Respiratory health and breath condensate acidity in sawmill workers

  • Anita Ljubičić Ćalušić
  • Veda Marija Varnai
  • Anka Ozana Čavlović
  • Maja Šegvić Klarić
  • Ružica Beljo
  • Ljerka Prester
  • Jelena Macan
Original Article

Abstract

Purpose

The aim of the study was to evaluate exhaled breath condensate acidity (EBC pH) as a biomarker of airway response to occupational respiratory hazards present in sawmill.

Methods

Sixty-one sawmill workers in total (26 from Sawmill 1 and 35 from Sawmill 2) provided EBC samples at the beginning and at the end of the working week. Respiratory symptoms, lung function, bronchodilator test and atopy status were assessed. Occupational environment was checked for the levels of respiratory hazards.

Results

Airborne dust concentrations were below threshold limit value. Endotoxin in Sawmill 1 and Sawmill 2, and moulds in Sawmill 1 were at the levels able to induce inflammatory response in the airways. Mould levels were 2.5 times higher in Sawmill 1 than in Sawmill 2. Compared to Sawmill 2 workers, lower spirometry values, higher prevalence of dry cough and positive bronchodilator test were found in Sawmill 1 workers. Monday EBC pH values did not differ between sawmills, but declined after one working week in Sawmill 1 workers (from 7.88 to 7.49, P = 0.012) and not in Sawmill 2 workers. Similar results were obtained when only respiratory healthy non-smokers were analysed. Monday-to-Friday change of other respiratory parameters was not observed.

Conclusion

The results suggest EBC pH as a biomarker of acute respiratory effects related to occupational exposure to respiratory hazards in sawmills, presumably increased mould levels. The effect was present even at subclinical level, namely in respiratory healthy subjects. The long-term health implications remain unclear and should be evaluated in a follow-up study.

