Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-29 (of 29 Records) |
Query Trace: Petsonk E[original query] |
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Historical shift in pathological type of progressive massive fibrosis among coal miners in the USA
Go LHT , Rose CS , Zell-Baran LM , Almberg KS , Iwaniuk C , Clingerman S , Richardson DL , Abraham JL , Cool CD , Franko AD , Green FHY , Hubbs AF , Murray J , Orandle MS , Sanyal S , Vorajee NI , Sarver EA , Petsonk EL , Cohen RA . Occup Environ Med 2023 80 (8) 425-430 BACKGROUND: Pneumoconiosis among coal miners in the USA has been resurgent over the past two decades, despite modern dust controls and regulatory standards. Previously published studies have suggested that respirable crystalline silica (RCS) is a contributor to this disease resurgence. However, evidence has been primarily indirect, in the form of radiographic features. METHODS: We obtained lung tissue specimens and data from the National Coal Workers' Autopsy Study. We evaluated specimens for the presence of progressive massive fibrosis (PMF) and used histopathological classifications to type these specimens into coal-type, mixed-type and silica-type PMF. Rates of each were compared by birth cohort. Logistic regression was used to assess demographic and mining characteristics associated with silica-type PMF. RESULTS: Of 322 cases found to have PMF, study pathologists characterised 138 (43%) as coal-type, 129 (40%) as mixed-type and 55 (17%) as silica-type PMF. Among earlier birth cohorts, coal-type and mixed-type PMF were more common than silica-type PMF, but their rates declined in later birth cohorts. In contrast, the rate of silica-type PMF did not decline in cases from more recent birth cohorts. More recent year of birth was significantly associated with silica-type PMF. CONCLUSIONS: Our findings demonstrate a shift in PMF types among US coal miners, from a predominance of coal- and mixed-type PMF to a more commonly encountered silica-type PMF. These results are further evidence of the prominent role of RCS in the pathogenesis of pneumoconiosis among contemporary US coal miners. |
Pathology and mineralogy demonstrate respirable crystalline silica is a major cause of severe pneumoconiosis in US coal miners
Cohen RA , Rose CS , Go LHT , Zell-Baran LM , Almberg KS , Sarver EA , Lowers HA , Iwaniuk C , Clingerman SM , Richardson DL , Abraham JL , Cool CD , Franko AD , Hubbs AF , Murray J , Orandle MS , Sanyal S , Vorajee NI , Petsonk EL , Zulfikar R , Green FHY . Ann Am Thorac Soc 2022 19 (9) 1469-1478 RATIONALE: The reasons for resurgent coal workers' pneumoconiosis and its most severe forms, rapidly progressive pneumoconiosis and progressive massive fibrosis (PMF), in the United States (US) are not yet fully understood. OBJECTIVE: To compare the pathologic and mineralogic features of contemporary coal miners suffering severe pneumoconiosis to their historical counterparts. METHODS: Lung pathology specimens from 85 coal miners with PMF were included for evaluation and analysis. We compared the proportion of cases with pathologic and mineralogic findings in miners born between 1910 and 1930 (historical) to those born in or after 1930 (contemporary). RESULTS: We found a significantly higher proportion of silica-type PMF (57% vs. 18%, p<0.001) among contemporary miners compared to their historical counterparts. Mineral dust alveolar proteinosis (MDAP) was also more common in contemporary miners compared to their historical counterparts (70% vs. 37%, p<0.01). In situ mineralogic analysis showed the percentage (26.1% vs. 17.8%, p<0.01) and concentration (47.3 x 108 vs. 25.8 X 108 particles/cm3, p=0.036) of silica particles was significantly greater in specimens from contemporary miners compared to their historical counterparts. The concentration of silica particles was significantly greater when silica-type PMF, MDAP, silicotic nodules, or immature silicotic nodules were present (p<0.05). CONCLUSIONS: Exposure to respirable crystalline silica appears causal in the unexpected surge in severe disease in contemporary miners. Our findings underscore the importance of controlling workplace silica exposure in order to prevent the disabling and untreatable adverse health effects afflicting US coal miners. Primary Source of Funding: Alpha Foundation for the Improvement of Mine Safety and Health, Inc. |
The NIOSH B Reader Certification Program-An Update Report (1987-2018) and Future Directions
Halldin CN , Hale J , Weissman D , Attfield M , Parker JE , Petsonk E , Cohen R , Markle T , Blackley D , Wolfe A , Tallaksen R , Laney AS . J Occup Environ Med 2019 61 (12) 1045-1051 OBJECTIVE: The NIOSH B Reader Program provides the opportunity for physicians to demonstrate proficiency in the International Labour Office (ILO) system for classifying radiographs of pneumoconioses. We summarize trends in participation and examinee attributes and performance during 1987-2018. METHODS: Since 1987, NIOSH has maintained details of examinees and examinations. Attributes of examinees and their examination performance were summarized. Simple linear regression was used in trend analysis of passing rates over time. RESULTS: The mean passing rate for certification and recertification for the study period was 40.4%, and 82.6%, respectively. Since the mid-1990 s, the number of B Readers has declined and the mean age and years certified has increased. CONCLUSIONS: To address the declining B Reader population, NIOSH is currently taking steps to modernize the program and offer more opportunities for training and testing. |
Pneumoconioses radiographs in a large population of U.S. coal workers: Variability in A reader and B reader classifications by using the International Labour Office Classification
