Asthme

BPCO

Risque augmenté de BPCO chez les infirmières exposées aux désinfectants de surface

Dr Irène Drogou| 12.09.2017
Source : Lequotidiendumedecin.fr

Les infirmières exposées de façon régulière aux désinfectants de surface présentent un risque augmenté de bronchopathie chronique obstructive (BPCO), selon une étude présentée ce lundi par le Dr Orianne Dumas de l’INSERM au Congrès international de l’European Respiratory Society (ERS).

Cette étude réalisée auprès de plus de 55 000 infirmières aux États-Unis avec un suivi d’environ 8 ans révèle que l’exposition professionnelle régulière aux désinfectants de surface, et en particulier certains composés chimiques, majore de 22 % à 32 % le risque de BPCO.

Première étude chez les professionnels de santé

Si un lien avait été montré entre asthme et utilisation de désinfectants chez les professionnels de santé, c’est la première étude à mettre en évidence un lien avec la BPCO, peu étudiée, « malgré deux études récentes en Europe montrant que travailler comme agent de nettoyage est associé à un risque de BPCO », explique le Dr Dumas.

Pour ce travail, l’équipe du Dr Dumas a analysé les données de la US Nurses’ Health Study II, qui a débuté en 1989. Les infirmières toujours en activité et sans antécédent de BPCO en 2009 ont été suivies jusqu’en mai 2017. Au cours de cette période, 663 infirmières ont développé une BPCO. L’exposition aux désinfectants était évaluée par questionnaire et par une matrice affectant certaines tâches à l’exposition aux désinfectants. Les résultats étaient ajustés au tabagisme, à l’âge, à l’indice de masse corporelle et à l’appartenance ethnique.

Dans la population étudiée, 37 % des infirmières ont utilisé des désinfectants pour nettoyer des surfaces une fois par semaine et 19 % pour nettoyer du matériel médical, expliquent les auteurs.

Cinq désinfectants pointés du doigt

Une association significative est ressortie pour l’utilisation régulière de désinfectants de surface, c’est-à-dire au moins une fois par semaine, mais pas pour les produits de désinfection du matériel médical. « L’étude suggère un lien entre l’utilisation hebdomadaire de désinfectants pour le matériel médical mais ce n’était statistiquement significatif », explique le Dr Dumas.

En regardant de plus près la composition des désinfectants, les chercheurs ont retrouvé un risque augmenté de BPCO de 24 % à 32 % avec le glutaraldéhyde, l’eau de Javel, l’eau oxygénée (ou peroxyde d’hydrogène), l’alcool et les composés ammonium quaternaires.

Pour les chercheurs, si cette étude observationnelle ne permet pas de conclure au lien de causalité, c’est un élément de plus en faveur de l’impact de l’exposition aux désinfectants sur la santé respiratoire, démontrant « l’urgence d’intégrer des considérations de santé professionnelle dans les recommandations de nettoyage et de désinfection de lieux de soins, comme les hôpitaux », a estimé le Dr Dumas.

Socioeconomic Status, Sex, Age and Access to Medications for
COPD in Ontario, Canada

Andrea Gershon, Michael A. Campitelli, Jeremiah Hwee, Ruth Croxford,
Teresa To, Matthew B. Stanbrook, Ross Upshur, Anne Stephenson & Thérèse A. Stukel (2015)
Socioeconomic Status, Sex, Age and Access to Medications for COPD in Ontario, Canada, COPD:
Journal of Chronic Obstructive Pulmonary Disease, 12:6, 668-679
https://www.tandfonline.com/doi/abs/10.3109/15412555.2015.1020148

Abstract
Disparities in COPD health outcomes have been found with older individuals, men and those of lower socioeconomic status doing worse. We sought to determine if this was due to differences in access to COPD medications. We conducted a retrospective cohort study using population health administrative data from Ontario, Canada, a province with universal prescription drug coverage for older

adults. All individuals with COPD aged 67 years and older in 2008 who were not taking inhaled long-acting bronchodilators or inhaled corticosteroids were followed for 2 years. Poisson regression was used to determine the effects of age, sex, and socioeconomic status on the likelihood of initiating one of these
medications, after adjusting for potential confounders. Over the study period, 54,050 of 185,698 (29.1%) older individuals with COPD not previously taking any inhaled long-acting bronchodilators or corticosteroids were initiated on one or more of these medications. After adjustment, individuals of low socioeconomic status, measured using neighborhood income level quintiles, were slightly more likely to initiate COPD medications than those of high socioeconomic status (relative risk (RR) 1.05; 95% confi dence interval (95% CI) 1.02–1.08). While men received COPD medication at a consistent rate across all age groups, the likelihood that a woman received medication decreased with increasing age. With the exception of older women, there was minimal disparity in prescription for COPD medications.
Disparity in health outcomes among Ontario COPD patients is not clearly explained by differences in medication access by socioeconomic status, sex or age.

