Standardization of the solute output from the Wright nebulizer is necessary in nonspecific bronchial challenge to obtain reproducible results. Airflow and driving pressure are known determinants of the output. In an epidemiological study, in which day-to-day variations in room temperature occurred, we found the reproducibility of the output from a Wright nebulizer to be outside the range of acceptance. We have, therefore, examined to what extent ambient temperature and humidity might influence the output from three Wright nebulizers. The solute output was linearly correlated not only to flow (r = 0.98) and driving pressure (r = 0.90) but also to room temperature (r = 0.96). The mean output increased approximately 23% when room temperature was increased from 19 to 24 degrees C. This is equivalent to an increase in airflow of more than one litre. Ambient humidity did not influence the nebulizer output. When temperature was included in the calibration procedure, the coefficient of variation of the output decreased from 5 to 2%. This emphasizes the need for calibration of the Wright nebulizer with regard to ambient temperature as well as to airflow and pressure, especially in epidemiological field studies in which large variations of temperature are likely to occur.
Norwegian Armed Forces reported episodes of acute respiratory symptoms after exposure to fumes from firing small arms weapon HK416 (Heckler and Koch) using unleaded ammunition. These fumes contain a mixture of gases and solid particles, that may be capable of inducing inflammatory immune responses. The aim of the present study was to find out if exposure to fumes from small arms could induce systemic and airway inflammation, and whether there were any differences between the ammunition types (leaded, and two types of unleaded).
Methods
Fifty-five healthy men (age 19–62) were recruited and randomised to three groups using HK416 and one of the three types of ammunition. Spirometry and collection of blood and sputum samples were performed 2–4 days before shooting, and 1.5 hour (spirometry), 24 hour (blood and spirometry) and 48 hour (sputum) after shooting under standardised conditions. Exposure was monitored.
Results
All subjects had a significant increase in median sputum and blood neutrophils (sputum: 46% to 73%, p<0.001; blood: 2.9 × 106/mL to 7.1 × 106/mL, p<0.001). CRP was significantly elevated from 1.3 mg/L to 18.5 mg/L (p<0.001) along with other markers of systemic inflammation (PTX3, YKL-40, SpD, CC16, CXCL16, vWF, MPO, CD25, CD14). CRP and number of neutrophils in blood had a larger increase with unleaded as compared to leaded ammunition. For the whole group, mean FEV1 and FVC decreased 290 mL (p<0.001) and 130 mL (p<0.001), respectively.
Discussion
All subjects displayed elevated airway and in particular systemic inflammation following the use of small arms. The changes in systemic markers were enhanced acute stress response (CRP, PTX3), immune cell upregulation (sCD25, sCD14) and increased vascular inflammation (MPO, vWF, CXL16, YKL40). Increased airway inflammation was present at 48 hour post exposure and was accompanied by reduced spirometry that appeared <1.5 hour and lasted >24 hour after exposure. These results suggest that soldiers may be at increased risk to inflammation-based disorders when repeatedly using small arms.
The relationship between dust exposure and annual decline in lung function among employees in the smelting industry is unknown.The aim of the study was to investigate the relationship between annual change in lung function and occupational dust exposure among workers in 15 Norwegian smelters.All employees (n = 2,620) were examined annually for 5 years (11,335 health examinations). At each examination spirometry was performed and a respiratory questionnaire was completed. The smelters were grouped as follows: (1) ferrosilicon alloys (FeSi) and silicon metal (Si-metal); and (2) silicon manganese (SiMn), ferromanganese (FeMn), and ferrochromium (FeCr). A job exposure matrix was available on the basis of 2,619 personal dust exposure measurements. The association between lung function expressed as FEV(1) and FVC per squared height (height(2)) and dust exposure was investigated using multivariate linear mixed model analyses.The annual change in FEV(1)/height(2) (deltaFEV(1)) related to dust exposure in the FeSi/Si-metal and SiMn/FeMn/FeCr smelters was -0.42 (95% confidence interval, -0.95 to 0.11) and -1.1 (-2.1 to -0.12) (ml/m(2)) x (mg/m(3))(-1) x year(-1), respectively. The annual decline in FEV(1)/height(2) was 1.6 ml/m(2) (0.15 to 3.1) steeper in smokers than in nonsmokers. The median geometric mean of the time-weighted dust exposure concentration levels of the employees was 2.3 mg/m(3) in the FeSi/Si-metal smelters and 1.6 mg/m(3) in the SiMn/FeMn/FeCr smelters. Among nonsmokers, deltaFEV(1) was -0.86 (-1.6 to -0.10) and -1.1 (-2.5 to 0.25) (ml/m(2)) x (mg/m(3))(-1) x year(-1) in the FeSi/Si-metal and SiMn/FeMn/FeCr smelters, respectively. Thus, for a 1.80 m tall employee the annual decline in FEV(1) associated with average dust exposure was 5.7 ml/year in the SiMn/FeMn/FeCr smelters, and 6.4 ml/year for a nonsmoker in the FeSi/Si-metal smelters.In all smelters combined, the annual change in FEV(1) was negatively associated with increasing dust exposure. This association was also significant among workers in SiMn/FeMn/FeCr smelters and among nonsmokers in the FeSi/Si-metal smelters.
