Occupational lung disease in Australia. Evolution of chronic airflow obstruction.
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Australia↗
Biomedical subjects
A W Musk
Publications and source records attributed to A W Musk.
Legislation for smoking control in Western Australia.
This historical analysis of public issues relating to smoking control in Western Australia examines relevant Western Australian state and Australian federal laws, their introduction, and their consequences. Public and political support and opinion led by the health professions resulted in two attempts to legislate against all forms of cigarette advertising in 1982 and 1983. Both attempts failed, and public support for such measures has been seen to be affected by the campaigns mounted in opposition by the tobacco and advertising industries. Other smoking control measures which have been successfully introduced in 1983 and 1984 are higher tobacco taxes and a comprehensive coordinated public education and information programme. The activities associated with the legislative initiatives resulted in a greatly increased level of community awareness of the dangers of smoking and acceptance of the need for some action on this major health problem.
Advertising↗
Policy on the treatment of cigarette dependence.
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Australia↗
A comparison of the binding of IgE in the sera of patients with bakers' asthma to soluble and insoluble wheat-grain proteins.
The IgE-binding proteins from flour, associated with bakers' asthma, have been reassessed by use of a modified RAST suitable for both soluble and insoluble proteins. Nitrocellulose sheet was used for preparing RAST discs, and seven different solvents were compared for their suitability in preparing discs. Dilute alkali (1% potassium hydroxide) was chosen as the best solvent for disc preparation, and its use was compared with that of water as solvent. RAST analyses of sera from 24 allergic bakers demonstrated that the albumin fraction of flour is clearly allergenic (as found in previous studies), but in addition, major IgE-binding proteins were found in the other three fractions (globulin, gliadin, and glutenin) when potassium hydroxide was the solvent (but not with water). We conclude that current RAST procedures, which favor water-soluble allergens, are inadequate because they do not satisfactorily test for water-insoluble allergens.
Albumins↗
Skin test and RAST responses to wheat and common allergens and respiratory disease in bakers.
Interrelationships between skin and humoral tests for immediate hypersensitivity to wheat and indicators of respiratory disease were examined in 176 male bakers. Skin tests were assessed by measuring the diameter of the weal resulting from prick innoculation of allergen extract and circulating allergen-specific IgE by radioallergosorbent test (RAST). Fifteen per cent of subjects showed positive skin-prick test responses to wheat extracts. These subjects demonstrated an increased prevalence of respiratory symptoms and of measurable bronchial responsiveness to methacholine. Thirty per cent of subjects had positive skin test responses to common allergens but negative responses to whole wheat. Compared to subjects with no positive skin test responses they had an increased prevalence of bronchial responsiveness to methacholine but a similar prevalence of respiratory symptoms. There was a significant association between skin test responses to whole wheat and skin test responses to common allergens suggesting that bakers with pre-existing sensitivity to common allergens are at increased risk of developing wheat flour sensitization. There was no significant difference between skin-prick test and RAST responses to wheat, water-soluble wheat protein and common allergens. Both tests showed similar relationships with indices of respiratory disease. The associations between skin test and RAST responses to wheat extracts and indices of respiratory disease was stronger for the water-soluble wheat proteins than for other wheat grain extracts. These results suggest that immediate hypersensitivity to wheat flour is important in the development of non-specific bronchial hyperreactivity in bakers and that the water-soluble fractions of wheat flour are the most important allergenic components.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Compensation, radiographic changes, and survival in applicants for asbestosis compensation.
The survival of 354 claimants for compensation for pulmonary asbestosis among former workers of the Wittenoom crocidolite mine and mill in Western Australia has been examined. There were 118 deaths up to December 1982. The median time between start of work and claim for compensation was 17 years. The standardised mortality ratio (SMR) for deaths from all causes was 2.65 (p less than 0.0001). The SMR for pneumoconiosis was 177.2 (p less than 0.0001), bronchitis and emphysema 2.6 (p = 0.04), tuberculosis 44.6 (p less than 0.0001), respiratory cancer (including five deaths from malignant pleural mesothelioma) 6.4 (p less than 0.0001), gastrointestinal cancer 1.6 (p = 0.22), all other cancers 1.6 (p = 0.17), heart disease 1.4 (p = 0.07), and all other causes 2.18 (p = 0.004). Plain chest radiographs taken within two years of claiming compensation were found for 238 subjects and were categorised independently by two observers according to the International Labour Organisation criteria without knowledge of exposure or compensation details. Profusion of radiographic opacities, age at claiming compensation, work in the Wittenoom mill, and degree of disability awarded by the pneumoconiosis medical board were significant predictors of survival, but total estimated exposure to asbestos was not. Radiographic profusion and degree of disability were, however, predictable by total exposure. The median survival from claim for compensation was 17 years in subjects with ILO category 1 pneumoconiosis, 12 years in category 2, and three years in category 3.