Halldin CN , Blackley DJ , Petsonk EL , Laney AS . Radiology 2017 284 (3) 162437 Purpose To assess the level of concordance between chest radiographic classifications of A and B Readers in a national surveillance program offered to U.S. coal miners over an approximate 36-year period. Materials and Methods The National Institute for Occupational Safety and Health (NIOSH) Coal Workers' Health Surveillance Program (CWHSP) is a surveillance program with nonresearch designation and is exempt from Human Subjects Review Board approval (11-DRDS-NR03). Thirty-six years of data (1979-2015) from the CWHSP were analyzed, which included all conventional screen-film radiographs with a classification by at least one A Reader and one B Reader. Agreement was assessed by using kappa statistics; prevalence ratios were used to describe differences between A and B Reader determinations of image technical quality, small opacity profusion, and presence of large opacities and pleural abnormalities. Results The analysis included 79 185 matched A and B Reader chest radiograph classifications. A majority of both A and B Readers were radiologists (74.2% [213 of 287] vs 64.7% [22 of 34]; P = .04). A and B Readers had minimal agreement on technical image quality (kappa = 0.0796; 95% confidence interval [CI]: 0.07, 0.08) and the distribution of small opacity profusion (subcategory kappa, 0.2352; 95% CI: 0.22, 0.25). A Readers classified more images as "good" quality (prevalence ratio, 1.38; 95% CI: 1.35, 1.41) and identified more pneumoconiosis (prevalence ratio, 1.22; 95% CI: 1.20, 1.23). Conclusion A Readers classified substantially more radiographs with evidence of pneumoconiosis and classified higher small opacity profusion compared with B Readers. These observations reinforce the importance of multiple classifications by readers who have demonstrated ongoing competence in the International Labour Office classification system to ensure accurate radiographic classifications. |
Small airway dysfunction and abnormal exercise responses. A study in coal miners
Petsonk EL , Stansbury RC , Beeckman-Wagner LA , Long JL , Wang ML . Ann Am Thorac Soc 2016 13 (7) 1076-80 RATIONALE: Coal mine dust exposure can cause symptoms and loss of lung function from multiple mechanisms, but the roles of each disease process are not fully understood. OBJECTIVES: We investigated the implications of small airway dysfunction for exercise physiology among a group of workers exposed to coal mine dust. METHODS: Twenty coal miners performed spirometry, first breathing air and then helium-oxygen, single-breath diffusing capacity, and computerized chest tomography, and then completed cardiopulmonary exercise testing. MEASUREMENTS AND MAIN RESULTS: Six participants meeting criteria for small airway dysfunction were compared with 14 coal miners who did not. At submaximal workload, miners with small airway dysfunction used a higher proportion of their maximum voluntary ventilation and had higher ventilatory equivalents for both O2 and CO2. Regression modeling indicated that inefficient ventilation was significantly related to small airway dysfunction but not to FEV1 or diffusing capacity. At the end of exercise, miners with small airway dysfunction had 27% lower O2 consumption. CONCLUSIONS: Small airway abnormalities may be associated with important inefficiency of exercise ventilation. In dust-exposed individuals with only mild abnormalities on resting lung function tests or chest radiographs, cardiopulmonary exercise testing may be important in defining causes of exercise intolerance. |
Lung pathology in U.S. coal workers with rapidly progressive pneumoconiosis implicates silica and silicates
Cohen RA , Petsonk EL , Rose C , Young B , Regier MPhD , Najmuddin AMd , Abraham JL , Churg A , Green FH . Am J Respir Crit Care Med 2015 193 (6) 673-80 RATIONALE: Recent reports of progressive massive fibrosis and rapidly progressive pneumoconiosis among US coal miners have raised concerns over excessive exposures to coal mine dust, despite reports of declining dust levels. OBJECTIVES: To evaluate the histologic abnormalities and retained dust particles in available coal miner lung pathology specimens and compare findings to those from corresponding chest radiographs. METHODS: Miners with severe disease and available lung tissue were identified through investigator outreach. Demographics, smoking, and work history were obtained. Chest radiographs were interpreted according to the International Labour Organization classification to determine if criteria for rapidly progressive pneumoconiosis were confirmed. Pathology slides were scored by three expert pulmonary pathologists, using standardized nomenclature and scoring system. MEASUREMENTS AND MAIN RESULTS: Of the 13 cases reviewed, 12 had progressive massive fibrosis, 11 had silicosis, many with features of accelerated silicosis and mixed dust lesions. Only four had classic lesions of simple coal workers' pneumoconiosis. Four had diffuse interstitial fibrosis with chronic inflammation, and two had focal alveolar proteinosis. Polarized light microscopy revealed large amounts of birefringent mineral dust particles consistent with silica and silicates; carbonaceous coal dust was less prominent. Specimens with features of silicosis were significantly associated (p=0.047) with rounded (p,q,r) opacities on chest imaging, while grade 3 interstitial fibrosis was associated (p=0.02) with the presence of irregular (s,t,u) opacities on chest imaging. CONCLUSIONS: Our findings suggest that rapidly progressive pneumoconiosis in these miners was caused by exposures to coal mine dusts containing high concentrations of respirable silica and silicates. |
Debilitating lung disease among surface coal miners with no underground mining tenure
