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Abstract Rationale Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.

Background: The Lung, hEart, sociAl, boDy (LEAD) Study (ClinicalTrials.gov; NCT01727518; http://clinicaltrials.gov) is a longitudinal, observational, population-based Austrian cohort that aims to investigate the relationship between genetic, environmental, social, developmental and ageing factors influencing respiratory health and comorbidities through life. The general working hypothesis of LEAD is the interaction of these genetic, environmental and socioeconomic factors influences lung development and ageing, the risk of occurrence of several non-communicable diseases (respiratory, cardiovascular, metabolic and neurologic), as well as their phenotypic (ie, clinical) presentation. Methods: LEAD invited from 2011–2016 a random sample (stratified by age, gender, residential area) of Vienna inhabitants (urban cohort) and all the inhabitants of six villages from Lower Austria (rural cohort). Participants will be followed-up every four years. A number of investigations and measurements were obtained in each of the four domains of the study (Lung, hEart, sociAl, boDy) including data to screen for lung, cardiovascular and metabolic diseases, osteoporosis, and cognitive function. Blood and urine samples are stored in a biobank for future investigations. Results: A total of 11.423 males (47.6%) and females (52.4%), aged 6–80 years have been included in the cohort. Compared to governmental statistics, the external validity of LEAD with respect to age, gender, citizenship, and smoking status was high. Conclusions: In conclusion, the LEAD cohort has been established following high quality standards; it is representative of the Austrian population and offers a platform to understand lung development and ageing as a key mechanism of human health both in early and late adulthood.

Background: Low-cost particulate matter sensors have enabled new opportunities for exposure monitoring but require evaluation before application in epidemiological studies. This study assessed the performance of the SPS30 sensor integrated into the ARMIE portable monitoring sensor-node under controlled laboratory conditions. Methods: Sensors were co-located with two comparison instruments—the optical DustTrak photometer and the combined Scanning Mobility Particle Sizer (SMPS) and Aerodynamic Particle Sizer (APS)—across multiple aerosol sources, including candle burning, cooking, cigarette smoke, and clean air, under both regular and high-humidity conditions. Calibration performance was evaluated using leave-one-sensor-out and leave-one-source-out approaches. Results: The ARMIE node demonstrated strong agreement with the DustTrak (r = 0.93–0.98) and maintained linear response characteristics across emission types. Calibration reduced mean errors and narrowed the limits of agreement. Agreement with the SMPS + APS was moderate (r = 0.74–0.94) and characterized by systematic underestimation at higher concentrations. Conclusions: Overall, the ARMIE node achieved high correlation with the DustTrak, demonstrating that low-cost optical sensors can reliably capture temporal variability in particle concentrations relative to mid-cost photometers.

Residential wood combustion (RWC) is one of the largest sources of fine particles (PM2.5) in the Nordic cities. The current study aims to calculate the related health effects in four studied city areas in Sweden, Finland, Norway, and Denmark.

Cladosporium spp. and Alternaria spp. spores are dominating the airspora of Denmark. Currently, little is known about the influence of climate change on the fungal spore abundance in the air. The aim of this study was to examine temporal changes in airborne Alternaria and Cladosporium spores over 26 years. This is the first report of long-term airborne Cladosporium spore occurrence in Denmark. Air spore concentrations were obtained with a Burkard volumetric spore sampler placed in Copenhagen, Denmark, during June–September, 1990–2015. The highest monthly Spore integrals (SIn) for Alternaria were measured in August, whereas for Cladosporium July SIn was nearly as high as August SIn. Average Alternaria seasonal spore integral (SSIn) was 8615 Spores day m −3 , while average 3-month (July–September) Cladosporium SIn was 375,533 Spores day m −3 . Despite increasing annual temperature and decreasing relative humidity, we found a decreasing trend for Alternaria seasonal SIn (Slope = − 277, R 2  = 0.38, p  < 0.05), Alternaria (Slope = − 31, R 2  = 0.27, p  < 0.05) and Cladosporium (Slope = − 440, R 2  = 0.23, p  < 0.05) annual peak concentrations. We did not find any statistically significant trends for airborne Alternaria seasonal characteristics and duration, and likewise for Cladosporium 3-month SIn and peak concentration dates. Mean temperature was the main meteorological factor affecting daily spore concentrations. However, effect of meteorological parameters on daily spore concentrations was stronger for Cladosporium ( R 2  = 0.41) than for Alternaria ( R 2  = 0.21). Both genera had diurnal peaks during the day hours, earlier for Cladosporium (11:30–14:30) and later for Alternaria (15:00–19:00). Although Alternaria and Cladosporium daily concentrations were moderately correlated (Spearman’s correlation coefficient: r s  = 0.55, p  < 0.05), their overall annual indices were different, which indicates different sources and different factors determining spore release. We explain temporal decreasing trends in Alternaria SSIn by growing urbanisation around Copenhagen and by changes in agricultural practices.

