Jennifer Hoyle

North Manchester General Hospital

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Paul Cullinan

Imperial College London

David Fishwick

Health & Safety Laboratory

Sherwood Burge

Heartlands Hospital

Robert Niven

Manchester Academic Health Science Centre

Olivier Vandenplas

UCLouvain

Xavier Muñoz

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Simon Bailey

Great North Children's Hospital

Hille Suojalehto

Finnish Institute of Occupational Health

Richard Booton

Wythenshawe Hospital

J. Sastre

Hospital Universitario Fundación Jiménez Díaz

Cooperative Institutions

John Wiley & Sons (United States)

Imperial College London

University of Manchester

Hudson Institute

Royal Brompton Hospital

Finnish Institute of Occupational Health

North Manchester General Hospital

Wythenshawe Hospital

Manchester Academic Health Science Centre

Manchester University NHS Foundation Trust

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Annals of Neurology (2021)

Ryan S. Dhindsa Anthony W. Zoghbi Daniel Krizay Chirag Vasavda David Goldstein

Canada & Mexico), €1286.00(Europe), £1020.00(UK), US$1993.00 (Rest of World).Prices are exclusive of tax.Asia-Pacific GST,

Annals

10.1002/ana.26007

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Guest Editors

European Respiratory Society eBooks (2020)

Vivi Schlünssen Else Toft Würtz Martin Rune Hassan Hansen Martin R Miller

10.1183/2312508x.10023520

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50 Malignant mesothelioma in the North West - are diagnostic delays affecting survival?

Lung Cancer (2011)

David Thomson Jennifer Hoyle Pauline Quennell

10.1016/s0169-5002(11)70050-2

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S4 Occupational asthma; is this the cause of excess respiratory symptoms and COPD described in bitumen exposed workers?

Thorax (2011)

N. Surange Jennifer Hoyle

Introduction

Epidemiological studies suggest increased risk of asthma and COPD in asphalt exposed workers.1 Bitumen is used in this industry. In this case we describe occupational asthma caused by bitumen exposure in a lab environment. This is the first such report to our knowledge.

Case History

A 49-year old male with no history of asthma or atopy and <5 pack years smoking history presented with airflow obstruction on surveillance spirometry, cough and wheeze. He analysed hot bitumen samples (1900 C) in a lab environment without using respiratory protective equipment. Spirometry FEV₁ 57%, FVC 85% ratio 55%. Respiratory symptoms improved after 3 weeks off work, returning soon after he rejoined the lab. Peak flow rates were variable and lower at work. Analysis with OASYS scored 3.08 (Abstract S4 figure 1). Histamine challenge test was positive (PC₂₀ 2.216 mg/ml). Skin prick test to paraldehyde was positive. After 8 weeks away from the exposed environment the subject was asymptomatic, continued to have obstructive spirometry but improved bronchial reactivity (PC₂₀ 7.489 mg/ml) without medication and improved peak flows with little diurnal variation. One week after restarting work the respiratory symptoms returned. Repeat OASYS charts scored 3.14 with histamine reactivity similar to baseline (PC₂₀ 2.81 mg/ml) after 4 weeks. A specific challenge test was not possible due to the problems with heating bitumen to 1900^°C in the hospital lab.

Conclusion

The progression of symptoms and lung function in relation to work history supports the diagnosis of occupational asthma induced by bitumen fume exposure. This has not been reported previously. The possible mechanisms include sensitisation to short chain aldehydes, produced by partial combustion of bitumen which oxidises at these temperatures. Other potential sensitisers contained in bitumen are nickel and vanadium. Further studies are needed to investigate the by-products of heated bitumen and whether the previously described excess of COPD and respiratory disease in these workers is due to unidentified occupational asthma from bitumen fume exposure.

Wheeze

Atopy

10.1136/thoraxjnl-2011-201054b.4

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Citations (2)

S158 Occupational asthma; referral patterns from primary care in the UK

Thorax (2010)

Jennifer Hoyle L. Hussey Raymond Agius

Introduction and Objectives

Occupational asthma is the commonest reported occupational lung disease in the UK¹.The British Occupational Health Research Foundation (BOHRF)² guidelines 2010 recommend that ‘all family practices be able to screen for occupational asthma, and have a plan for further management’. The standards of care for occupational asthma³ recommend ‘early referrals to a specialist with an interest in occupational asthma if such a diagnosis is suspected’. This referral should take place ‘after occupational asthma is screened for before important life decisions are made’. (SIGN guidelines⁴). Very little is known about the proportion of cases that are referred on to clinical specialists once identified.