Halldin CN , Reed WR , Joy GJ , Colinet JF , Rider JP , Petsonk EL , Abraham JL , Wolfe AL , Storey E , Laney AS . J Occup Environ Med 2015 57 (1) 62-7 OBJECTIVE: To characterize exposure histories and respiratory disease among surface coal miners identified with progressive massive fibrosis from a 2010 to 2011 pneumoconiosis survey. METHODS: Job history, tenure, and radiograph interpretations were verified. Previous radiographs were reviewed when available. Telephone follow-up sought additional work and medical history information. RESULTS: Among eight miners who worked as drill operators or blasters for most of their tenure (median, 35.5 years), two reported poor dust control practices, working in visible dust clouds as recently as 2012. Chest radiographs progressed to progressive massive fibrosis in as few as 11 years. One miner's lung biopsy demonstrated fibrosis and interstitial accumulation of macrophages containing abundant silica, aluminum silicate, and titanium dust particles. CONCLUSIONS: Overexposure to respirable silica resulted in progressive massive fibrosis among current surface coal miners with no underground mining tenure. Inadequate dust control during drilling/blasting is likely an important etiologic factor. |
Validation of the International Labour Office digitized standard images for recognition and classification of radiographs of pneumoconiosis
Halldin CN , Petsonk EL , Laney AS . Acad Radiol 2014 21 (3) 305-11 RATIONALE AND OBJECTIVES: Chest radiographs are recommended for prevention and detection of pneumoconiosis. In 2011, the International Labour Office (ILO) released a revision of the International Classification of Radiographs of Pneumoconioses that included a digitized standard images set. The present study compared results of classifications of digital chest images performed using the new ILO 2011 digitized standard images to classification approaches used in the past. MATERIALS AND METHODS: Underground coal miners (N = 172) were examined using both digital and film-screen radiography (FSR) on the same day. Seven National Institute for Occupational Safety and Health-certified B Readers independently classified all 172 digital radiographs, once using the ILO 2011 digitized standard images (DRILO2011-D) and once using digitized standard images used in the previous research (DRRES). The same seven B Readers classified all the miners' chest films using the ILO film-based standards. RESULTS: Agreement between classifications of FSR and digital radiography was identical, using a standard image set (either DRILO2011-D or DRRES). The overall weighted kappa value was 0.58. Some specific differences in the results were seen and noted. However, intrareader variability in this study was similar to the published values and did not appear to be affected by the use of the new ILO 2011 digitized standard images. CONCLUSIONS: These findings validate the use of the ILO digitized standard images for classification of small pneumoconiotic opacities. When digital chest radiographs are obtained and displayed appropriately, results of pneumoconiosis classifications using the 2011 ILO digitized standards are comparable to film-based ILO classifications and to classifications using earlier research standards. |
Rapid decline in lung function in coal miners: evidence of disease in small airways
Stansbury RC , Beeckman-Wagner LA , Wang ML , Hogg JP , Petsonk EL . Am J Ind Med 2013 56 (9) 1107-12 BACKGROUND: Coal mine dust exposure can cause both pneumoconiosis and chronic airflow limitation. The contributions of various pathophysiologic mechanisms to dust-related lung function decrements remain unclear. METHODS: Clinical and physiological findings were assessed for 15 underground coal miners who had demonstrated accelerated FEV1 losses (decliners) over 6-18 years. Decliners' findings were evaluated in comparison to a group of 11 miners who had shown relatively stable lung function (referents) during the same period. RESULTS: At follow-up examination, the decliners showed significantly greater mean airway resistance (10.47 vs. 6.78 cmH2 O/L/s; P = 0.05) and more air trapping (RV/TLC = 37.5 vs. 29.1%; P < 0.01) compared to the referents. Decliners also demonstrated more evidence of small airways dysfunction and tended to have more bronchospasm than the referent group. Total lung capacity, lung compliance, diffusing capacity, and chest radiography did not differ significantly between the two groups. After cessation of mine dust exposures, the decliners' mean rate of FEV1 loss normalized. CONCLUSION: In a series of working coal miners, accelerated lung function declines were associated with air trapping and evidence of small airways dysfunction. A preventive benefit from controlling dust exposures was suggested. |
Lung-function impairment among US underground coal miners, 2005 to 2009: geographic patterns and association with coal workers' pneumoconiosis
Wang ML , Beeckman-Wagner LA , Wolfe AL , Syamlal G , Petsonk EL . J Occup Environ Med 2013 55 (7) 846-50 OBJECTIVE: To investigate contemporary geographic distributions of lung-function impairment and radiographic evidence of coal workers' pneumoconiosis (CWP) and their associations. METHODS: From 2005 to 2009, 6373 underground coal miners completed a health survey, including spirometry testing and chest radiography. Coal workers' pneumoconiosis and progressive massive fibrosis were determined by NIOSH B readers, using the International Labour Office classification. Prevalences of CWP and spirometry less than lower normal limits were mapped by county, and their association assessed. RESULTS: The prevalences of abnormal spirometry results and CWP were 13.1% and 4.0%, respectively. Counties with elevated prevalences for both the outcomes were located in contiguous areas of southeastern Kentucky, western Virginia, southern West Virginia, and eastern Pennsylvania. Prevalence of abnormal spirometry results increases with increasing category of simple CWP and progressive massive fibrosis. CONCLUSIONS: Abnormal spirometry in coal miners is associated with CWP; these two health outcomes have similar geographic distributions. |
Coal mine dust lung diseases: new lessons from an old exposure
