Etiologic Factors of Chronic Bronchitis in Dairy Farmers: Case Control Study in the Doubs Region of France

doi:10.1378/chest.103.2.417

Chest

Volume 103, Issue 2, February 1993, Pages 417-421

https://doi.org/10.1378/chest.103.2.417 Get rights and content

Relationships were investigated between chronic bronchitis and plant dust exposure assessed by quantification of barn threshing and cattle foddering and chronic bronchitis and acute respiratory syndromes after plant mold dust exposure. Two groups of male dairy farmers were studied in the Doubs region, France: 197 with chronic bronchitis and 163 control subjects without chronic bronchitis. There was no relationship between chronic bronchitis and exposure. Thirty-three chronic bronchitis patients had semidelayed respiratory syndromes (SDRS) vs two control subjects. Twenty-seven times out of 33 (16 of 17 in the nonsmokers), the SDRS preceded chronic bronchitis. Past history of acute respiratory syndromes during barn threshing (RSBT) was more frequent in chronic bronchitis; RSBT always preceded chronic bronchitis. It is concluded that host factors are important in chronic bronchitis and that acute effects after exposure may be predisposing factors to chronic bronchitis.

Section snippets

METHODS

This is a case-control study, carried out with the cooperation of the medical department of the Mutualité Sociale Agricole du Doubs, which organizes medical examinations for the farmers every five years. The Mutualité Sociale Agricole is the national health organization for farmers in France. The study took place between January 1987 and January 1989 and included practicing farmers from nine cantons in the Doubs region who underwent medical examinations during these two years.

RESULTS

The 197 male patients suffering from chronic bronchitis (cases) represented 14 percent of the men undergoing examination.

Table 2 shows the frequency of dyspnea and the results of respiratory function tests in the two groups studied. Ninety-seven of those suffering from chronic bronchitis had chronic dyspnea, as opposed to 33 control subjects (p<0.001). All measured expiratory flow (FEV₁, FEV₁ to vital capacity ratio, mean forced expiratory flow during the middle half of forced vital capacity,

DISCUSSION

This study demonstrates that there is, among dairy farmers, a strong positive relationship between chronic bronchitis and previous history of acute respiratory syndromes, whereas there is no positive relationship between chronic bronchitis and plant exposure. This study also verifies that chronic bronchitis in dairy farmers is an obstructive disease and not simple mucus hypersecretion.

These data must, however, be tempered by the fact that it is a retrospective analysis where no measures of