The respiratory health effects of livestock farming have been on debate for more than three decades. Endotoxin-contaminated organic dusts are considered as the most important respiratory hazards within livestock environments. A comprehensive review of the knowledge from studies assessing the exposure status of livestock farmers is still to be published. The present study reviews research published within the last 30 years on personal exposure of livestock farmers to organic dust and endotoxin, focusing on studies on pig, poultry and cattle farmers. Applied measurement methods and reported levels of personal exposure for the total, inhalable and respirable fractions are summarized and discussed, with emphasis on the intensity of exposure and the size and distribution of the reported exposure variability. In addition, available evidence on potential determinants of personal exposure to dust and endotoxin among these farmers are documented and discussed, taking results from exposure determinant studies using stationary sampling approaches into consideration. Research needs are addressed from an epidemiological and industrial hygiene perspective. Published studies have been heterogeneous in design, and applied methodologies and results were frequently inadequately reported. Despite these limitations and the presence of an enormous variability in personal exposure to dust and endotoxin, no clear downward trends in exposure with time were observed, suggesting that working environments within stables remains largely uncontrolled. Exposure control and prevention strategies for livestock farmers are urgently required. These should focus on the development of novel and improved methods of controlling dust and endotoxin exposure within stables based on the currently available knowledge on determinants of exposure.

Abstract Purpose This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. Methods Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950–2012 and Embase 1980–2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. Results Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian–specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. Conclusions Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.

OBJECTIVE: The aim of this systematic review was to identify, evaluate, and synthesize the relation between ten potential occupational sensitizing exposure groups and asthma. METHODS: A systematic literature search was conducted in three databases for peer-reviewed articles published between July 2011 and March 2023. Exposures included ten potential occupational sensitizing exposure groups (amines, anhydrides, biocides [eg, pesticides], crustaceans, enzymes, mammals, metals, “mold, fungi and yeast”, molluscs, and other chemicals [eg, cleaning agents]) classified as having no or limited evidence of a causal relation with asthma in our previous overview of systematic reviews. We included observational and case studies. Study selection, data extraction, risk of bias assessment, and evidence level evaluation were conducted independently by two reviewers, who also upgraded or downgraded the level of evidence found in our overview. RESULTS: This review included 55 articles. The overall confidence in study results was rated high in 8, moderate in 18, and low in 29 studies. No new studies were found for molluscs. For the remaining exposures, we upgraded main groups of crustaceans and enzymes to moderate evidence, mammals and metals to limited/contradictory, and amines and biocides to very limited/contradictory. For subgroups/specific exposures, pesticides, cleaning agents – such as chloramine and disinfection products – and an unspecified group of other chemicals, specifically acrylates and epoxy, were upgraded to moderate. CONCLUSION: New occupational sensitizing exposures with moderate evidence include crustaceans, enzymes, pesticides, cleaning agents such as chloramine and disinfection products, and chemicals such as acrylates and epoxy.

OBJECTIVES: We investigated associations between bioaerosol exposures and work-shift changes in lung function and inflammatory markers among recycling workers. METHODS: Inhalable dust was measured with personal samplers and analyzed for endotoxin, bacteria, and fungi (incubated at 25 °C and 37 °C) levels. Lung function (FEV1, FVC) was measured before and after work-shifts and serum concentrations of inflammatory markers (CRP, SAA, CC16, IL1B, IL2, IL4, IL5, IL6, IL8, IL10, IL13, and TNF) after the shift. Associations were explored by linear mixed-effects models. RESULTS: We included 170 measurements from 88 production workers exposed to inhalable dust, endotoxin, bacteria, and fungi (25 °C and 37 °C) at geometric mean levels of 0.6 mg/m3, 10.7 EU/m3, 1.6×104 CFU/m3, 4.4×104 CFU/m3, and 103 CFU/m3, respectively, and 14 administrative workers exposed at 7-fold lower levels. No associations were observed between bioaerosol exposures and work-shift change in lung function. IL2, IL6, IL10, and TNF concentrations were positively associated with inhalable dust levels, SAA and IL6 with bacteria, CRP, SAA, IL8, and TNF with fungi (25 °C or 37 °C), with the latter being the only statistically significant finding (exp(β) 1.40, 95% confidence interval 1.01–1.96). CONCLUSIONS: This study of recycling workers exposed to bioaerosol levels generally below those of farmers and compost workers and above background levels did not indicate any acute effect on lung function. Several inflammatory markers tended to increase with exposure, suggesting a systemic effect. Future research should combine data from bioaerosol-exposed workers to uncover health risks that may form the basis for health-based occupational exposure limits.

Objective Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometrie criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures. Methods We used PubMed and Embase to identify relevant original epidemiological peer-reviewed articles, supplemented with citations identified from references in key review articles. This yielded 4528 citations. Articles were excluded for lack of lung function measurement, insufficient occupational exposure classification, lack of either external or internal referents, non-accounting of age or smoking effect, or major analytic inadequacies preventing interpretation of findings. A structured data extraction sheet was used for the remaining 147 articles. Final inclusion was based on a positive qualitative Scottish Intercollegiate Guidelines Network (SIGN) score (≥2+) for study quality, yielding 25 population-wide and 34 industry/occupation-specific studies, 15 on inorganic and 19 on organic dust exposure, respectively. Results There was a consistent and predominantly significant association between occupational exposures and COPD in 22 of 25 population-based studies, 12 of 15 studies with an inorganic/mineral dust exposure, and 17 of 19 studies on organic exposure, even though the studies varied in design, populations, and the use of measures of exposure and outcome. A nearly uniform pattern of a dose-response relationship between various exposures and COPD was found, adding to the evidence that occupational exposures from vapors, gas, dust, and fumes are risk factors for COPD. Conclusion There is strong and consistent evidence to support a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.