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Occupational and Environmental Asthma
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Occupational and Environmental Asthma

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 52110

Special Issue Editors

Dr. Francisco-Javier González-Barcala

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Guest Editor
Department of Medicine, Faculty of Medicine, Fundacion Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), University of Santiago de Compostela (USC), 15706 Santiago de Compostela, Spain
Interests: asthma; rhinitis; COPD
Dr. Maribel Casas

E-Mail Website
Guest Editor
Barcelona Institute for Global Health (ISGlobal), Doctor Aiguader 88, 08003 Barcelona, Spain
Interests: child health; endocrine-disrupting chemicals; respiratory health; epidemiology; human biomonitoring; air pollution
Special Issues, Collections and Topics in MDPI journals
Dr. Isabel Inés Urrutia Landa

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Guest Editor
Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain
Dr. Xavier Muñoz

E-Mail Website
Guest Editor
Department of Pneumology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

Special Issue Information

Dear colleagues,

Asthma is a heterogeneous disease, characterized by chronic airway inflammation. The disease affects 1%–18% of the population in the world, and its prevalence is increasing in many countries, particularly among children [1].

Air pollution is a serious problem worldwide, and the growing use of fuels is one of its primary drivers. Exposure to air pollutants has been correlated with an increase in the severity of asthma, and its implication in the exacerbation of pre-existing asthma is supported by a body of evidence that has accumulated over several decades [2–10].

In patients with asthma, high levels of particulate matter (i.e., diesel exhaust particles), ozone, sulphur dioxide, and nitrous oxide (O3, SO2, and NO2) can accelerate the appearance of symptoms, increasing the number of consultations at emergency services and hospitalizations due to decompensation of the disease [3]. Furthermore, there is growing evidence that environmental pollution not only aggravates asthma but may cause it. Apart from air pollution, there are other environmental factors associated with urban living that are suspected to play a role in asthma onset and exacerbation. Environmental exposures in urban settings are largely explained by urban and transport planning indicators (e.g., road network, distance to major roads, and traffic density, household density, industry, and natural and green space explain a large proportion of the variability), but also by personal behaviour. The potential influence of the urban environment on asthma is especially important during the first years of life when the lung and immune system are rapidly developing.

On the other side, work-related asthma (occupational asthma or work aggravated asthma) is frequently missed. Epidemiological studies indicate that occupational exposure may be the cause of up to 25% of all cases of adult-onset asthma [9,11]. Asking patients whether their symptoms improve when they are away from work should be always considered.

References:

  1. Global Strategy for Asthma Management and Prevention. Avalibale online: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf (accessed on 18 October 2019).
  2. Zheng, X.Y.; Ding, H.; Jiang, L.N.; Chen, S.W.; Zheng, J.P.; Qiu,M.; et al. Association between air pollutants and asthma emergency room visits and hospital admissions in time series studies: A systematic review and meta-analysis. PLoS ONE 2015, 10, e0138146.
  3. Chanel O.; Perez, L.; Künzli, N.; Medina S.; Aphekom Group. The hidden economic burden of air pollution-related morbidity: Evidence from the Aphekom project. J. Health Econ. 2016, 17, 1101–1115.
  4. Gehring, U.; Wijga, A.H.; Hoek, G.; Bellander, T.; Berdel, D.; Brüske, I.; Fuertes, E.; Gruzieva, O.; Heinrich, J.; Hoffmann, B; et al. Exposure to air pollution and development of asthma and rhinoconjunctivitis throughout childhood and adolescence: A population-based birth cohort study. Lancet Respir. Med. 2015, 3, 933–942.
  5. Jacquemin, B.; Siroux, V.; Sanchez, M.; Carsin, A.E.; Schikowski, T.; Adam, M.; Bellisario, V.; Buschka, A.; Bono, R.; Brunekreef, B.; et al. Ambient air pollution and adult asthma incidence in six European cohorts (ESCAPE). Health Perspect. 2015, 123, 613–621.
  6. Guarnieri, M.; Barles, J.R. Outdoor air pollution and asthma. Lancet 2014, 383, 1581–1592.
  7. Elizalde-Beiras, I.; Guillén-Grima, F.; Aguinaga-Ontoso, I. Prevalence of asthma in children and adolescents in a rural area. Bronconeumol. 2017, 53, 460–461
  8. Gonzalez-Barcala, F.J.; Pertega, S.; Garnelo, L.; Castro, T.P.; Sampedro, M.; Lastres, J.S.; San Jose Gonzalez, M.A.; Bamonde, L.; Valdes, L.; Carreira, J.M.; et al. Truck traffic related air pollution associated with asthma symptoms in young boys: A cross-sectional study. Public Health 2013, 127, 275–281.
  9. Cruz, M.J.; Muñoz, X. Work-Related Asthma: The Dawn of Knowledge? Bronconeumol. 2017, 53, 180–181.
  10. Muñoz, X.; Barreiro, E.; Bustamante, V.; Lopez-Campos, J.L.; González-Barcala, F.J.; Cruz, M.J.; Diesel exhausts particles: Their role in increasing the incidence of asthma. Reviewing the evidence of a causal link. Total Environ. 2019, 652, 1129–1138. 
  11. Muñoz, X.; Cruz, M.J.; Bustamante, V.; Lopez-Campos, J.L.; Barreiro, E. Work-related asthma: Diagnosis and prognosis of immunological occupational asthma and work-exacerbated asthma. Investig. Allergol. Clin. Immunol. 2014, 24, 396–405.