Petsonk EL , Rose C , Cohen R . Am J Respir Crit Care Med 2013 187 (11) 1178-85 Coal mining remains a sizable industry, with millions of working and retired coal miners worldwide. This article provides an update on recent advances in the understanding of respiratory health issues in coal miners and focuses on the spectrum of disease caused by inhalation of coal mine dust, termed coal mine dust lung disease (CMDLD). In addition to the historical interstitial lung diseases (coal worker's pneumoconiosis, silicosis, and mixed dust pneumoconiosis), coal miners are at risk for dust-related diffuse fibrosis (DDF) and chronic airway diseases including emphysema and chronic bronchitis. Recent recognition of rapidly progressive pneumoconiosis in younger miners, mainly in the eastern United States, has increased the sense of urgency and the need for vigilance in medical research, clinical diagnosis, and exposure prevention. Given the risk for disease progression even after exposure removal, along with few medical treatment options, there is an important role for chest physicians in the recognition and management of lung disease associated with work in coal mining. |
Combined effect of lung function level and decline increases morbidity and mortality risks
Baughman P , Marott JL , Lange P , Martin CJ , Shankar A , Petsonk EL , Hnizdo E . Eur J Epidemiol 2012 27 (12) 933-43 Lung function level and decline are each predictive of morbidity and mortality. Evaluation of the combined effect of these measurements may help further identify high-risk groups. Using Copenhagen City Heart Study longitudinal spirometry data (n = 10,457), 16-21 year risks of chronic obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease mortality, and all-cause mortality were estimated from combined effects of level and decline in forced expiratory volume in one second (FEV(1)). Risks were evaluated using Cox proportional hazards models for individuals grouped by combinations of baseline predicted FEV(1) and quartiles of slope. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated using stratified analysis by gender, smoking status, and baseline age (≤45 and >45). For COPD morbidity, quartiles of increasing FEV(1) decline increased HRs (95 % CI) for individuals with FEV(1) at or above the lower limit of normal (LLN) but below 100 % predicted, reaching 5.11 (2.58-10.13) for males, 11.63 (4.75-28.46) for females, and 3.09 (0.88-10.86) for never smokers in the quartile of steepest decline. Significant increasing trends were also observed for mortality and in individuals with a baseline age ≤45. Groups with 'normal' lung function (FEV(1) at or above the LLN) but excessive declines (fourth quartile of FEV(1) slope) had significantly increased mortality risks, including never smokers and individuals with a baseline age ≤45. |
Self-reported hand symptoms: a role in monitoring health care workers for latex sensitization?
Wang ML , Kelly KJ , Klancnik M , Petsonk EL . Ann Allergy Asthma Immunol 2012 109 (5) 314-8 BACKGROUND: The use of powdered natural rubber latex (NRL) gloves increased greatly in the 1980s because of concerns about transmission of blood-borne infections and the subsequent implementation of universal precautions. The most common clinical reactions to glove use are irritant and T-cell-mediated contact dermatitis. However, IgE-mediated immediate reactions to latex have become a serious concern for health care workers (HCWs). The diagnosis of latex allergy requires a comprehensive medical history and diagnostic tests. The skin prick test is the preferred diagnostic method, although it can be time-consuming. OBJECTIVE: To determine the role of hand symptoms reported on questionnaires in monitoring HCWs for latex sensitization. METHODS: Questionnaires were completed by 804 HCWs at 2 hospitals. Using a positive skin prick test (SPT) result as a criterion standard of latex sensitization, the diagnostic performance of hand symptoms was evaluated. RESULTS: Increasing latex glove use was strongly related to increasing reports of hand symptoms. Hand symptoms were highly associated with glove-related respiratory and systemic symptoms. A positive SPT result was seen in 5% of HCWs and increased with the number of hand symptoms: 0 (1.6%), 1 to 2 (3.4%), and 3 to 7 (19.0%). Participants reporting more than 2 hand symptoms were 11 times more likely to have positive SPT results compared with those with 2 or fewer hand symptoms. CONCLUSION: Hand symptoms are closely associated with latex sensitization. Questionnaires should be useful in health monitoring for HCWs who use latex gloves. |
Small pneumoconiotic opacities on U.S. coal worker surveillance chest radiographs are not predominantly in the upper lung zones
Laney AS , Petsonk EL . Am J Ind Med 2012 55 (9) 793-8 BACKGROUND: Radiographic shadows of coal workers' pneumoconiosis (CWP) are commonly described as predominantly in the upper lung zones. METHODS: We evaluated the lung distribution of small opacities on surveillance chest radiographs (CXRs) taken between 1981 and 2010 among 2,467 underground US coal miners. All had evidence of pneumoconiosis (category ≥1/0), based on the contemporary International Labour Office Classification of Radiographs of Pneumoconioses. RESULTS: Small opacity involvement was approximately equal over all lung zones, with 30.7% of the total involvement reported in the upper zones, 37.1% in the middle zones, and 32.1% in the lower zones. Primarily rounded opacities were seen in 62.1% of miners and primarily irregular opacities were seen in 37.9%. Miners with primarily rounded opacities had a distribution with moderate upper zone predominance (upper = 36.8%, middle = 36.5%, and lower = 27.2%). In contrast, miners with primarily irregular opacities showed a lower zone preponderance (upper = 20.5%, middle = 38.4%, and lower = 41.1%). CONCLUSION: The distribution of small pneumoconiotic opacities on surveillance CXRs of working US coal miners is not consistent with the conventional expectations of upper lung zone predominance. ( Am. J. Ind. Med. (c) 2012 Wiley Periodicals, Inc.) |
