title: Exacerbation of symptoms in agricultural pesticide applicators with asthma.
abstract: OBJECTIVE
  Exacerbation is a critical event in asthma management. We investigated whether exacerbation of symptoms is associated with farming exposures among agricultural pesticide applicators with asthma.
  
  
  METHODS
  Participants were pesticide applicators with active asthma (wheezing and breathing problems in past 12 months) who completed enrollment questionnaires for the Agricultural Health Study (AHS). Exacerbation of asthma was defined as having visited a hospital emergency room or doctor for an episode of wheezing or whistling in the past 12 months. Exposures of interest were using 36 specific pesticides in the past 12 months and conducting various agricultural activities. Adjusted odds ratios (ORs) were estimated by logistic regression while controlling for potential confounders.
  
  
  RESULTS
  The 926 AHS adult pesticide applicators with active asthma included 202 (22%) with exacerbation. Inverse associations with exacerbation were observed for two herbicides [glyphosate, odds ratio (OR) = 0.5, 95% confidence interval (CI) 0.3, 0.8, and paraquat, OR = 0.3, 95% CI 0.1, 0.9] and several agricultural activities (repairing engines, grinding metal, driving diesel tractors, and performing veterinary procedures). Only asthma cases with allergies (i.e., doctor-diagnosed hay fever or eczema, 46%) had positive exacerbation-pesticide associations, with OR = 2.1 (95% CI 1.1, 4.1) for the herbicide pendimethalin and OR = 10.2 (95% CI 1.9, 55) for the insecticide aldicarb.
  
  
  CONCLUSIONS
  The inverse associations with two pesticides and specific farm activities are consistent with the possibility that asthma cases prone to exacerbation may avoid exposures that trigger symptoms. Although limited by small sample size and a cross-sectional design, our study suggests that use of specific pesticides may contribute to exacerbation of asthma among individuals with allergies.
authors.affiliation: Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, MS 2800, 1095 Willowdale Road, Morgantown, WV, 26505, USA, pkh0@cdc.gov.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Henneberger
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Liang
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: London
authors.forename: David M
authors.initials: DM
authors.lastname: Umbach
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hoppin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000382:Agricultural Workers' Diseases / Q000453:epidemiology / Q000209:etiology*; D059366:Asthma, Occupational / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010575:Pesticides / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D010575:Pesticides