Keywords

Atopy Bronchodilator test EBC pH Moulds Smoking Wood dust 

References

  1. Aberer W, Kranke B (2002) Measurement of IgE antibodies using liquid allergens—an inter-method and inter-laboratory quality assessment. Wien Klin Wochenschr 114:929–937Google Scholar
  2. Bloemen K, Hooyberghs J, Desager K, Witters E, Schoeters G (2009) Non-invasive biomarker sampling and analysis of the exhaled breath proteome. Proteomics Clin Appl 3:498–504CrossRefGoogle Scholar
  3. Boyce PD, Kim JY, Weissman DN, Hunt J, Christiani DC (2006) pH increase observed in exhaled breath condensate from welding fume exposure. J Occup Environ Med 48:353–356CrossRefGoogle Scholar
  4. Braun-Fahrlander C, Riedler J, Herz U et al (2002) Environmental exposure to endotoxin and its relation to asthma in school-age children. New Engl J Med 347:869–877CrossRefGoogle Scholar
  5. Brooks SM, Haight RR, Gordon RL (2006) Age does not affect airway pH and ammonia as determined by exhaled breath measurements. Lung 184:195–200CrossRefGoogle Scholar
  6. Carpagnano GE, Spanevello A, Sabato R, Depalo A, Turchiarelli V, Foschino Barbaro MP (2008) Exhaled pH, exhaled nitric oxide, and induced sputum cellularity in obese patients with obstructive sleep apnea syndrome. Transl Res 151:45–50CrossRefGoogle Scholar
  7. Chow S, Campbell C, Sandrini A, Thomas PS, Johnson AR, Yates DH (2009) Exhaled breath condensate biomarkers in asbestos-related lung disorders. Respir Med 103:1091–1097CrossRefGoogle Scholar
  8. Corradi M, Gergelova P, Mutti A (2010) Use of exhaled breath condensate to investigate occupational lung diseases. Curr Opin Allergy Clin Immunol 10:93–98CrossRefGoogle Scholar
  9. Cruz MJ, Sánchez-Vidaurre S, Romero PV, Morell F, Muñoz X (2009) Impact of age on pH, 8-isoprostane, and nitrogen oxides in exhaled breath condensate. Chest 135:462–467CrossRefGoogle Scholar
  10. Demers PA, Teschke K, Kennedy SM (1997) What to do about softwood—a review of respiratory effects and recommendations regarding exposure limits. Am J Ind Med 31:385–398CrossRefGoogle Scholar
  11. Do R, Bartlett KH, Chu W, Dimich-Ward H, Kennedy SM (2008a) Within- and between-person variability of exhaled breath condensate pH and NH+4 in never and current smokers. Resp Med 102:457–463CrossRefGoogle Scholar
  12. Do R, Bartlett KH, Dimich-Ward H et al (2008b) Biomarkers of airway acidity and oxidative stress in exhaled breath condensate from grain workers. Am J Respir Crit Care Med 178:1048–1054CrossRefGoogle Scholar
  13. Douwes J, McLean D, Slater T, Pearce N (2001) Asthma and other respiratory symptoms in New Zealand pine processing sawmill workers. Am J Ind Med 39:608–615CrossRefGoogle Scholar
  14. Dreborg S, Frew A eds (1993) Position paper. Allergen standardisation and skin tests. Allergy 48(suppl 14):49–82Google Scholar
  15. Ferrazzoni ScarpaMC, Guarnieri G, Corradi M, Mutti A, Maestrelli P (2009) Exhaled nitric oxide and breath condensate pH in asthmatic reactions induced by isocyanates. Chest 136:155–162CrossRefGoogle Scholar
  16. Fireman E, Lerman Y, Stark M et al (2008) Detection of occult lung impairment in welders by induced sputum particles and breath oxidation. Am J Ind Med 51:503–511CrossRefGoogle Scholar
  17. Gube M, Ebel J, Brand P et al (2010) Biological effect markers in exhaled breath condensate and biomonitoring in welders: impact of smoking and protection equipment. Int Arch Occup Environ Health 83:803–811CrossRefGoogle Scholar
  18. Hauswirth DW, Sundy JS, Mervin-Blake S et al (2008) Normative values for exhaled breath condensate pH and it’s relationship to exhaled nitric oxide in healthy African Americans. J Allergy Clin Immunol 122:101–106CrossRefGoogle Scholar
  19. Heida H, Bartman F, van der Zee SC (1995) Occupational exposure and indoor air quality monitoring in a composting facility. Am Ind Hyg Assoc J 56:39–43CrossRefGoogle Scholar
  20. Hessel PA, Herbert FA, Melenka LS et al (1995) Lung health in sawmill workers exposed to pine and spruce. Chest 108:642–646CrossRefGoogle Scholar
  21. Hillas G, Kostikas K, Mantzouranis K et al (2011) Exhaled nitric oxide and exhaled breath condensate pH as predictors of sputum cell counts in optimally treated asthmatic smokers. Respirology 16(5):811–818CrossRefGoogle Scholar
  22. Hoffmeyer F, Weiss T, Lehnert M et al (2011) Increased metal concentrations in exhaled breath condensate of industrial welders. J Environ Monit 13:212–218CrossRefGoogle Scholar
  23. Horvath I, Hunt J, Barnes PJ et al (2005) ATS/ERS task force on exhaled breath condensate. Exhaled breath condensate: methodological recommendations and unresolved questions. Eur Respir J 26:523–548CrossRefGoogle Scholar
  24. Hunt J (2006) Exhaled breath condensate pH: reflecting acidification of the airway at all levels. Am J Respir Crit Care Med 173:366–367CrossRefGoogle Scholar
  25. Hunt JF, Fang KZ, Malik R et al (2000) Endogenous airway acidification—implications for asthma pathophysiology. Am J Respir Crit Care Med 161:694–699CrossRefGoogle Scholar