Asbestos↗
Absence of respiratory effects in subjects exposed to low concentrations of TDI and MDI: a reevaluation.
Because of criticisms of the authors' previously reported study showing absence of respiratory effects in subjects exposed to low concentrations of toluene diisocyanate (TDI) and diphenylmethane diisocyanate (MDI), the data have been reanalyzed. This reanalysis confirms the accuracy of the results and the conclusions based on them. Subjects exposed to 0.0010 to 0.0015 ppm of TDI and around 0.0003 to 0.0006 ppm of MDI demonstrated a normal age- and smoking-related rate of decline in forced expiratory volume in 1 s and no evidence that it was related to isocyanate exposures. Control of isocyanate exposure sufficient to protect industrial workers against measurable deterioration in lung function appears feasible.
Cyanates↗
Benign and malignant pleural effusions in former Wittenoom crocidolite millers and miners.
Serial plain chest radiographs taken between 1943 and 1982 for 280 claimants for compensation for asbestosis and 32 claimants for malignant pleural mesothelioma from the Wittenoom asbestos industry were reviewed by two observers to identify diffuse pleural thickening and pleural effusion. A pleural effusion which appeared and resolved within two years without radiographic or clinical evidence of underlying malignancy, infection or cardiac failure was seen in 15 cases by reader 1 and 24 cases by reader 2. Eighteen cases of effusion, determined from clinical records to be caused by malignant pleural mesothelioma, were seen by reader 1 and 20 by reader 2. The latent periods between commencing work and the first radiograph showing effusion were much shorter for subjects with benign asbestos pleural effusion than for subjects with effusion due to malignant pleural mesothelioma, although there was considerable overlap in the range. The longest latent period for benign asbestos pleural effusion was 22 years and the shortest period for effusion due to malignant pleural mesothelioma was 12 years. The latent period for benign asbestos pleural effusion was inversely related to total cumulative exposure, whereas that for effusion due to malignant pleural mesothelioma was significantly shorter for subjects who had worked in the mill than for those who had worked in the mine. A long latent period and a history of working in the mill were significant discriminators for a malignant as opposed to a benign basis for an effusion. The appearance of a benign asbestos pleural effusion appeared to be a risk factor for the severity of subsequent diffuse pleural thickening.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Epidemiology of malignant mesothelioma in Western Australia.
Crocidolite was mined and milled at Wittenoom Gorge in Western Australia from 1943 to 1966. Between 1960-1964 and 1980-1982, the estimated incidence of malignant mesothelioma in Western Australia rose from 0.6/100 000 in men and less than 0.1/100 000 in women, aged 35 years or older, to 6.6/100 000 in men and 0.7/100 000 in women in this age group. Overall, 97 (70%) of 138 patients with malignant mesothelioma had definite or probable exposure to asbestos; 76 of these (55%) to Western Australian crocidolite. Of the latter 76 patients, 56 had worked in the mine or mill at Wittenoom and 4 had non-occupational exposure in the Wittenoom area; the remaining 16 had been exposed to crocidolite elsewhere in the State. There were only 4 (3%) patients with malignant peritoneal mesothelioma, of whom three had been exposed to crocidolite.
Adult↗
Asbestosis and cryptogenic fibrosing alveolitis: a radiological and functional comparison.
This study compares the relationship between lung function and radiological abnormality in 46 subjects with asbestosis and 38 subjects with cryptogenic fibrosing alveolitis. Radiographs were graded separately by two observers according to the 1980 International Labour Organisation criteria for classification of the pneumoconioses. The correlation between the transfer factor of the lungs and the radiographic profusion of small parenchymal opacities was found to be greater in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis. At any level of radiological profusion transfer factor was higher in cases with asbestosis than in cases with fibrosing alveolitis. As pleural thickening is seen commonly in asbestosis and may influence lung volumes and the ratio of transfer factor to effective alveolar volume, the results of these measurements were compared only in the cases showing absent or minimal pleural thickening. Both of these variables were higher in the subjects with asbestosis. The results indicate that despite pathological, functional and radiographic similarities, lung function for a given degree of radiographic parenchymal abnormality is better in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis, and that changes in the plain chest x-ray appearances in asbestosis correlate more closely with the results of lung function tests.
Asbestosis↗
Wheat flour sensitisation and airways disease in urban bakers.