ABSTRACTS — STATE OF THE ART Inflammation in COPDC.-G. Lofdahl Department of Respiratory Medicine and Allergology,Lund University, SwedenE-mail address: Claes-Goran.Lofdahl@skane.seThe role of inflammation in the pathogenesis of COPDhas been emphasised during the last years, and this areais now intensively researched. The current concept ofinflammation as a response to environmental noxiousagents, as cigarette smoke resulting in a local airwayinflammation is getting increasing evidence. However,recently systemic inflammation has been studied, wherestill the hen and egg debate between local and systemiceffects is ongoing.The local inflammation in the airway is involvinginnate and adaptive immune reactions. Throughout theairway inflammatory reactions are seen, most wellstudied in morphological samples of smokers with andwithout COPD. In most patients there is a centralbronchitis seen, with inflammatory cells, hypertrophiaof mucous producing cells and glands. In the bronchiolesthe inflammation can be intensive in spite of relativelymild COPD. Emphysema can occur early in the develop-ment of disease, and recently it has also been empha-sised that there is often an intensive vascular inflam-mation in COPD lungs. Most inflammatory cells arerecruited and activated in the airways of COPD patients.The epithelium as the first resort for noxious agents isactivated, with certain pro-inflammatory activities.Macrophages are recruited to both the airway paren-chyma and perhaps more important to the airwaylumen, the obvious reason being phagocytosis particlesin the cigarette smoke. They also take part in thefurther recruitment of inflammatory cells as neutro-phils. Both macrophages and neutrophils produce pro-teases, with important effects on the alveolar structureduring emphysema development. Both cell types alsoproduce oxygen radicals, which further enhances theinflammatory reaction, and also decreases the ant-protease activity in the airway. Lymphocyte reactionsseem to be abundant in the COPD inflammation, and thenumber of cytotoxic T-lymphocytes(CD8 positive) is wellcorrelated to the severity of the disease, with earlychanges also in the preclinical phase. A more recentfinding is that the adaptive immune system is involved
A number of Norwegian soldiers have reported health problems after live-fire training using the HK416 rifle. The objective of this study was to characterize gaseous and particulate emissions from three different types of ammunition, and record the health effects after exposure to emissions from live-firing. Fifty-five healthy, non-smoking men (mean age 40 years) were recruited and divided randomly into three groups, one for each type of ammunition. All subjects fired the HK416 rifle in a semi-airtight tent for 60 min using leaded ammunition, unleaded ammunition and modified unleaded ammunition. Gaseous and particulate emissions were monitored within the tent. The symptoms experienced by the subjects were recorded immediately after and the day after firing using a standardized questionnaire. The concentrations of particulate matter and copper exceeded their respective occupational exposure limits (eight hours per day, five days a week) by a factor of 3 and 27, respectively. Of the 55 subjects, 54 reported general and respiratory symptoms. The total number of symptoms reported was significantly higher among shooters using unleaded ammunition as compared with the use of leaded and modified unleaded ammunition. Copper was the substance that had the highest concentration relative to its toxicity. Although the general symptoms were found to be consistent with the development of metal fume fever, the respiratory symptoms indicated an irritant effect of the airways different from that seen in metal fume fever. More symptoms were reported when unleaded ammunition was used compared with leaded and modified unleaded ammunition.
