In research from the Agricultural Health Study involving 20,898 U.S. farmers, investigators found that driving tractors powered by diesel fuel, along with regular use of solvents to clean and paint, were consistently associated with increased risk of wheeze in this occupational group. Researchers noted that 19 percent (3,922) of the farmers reported at least one episode of wheezing in the year prior to study enrollment, although only 5 percent mentioned a history of asthma. Driving diesel tractors and trucks on the farm were consistently associated with elevated odds of wheeze, and the data showed a significant duration-response trend. However, the highest odds of wheeze for all farm activities were associated with using solvents daily. All aspects of daily solvent exposure were associated with elevated odds of wheeze: painting, cleaning with gasoline, and cleaning with other solvents. The respondents in the Agricultural Health Study were involved in diverse farming activities in the states of Iowa and North Carolina. They were mostly white males who ranged in age from 16 to 88. From two questionnaires, researchers obtained information on smoking history, demographics, and data on wheeze, doctor diagnosis of asthma, and any history of eczema or hay fever. They gathered information on common farm tasks, including types of tractors used, farm maintenance activities, and types of solvents employed. The study appears in the second issue for June 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
EARLY THERAPY START IMPROVES EXACERBATION OUTCOME IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
A six-year study of 128 patients showed that early treatment of exacerbations associated with moderate to severe chronic obstructive pulmonary disease (COPD) hastened and improved recovery, reduced the risk of hospitalization, and led to a better health-related quality of life. British researchers performed the first prospective study to demonstrate the important effect of early treatment on COPD exacerbation outcomes. The study took place between November 1996 and October 2002. (In the disease COPD, patients have persistent obstruction of the airways associated with emphysema or chronic bronchitis.) According to the study authors, the frequency of exacerbations has been shown to be an important determinant of the impaired health-related quality of life seen in COPD, and to affect decline in lung function. An exacerbation was defined as the presence, for at least two consecutive days, of an increase in two "major" symptoms (including severe breathlessness (dyspnea) and the quantity of pus in the sputum), or an increase in one "major" and one "minor" symptom (such as wheeze, sore throat, and cold symptoms). There were 1,099 exacerbations recorded by patients in the daily dairies. Of this number, 625 were reported to a physician. The investigators noted that failure to report exacerbations was associated with an increased risk of emergency hospitalization. A total of 266 exacerbations were treated with oral corticosteroids, which hastened recovery time by 2.63 days. Six hundred of the exacerbations were treated with antibiotics and of these, 241 were given both oral corticosteroids and antibiotics. The paper appears in the second issue for June 2004 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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Journal
American Journal of Respiratory and Critical Care Medicine