Prof. Francisco-Javier González-Barcala
Dr. Maribel Casas
Dr. Isabel Inés Urrutia Landa
Dr. Xavier Muñoz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Asthma
  • Occupational asthma
  • Environmental pollution
  • Irritants
  • Urban environment
  • Particulate matter
  • Diesel exhaust particles
  • Eosinophils
  • Neutrophils
  • Dendritic cells
  • Interleukins
  • Inflammation

Published Papers (8 papers)

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Research

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11 pages, 660 KiB  
Article
Allergies, Allergic Comorbidities and the Home Environment in Pediatric Asthma in Southern Florida
by Nadia T. Saif, Gary I. Kleiner, Lourdes Q. Forster, Eugene R. Hershorin, Andrew A. Colin, Mehdi Mirsaeidi and Naresh Kumar
Int. J. Environ. Res. Public Health 2021, 18(8), 4142; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084142 - 14 Apr 2021
Cited by 6 | Viewed by 2339
Abstract
Background: Environmental exposure is critical in sensitization to environmental allergens and pediatric asthma morbidity, especially in tropical climates where children are perennially exposed to bioaerosols, such as pollen and mold spores, and endotoxins. Objective: This cross-sectional study examines the association of allergies, [...] Read more.
Background: Environmental exposure is critical in sensitization to environmental allergens and pediatric asthma morbidity, especially in tropical climates where children are perennially exposed to bioaerosols, such as pollen and mold spores, and endotoxins. Objective: This cross-sectional study examines the association of allergies, associated allergic comorbidities, and the home environment separately and synergistically in pediatric asthma, including in asthma prevalence, severity of asthma, and undiagnosed asthma, in South Florida. Methods: An online survey was administered to the parents of children attending two of the University of Miami pediatric clinics from June to October 2016. Descriptive, factor, and multivariate regression analyses were used to analyze the data. Results: Of 163 children, 22% (36) children had physician-diagnosed asthma; 10% and 32% had allergic rhinitis diagnosis and rhinitis symptoms, respectively, in the past. The allergy diagnosis age was 2.3 years higher than the asthma diagnosis age (p < 0.01). Children with ≥ 2 allergies were 12.8 times more likely to have physician-diagnosed asthma than those without allergies (p < 0.01). Children with allergies and allergic rhinitis were 4.3 (p < 0.05) times more likely to have asthma, and those with asthma were 15 (p < 0.05) times more likely to have an asthma attack than those without known allergies and allergic rhinitis. Conclusion: Allergies and associated comorbidities are risk factors of asthma, asthma persistence, and multiple allergies exacerbate their effects. Early screening for allergies and treatment are warranted to manage asthma. Since the home environment plays an important role in sensitization to allergens, further research is needed to assess home-environment-mediated allergic conditions in the onset and persistence of asthma. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
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7 pages, 6742 KiB  
Communication
Pediatric Asthma Attack and Home Paint Exposure
by Nadia T. Saif, Julia M. Janecki, Adam Wanner, Andrew A. Colin and Naresh Kumar
Int. J. Environ. Res. Public Health 2021, 18(8), 4118; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084118 - 13 Apr 2021
Cited by 3 | Viewed by 2471
Abstract
Although asthma mortality has been declining for the past several decades, asthma morbidity is on the rise, largely due to deteriorating indoor air quality and comorbidities, such as allergies. Consumer products and building materials including paints emit volatile organic compounds (VOCs), such as [...] Read more.
Although asthma mortality has been declining for the past several decades, asthma morbidity is on the rise, largely due to deteriorating indoor air quality and comorbidities, such as allergies. Consumer products and building materials including paints emit volatile organic compounds (VOCs), such as propylene glycol (PG), which is shown to dehydrate respiratory tracts and can contributor to airway remodeling. We hypothesize that paint exposure increases the risk of asthma attacks among children because high levels of VOCs persist indoors for many weeks after painting. Children 1–15 years old visiting two of the University of Miami general pediatric clinics were screened for their history of asthma and paint exposure by interviewing their parents and/or guardians accompanying them to the clinic. They were also asked questions about asthma diagnosis, severity of asthma and allergies and their sociodemographics. The risk of asthma attack among asthmatic children was modeled with respect to paint exposure adjusting for potential confounders using multivariate logistic regressions. Of 163 children, 36 (22%) reported physician-diagnosed asthma and of these, 13 (33%) had an asthma attack during the last one year. Paint exposure was marginally significant in the univariate analysis (OR = 4.04; 95% CI = 0.90–18.87; p < 0.1). However, exposed asthmatic children were 10 times more likely to experience an asthma attack than unexposed asthmatic children (OR = 10.49; CI = 1.16–94.85, p < 0.05) when adjusted for other risk factors. Given paint is one of the sources of indoor VOCs, multiple strategies are warranted to manage the health effects of VOC exposure from paint, including the use of zero-VOC water-based paint, exposure avoidance and clinical interventions. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
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8 pages, 326 KiB  
Article
Pulmonary Function Testing in Work-Related Asthma: An Overview from Spirometry to Specific Inhalation Challenge
by Mathias Poussel, Isabelle Thaon, Emmanuelle Penven and Angelica I. Tiotiu
Int. J. Environ. Res. Public Health 2021, 18(5), 2325; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052325 - 26 Feb 2021
Cited by 3 | Viewed by 2331
Abstract
Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA [...] Read more.
Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
11 pages, 733 KiB  
Article
Pulmonary Health Effects of Indoor Volatile Organic Compounds—A Meta-Analysis
by Kyle L. Alford and Naresh Kumar