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Several studies have shown that prevalence of COPD is higher among farmers (i.e. organic dust exposure) than in the general population [3,4]. COPD among farmers seems mainly driven by an inflammatory reaction in the lung due to chronic exposure and inhalation of organic dusts [5–7]. In addition, the diversity of organic particles in the farming environment, among which many micro-organisms (virus, fungi, bacteria) are able to stimulate inflammatory innate cells through toll-like receptors [7,8].
Inflammatory response in patients with COPD secondary to organic dust exposure (OD-COPD) is poorly understood. We therefore aimed to characterize inflammatory and immune profile from peripheral blood mononuclear cells (PBMC) in a group of patients with mild-to-moderate COPD secondary to organic dust exposure (OD-COPD), tobacco smoking (T-COPD), or both. We compared T, B and NK cells distribution and inflammatory (TNF-α, Il-1β, IL-6), type 1 (IFN-γ), type 2 (IL-4, IL-13) and type 3 (IL-17) immunity related cytokines at baseline, and after stimulation with LPS, flagellin and CD3/CD28 beads in all COPD groups. OD-COPD displayed significantly lower NK cells and CD8+ T cells compared with controls. After flagellin stimulation, T-COPD had significantly lower IL-13 levels than OD-COPD and controls (p < 0.05) whereas IFN-γ tended to be lower in OD-COPD. All COPD groups displayed higher IL-1β and IL-17 than controls after CD3/CD28 stimulation. Inflammatory responses in OD-COPD were different from T-COPD. OD-COPD displayed higher levels of type 2 immunity related cytokines.
Characterization of chronic obstructive pulmonary disease in dairy farmers
2020, Environmental Research
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An “immunoallergic” and inflammatory reaction following the inhalation of organic dust contained in hay has been proposed to explain this phenomenon (Dalphin et al., 1993; Eduard et al., 2009; Poole and Romberger, 2012). Bronchial hyperresponsiveness during exposure to organic particles could be an indicator associated with the subsequent onset of COPD (Dalphin et al., 1993; Westeel et al., 2000). However, current knowledge on occupational COPD in dairy farming remains sparse, not only with regard to its mechanisms but also to its specific clinical characteristics.
Although farming is often considered a risk factor for COPD, data regarding the burden and characteristics of COPD in dairy farmers are sparse and conflicting.
To characterize COPD in dairy farmers.
4788 subjects entered two parallel COPD screening programs, one in agricultural workers and one in general practice from 2011 to 2015. Subjects with COPD were invited to participate in the characterization phase of the study. Those who accepted were included in two subgroups: dairy farmers with COPD (DF-COPD) (n = 101) and non-farmers with COPD (NF-COPD) (n = 85). Patients with COPD were frequency-matched with subjects with normal spirometry for age, sex and tobacco smoking (pack-years and status) (DF-controls n = 98, NF-controls n = 89). All subjects from these four groups underwent lung function and exercise testing, questionnaires and blood analysis.
The frequency of COPD in dairy farmers was 8.0% using the GOLD criterion and 6.2% using the lower limit of normal criterion and was similar in non-farming subjects (7.3% and 5.2%, respectively) although dairy farmers had lower tobacco consumption (screening phase). DF-COPD had better pulmonary function, exercise capacity and quality of life, fewer symptoms and comorbidities than NF-COPD, and higher levels of some Th2 biomarkers (MCP-2, periostin) (characterization phase). In farmers, COPD was not related to occupational exposure factors, supporting the role of host factors.
COPD secondary to organic dust exposure (dairy farming) appears less severe and associated with fewer comorbidities than COPD secondary to tobacco smoking.
Environmental causes of the distal airways disease. Hypersensitivity pneumonitis and rare causes
2013, Revue des Maladies Respiratoires
La pneumopathie d’hypersensibilité (PHS) est une des causes les plus fréquentes d’atteinte des petites voies aériennes. L’infiltration inflammatoire à prédominance lymphocytaire est centrée par les bronchioles et le granulome comprime et/ou obstrue volontiers celles-ci. Cela explique la fréquence des signes cliniques bronchiques, la présence à l’exploration fonctionnelle respiratoire d’une obstruction distale et, dans près de 20 % des cas, proximale, les images tomodensitométriques qui traduisent l’infiltration lymphocytaire et le piégeage aérique, et enfin l’évolution non exceptionnelle vers une maladie obstructive emphysémateuse. Les bronchiolites liées à l’inhalation chronique de poussières minérales et aiguës de gaz toxiques (NO₂ notamment) sont d’autres exemples d’atteinte des petites voies aériennes d’origine environnementale. Les mécanismes physiopathologiques sont ici très différents et l’atteinte bronchiolaire est exclusive ou prédominante. La bronchiolite du fumeur, classée généralement dans les pneumonies interstitielles à l’instar de la PHS, a un diagnostic facile grâce au LBA. Son pronostic est lié au tabagisme et à ses autres conséquences respiratoires. Enfin, des expositions complexes dans des contextes particuliers (« World Trade Center », guerres…) peuvent conduire à des atteintes mal caractérisées des petites voies aériennes.
