The role of occupational factors and individual susceptibility in the development and course of bronchopulmonary diseases

Over the past decades, the world has seen an increase in occupational lung diseases, the leaders being asthma and chronic obstructive pulmonary disease (COPD). The article presents the results of 5-year observation of food industry workers. Clinical functional and molecular genetic studies have been carried out to identify the frequency and severity of asthma and COPD along with the individual predisposition to pulmonary conditions.

Methods. 76 people of both sexes with the average age of 43.5 ± 3.6 years were examined on an outpatient basis. All subjects had daily contact with toxic and allergenic aerosols and organo-mineral dust. The respiratory function and the presence of bronchial hyperresponsiveness to occupational factors was assessed by spirography and peak flowmetry in response to exposure and elimination of industrial aerosols. Immunological and molecular genetic tests were performed: identification of hyposecretory alleles of the α1 -АТ gene, determination of polymorphisms of the GSTM1 and GSTT1 genes, immunoglobulin levels (IgE, IgM, IgG) and cytokine status (IL-4, -6, -8; TNF-α).

Results. During the 5-year follow-up period, there was a significant increase in the number of employees with severe respiratory symptoms – 36.8% (95% CI – 21.2–36.8; p < 0.05) and a statistically significant decrease in the respiratory function (p < 0.001). Progressive decrease in the respiratory function in healthy individuals and the appearance of new and more severe cases of asthma and COPD were registered primarily among workers with hyposecretory alleles of the α₁ -АТ gene and/or zero alleles of the glutathioneS-transferase genes (GSTM1 and GSTT1) in combination with abnormal cytokine status.

Conclusion. Individual risk factors for the development of asthma and COPD in individuals working in contact with toxic and allergenic aerosols and organo-mineral dust are hyposecretory PiMZ variant of the α₁ -АТ gene and deletions in the glutathione-S-transferase genes (GSTM1 0/0 and GSTT1 0/0) in combination with abnormal cytokine status. Long-term research results suggest the prognostic value of assessing individual sensitivity to industrial aerosols and the development of bronchopulmonary pathology.

1. De Matteis S., Heederik D., Burdorf A. et al. Current and new challenges in occupational lung diseases. Eur. Respir. Rev. 2017; 26 (146): 170080. DOI: 10.1183/16000617.0080-2017.

2. Baur X., Sigsgaard T., Aasen T.B. et al. Guidelines for the management of work-related asthma. Eur. Respir. J. 2012; 39 (3): 529–545. DOI: 10.1183/09031936.00096111.

3. Suganuma N., Natori Y., Kurosawa H. et al. Update of occupational lung disease. J. Occup. Health. 2019; 61 (1): 10–18. DOI: 10.1002/1348-9585.12031.

4. Thirteenth Session of the Joint ILO/WHO Committee on Occupational Health. Report of the Committee, JCOH/XIII/D.4. Geneva, 9–12 December, 2003. Available at: http://www.icohweb.org/site/multimedia/asbestos/Enclosure_5.pdf [Accessed: July 6, 2018].

5. Kobayashi S., Hanagama M., Yamanda S. et al.Impact of a large-scale natural disaster on patients with chronic obstructive pulmonary disease: the aftermath of the 2011 Great East Japan Earthquake. Respir. Investig. 2013; 51 (1): 17–23. DOI: 10.1016/j.resinv.2012.10.004.

6. Tarlo S.M. Occupational lung diseases. Can. J. Respir. Crit. Care Sleep Med. 2020; 4 (Suppl. 1): S6–8. DOI: 10.1080/24745332.2020.1726231.

7. Cullinan P., Muñoz X., Suojalehto H. et al. Occupational lung diseases: from old and novel exposures to effective preventive strategies. Lancet Respir. Med. 2017; 5 (5): 445–455. DOI: 10.1016/S2213-2600(16)30424-6.

8. European Lung White Book. Occupational risk factors. Available at: https://www.erswhitebook.org/chapters/occupational-risk-factors/ [Accessed: July 6, 2018].

9. Burge P.S. Recent developments in occupational asthma. Swiss. Med. Wkly. 2010; 140 (9–10): 128–132.

10. Schulte P., Howard J. Genetic susceptibility and the setting of occupational health standards. Annu. Rev. Public. Health. 2011; 32: 149–159. DOI: 10.1146/annurev-publhealth-031210-101144.

11. Vasil'eva O.S., Kuz'mina L.P., Kulemina E.A., Kolyaskina M.M. [Clinical and molecular aspects of occupational asthma development in meat packers]. Pul'monologiya. 2012; (3): 39–44. DOI: 10.18093/0869-0189-2012-0-3-39-44 (in Russian).

12. Kuz'mina L.P., Khotuleva A.G. [Molecular mechanisms of nosological syntropy of occupational bronchial asthma]. In: Izmerov N.F., ed. [Occupational Respiratory Diseases: National Guidelines]. Moscow: GEOTAR-Media; 2015: 180–187 (in Russian).

13. Park D., Moore V.C., Burge C.B.S. et al. Serial PEF measurement is superior to cross-shift change in diagnosing occupational asthma. Eur. Respir. J. 2009; 34 (3): 574–578. DOI: 10.1183/09031936.00150108.

14. Vasil'eva O.S., Sorokina N.S. [Occupational bronchial asthma]. In: Izmerov N.F., ed. [Occupational Respiratory Diseases: National Guidelines]. Moscow: GEOTAR-Media; 2015: 338–363 (in Russian).

15. Vasil'eva O.S., Chernyak A.V., Neklyudova G.V. at al. [Clinical and functional examination methods in the diagnosis of occupational bronchopulmonary diseases]. In: Izmerov N.F., ed. [Occupational Respiratory Diseases: National Guidelines]. Moscow: GEOTAR-Media; 2015: 607–634 (in Russian).

16. Burge S. Management of an individual worker with occupational asthma. In: Sigsgaard T., Heederik D., eds. Occupational Asthma. Progress in Inflammation Research. Birkhäuser Basel. 2010: 249–270. DOI: 10.1007/978-3-7643-8556-9_14.

17. Trivedi V., Apala D.R., Iyer V.N. Occupational asthma: diagnostic challenges and management dilemmas. Curr. Opin. Pulm. Med. 2017; 23 (2): 177–183. DOI: 10.1097/MCP.0000000000000352.

18. Lemiere C., Bernstein D. Occupational asthma: Management, prognosis and prevention. UpToDate. November 07, 2019. Available at: https://www.uptodate.com/contents/occupational-asthma-management-prognosis-and-prevention [Accessed: July 1, 2021].

19. British Thoracic Society. British Guidelines on the Management of Asthma. Revised 2017. Available at: https://www.brit-thoracic.org.uk [Accessed: July 6, 2018].

20. Mehta A.J., Miedinger D., Keidel D. et al. Occupational exposure to dusts, gases and fumes and incidence of chronic obstructive pulmonary disease in the swiss cohort study on air pollution and lung and heart diseases in adults. Am. J. Respir. Crit. Care Med. 2012; 185 (12): 1292–1300. DOI: 10.1164/rccm.201110-1917OC.

21. Kurth L., Doney B., Weinmann S. Occupational exposures and chronic obstructive pulmonary disease (COPD): comparison of a COPD-specific job exposure matrix and expert-evaluated occupational exposures. Occup. Environ. Med. 2017; 74 (4): 290–293. DOI: 10.1136/oemed-2016-103753.