The association between tobacco burden and "dirty chest" is unlikely to follow a linear dose-response pattern
Laney A , Tramma S , Petsonk E , Attfield M . Br J Radiol 2012 85 (1012) 470-1 We read with interest the recent report by Kirchner et al [1] in BJR, which describes the results of the International Labour Office (ILO) classifications of routine digital chest radiographs as well as readings of contrast-enhanced chest CT images among a convenience-based sample of 85 tobacco smokers who were clinically referred for chest imaging, primarily for known or suspected cancer. Chest radiographs for the study were obtained using a storage phosphor digital system, and hard copies were printed from the digital image files via a laser printer. Transparencies were then displayed and classified by two board-certified radiologists. It was not described whether or not the classifications were made independently, and if so, how the readings were summarised. The data were presented as a correlation (see Figure 2) between pack-years and the ILO classification scores, which was found to be significant. Only slightly more than half of the data points were visible in this figure, leaving the reader to infer that some of the points presented represented more than one value. However, the actual distribution of the data cannot be inferred with the presentation of the results in this format. Additionally, there was no mention of how recognised confounding factors, such as age or occupational exposures, were accounted for in the correlation. | A number of previous studies have shown that, in the absence of occupational dust exposures, cigarette smoking and increasing age may lead to a one- or two-subcategory increase in the profusion of irregular type opacities. However, our reading of this report raised a number of concerns regarding study methods, including image acquisition and classification, as well as conclusions. |
Post-hire asthma among insect-rearing workers
Suarthana E , Shen A , Henneberger PK , Kreiss K , Leppla NC , Bueller D , Lewis DM , Bledsoe TA , Janotka E , Petsonk EL . J Occup Environ Med 2012 54 (3) 310-317 OBJECTIVE: To evaluate the incidence of post-hire asthma (PHA) among insect-rearing workers, defined as asthma, the symptoms of which appeared after hire at the current workplace. METHODS: We surveyed the health of workers at three insect-rearing facilities and an associated office facility. We calculated the incidence and estimated hazard ratios for PHA. RESULTS: Post-hire asthma incidence in 157 insect-rearing workers was 16.2 per 1000 person-years compared with 9.2 per 1,000 person-years in 70 office workers. Workers with predominant exposure to Lepidoptera had an incidence of 26.9 per 1000 person-years and a hazard ratio of 5.5 (95% confidence interval: 1.6 to 23.9) adjusted for sex, race, and parental asthma. In contrast, the presence of specific immunoglobulin E to Lepidoptera antigens was not associated with PHA. CONCLUSION: Insect-rearing workers had a high incidence of PHA, primarily accounted for by workplace exposure to Lepidoptera. |
Potential determinants of coal workers' pneumoconiosis, advanced pneumoconiosis, and progressive massive fibrosis among underground coal miners in the United States, 2005-2009
Laney AS , Petsonk EL , Hale JM , Wolfe AL , Attfield MD . Am J Public Health 2012 102 Suppl 2 S279-83 OBJECTIVES: We better defined the distribution and determinants of coal workers' pneumoconiosis (CWP) among US underground coal miners. METHODS: We obtained chest radiographs from the mobile unit of an enhanced surveillance program begun in 2005 by the National Institute for Occupational Safety and Health for underground coal miners. B Readers classified them for presence of pneumoconiosis. RESULTS: Miners from 15 states participated (n = 6658). The prevalence of CWP was higher in 3 states (Kentucky, 9.0%; Virginia, 8.0%; West Virginia, 4.8%) than in 12 other states (age-adjusted risk ratio [RR] = 4.5; 95% confidence interval [CI] = 3.3, 6.1). Miners in these 3 states were younger and had less mining tenure, but advanced CWP (category ≥ 2/1; RR = 8.1; 95% CI = 3.9, 16.9) and progressive massive fibrosis (RR = 10.5; 95% CI = 3.8, 29.1) was more prevalent among them. Advanced CWP and progressive massive fibrosis were more prevalent among workers at mines with fewer than 155 miners, irrespective of mining region, than among workers at larger mines. CONCLUSIONS: Enhanced surveillance results confirmed the persistence of severe CWP among US coal miners and documented the health consequences of inadequate dust control for miners in parts of Appalachia and at smaller mines. (Am J Public Health. Published online ahead of print March 8, 2012: e1-e5. doi:10.2105/AJPH.2011.300427). |
Fixed FEV1/FVC ratio <0.7 for identifying airflow limitation: not a good idea in occupational settings
Hnizdo E , Petsonk EL . Occup Environ Med 2012 69 (3) 227 Dr Søyseth and colleagues recently reported an increased prevalence of airflow limitation in workers employed in the Norwegian smelting industry and significant associations with workplace dust exposures.1 The prevalence of airflow limitation was assessed using prebronchodilator spirometry and two measures of airflow limitation: FEV1/FVC ratio <0.7 and FEV1/FVC ratio <lower limit of normal (LLN). When compared across age categories (<35, 35–44, ≥45 years), the prevalence of airflow limitation based on the ratio <0.7 versus LLN was approximately doubled in the ≥45 years age categories across all levels of exposure duration (overall ≈17.6 vs ≈8.8%). The rate of FEV1 decline was increased for prevalent and incident cases of airflow limitation defined by both criteria, but it would be of interest to see the rates of decline for workers with FEV1/FVC <0.7 compared with those where the ratio is <LLN and ≥LLN. | The authors recommended that ‘in occupational healthcare settings, FEV1/FVC ratio <0.7 should be the preferred index for airflow limitation’. | Although we find the associations between airflow obstruction and occupational exposure to be convincing, we believe that the authors' recommendation regarding the preferred index of airflow limitation is not substantiated by their results (as well as others). The proportionate increase in the presence of obstruction comparing exposed and unexposed smelter workers was consistently greater using the FEV1/FVC ratio <LLN compared with the ratio <0.7 (table 21). Workers showed a highly significant effect of a 1 mg/m3 geometric mean dust exposure when using the ratio <LLN (p=0.01), but not the ratio <0.7 (p>0.05). Similarly, the effect of a 1 mg/m3 exposure to dusts of SiMn, FeMn and FeCr was highly significant using the ratio <LLN (p=0.005) but not the ratio <0.7 (p>0.05, table 41). |
