three consecutive days. Loratadine (10 mg), terfenadine (120 mg) and a placebo loratadine were administered daily for 1 week to 3 groups of subjects. The PC20 was measured at the end of the medication period, 3 days later, and weekly until PC20 returned to baseline value (upper limit of 2 SD from the mean baseline value). Results The mean blocking duration on cutaneous reactivity for loratadine was 6.9 days and for terfenadine, 7.2 days. The mean duration of the blocking effect on PC20 histamine was 8.5 days for loratadine and 7.2 days for terfenadine. These figures were significantly longer than for the placebo. Conclusion These data suggest that terfenadine and loratadine have a comparable blocking effect on reactivity to cutaneous and inhaled histamine. A daily dose taken for one week will result in a mean blocking effect of one week.

In a previous issue of this journal, Kraut and colleagues (Occup Environ Med 1994;51:408–13) reported occupational allergies to caddies flies in the workforce of a hydroelectric power plant. In this survey a significant cross-shift change in forced expiratory volume in 1 second (FEV1) of one sensitised individual was interpreted as occupational asthma (OA) to caddis flies. However pre- and post-shift measures of FEV1 are not recommended to either confirm or refute OA.1 2 We herein report the first case of OA to Phryganeiae confirmed objectively by a specific inhalation challenge using an extract of these insects. An engineer started working for an electric power company 7 years ago carrying out repair and maintenance works. …

in a Cluster of Cases Suggestive of Organic Dust Toxic Syndrome R. Castano, J. L. Malo, C. Lemiere, M. Labrecque, A. Cartier; Hopital du Sacre-Coeur de Montreal, Montreal, PQ, CANADA. RATIONALE: To examine pulmonary responses and characterize airway inflammation in workers with respiratory symptoms suggestive of Organic Dust Toxic Syndrome (ODTS). METHODS: We assessed 14 workers of a large factory of sanitary napkins complaining of recurrent work-related cough, shortness of breath, phlegm production and fever with chills. All workers underwent specific inhalation challenges (SIC) for 2 to 4 hours with dust obtained from the floor next to the operating machines. All subjects had measurements of temperature, expiratory flows, white blood cell count (WBC), carbon monoxide diffusing capacity (DLCO) and induced sputum before and after exposure. RESULTS: Only one subject presented symptoms on exposure suggesting extrinsic allergic alveolitis (EAA) with increases in temperature (36.3 to 37.88C) and WBC (5.2 to 10.7 cells per cc) and a decrease in DLCO (23.3 to 18.4). After exposure only one subject had a significant decrease (26%) in forced expiratory volume in one second. In induced sputum 13 subjects had an increase in total cell counts (mean 55.3 10 c/ml; range 8.2-113.4) and 12 in neutrophils (mean 39%; range 20-92%). CONCLUSIONS: We have thus described workers with features of ODTS, EAA and asthma. We hypothesize that these conditions may be considered one syndrome with a wide spectrum of severity ranging from a less severe condition (ODTS) in one end of the spectrum to a more severe disease in the other (EAA). Results also support the use of induced sputum in the investigation of ODTS. The etiology of this syndrome in our workers is still unknown. Funding: Universite de Montreal