Grantee Research Project Results
1999 Progress Report: Interstitial Lung Disease: Moisture, Molds, and Mycotoxins
EPA Grant Number: R825251Title: Interstitial Lung Disease: Moisture, Molds, and Mycotoxins
Investigators: Storey, Eileen , Hodgson, Michael J , Jarvis, Bruce , Yang, Chin , Turner, William
Institution: University of Connecticut , University of Maryland - College Park
EPA Project Officer: Chung, Serena
Project Period: December 2, 1996 through December 1, 1999 (Extended to October 1, 2001)
Project Period Covered by this Report: December 2, 1998 through December 1, 1999
Project Amount: $572,710
RFA: Air Quality (1996) RFA Text | Recipients Lists
Research Category: Air Quality and Air Toxics , Air
Objective:
The objective of this study is to examine the association between moisture and Interstitial Lung Disease (ILD). The project consists of five related studies that include: a case-control study of ILD, a case-control study of sarcoidosis, an exposure assessment of sources among metalworkers, a study of lung disease among school teachers with an assessment of schools for the presence of moisture and bioaerosols, and a mortality study.Progress Summary:
Case-Control Study of Interstitial Lung Disease. The case-control study of ILD consists of two parts. The first part focuses on questionnaire-defined exposures in the home and worksite. All living, biopsy-confirmed ILD patients from 1992 to 1998 and matched controls complete a self-administered questionnaire that addresses moisture in buildings and aerosolization in the work environment.A final review of a pathology registry in April 1999, brought the total number of lung disease cases diagnosed between 1992 and 1998 to 1,668. Of these, 1,262 were excluded because they represented cancer or a disease other than ILD. Of the 406 remaining ILD biopsies, only 141 had a pulmonologist listed. The names of 28 additional cases were acquired from a few of the pulmonologists who were originally asked to participate in the study. A total of 169 biopsy-proven ILD cases were eligible for participation. The physicians of 131 eligible cases responded to the enrollment letter, 38 cases were excluded for various reasons (e.g., death, moved out of state, mail problems, etc.). Fourteen additional cases were excluded because some participating physicians were selective about which of their patients were allowed to be contacted. Of the 79 remaining cases, 53 returned questionnaires. One control has been matched to 52 of the 53 cases based on age, gender, and ethnicity. The remaining case is quite elderly, and it has been difficult to find a matched control. Fifty controls have returned questionnaires; we are awaiting the return of the two remaining questionnaires.
The second part of the study includes patients biopsied on or after January 1, 1997. It examines the relationship between questionnaire data and observations of trained field personnel who take physical and bioaerosol measurements. Thirty case-control pairs are included in this portion of the study. We have scheduled the last home site visit for January 17, 2000. After these data are collected, we will begin cleaning and analyzing the data from both parts of the study.
Case-Control Study of Sarcoidosis. A case-control study of sarcoidosis was conducted to explore a potential association with occupational and environmental exposure. All 59 patients seen between 1992 and 1997 in a pulmonary division, and unmatched controls from orthopedic surgeons, received two copies of a self-administered questionnaire inquiring about occupational and environmental histories. The respondents included 52.2 percent of the patients and 32.4 percent of the controls. Patients were significantly more likely than the control subjects to have been exposed to inorganic dusts (odds ratio [OR] 3.48; 95% confidence interval [CI]: 1.02?11.80), molds (OR 9.8; 95% CI: 0.98?98.40), and solvents or oils in the workplace (OR 9.8; 95% CI: 1.60?48.0). They described exposure at home through moldy basements (OR 2.37; 95% CI: 0.97?5.8) or mold on bathroom walls (OR 5.69; 95% CI: 1.3?25.6) more frequently than the controls. Sarcoidosis may represent a disease at least in part attributable to occupational and environmental exposures. These results allowed us to conduct sampling in the homes of some of the study subjects. Thirty-six of the 51 identified subjects participated. Only one subject still worked for the same employer; this employer refused participation. We were able to identify occupational exposures for one patient with sarcoidosis. This patient worked for the metal working facility described in the next section.
