title: Airway injury in swine confinement workers.
abstract: OBJECTIVE
  To determine whether work-related respiratory symptoms are indicative of underlying lung disease among swine confinement workers and, if so, to identify whether respiratory changes were more indicative of airway or of interstitial lung injury.
  
  
  METHODS
  Nested case-control study within a population-based longitudinal study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Study participants were randomly selected from a group of 207 swine confinement workers followed longitudinally. Of these, 43 workers with respiratory symptoms were identified, and 31 were randomly selected for inclusion in this study. Three control groups (swine confinement workers, neighbor farmers, and blue collar workers) without work-related respiratory symptoms were frequency-matched by age, sex, and smoking status to the symptomatic swine confinement workers.
  
  
  METHODS
  Spirometry and lung volumes, diffusing capacity of carbon monoxide, chest radiograph, methacholine airway challenge, and bronchoalveolar lavage were done. An endobronchial biopsy was done in the last 27 participants evaluated.
  
  
  RESULTS
  Although spirometric measures of airflow were similar between the symptomatic swine confinement workers and the three control groups, swine confinement cases were found to have significant elevations in residual volume (126.5 +/- 28.2 L) when compared to swine confinement controls (115.4 +/- 38.4 L; P less than or equal to 0.05), neighborhood farmer controls (101.1 +/- 29.4 L; P less than or equal to 0.005), and blue collar controls (106.4 +/- 30.4 L; P less than or equal to 0.05). Swine confinement cases also had an enhanced airway response to inhaled methacholine and had thickening of the epithelial basement membrane of the lobar bronchi. No parenchymal injury was observed in the swine confinement cases.
  
  
  CONCLUSIONS
  Our findings suggest that swine confinement workers who have work-related respiratory symptoms are at risk for airway, but not parenchymal, lung injury, and that spirometry may not accurately reflect the extent of airway injury.
authors.affiliation: University of Iowa, Iowa City.
authors.forename: D A
authors.initials: DA
authors.lastname: Schwartz
authors.forename: S K
authors.initials: SK
authors.lastname: Landas
authors.forename: D L
authors.initials: DL
authors.lastname: Lassise
authors.forename: L F
authors.initials: LF
authors.lastname: Burmeister
authors.forename: G W
authors.initials: GW
authors.lastname: Hunninghake
authors.forename: J A
authors.initials: JA
authors.lastname: Merchant
mesh_terms: D000328:Adult; D000382:Agricultural Workers' Diseases / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D000818:Animals; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001985:Bronchial Provocation Tests; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D016022:Case-Control Studies; D005260:Female; D006799:Housing, Animal; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008137:Longitudinal Studies; D008173:Lung Diseases, Obstructive / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D013552:Swine