Objectives Declining participation in epidemiological studies has been reported in recent decades and may lead to biased prevalence estimates and selection bias. The aim of the study was to identify possible causes and effects of non-response in a population-based study of respiratory health in Norway. Design The Telemark study is a longitudinal study that began with a cross-sectional survey in 2013. Setting In 2013, a random sample of 50 000 inhabitants aged 16–50 years, living in Telemark county, received a validated postal questionnaire. The response rate was 33%. In this study, a random sample of 700 non-responders was contacted first by telephone and then by mail. Outcome measures Response rates, prevalence and OR of asthma and respiratory symptoms based on exposure to vapours, gas, dust or fumes (VGDF) and smoking. Causes of non-response. Results A total of 260 non-responders (37%) participated. Non-response was associated with younger age, male sex, living in a rural area and past smoking. The prevalence was similar for responders and non-responders for physician-diagnosed asthma and several respiratory symptoms. The prevalence of chronic cough and use of asthma medication was overestimated in the Telemark study, and adjusted prevalence estimates were 17.4% and 5%, respectively. Current smoking was identified as a risk factor for respiratory symptoms among responders and non-responders, while occupational VGDF exposure was a risk factor only among responders. The Breslow-Day test detected heterogeneity between productive cough and occupational VGDF exposure among responders. Conclusions The Telemark study provided valid estimates for physician-diagnosed asthma and several respiratory symptoms, while it was necessary to adjust prevalence estimates for chronic cough and use of asthma medication. Reminder letters had little effect on risk factor associations. Selection bias should be considered in future investigations of the relationship between respiratory outcomes and exposures.
Chronic lung allograft dysfunction (CLAD) is a serious complication after lung transplantation (LuTx) and is associated with elevated proportions of neutrophils in bronchoalveolar lavage (BAL). Induced sputum is a less-invasive sampling method than BAL and assesses markers of inflammation on the surfaces of large central airways. We wanted to examine whether % neutrophil levels in induced sputum were elevated prior to CLAD diagnosis among LuTx recipients, and whether sputum markers of inflammation can be used as a tool for predicting the development of CLAD. Induced sputum samples were collected at 1, 3, 6, 12, and 24 months post-LuTx in 36 patients with a history of COPD or pulmonary fibrosis, and of these, 16 developed CLAD either during or after the sputum surveillance period. At 2 years, median (IQR) % neutrophils in induced sputum were significantly higher among patients with CLAD compared with those without CLAD [73 (52-80) % vs 59 (41-76) %, p = .01]. Interestingly, we found a significant increase in the rate of change in % neutrophils beginning at 90 days preceding the diagnosis of CLAD. This suggests using sputum neutrophil percentage as a surveillance modality for monitoring lung allograft function after LuTx.
Abstract Background : For interpretation of pulmonary function tests (PFTs), reference values based on sex, age, height and ethnicity are needed. In Norway, the European Coal and Steel Community (ECSC) reference values remain widely used, in spite of recommendations to implement the more recent Global Lung Function Initiative (GLI) reference values. Objective : To assess the effects of changing from ECSC to GLI reference values for spirometry, DLCO and static lung volumes, using a clinical cohort of adults with a broad range in age and lung function. Methods : PFTs from 577 adults (18-85 years, 45% females) included in recent clinical studies were used to compare ECSC and GLI reference values for FVC, FEV1, DLCO, TLC and RV. Percent predicted and lower limit of normal (LLN) were calculated. Bland-Altman plots and paired t-test were used to compare GLI and ECSC predicted values. Results : In both genders, GLI predicted values were lower for FVC and FEV1, and higher for DLCO and RV, compared to ECSC. The disagreement was most pronounced in females, with mean (SD) difference 15 (5) percent points (pp) for DLCO and 17 (9) pp for RV (p<0.001). With GLI, DLCO was below LLN in 23% females, as compared to in 49% with ECSC. Conclusions : The observed differences between GLI and ECSC reference values are likely to entail significant consequences with respect to criteria for diagnostics and treatment, health care benefits and inclusion in clinical trials. To ensure equity of care, the same reference values should be consistently implemented across centers nationwide.
