Epidemiology of occupational hypersensitivity pneumonitis; reports from the SWORD scheme in the UK from 1996 to 2015

Barber, Christopher M.; Wiggans, Ruth; Carder, Melanie; Agius, Raymond

doi:10.1136/oemed-2016-103838

Cited by 43 publications

(32 citation statements)

References 14 publications

(33 reference statements)

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“…For occupational causes, the most commonly suspected exposures are to MWF or organic material (eg, compost, hay, leaves, soil, wood). This is entirely in keeping with data from the UK reporting scheme for occupational HP between 1996 and 2015, where exposure to MWF (35% of cases) and farming (17% of cases) were the most common causes 27. The reporting data demonstrated that over this time period, ‘Metalworking fluid HP’ has become the most commonly reported cause of occupational HP in the UK, a change in epidemiology that merits further research 28…”

Section: Discussionsupporting

confidence: 72%

Identifying causation in hypersensitivity pneumonitis: a British perspective

Barber

Burge²,

Feary

et al. 2019

BMJ Open Resp Res

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BackgroundEstablishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP).ObjectiveThis study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP.MethodsBritish ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’.Results54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP.ConclusionsThis survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients.

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Section: Discussionsupporting

confidence: 72%

Identifying causation in hypersensitivity pneumonitis: a British perspective

Barber

Burge²,

Feary

et al. 2019

BMJ Open Resp Res

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“…[1,2] Recently, the reported incidence of occupational HP in the United Kingdom was one to two cases per million workers per year. [3] The 1-year cumulative incidence rate ranged from 1.28 to 1.94 per 100,000 persons in the United States, which is lower than the incidence of idiopathic pulmonary fibrosis (IPF; approximately 6.8–16.3 per 100,000 persons). [4,5]…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and outcomes of hypersensitivity pneumonitis

Wang

Cai

Xiao

et al. 2019

Chinese Medical Journal

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Backgrounds: Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) that develops in response to the inhalation of various antigens. The clinical pathologies are very complex and undetermined. The clinical features and outcomes of HP have not been fully elucidated. The aim of this study was to analyze the incidence, clinical features, and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP (CHP). Methods: The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017. The patients were categorized into acute HP (AHP, n = 72) and CHP ( n = 29) groups according to the updated international criteria. The clinical, imaging, treatment, and follow-up data were retrospectively reviewed. All patients were followed up until December 31, 2017. Statistical analysis was performed, and a clinical scoring system for CHP was constructed by SPSS 20.0 software. Results: The incidence of HP was 2.4% in ILD inpatients in our center. Patients in the CHP group were older ( t = −2.212, P = 0.029), had more smokers ( χ 2 = 8.428, P = 0.004), and longer duration of symptoms ( t = −4.852, P < 0.001) than those in the AHP group. Weight loss, crackles, digital clubbing, and cyanosis were more common in the CHP group than those in the AHP group ( χ 2 = 5.862, P < 0.001; χ 2 = 8.997, P = 0.003; χ 2 = 11.939, P = 0.001; and χ 2 = 4.025, P = 0.045, respectively). On chest high-resolution computed tomography (HRCT), reticular patterns, traction bronchiectasis, and accompanying honeycombing were more common in CHP cases than those in AHP cases ( χ 2 = 101.000, P < 0.001; χ 2 = 32.048, P < 0.001; and χ 2 = 36.568, P < 0.001, respectively). The clinical scoring system for CHP was established based on the clinical variables (age [A], duration of symptoms [D], smoking history [S], unidentified exposure [U], and chest HRCT [C]; ADSUC) (area under the curve 0.935, 95% confidence interval: 0.883–0.987, P < 0.001). Eleven patients (15.3%) in the AHP group developed CHP, and unidentified exposure was an independent risk factor for the progression of disease ( P = 0.038). The s...

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“…The causative organisms may vary from outbreak to outbreak, but we suggest that molecular-based screening of MWF and the monitoring of spatially clustered distributions of contamination could be useful in the early detection and prevention of what is now the most common cause of occupational HP in the UK. 28 …”

Section: Discussionmentioning

confidence: 99%

Metal worker’s lung: spatial association with Mycobacterium avium

James

Cannon

Barber

et al. 2017

Thorax

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BackgroundOutbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metal working fluid (MWF) is used to facilitate metal turning. Inhalation of microbe-contaminated MWF has been assumed to be the cause, but previous investigations have failed to establish a spatial relationship between a contaminated source and an outbreak.ObjectivesAfter an outbreak of five cases of HP in a UK factory, we carried out blinded, molecular-based microbiological investigation of MWF samples in order to identify potential links between specific microbial taxa and machines in the outbreak zone.MethodsCustom-quantitative PCR assays, microscopy and phylogenetic analyses were performed on blinded MWF samples to quantify microbial burden and identify potential aetiological agents of HP in metal workers.Measurements and main resultsMWF from machines fed by a central sump, but not those with an isolated supply, was contaminated by mycobacteria. The factory sump and a single linked machine at the centre of the outbreak zone, known to be the workstation of the index cases, had very high levels of detectable organisms. Phylogenetic placement of mycobacterial taxonomic marker genes generated from these samples indicated that the contaminating organisms were closely related to Mycobacterium avium.ConclusionsWe describe, for the first time, a close spatial relationship between the abundance of a mycobacterium-like organism, most probably M. avium, and a localised outbreak of MWF-associated HP. The further development of sequence-based analytic techniques should assist in the prevention of this important occupational disease.

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Epidemiology of occupational hypersensitivity pneumonitis; reports from the SWORD scheme in the UK from 1996 to 2015

Cited by 43 publications

References 14 publications

Identifying causation in hypersensitivity pneumonitis: a British perspective

Identifying causation in hypersensitivity pneumonitis: a British perspective

Clinical characteristics and outcomes of hypersensitivity pneumonitis

Metal worker’s lung: spatial association with Mycobacterium avium

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