Hypersensitivity pneumonitis is one of the most frequent causes of distal airways disease. It is associated with inflammation of the bronchioles, predominantly by lymphocytic infiltrates, and with granuloma formation causing bronchial obstruction. This inflammation explains the clinical manifestations and the airways obstruction seen on pulmonary function tests, most often in the distal airways but proximal in almost 20%. CT scan abnormalities reflect the lymphocytic infiltrates and air trapping and, in some cases, the presence of emphysema. Bronchiolitis induced by chronic inhalation of mineral particles or acute inhalation of toxic gases (such as NO₂) are other examples of small airways damage due to environmental exposure. The pathophysiological mechanisms are different and bronchiolar damage is either exclusive or predominant. Bronchiolitis induced by tobacco smoke exposure, usually classified as interstitial pneumonitis, is easily diagnosed thanks to broncho-alveolar lavage. Its prognosis is linked to the other consequences of tobacco smoke exposure including respiratory insufficiency. Finally, the complex lung exposure observed in some rare cases (such as the World Trade Center fire or during wars) may lead to a less characteristic pattern of small airways disease.
COPD in dairy farmers: Screening, characterization and constitution of a cohort. the BALISTIC study
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Une étude pilote suggère que la prévalence de la bronchopneumopathie chronique obstructive (BPCO) chez les producteurs laitiers dépasse celle de la population générale malgré une plus faible proportion de sujets tabagiques.
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A pilot study from our group suggests that the prevalence of chronic obstructive pulmonary disease (COPD) among dairy farmers is higher than in the general population although dairy workers are less frequently smokers.
The study presented here aims at (i) determining the prevalence of COPD in a large and representative population of dairy farmers; (ii) characterizing these patients in terms of smoking habits, dyspnoea, quality of life, lung function, bronchial exhaled nitric oxide, systemic inflammation, arterial stiffness and exercise capacity; (iii) comparing characteristics of dairy farmers’ COPD with the characteristics of COPD in patients without any occupational exposure; (iv) identifying the etiological factors of COPD in dairy farmers; and (v) constituting a cohort of COPD patients and control subjects for further longitudinal studies. Two groups of COPD patients (dairy farmers or not) and two groups of controls subjects will be selected among a representative panel of 2000 dairy workers and 2000 subjects without any occupational exposure, all aged 40 to 75 years.
A better knowledge of the epidemiology and pathophysiology of COPD in dairy farmers should guide a specific strategy of prevention. The knowledge of the characteristics of COPD occurring in dairy farmers will help to define the therapeutic modalities that might be different compared with the therapeutic recommendations for COPD secondary to tobacco smoking.
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Elle est caractérisée par une inflammation granulomateuse à cellules mononucléées, qui intéresse les régions alvéolaires et de façon quasi constante les petites voies aériennes. Cette atteinte bronchique explique notamment les hyperclartés lobulaires donnant un aspect en mosaïque et le trappage d’air, visibles à la tomodensitométrie (TDM) thoracique.
La bronchite chronique, le trouble ventilatoire obstructif et l’évolution vers un emphysème sont des conséquences fréquentes de cette atteinte bronchique.
Hypersensitivity pneumonitis is a respiratory disease resulting from the inhalation of antigens to which the exposed subject has been previously sensitized.
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Airway involvement in hypersensitivity pneumonitis
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La pneumopathie d’hypersensibilité est une maladie respiratoire due à l’inhalation chronique d’antigènes auxquels le sujet exposé a été préalablement sensibilisé. Elle est caractérisée par une inflammation granulomateuse à cellules mononucléées qui touche les régions alvéolaires et intéresse la plupart du temps les petites voies aériennes. Les lésions de bronchiolite sont bien caractérisées dans les études histopathologiques. Cette atteinte bronchique explique, notamment, les hyperclartés lobulaires donnant un aspect en mosaïque et le trappage d’air, visibles au scanner thoracique. La bronchite chronique, le trouble ventilatoire obstructif et l’évolution vers un emphysème sont les conséquences possibles de cette atteinte bronchique.
Hypersensitivity pneumonitis (HP) is a respiratory disease resulting from the inhalation of antigens to which the exposed subject was previously sensitized. HP is characterized by a diffuse and predominantly mononuclear cell inflammation of the alveolar regions that generally involves the small airways. Bronchiolitic lesions are well-described in histopathologic studies. This pathology explains the presence of mosaic attenuation and expiratory air trapping on thoracic scans. Chronic bronchitis with ventilatory obstruction and emphysema as a long-term outcome are possible consequences of this bronchial involvement.

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Supported by the Assurances Mutuelles Agricoles of Bourgogne—Franche-Comté and the Conseil Général of Doubs.

Manuscript revision accepted June 10.

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