Methods

The Health & Occupation Reporting network in General Practice (THOR-GP) at the University of Manchester, collects work-related ill-health data between 250 and 300 GPs trained to diploma level in occupational medicine. Cases with a diagnosis of occupational asthma reported in 2006–2009 were divided into subgroups by their causative agent. Cases referred to a hospital specialist were compared to those not referred.

Results

In 2006–2009, GPs reported 4902 cases of work-related ill-health, of which 115 (2%) were reports of respiratory disease. 33 were diagnosed with asthma, 6 were referred to a hospital specialist (Abstract S158 Figure 1). The cases not referred included workers exposed to a variety of known asthmagens.

Conclusion

Despite national recommendations, these data show that the majority of cases suspected as having occupational asthma are not referred to hospital specialists from primary care. It is not known if the lack of referral affects outcome with regards to disease prognosis, disability or employment status.

Occupational Asthma

Occupational lung disease

10.1136/thx.2010.150953.9

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The provision of EBUS-TBNA services across a UK lung cancer network; a report from the Greater Manchester and Cheshire Lung Cancer Network EBUS Sub-Group

Matthew Evison Philip Crosbie Julie Martin Rajesh Shah Helen Doran

Introduction: Given the expansion of EBUS services in recent years, there is a need to ensure timely and equitable access to quality assured EBUS for lung cancer patients. Materials and Methods: In 2012, the number of centres providing EBUS in the former Greater Manchester and Cheshire Cancer Network increased from one to four. This prompted the development of a Network EBUS sub-group and service specification mandating the collection of pre-defined data for all procedures. Analysis of the prospectively maintained central database was undertaken for this report. Results: From the 1st January 2012 to 30th September 2013, 758 lung cancer patients underwent EBUS-TBNA. Fifty six per cent of procedures (425/758) were for nodal staging with the remainder for pathological diagnosis. The mean time from referral to procedure was 7.4 days (SD +/-4.9). There were 6 major complications (0.7%). 4.8% (43/894) of lymph nodes were inadequately sampled and malignancy was confirmed in 496 lymph nodes. The overall sensitivity and negative predictive value was 84.5% (CI 81.4-87.2%) and 75.6% (CI 71.0-79.7%) respectively, when inadequate results are classified as false-negatives. There was variability in the rate of missing data, inadequate sampling, sensitivity, negative predictive value and rate of surgical sampling of negative nodes across the EBUS centres. Discussion: A collaborative approach to the provision of EBUS services in a Cancer Network is feasible. All centres need to reduce variation in key outcomes. We believe that quality assurance of EBUS services should be mandated by all Cancer Networks to ensure best outcomes for all patients.

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Occupational Asthma in Foundry Workers

The Annals of Occupational Hygiene (2002)

Nicola Cherry Jennifer Hoyle G Burgess Martin Dippnall Julia Smedley

A study was carried out of 911 men in 10 ferrous foundries in England. The 509 men exposed to chemical binders in core and mould work were more likely to complain of chest tightness (16.1%) that was worse on working days than the 402 non-exposed men (7.7%) from the comparison group; an odds ratio of 2.32 (95% confidence interval 1.50–3.61) was found for chest tightness having allowed for confounders. Of the 170 exposed men complaining of at least one work-related symptom, 144 underwent histamine challenge testing; 20 (3.9% of exposed men) were positive. In the non-exposed group only eight (2.0% of the unexposed group) were positive. No difference was seen between exposure groups in the small number of cases diagnosed as occupational asthma. Exposures to isocyanates and amines were below detection levels in all foundries but aldehydes were detected in two and furfuryl alcohol in six. Tracing of ex-employees was difficult, but gave no evidence of major differences in health between those who had left exposed or other jobs. Although there was only weak evidence of respiratory ill health associated with foundry work in this study, the potential exists where exposures to chemical binders are high.