  26. International Agency for Research on Cancer (1995) Monographs on the evaluation of carcinogenic risks to humans. Lyon. Wood dust and formaldehyde. Stud Cancer Hum 62:1–72Google Scholar
  27. Jacobsen G, Schaumburg I, Sigsgaard T, Schlunssen V (2010) Non-malignant respiratory disease and occupational exposure to wood dust. Part I. Fresh wood and mixed wood industry. Ann Agr Env Med 17:15–28Google Scholar
  28. Kauppinen T, Vincent R, Liukkonen T et al (2006) Occupational exposure to inhalable wood dust in the member states of the European Union. Ann Occup Hyg 50:549–561CrossRefGoogle Scholar
  29. Koczulla AR, Noeske S, Herr C et al (2010) Acute and chronic effects of smoking on inflammation markers in exhaled breath condensate in current smokers. Respiration 79:61–67CrossRefGoogle Scholar
  30. Kos A, Beljo-Lučić R, Šega K, Rapp AO (2004) Influence of woodworking machine cutting parameters on the surrounding air dustiness. Holz Roh Werkst 62:169–176CrossRefGoogle Scholar
  31. Kostikas K, Papatheodorou G, Ganas K, Psathakis K, Panagou P, Loukides S (2002) pH in expired breath condensate of patients with inflammatory airway diseases. Am J Respir Crit Care Med 65:1364–1370CrossRefGoogle Scholar
  32. Koutsokera A, Loukides S, Gourgoulianis KI, Kostikas K (2008) Biomarkers in the exhaled breath condensate of healthy adults: mapping the path towards reference values. Curr Med Chem 15:620–630CrossRefGoogle Scholar
  33. Ljubičić Ćalušić A, Varnai VM, Macan J (2011) Acute effects of smoking and food consumption on breath condensate pH in healthy adults. Exp Lung Res 37:92–100CrossRefGoogle Scholar
  34. Macan J, Varnai VM, Maloca I, Kanceljak-Macan B (2007) Increasing trend in atopy markers prevalence in a Croatian adult population between 1985 and 1999. Clin Exp Allergy 37:1756–1763CrossRefGoogle Scholar
  35. MacNee W, Rennard SI, Hunt JF et al (2011) Evaluation of exhaled breath condensate pH as a biomarker for COPD. Respir Med 105:1037–1045CrossRefGoogle Scholar
  36. Paget-Brown AO, Ngamtrakulpanit L, Smith A et al (2006) Normative data for pH of exhaled breath condensate. Chest 129:426–430CrossRefGoogle Scholar
  37. Papaioannou AI, Koutsokera A, Tanou K et al (2010) The acute effect of smoking in healthy and asthmatic smokers. Eur J Clin Invest 40:103–109CrossRefGoogle Scholar
  38. Papaioannou AI, Loukides S, Minas M et al (2011) Exhaled breath condensate pH as a biomarker of COPD severity in ex-smokers. Respir Res 12:67CrossRefGoogle Scholar
  39. Pellegrino R, Viegi G, Brusasco V et al (2005) Interpretative strategies for lung function tests. Eur Resp J 26:948–968CrossRefGoogle Scholar
  40. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40Google Scholar
  41. Radon K (2006) The two sides of the “endotoxin coin”. Occup Environ Med 63:73–78CrossRefGoogle Scholar
  42. Ricciardolo FL, Gaston B, Hunt J (2004) Acid stress in the pathology of asthma. J Allergy Clin Immunol 113:610–619CrossRefGoogle Scholar
  43. Rylander R, Carvalheiro MF (2006) Airways inflammation among workers in poultry houses. Int Arch Occup Environ Health 79:487–490CrossRefGoogle Scholar
  44. Rylander R, Peterson Y, Donham KJ (1990) Questionnaire evaluating organic dust exposure. Am J Ind Med 17:121–126Google Scholar
  45. Šegvić Klarić M, Varnai VM, Ljubičić Čalušić M, Macan J (2012) Occupational exposure to airborne fungi in two Croatian sawmills and atopy in exposed workers. Ann Agric Environ Med 19; 2:205–211 (in press)Google Scholar
  46. Varnai VM, Macan J, Plavec D, Jureša D (2004) Endotoxin level measurement in the house dust by the end-point Limulus amoebocyte lysate method. Arh Hig Rada Toksikol 55:175–181Google Scholar
  47. Varnai VM, Ljubičić Ćalušić A, Preskar L, Macan J (2009) Exhaled breath condensate pH in adult Croatian population without respiratory disorders-how healthy a population should be to provide a normative data? Arch Occup Med Toxicol 60:87–97Google Scholar
  48. Von Mutius E, Braun-Fahrlander C, Schierl R et al (2000) Exposure to endotoxin or other bacterial components might protect against the development of atopy. Clin Exp Allergy 30:1230–1234CrossRefGoogle Scholar
  49. Yeh MY, Burnham EL, Moss M, Brown LAS (2008) Non-invasive evaluation of pulmonary glutathione in the exhaled breath condensate of otherwise healthy alcoholics. Respir Med 102:248–255CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Anita Ljubičić Ćalušić
    • 1
  • Veda Marija Varnai
    • 1
  • Anka Ozana Čavlović
    • 2
  • Maja Šegvić Klarić
    • 3
  • Ružica Beljo
    • 2
  • Ljerka Prester
    • 1
  • Jelena Macan
    • 1
  1. 1.Institute for Medical Research and Occupational HealthZagrebCroatia
  2. 2.Faculty of ForestryUniversity of ZagrebZagrebCroatia
  3. 3.Faculty of Pharmacy and BiochemistryUniversity of ZagrebZagrebCroatia

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