Int. J. Environ. Res. Public Health 2021, 18(4), 1578; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041578 - 07 Feb 2021
Cited by 40 | Viewed by 5447
Abstract
Volatile organic compounds (VOCs) are commonly found in consumer products, including furniture, sealants and paints. Thus, indoor VOCs have become a public health concern, especially in high-income countries (HICs), where people spend most of their time indoors, and indoor and outdoor air exchange [...] Read more.
Volatile organic compounds (VOCs) are commonly found in consumer products, including furniture, sealants and paints. Thus, indoor VOCs have become a public health concern, especially in high-income countries (HICs), where people spend most of their time indoors, and indoor and outdoor air exchange is minimal due to a lack of ventilation. VOCs produce high levels of reaction with the airway epithelium and mucosa membrane and is linked with pulmonary diseases. This paper takes a stock of the literature to assess the strength of association (measured by effect size) between VOCs and pulmonary diseases with the focus on asthma and its related symptoms by conducting a meta-analysis. The literature was searched using the PubMed database. A total of 49 studies that measured VOCs or VOC types and pulmonary health outcomes were included in the analysis. The results of these studies were tabulated, and standard effect size of each study was computed. Most studies were conducted in high-income countries, including France (n = 7), Japan (n = 7) and the United States (n = 6). Our analysis suggests that VOCs have a medium-sized effect on pulmonary diseases, including the onset of asthma (effect size (or Cohen’s d) ~0.37; 95% confidence interval (CI) = 0.25–0.49; n = 23) and wheezing (effective size ~0.26; 95% CI = 0.10–0.42; n = 10). The effect size also varied by country, age and disease type. Multiple stakeholders must be engaged in strategies to mitigate and manage VOC exposure and its associated pulmonary disease burden. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
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12 pages, 392 KiB  
Article
The Impact of Tobacco Smoking on Adult Asthma Outcomes
by Angelica Tiotiu, Iulia Ioan, Nathalie Wirth, Rodrigo Romero-Fernandez and Francisco-Javier González-Barcala
Int. J. Environ. Res. Public Health 2021, 18(3), 992; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030992 - 23 Jan 2021
Cited by 21 | Viewed by 4290
Abstract
Background: Tobacco smoking is associated with more severe asthma symptoms, an accelerated decline in lung function, and reduced responses to corticosteroids. Our objective was to compare asthma outcomes in terms of disease control, exacerbation rates, and lung function in a population of [...] Read more.
Background: Tobacco smoking is associated with more severe asthma symptoms, an accelerated decline in lung function, and reduced responses to corticosteroids. Our objective was to compare asthma outcomes in terms of disease control, exacerbation rates, and lung function in a population of asthmatic patients according to their smoking status. Methods: We compared patients’ demographics, disease characteristics, and lung-function parameters in current-smokers (CS, n = 48), former-smokers (FS, n = 38), and never-smokers (NS, n = 90), and identified predictive factors for asthma control. Results: CS had a higher prevalence of family asthma/atopy, a lower rate of controlled asthma, impaired perception of dyspnea, an increased number of exacerbations, and poorer lung function compared to NS. The mean asthma control questionnaire’s (ACQ) score was higher in CS vs. NS and FS (1.9 vs. 1.2, p = 0.02). Compared to CS, FS had a lower rate of exacerbations, a better ACQ score (similar to NS), a higher prevalence of dyspnea, and greater lung-diffusion capacity. Non-smoking status, the absence of dyspnea and exacerbations, and a forced expiratory volume in one second ≥80% of predicted were associated with controlled asthma. Conclusions: CS with asthma exhibit worse clinical and functional respiratory outcomes compared to NS and FS, supporting the importance of smoking cessation in this population. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
10 pages, 1019 KiB  
Article
Lagged Association of Ambient Outdoor Air Pollutants with Asthma-Related Emergency Department Visits within the Pittsburgh Region
by Brandy M. Byrwa-Hill, Arvind Venkat, Albert A. Presto, Judith R. Rager, Deborah Gentile and Evelyn Talbott
Int. J. Environ. Res. Public Health 2020, 17(22), 8619; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228619 - 20 Nov 2020
Cited by 10 | Viewed by 3088
Abstract
Asthma affects millions of people globally and is especially concerning in populations living with poor air quality. This study examines the association of ambient outdoor air pollutants on asthma-related emergency department (ED) visits in children and adults throughout the Pittsburgh region. A time-stratified [...] Read more.
Asthma affects millions of people globally and is especially concerning in populations living with poor air quality. This study examines the association of ambient outdoor air pollutants on asthma-related emergency department (ED) visits in children and adults throughout the Pittsburgh region. A time-stratified case-crossover design is used to analyze the lagged effects of fine particulate matter (PM2.5) and gaseous pollutants, e.g., ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) on asthma-related ED visits (n = 6682). Single-, double-, and multi-pollutant models are adjusted for temperature and analyzed using conditional logistic regression. In children, all models show an association between O3 and increased ED visits at lag day 1 (OR: 1.12, 95% CI, 1.03–1.22, p < 0.05) for the double-pollutant model (OR: 1.10, 95% CI: 1.01-1.20, p < 0.01). In adults, the single-pollutant model shows associations between CO and increased ED visits at lag day 5 (OR: 1.13, 95% CI, 1.00–1.28, p < 0.05) and average lag days 0–5 (OR: 1.22, 95% CI: 1.00–1.49, p < 0.05), and for NO2 at lag day 5 (OR: 1.04, 95% CI: 1.00–1.07, p < 0.05). These results show an association between air pollution and asthma morbidity in the Pittsburgh region and underscore the need for mitigation efforts to improve public health outcomes. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
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Review