The influence of dust standards on the prevalence and severity of coal worker's pneumoconiosis at autopsy in the United States of America
Vallyathan V , Landsittel DP , Petsonk EL , Kahn J , Parker JE , Osiowy KT , Green FHY . Arch Pathol Lab Med 2011 135 (12) 1550-1556 CONTEXT: Coal worker's pneumoconiosis is a major occupational lung disease in the United States. The disease is primarily controlled through reducing dust exposure in coal mines using technological improvements and through the establishment of dust standards by regulatory means. OBJECTIVE: To determine if dust standards established in the US Federal Coal Mine Health and Safety Act of 1969 have reduced the prevalence and severity of coal worker's pneumoconiosis. DESIGN: The study population included materials from 6103 deceased coal miners submitted to the National Coal Workers' Autopsy Study from 1971 through 1996. Type and severity of coal worker's pneumoconiosis were classified using standardized diagnostic criteria. RESULTS: Among miners who worked exclusively prior to the 1969 dust standard, 82.6% had coalmacules, 46.3% coal nodules, 28.2% silicotic nodules, and 10.3% progressive massive fibrosis. Lower prevalences were noted among miners exposed exclusively to post-1970 dust levels: 58.8% had coal macules, 15.0% coal nodules, 8.0% silicotic nodules, and 1.2% progressive massive fibrosis. The differences in prevalence were highly significant (P < .001) for all types of pneumoconiosis, including progressive massive fibrosis, after adjustment for age, years of mining, and smoking status. CONCLUSIONS: The study confirms a beneficial impact of the first 25 years of the dust standard established by the 1969 act on the prevalence and severity of coal worker's pneumoconiosis in US coal miners. However, pneumoconiosis continues to occur among miners who have worked entirely within the contemporary standard, suggesting a need for further reductions in exposure to respirable coal mine dust. (Arch Pathol Lab Med. 2011; 135:1550-1556; doi:10.5858/arpa.2010-0393-OA) |
Prevention of IgE sensitization to latex in health care workers after reduction of antigen exposures
Kelly KJ , Wang ML , Klancnik M , Petsonk EL . J Occup Environ Med 2011 53 (8) 934-40 OBJECTIVE: To investigate occupational latex allergy in health care workers (HCWs) before and after an intervention designed to reduce latex allergen exposure from gloves. METHODS: Latex antigen concentrations in work area air ducts were measured before the intervention. Symptoms and latex sensitization were monitored annually before and after the intervention in 805 HCWs, using questionnaires and skin prick testing. RESULTS: The prevalence of latex sensitization before the intervention correlated with air duct latex antigen measurements, for HCWs exposed to low (9/413, 2%), intermediate (23/292, 8%), and high (11/67, 16%) antigen levels, P < 0.0001. After the intervention, new latex sensitization rates declined 16-fold, and 25% of previously sensitized employees reverted to negative skin tests. CONCLUSION: Airborne antigen exposure is a major source of latex sensitization among HCWs. Use of powder-free latex gloves markedly reduces the risk of sensitization. |
Intra- and inter-modality comparisons of storage phosphor computed radiography and conventional film-screen radiography in the recognition of small pneumoconiotic opacities
Laney AS , Petsonk EL , Attfield MD . Chest 2011 140 (6) 1574-1580 BACKGROUND: Digital radiography systems are replacing traditional film for chest radiographic monitoring in the recognition of pneumoconiosis. METHODS: To further investigate previous findings regarding the equivalence of film screen radiographs (FSR) and storage phosphor computed radiographs (CR), FSR and CR from 172 underground coal miners were classified independently by seven NIOSH-approved B Readers, using the International Labour Office (ILO) classification of radiographs of pneumoconiosis. RESULTS: More CR were classified as "good" quality compared to FSR (prevalence ratio (PR) =1.5; 95% CI, 1.4-1.6; P<0.001). B Readers showed good overall agreement on scoring small opacity profusion using CR versus FSR, (weighted kappa =0.58, 95% CI 0.54-0.62). Significantly more irregular opacities (compared to rounded) were classified using CR images compared to FSR (PR=1.3; 95% CI=1.1-1.6; P=0.01). Similarly, the smallest size opacities (width <1.5 mm, p and s-type) were reported more frequently using CR vs. FSR images (PR=1.3; 95% CI= 1.1-1.5; P<0.001). Inter- and intra-reader agreement was lower with respect to the classification of shape/size than for small opacity profusion. Overall, inter- and intra-reader variability did not significantly differ using CR versus FSR. CONCLUSIONS: Under optimal conditions using standardized methods and equipment, reader visualization of small pneumoconiotic opacities does not appear to meaningfully differ whether using CR or FSR. Variability in ILO classifications between imaging modalities appears considerably less than variability between readers. The well-documented challenge of reader variability does not appear to be resolved through the use of digital imaging alone, and additional approaches must be evaluated. |
