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Summary To evaluate occupational exposures as risk factors for hairy cell leukaemia (HCL), a population-based case-control study on 121 male HCL patients and 484 controls matched for age and sex was conducted. Elevated odds ratio (OR) was found for exposure to farm animals in general: OR 2.0, 95% confidence interval (Cl) 1.2-3.2. The ORs were elevated for exposure to cattle, horse, hog, poultry and sheep. Exposure to herbicides (OR 2.9, Cl 1.4-5.9), insecticides (OR 2.0, Cl 1.1-3.5), fungicides (OR 3.8, Cl 1.4-9.9) and impregnating agents (OR 2.4, Cl 1.3-4.6) also showed increased risk. Certain findings suggested that recall bias may have affected the results for farm animals, herbicides and insecticides. Exposure to organic solvents yielded elevated risk (OR 1.5, Cl 0.99-2.3), as did exposure to exhaust fumes (OR 2.1, Cl 1.3-3.3). In an additional multivariate model, the ORs remained elevated for all these exposures with the exception of insecticides. We found a reduced risk for smokers with OR 0.6 (Cl 0.4-1.1) because of an effect among non-farmers.

Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

The incidence of allergic alveolitis (AA) and of febrile reactions (FR) to inhaled mold dust in those who did not meet the criteria of AA was investigated in Swedish farmers, and the findings were related to farming methods and exposure type. A questionnaire was completed by 6,702 farmers. A stratified sample of 390 farmers underwent examination comprising spirometry, a skin-prick test, blood tests for precipitating antibodies and total IgE and an interview concerning symptoms, exposure and farming methods. The yearly incidence of AA was 2–3/10,000 farmers. The incidence of FR was 30–50 times higher (1/100 farmers) and the majority of these reactions was of a toxic rather than allergic type (organic dust toxic syndrome). Among farmers with recent FR or AA there was a higher frequency of positive precipitin reactions (p < 0.05). Exposures to moldy grain, straw, wood chips and hay were associated with both AA and FR. A major difference in exposure between 17 farmers with AA and 80 with FR was that AA appeared to require repeated exposure, while FR was associated with occasional heavy exposure to mold dust.

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