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29 pages, 804 KiB  
Review
Impact of Air Pollution on Asthma Outcomes
by Angelica I. Tiotiu, Plamena Novakova, Denislava Nedeva, Herberto Jose Chong-Neto, Silviya Novakova, Paschalis Steiropoulos and Krzysztof Kowal
Int. J. Environ. Res. Public Health 2020, 17(17), 6212; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176212 - 27 Aug 2020
Cited by 203 | Viewed by 25727
Abstract
Asthma is a chronic respiratory disease characterized by variable airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. Evidence suggests that air pollution has a negative impact on asthma outcomes in both adult and pediatric populations. The aim of this review is to summarize the [...] Read more.
Asthma is a chronic respiratory disease characterized by variable airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. Evidence suggests that air pollution has a negative impact on asthma outcomes in both adult and pediatric populations. The aim of this review is to summarize the current knowledge on the effect of various outdoor and indoor pollutants on asthma outcomes, their burden on its management, as well as to highlight the measures that could result in improved asthma outcomes. Traffic-related air pollution, nitrogen dioxide and second-hand smoking (SHS) exposures represent significant risk factors for asthma development in children. Nevertheless, a causal relation between air pollution and development of adult asthma is not clearly established. Exposure to outdoor pollutants can induce asthma symptoms, exacerbations and decreases in lung function. Active tobacco smoking is associated with poorer asthma control, while exposure to SHS increases the risk of asthma exacerbations, respiratory symptoms and healthcare utilization. Other indoor pollutants such as heating sources and molds can also negatively impact the course of asthma. Global measures, that aim to reduce exposure to air pollutants, are highly needed in order to improve the outcomes and management of adult and pediatric asthma in addition to the existing guidelines. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
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19 pages, 1446 KiB  
Review
Progress in Occupational Asthma
by Angelica I. Tiotiu, Silviya Novakova, Marina Labor, Alexander Emelyanov, Stefan Mihaicuta, Plamena Novakova and Denislava Nedeva
Int. J. Environ. Res. Public Health 2020, 17(12), 4553; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124553 - 24 Jun 2020
Cited by 25 | Viewed by 5557
Abstract
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of [...] Read more.
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation. Full article
(This article belongs to the Special Issue Occupational and Environmental Asthma)
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