Occupational Asthma

Health Surveillance

10.1093/annhyg/46.suppl_1.373

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Citations (2)

Assessment of Dyspnea in Asthma: Validation of the Dyspnea-12

Journal of Asthma (2011)

Janelle Yorke Anne‐Marie Russell Jeff Swigris Caroline Shuldham Carol Haigh

Background. Dyspnea is a prominent symptom in asthma. The Dyspnea-12 (D-12), an instrument that quantifies breathlessness using 12 descriptors that tap the physical and affective aspects, has shown promise for the measurement of dyspnea in cardiorespiratory disease. Objective. We report the results of a study designed to test the validity and reliability of the D-12 in a population of patients with asthma. Methods. This cross-sectional study included 102 patients with asthma. Subjects completed the D-12, Hospital Anxiety and Depression scale, St. George's Respiratory Questionnaire (SGRQ), and Medical Research Council scale. Confirmatory factor analysis confirmed the two-component structure of the D-12 (i.e., seven items that tap the physical aspects of breathlessness and five items that tap the affective aspects). Results. The D-12 subscales had excellent internal reliability (Cronbach's alpha for the "physical" score was 0.94 and the affective score was 0.95). The D-12 physical component was more strongly correlated with SGRQ Symptoms (r = 0.648), SGRQ Activities (r = 0.635) and Medical Research Council grade (r = 0.636), while the affective component was more strongly correlated with SGRQ Impacts (r = 0.765) and Hospital Anxiety and Depression scale scores (anxiety r = 0.641 and depression r = 0.602). Conclusion. This study supports validity of the D-12 for use in the assessment of dyspnea of patients with asthma. It assesses one of the most pertinent symptoms of asthma from two viewpoints—physical and affective.

Depression

10.3109/02770903.2011.585412

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Citations (72)

EBUS-guided mediastinal lung cancer staging: monitoring of quality standards improves performance: Table 1

Thorax (2016)

Matthew Evison Philip Crosbie Julie Martin Rajesh Shah Helen Doran

This audit examined key performance indices related to endobronchial ultrasound (EBUS)-guided mediastinal lung cancer staging before and after the introduction of defined quality standards, at four independent EBUS centres in one cancer network. Data from 642 procedures were prospectively collected and analysed. The introduction of standards was associated with a significant increase (p<0.001) in sampling of key mediastinal lymph node stations (4R, 4L and 7) and a reduction in the variability of staging sensitivity between centres. These data reinforce the requirement for an appropriate regulatory framework for EBUS-transbronchial needle aspiration provision that includes quality assurance and performance monitoring.

Endobronchial ultrasound

Mediastinal lymph node

Lung cancer staging

10.1136/thoraxjnl-2015-206985

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Occupational asthma and the paper recycling industry

Occupational Medicine (2009)

Steven Tran H. Francis Jennifer Hoyle Robert Niven

Occupational disease linked to the paper recycling industry has not been well documented. No previously confirmed formal diagnosis of occupational asthma (OA) caused by hydroxylamine has been made.We have assessed and performed occupational assessment of eight workers involved in this industry. Two of these were later diagnosed with OA and are reported here.Both workers developed their respiratory symptoms within 2 years of the first use of the chemical hydroxylamine as part of the 'de-inking' process. Hydroxylamine was used as a substitute for glutaraldehyde on risk grounds, although no prior cases of OA had been found. The two workers had worked at the same plant for 11 and 20 years, respectively. Both gave histories of work-related wheeze, shortness of breath and cough. Both cases performed OASYS peak flow records over a 3-week period and had OASYS II index of 2.85 and 2.67, respectively. Both were redeployed on site to non-exposed areas and subsequently demonstrated improvement in bronchial reactivity. Case 2 subsequently consented to and underwent a blinded, placebo-controlled occupational challenge using hydroxylamine demonstrating a significant isolated late asthmatic response.We believe that these are the first two confirmed cases of OA caused by hydroxylamine in the paper recycling industry.

Occupational Asthma

Wheeze

Hydroxylamine

Occupational disease

Occupational lung disease

10.1093/occmed/kqp024

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Citations (7)