Exposure Assessment in a Metal Working Facility. An outbreak of hypersensitivity pneumonitis (HP) was first recognized by the Division of Occupational and Environmental Medicine (DOEM) at a metal working plant in Autumn 1997. Research activities in collaboration with the National Institute for Occupational Safety and Health (NIOSH), Division of Respiratory Disease Studies include a cross-sectional epidemiological study, an industrial hygiene sampling program, and immunological research. A review of the work zones and job titles of HP cases was completed and individuals in jobs with more metalworking exposure were more highly represented than other job categories in the group of clinical HP cases. Relationships among the health status of individuals, characterization of risk factors from questionnaire responses, and environmental data are being explored.
Longitudinal industrial hygiene data were collected to track plant changes that may have affected worker exposures to bioaerosols from point sources. In addition, the project team collected heating ventilation and air conditioning (HVAC) system bulk samples and area air samples using a "quiescent/semi-aggressive" strategy. The initial results of the air and sump sampling have not implicated any specific cause. Grab samples from the direct environment of newly diagnosed cases have been collected and sent for laboratory analysis. The data will continue to be reviewed and analyzed to look for statistical relationships among environmental samples and outbreak cases.
Associations between clinical disease and immunologic reactivity to environmental agents may help define the etiology of ILD from exposure to metal working fluids. NIOSH researchers are testing the immunological reactivity of serum from individuals with HP with environmental samples taken from the plant and with selected microbes. The DOEM is collecting serum from a control population, similar to the plant population in that they are workers from the same geographic area, but are not exposed to a metal working environment, to be similarly tested.
Schools. Researchers at DOEM developed a protocol that includes risk factor and health questionnaire surveys of students and teachers, and pulmonary function testing (Monday morning before school, Monday afternoon, and Friday afternoon). The results from two pilot research programs, one comparing teachers' health at schools with and without moisture problems, and the second following a small group of asthmatic children over 3 years of middle school, suggest a relationship between school building occupancy and respiratory health. In the next phase of work, the investigators will further analyze the spirometry, questionnaire, and air quality data. Detecting and measuring bioaerosols in the indoor school environment is difficult and cumbersome. Together with engineers from the H.L. Turner Group, Inc., the researchers evaluated a checklist approach at the study schools to assess indoor air quality using easy-to-measure and subjective surrogate variables for air movement, moisture, and dirt.
The researchers evaluated pilot data from an urban school system and concluded that a significant amount of variability in asthma prevalence across grade schools is not attributable to ethnicity, and may be reflective of building condition, specifically factors that generate bioaerosols.
Mortality Study. Clusters of lung disease have occurred among teachers who frequently work in buildings that are quite "wet," and metalworkers who work around water-based aerosols. We have collected mortality data from 1985 to 1996 using the Multiple Cause of Death File compiled by the National Center for Health Statistics (NCHS). The NCHS data file includes all causes of death listed on the death certificate. We used specific codes from the ninth revision of the International Classification of Diseases (ICD-9), Standard Industry and Occupation Codes (SIC and SOC), and Census occupation codes to capture deaths by specific diseases and occupations. We currently are writing a FORTRAN program to assist in calculating proportional mortality ratios (PMR). Increased death rates of sarcoidosis, HP, and other forms of ILD and ILD-related diseases among school teachers and metalworkers can be identified using PMRs.
Future Activities:
In the coming year, we will complete data collection and analysis for all parts of these projects. These analyses will result in several publications.Journal Articles:
No journal articles submitted with this report: View all 13 publications for this projectSupplemental Keywords:
indoor air, health effects, risk, exposure, children, bacteria, fungus, engineering, epidemiology, measurement methods, occupation, industry, school teachers., Health, Scientific Discipline, Air, Geographic Area, air toxics, Epidemiology, State, Disease & Cumulative Effects, Biochemistry, indoor air, Biology, health effects, risk assessment, interstitial lung disease, exposure and effects, effects assessment, population based study, airway disease, pulmonary disease, mold exposure, lung dysfunction, public health, bioaerosols, ambient particulates, harmful environmental agents, Connecticut (CT), indoor air quality, mycotoxinsProgress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.