Interpreting screening questionnaires: specific respiratory symptoms and their relationship to objective test results
Petsonk EL , Wang ML . J Occup Environ Med 2010 52 (12) 1225-9 OBJECTIVE: To better delineate the relationship between responses to screening respiratory symptom questionnaires and various pulmonary function test results. METHODS: Spirometry, methacholine challenge, standardized questionnaires, smoking, medical, and work histories were recorded at initial and 5-year follow-up surveys among 411 participants. Percent-predicted forced expiratory volume in 1 second (ppFEV1), 5-year FEV1 decline, and proportion of methacholine responders (% hyper-responders) were compared with questionnaire responses utilizing generalized estimating equations modeling and analysis of variance. RESULTS: Significant associations were found between ppFEV1 and cough, phlegm, dyspnea, or ever wheezing; between greater percentage of hyper-responders and dyspnea with wheezing, ever/persistent wheezing, or history of asthma/hay fever; and between accelerated FEV1 decline and new onset dyspnea with wheezing, phlegm, or persistent wheeze. CONCLUSIONS: Particular respiratory symptoms reported on screening questionnaires are associated with specific physiologic abnormalities, enhancing questionnaire utility in workplace health surveillance. |
Spirometry Longitudinal Data Analysis Software (SPIROLA) for analysis of spirometry data in workplace prevention or COPD treatment
Hnizdo E , Yan T , Hakobyan A , Enright P , Beeckman-Wagner LA , Hankinson J , Fleming J , Petsonk E . Open Med Inform J 2010 4 94-102 Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Periodic spirometry is often recommended for individuals with potential occupational exposure to respiratory hazards and in medical treatment of respiratory disease, to prevent COPD or improve treatment outcome. To achieve the full potential of spirometry monitoring in preserving lung function, it is important to maintain acceptable precision of the longitudinal measurements, apply interpretive strategies that identify individuals with abnormal test results or excessive loss of lung function in a timely manner, and use the results for intervention on respiratory disease prevention or treatment modification. We describe novel, easy-to-use visual and analytical software, Spirometry Longitudinal Data Analysis software (SPIROLA), designed to assist healthcare providers in the above aspects of spirometry monitoring. Software application in ongoing workplace spirometry-based medical monitoring programs helped to identify increased spirometry data variability due to deteriorating test quality and subsequent improvement following interventions, and helped to enhance identification of individuals with excessive decline in lung function. |
Workplace spirometry monitoring for respiratory disease prevention: a methods review
Hnizdo E , Glindmeyer HW , Petsonk EL . Int J Tuberc Lung Dis 2010 14 (7) 796-805 This report reviews methods applicable in workplace spirometry monitoring for the identification of individuals with excessive lung function decline. Specific issues addressed include 1) maintaining longitudinal spirometry data precision at an acceptable level so that declines due to adverse physiological processes in the lung can be readily detected in an individual; 2) applying interpretative strategies that have a high likelihood of identifying workers at risk of developing lung function impairment; and 3) enhancing effectiveness of spirometry monitoring for intervention and disease prevention. Applications in ongoing computerized spirometry monitoring programs are described that demonstrate approaches to improving spirometry data precision and quality, and facilitating informed decision-making on disease prevention. |
Comparing film and digital radiographs for reliability of pneumoconiosis classifications: a modeling approach
Sen A , Lee SY , Gillespie BW , Kazerooni EA , Goodsitt MM , Rosenman KD , Lockey JE , Meyer CA , Petsonk EL , Wang ML , Franzblau A . Acad Radiol 2010 17 (4) 511-9 RATIONALE AND OBJECTIVES: The International Labour Office (ILO) system for classifying chest radiographic changes related to inhalation of pathogenic dusts is predicated on film-screen radiography. Digital radiography has replaced film in many centers. Digital images can be printed on film ("hard copy") or can be viewed at a computer workstation ("soft copy"). The goal of the present investigation was to compare the inter-reader and intra-reader agreement of ILO classifications for pneumoconiosis across image formats. MATERIALS AND METHODS: Traditional film radiographs, hard copy digital images, and soft copy digital images from 107 subjects were read by six B readers. A multiple reader version of the inter-reader kappa statistic was compared across image formats. Intra-reader kappa comparisons were carried out using an iterative least-squares approach (unadjusted analysis) as well as a two-stage regression model adjusting for readers and subject-level covariates. RESULTS: There were few significant differences in the inter-reader and intra-reader agreement across formats. For parenchymal abnormalities, inter-reader and intra-reader kappa values ranged from 0.536 to 0.646, and 0.65 to 0.77, respectively. In the covariate-adjusted analysis film-screen radiography was generally associated with a numerically greater reliability (ie, higher kappa values) than the other image formats, although differences were rarely statistically significant. CONCLUSION: Film-screen radiographs, hard copy digital images, and soft copy digital images yielded similar reliability measures. These findings provide further support to the recommendation that soft copy digital images can be used for the recognition and classification of dust-related parenchymal abnormalities using the ILO system. |