Improving the Management of COPD in Women

Christine R. Jenkins, MDCorrespondence information about the author MD Christine R. JenkinsEmail the author MD Christine R. Jenkins, Kenneth R. Chapman, MD, James F. Donohue, MD, Nicolas Roche, MD, Ioanna Tsiligianni, MD, MeiLan K. Han, MD

COPD is a highly debilitating disease that represents a substantial and growing health burden in women. There is increasing evidence for sex-related differences in COPD risk, progression, and outcomes. However, the disease receives scant attention as a women’s health issue. Thus, a multifaceted approach is required to address COPD in women, including greater awareness, minimization of risk, and further elucidation of the sex-specific factors (biological and cultural) that affect risk, disease progression, and treatment success. This article reviews the current literature on the topic and provides suggestions for achieving better outcomes for the millions of women with COPD worldwide.

CHEST March 2017Volume 151, Issue 3, Pages 686–696

DOI: http://dx.doi.org/10.1016/j.chest.2016.10.031

Gender inequalities in COPD decision-making in primary care

Ana Delgado, Lorena Saletti-Cuesta , , Luis Andrés Lopez-Fernandez ,
Natalia Gil-Garrido c, Juan de Dios Luna del Castillo

Abstract
Background: COPD is a frequent severe illness that increasingly affects females. Gender inequalities have been reported in COPD care.
Objective: To analyze decision-making in primary care for men and women with identical COPD as a
function of the gender of the family physician (FP).
Methods: Cross-sectional, multicenter study in 457 Andalusian FPs, using a self-administered vignettebased
questionnaire on COPD featuring a male or female patient, with four variables on clinical
reasoning: “tobacco as most important risk factor (RF)”, “ordering of spirometry”, “COPD as most likely
diagnosis”, and “referral”. Multilevel logistic regression analysis.
Results: Response rate was 67.4% (308/457). In analysis of the four FP gender-patient gender dyads, tobacco
was more frequently considered as priority RF for the man than for the woman in the vignette by
female (95.6%vs.67.1%) and male (79.8%vs.62.5%) FPs. COPD was more frequently the most likely diagnosis
for the man versus woman by female (84.4%vs.49.9%) and male (78.5%vs.57.8%) FPs. Male FPs more
frequently ordered spirometry for the man versus woman (68.1%vs.46.8%). There were no differences in
referral between male and female patients. Male FPs were more likely than female FPs to consider tobacco
as priority RF for the man (p ¼ 002). Female FPs were more likely than male FPs to refer the man
(22.5%vs.8%).
Conclusions: There may be gender inequalities in primary care for COPD in our setting. Diagnostic and
therapeutic efforts appear lower in female patients. Male and female FPs only differed in care of the male
patient, indicating FP gender-patient gender interaction.
© 2016 Elsevier Ltd. All rights reserved.

1.    Int J Chron Obstruct Pulmon Dis. 2016 Oct 26;11:2681-2690. eCollection 2016.

Management of COPD, equal treatment across age, gender, and social situation? A register study.

Henoch I1, Strang S1, Löfdahl CG2, Ekberg-Jansson A3.
Author information:

1Angered Hospital, Research and Development Department; The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg.
2Angered Hospital, Research and Development Department; University of Lund, Lund.
3Angered Hospital, Research and Development Department; Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.

Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease where treatment decisions should be based on disease severity and also should be equally distributed across age, gender, and social situation. The aim of this study was to determine to what extent patients with COPD are offered evidence-based interventions and how the interventions are distributed across demographic and clinical factors in the sample. Baseline registrations of demographic, disease-related, and management-related variables of 7,810 patients in the Swedish National Airway Register are presented. One-third of the patients were current smokers. Patient-reported dyspnea and health-related quality of life were more deteriorated in elderly patients and patients living alone. Only 34% of currently smoking patients participated in the smoking cessation programs, and 22% of all patients were enrolled in any patient education program, with women taking part in them more than men. Less than 20% of the patients had any contact with physiotherapists or dieticians, with women having more contact than men. Men had more comorbidities than women, except for depression and osteoporosis. Women were more often given pharmacological treatments. With increasing severity of dyspnea, participation in patient education programs was more common. Dietician contact was more common in those with lower body mass index and more severe COPD stage. Both dietician contact and physiotherapist contact increased with deteriorated health-related quality of life, dyspnea, and increased exacerbation frequency. The present study showed that COPD management is mostly equally distributed across demographic characteristics. Only a minority of the patients in the present study had interdisciplinary team contacts. Thus, this data shows that the practical implementation of structured guidelines for treatment of COPD varies, to some extent, with regard to age and gender. Also, disease characteristics influence guideline implementation for each individual patient. Quality registers have the strength to follow-up on compliance with guidelines and show whether an intervention needs to be adapted prior to implementation in health care practice.