A total of 176 bakers and 24 subjects employed as bread slicers and wrappers were studied to examine the effect of occupational category on respiratory symptoms, ventilatory capacity, non-specific bronchial reactivity, and prick skin test responses to wheat and common allergens. Bakers had a greater prevalence of attacks of wheeze and dyspnoea and more frequently considered that work affected their chests than did slicers and wrappers. Bakers with a history of asthma with onset since starting work in a bakery had a greater prevalence of chronic cough and sputum, increased bronchial reactivity, and positive prick skin test responses to wheat and common allergens than other bakers. There was a significant association between the frequency of positive prick skin tests to wheat and common allergens, suggesting that prior atopy facilitates sensitisation to cereal antigens. The frequency of positive prick skin responses to common allergens, however, declined with increasing baking duration whereas the frequency of positive skin responses to wheat increased with increasing baking duration, suggesting that subjects who were sensitised to common allergens were leaving the industry whereas subjects who stayed in the industry increased their risk of developing sensitisation to wheat. Oven handlers had a greater prevalence of attacks of wheeze and dyspnoea and more frequently considered that work affected their chests than either dough makers or general bakers. They also had a greater prevalence of positive prick skin test responses to wheat than dough makers or general bakers. Oven handlers also had a lower mean standardised casual FEV1 than either general bakers or dough makers. Thus oven handlers appear to have a greater risk of developing respiratory allergy and airflow obstruction than bakers in other occupational categories.
Adult↗
Adverse effect of pregnancy on familial fibrosing alveolitis.
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Adult↗
Pulmonary asbestosis--an example of industrial diffuse lung disease.
This account reviews the clinical and pathological features of asbestosis, with a brief comment on the incidence of asbestosis in workers exposed occupationally to Western Australian crocidolite at Wittenoom Gorge. In keeping with common usage, the term "asbestosis" is restricted to pulmonary parenchymal fibrosis--with or without associated visceral pleural fibrosis--related to inhalation of asbestos fibres, thereby excluding parietal pleural fibrous plaques. The mechanisms underlying the development of the interstitial fibrosis are incompletely understood, but they appear to involve complex interactions of asbestos with alveolar macrophages, fibroblasts, lymphocytes and the complement system.
Asbestos↗
Sputum asbestos bodies and radiographic changes in residents of Wittenoom, Western Australia.
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Adolescent↗
Pleural thickening and gas transfer in asbestosis.
Anomalies in the ratio of transfer factor to effective alveolar volume as an indicator of pulmonary gas exchange in cases of asbestosis may be related to diffuse pleural thickening. To examine the effect of pleural disease on gas transfer the plain chest radiographs of patients with asbestosis were assessed by two observers for profusion of parenchymal opacities and extent of pleural disease and the results were related to lung function. In 30 cases of category 1 profusion of parenchymal abnormality (according to the ILO international classification of radiographs for pneumoconiosis) transfer factor was independent of the degree of pleural thickening. The ratio of transfer factor to effective alveolar volume correlated directly with the degree of pleural thickening as alveolar volume fell with increasing severity of pleural disease. The results indicate that correcting transfer factor for alveolar volume does not provide an accurate reflection of severity of diffuse parenchymal fibrosis in patients with asbestosis and even minor pleural disease.
Aged↗
Relation of pulmonary vessel size to transfer factor in subjects with airflow obstruction.
In a group of 61 consecutive patients undergoing assessment of airflow obstruction, a significant linear relation was demonstrated between measurements of the diameter of the midzonal pulmonary vessels on the plain chest radiographs and transfer factor (diffusing capacity for carbon monoxide) (r = 0.46, p less than 0.001). Since reduction in transfer factor has been shown to relate to structural emphysema, reduction in midzone vessel caliber implies the same. However, in the individual patient neither the transfer factor nor structural emphysema can be reliably predicted from midzone vessel diameters alone.
Carbon Monoxide↗
Asthma caused by occupational exposure to vanadium compounds.
Four workers from a recently established vanadium pentoxide refinery in Western Australia presented with green discoloration of the tongue, upper respiratory symptoms, and asthma. Three of them were non-atopic as judged by history, prick skin test responses, and total serum IgE levels. The two with most recent exposure to vanadium compounds exhibited bronchial hyperreactivity to histamine. Vanadium compounds appear to be capable of inducing asthma in previously normal subjects. One subject continued to wheeze eight weeks after this last exposure.
Adult↗
Pulmonary function in firefighters: a six-year follow-up in the Boston Fire Department.
Tests of ventilatory capacity, objective cough, and standardized respiratory questionnaires were used in a prospective study to measure the effect of firefighting on pulmonary function in a cohort of 951 white Boston firefighters between 1970-1976. During the six years of follow-up, the mean annual decrements in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were 36 and 29 ml per year, respectively. At the end of the study in 1976, the mean FEV1 for this group was 98.3% of the level predicted for healthy nonsmoking adults, while the FVC was 97.8%. Current cigarette smoking was associated with an increased prevalence of bronchitis, a loose cough, reduced levels of FEV1 and FVC, and increased longitudinal changes in FEV1 and FVC. The longitudinal changes and current levels of FEV1 and FVC were not correlated with any index of firefighting exposure in active firefighters. Increased use of protective respiratory apparatus and previously described selection effects within the Boston Fire Department appear to be protecting this group of firefighters from long-term effects of smoke exposure as measured by these techniques.
Adult↗