title: Sputum eosinophilia is a determinant of FEV1 decline in occupational asthma: results of an observational study.
abstract: OBJECTIVE
  To evaluate the potential determinants of forced expiratory volume in 1 s (FEV1) decline in workers with occupational asthma (OA) still exposed to the causative agent. We hypothesised that sputum eosinophilia might be a predictor of poor asthma outcome after diagnosis.
  In a specialistic clinical centre of the University Hospital of Pisa, we studied 39 participants (28 M, 11 F) diagnosed as having OA, routinely followed up between 1990 and 2009. They were a subgroup of 94 participants diagnosed as affected by OA in that period: 9 had been removed from work at the diagnosis, 21 were excluded for having ceased occupational exposure after few months from diagnosis, and 25 were lost at the follow-up or had no acceptable sputum measurements at the diagnosis. Estimates of the decline in FEV1 were obtained by means of simple regression analysis during the period of occupational exposure after diagnosis. Logistic regression was used to analyse the effects of factors (baseline FEV1 and sputum inflammatory cells, duration and type of exposure) that may potentially influence FEV1 decline.
  
  
  RESULTS
  At follow-up (5.7+3.7 years), most participants were still symptomatic despite inhaled corticosteroids (ICS) treatment and had their occupational exposure reduced. Participants with higher sputum eosinophils (>3%) at baseline had a significantly greater decline of FEV1 (-52.5 vs -18.6 mL/year, p=0.012). Logistic regression showed that persistent exposure and sputum eosinophilia were significantly associated with a greater decline in FEV1 (OR 11.5, 95% CI 1.8 to 71.4, p=0.009 and OR 6.7, 95% CI 1.1 to 41.7, p= 0.042, respectively).
  
  
  CONCLUSIONS
  Sputum eosinophilia at diagnosis, together with the persistence of occupational exposure during follow-up, may contribute to a greater decline in FEV1 in patients with OA still at work. Further long-term studies are required as to whether intensive ICS treatment may be beneficial for patients with OA and increase ad eosinophilic inflammation.
authors.affiliation: Regione Toscana, CERIMP, Pisa, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Talini
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Novelli
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bacci
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Marialaura
authors.initials: M
authors.lastname: Bartoli
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Cianchetti
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Costa
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Federico L
authors.initials: FL
authors.lastname: Dente
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Di Franco
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Latorre
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Malagrinò
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vagaggini
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Celi
authors.affiliation: Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Paggiaro
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D059366:Asthma, Occupational / Q000188:drug therapy / Q000276:immunology*; D004802:Eosinophilia / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000276:immunology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016273:Occupational Exposure; D013183:Sputum / Q000276:immunology*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: OCCUPATIONAL & INDUSTRIAL MEDICINE