>>>Voir l’abstract sur PubMed 

Cancer

J Occup Environ Med. 2016 Jun;58(6):610-6. doi: 10.1097/JOM.0000000000000722.

Professional Cleaning Activities and Lung Cancer Risk Among Women: Results From the ICARE Study.

Atramont A¹, Guida F, Mattei F, Matrat M, Cenée S, Sanchez M, Carton M, Menvielle G, Marrer E, Neri M, Luce D, Stücker I; Icare study group.

Author information

Abstract

OBJECTIVES:

Lung cancer risk associated with occupational cleaning activities has been investigated in the population-based case-control study ICARE.

METHODS:

Occupational history was collected by standardized interviews. Jobs were first defined according to the International Standard Classification of Occupations (ISCO) codes and then categorized according to activity sectors. Adjusted odds ratios (ORs) were estimated by unconditional logistic regression, separately for women (619 cases and 760 controls) and men (2265 and 2780).

RESULTS:

Thirty percent of women and 2.3% of men controls ever held a cleaner or care job. Women who worked as housemaids longer than 7 years showed an OR of 1.76 [95% confidence interval (95% CI) 1.09 to 2.87] with respect to controls. Women employed in domestic service sector for a long time had an OR of 2.06 (95% CI 1.15 to 3.66).

CONCLUSION:

We confirmed and redefined the association of lung cancer with occupational cleaning, which concerns a considerable proportion of women workers.

PMID:

27206119

DOI:

10.1097/JOM.0000000000000722

Hormonal receptors in lung adenocarcinoma: expression and
difference in outcome by sex

Rossana Berardi, Francesca Morgese, Alfredo et al
© www.impactjournals.com/oncotarget/ Oncotarget, 2016, Vol. 7, (No. 50), pp: 82648-82657

[hr]J Occup Environ Med. 2016 Jun;58(6):610-6. doi: 10.1097/JOM.0000000000000722.

Professional Cleaning Activities and Lung Cancer Risk Among Women: Results From the ICARE Study.

Atramont A¹, Guida F, Mattei F, Matrat M, Cenée S, Sanchez M, Carton M, Menvielle G, Marrer E, Neri M, Luce D, Stücker I; Icare study group.

Author information

Abstract

OBJECTIVES:

Lung cancer risk associated with occupational cleaning activities has been investigated in the population-based case-control study ICARE.

METHODS:

Occupational history was collected by standardized interviews. Jobs were first defined according to the International Standard Classification of Occupations (ISCO) codes and then categorized according to activity sectors. Adjusted odds ratios (ORs) were estimated by unconditional logistic regression, separately for women (619 cases and 760 controls) and men (2265 and 2780).

RESULTS:

Thirty percent of women and 2.3% of men controls ever held a cleaner or care job. Women who worked as housemaids longer than 7 years showed an OR of 1.76 [95% confidence interval (95% CI) 1.09 to 2.87] with respect to controls. Women employed in domestic service sector for a long time had an OR of 2.06 (95% CI 1.15 to 3.66).

CONCLUSION:

We confirmed and redefined the association of lung cancer with occupational cleaning, which concerns a considerable proportion of women workers.

PMID:

27206119

DOI:

10.1097/JOM.0000000000000722

>>Voir l’abstract sur PubMed

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Grossesse

Determinants of low risk of asthma exacerbation during pregnancy.
Zarqa Ali, Lisbeth Nilas, Charlotte Suppli Ulrik

Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology 2017 Sep 19;

PMID: 28925525

Performance of Low Dose Perfusion Scintigraphy and Computed Tomographic Pulmonary Angiography for Pulmonary Embolism in Pregnancy.
Jean-Ju Sheen, Linda B Haramati, Anna Natenzon, Hong Ma, Pamela Tropper, Anna S Bader, Leonard M Freeman, Peter S Bernstein, Renee M Moadel

Chest 2017 August 17

PMID: 28823756

Lung cancer during pregnancy: A narrative review
Sotirios Mitrou, Dimitrios Petrakis , George Fotopoulos , George Zarkavelis , Nicholas Pavlidis
© Journal of Advanced Research (2016) 7, 571–574
[hr]

American Journal of Respiratory and Critical Care Medicine 2017 Jan 12;

Randomized Controlled Ethanol Cookstove Intervention and Blood Pressure in Pregnant Nigerian Women.
Donee Alexander, Amanda Northcross, Nathaniel Wilson, Anindita Dutta, Rishi Pandya, Tope Ibigbami, Damilola Adu, John Olamijulo, Oludare Morhason-Bello, Theodore Karrison, Oladosu Ojengbede, Christopher O Olopade

PMID: 28081369

American Journal of Respiratory and Critical Care Medicine 2017 Jan 11;

Female Smokers are at Greater Risk of Airflow Obstruction than Male Smokers: UK Biobank.
André F S Amaral, David P Strachan, Peter Gj Burney, Deborah L Jarvis

PMID: 28075609

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