Comparison of storage phosphor computed radiography with conventional film-screen radiography in the recognition of pneumoconiosis
Laney AS , Petsonk EL , Wolfe AL , Attfield MD . Eur Respir J 2009 36 (1) 122-7 Traditional film-screen radiography (FSR) has been useful in the recognition and evaluation of interstitial lung diseases, but is becoming increasingly obsolete. To evaluate the applicability of storage phosphor digital computed radiography (CR) images in the recognition of small lung opacities, we compared image quality and the profusion of small opacities between FSR and CR radiographs.We screened 1388 working coal miners during the course of the study with FSR and CR images obtained on the same day from all participants. Each traditional chest film was independently interpreted by two of eight experienced readers using the International Labour Office (ILO) classification of radiographs of pneumoconiosis, as were CR images displayed on medical-grade computer monitors.The prevalence of small opacities (ILO category 1/0 or greater) did not differ between the two imaging modalities (5.2%, for FSR and 4.8% for soft copy CR, p>0.50). Inter-reader agreement was also similar between FSR and CR. Significant differences between image modalities were observed in the shape of small opacities, and in the proportion of miners demonstrating high opacity profusion (category ≥2/1).Our results indicate that, with appropriate attention to image acquisition and soft copy display, CR digital radiography can be equivalent to FSR in the identification of small interstitial lung opacities. |
Excessive longitudinal FEV1 decline and risks to future health: A case-control study
Wang ML , Avashia BH , Wood J , Petsonk EL . Am J Ind Med 2009 52 (12) 909-15 BACKGROUND: Accelerated loss of forced expiratory volume in 1 s (FEV(1)) in an individual is considered an indicator of developing lung disease. METHODS: We investigated longitudinal FEV(1) slopes, calculated by simple linear regression, and adverse health outcomes after 10-30 years, among 1,428 chemical plant workers. Cases were defined by FEV(1) slopes below 5th percentile values for the cohort. Cases were matched with controls (107 pairs) for race, gender, smoking status, year of birth, age, height, and calendar year at first test. Matched pair statistics were used for comparisons. RESULTS: Cases had a higher proportion, compared to controls, of diagnosis of COPD or emphysema (17.8% vs. 1.9%, P = 0.0002), medication use for respiratory diseases (24.3% vs. 4.7%, P < 0.0001), dyspnea (15% vs. 3.7%, P = 0.0042), and wheezing or rhonchi on examination (10.3% vs. 1.9%, P = 0.0225). CONCLUSIONS: Chemical plant workers who experienced accelerated FEV(1) declines experienced four to nine times as many adverse health conditions over 10-30 years. Am. J. Ind. Med. (c) 2009 Wiley-Liss, Inc. |
Pneumoconiosis among underground bituminous coal miners in the United States: is silicosis becoming more frequent?
Laney AS , Petsonk EL , Attfield MD . Occup Environ Med 2009 67 (10) 652-6 OBJECTIVES: Epidemiologic reports since 2000 have documented increased prevalence and rapid progression of pneumoconiosis among underground coal miners in the United States. To investigate a possible role of silica exposure in the increase, we examined chest x-rays (CXRs) for specific abnormalities (r-type small opacities) known to be associated with silicosis lung pathology. METHODS: Underground coal miners are offered CXRs every 5 years. Abnormalities consistent with pneumoconiosis are recorded by National Institute for Occupational Safety and Health (NIOSH) B Readers using the International Labour Office Classification of Radiographs of Pneumoconioses. CXRs from 1980-2008 of 90,973 participating miners were studied, focusing on reporting of r-type opacities (small rounded opacities 3-10 mm in diameter). Log binomial regression was used to calculate prevalence ratios adjusted for miner age and profusion category. RESULTS: Among miners from Kentucky, Virginia, and West Virginia, the proportion of radiographs showing r-type opacities increased in the 1990s (PR=2.5; 95% CI=1.7-3.7) and after 1999 (PR=4.1; 95% CI=3.0-5.6), compared to the 1980s (adjusted for profusion category and miner age). The prevalence of progressive massive fibrosis in 2000-2008 was also elevated compared to the 1980's (PR=4.4; 95% CI=3.1-6.3) and 1990's (PR=3.8; 95% CI=2.1-6.8) in miners from Kentucky, Virginia, and West Virginia. CONCLUSIONS: The increasing prevalence of pneumoconiosis over the past decade and the change in the epidemiology and disease profile documented in this and other recent studies imply that U.S. coal miners are being exposed to excessive amounts of respirable crystalline silica. |
Interpreting longitudinal spirometry: weight gain and other factors affecting the recognition of excessive FEV(1) decline
Wang ML , Avashia BH , Petsonk EL . Am J Ind Med 2009 52 (10) 782-9 BACKGROUND: Excessive FEV(1) loss in an individual or a group can reflect hazardous exposures and development of lung disease. However, multiple factors may affect FEV(1) measurements. METHODS: Using medical screening data collected in 1884 chemical plant workers between 1973 and 2003, the influence of multiple factors on repeated measurements of FEV(1) was examined. RESULTS: The FEV(1) level was associated with age, height, race, sex, cigarette smoking, changes in body weight, and spirometer model. After controlling for these factors, longitudinal FEV(1) decline averaged 23.8 ml/year for white males; an additional loss of 8.3 ml was associated with one pack-year smoking and 5.4 ml with a one pound weight gain. Depending on the spirometer model, FEV(1) differed by up to 95 ml. CONCLUSIONS: The study results provide quantitative estimates of the effect of specific factors on FEV(1), and should be useful to health professionals in the evaluation of accelerated lung function declines. Am. J. Ind. Med. (c) 2009 Wiley-Liss, Inc. |
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