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      Cross-sectional Study of Workers Employed at a Copper Smelter—Effects of Long-term Exposures to Copper on Lung Function and Chronic Inflammation


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          The present cross-sectional study investigates whether biological relevant differences in lung function and inflammatory biomarkers exist between workers of a German copper plant and an internal comparison group. It complements a previously published historical health surveillance study and sheds light on possible subtle changes following long-term exposure to copper-containing dust.


          The aim of the study was to assess the effect of exposure to copper-containing dust on lung function and inflammatory endpoints among workers of a German copper plant, effects rarely studied before.


          One hundred four copper-exposed smelter workers and 70 referent workers from the precious metal and lead facilities were included, with different metal exposures in both groups due to the different process materials. Body plethysmography, exhaled nitric oxide (FeNO) measurements, and blood sampling were conducted in all workers. Smoking status and the use of respiratory protective equipment were considered. In a subgroup of 40 nonsmoking volunteers (28 copper-exposed and 12 referents), sputum biomarkers were assessed.


          Median lung function values of both copper-exposed and the referent groups were within reference ranges of “healthy” individuals, and statistical differences between the groups were mostly not evident. Similarly, differences in blood and sputum biomarkers were too small to be biologically relevant.


          The results suggest the absence of the detectable effects of copper-containing dust exposure on lung function or chronic inflammation within the investigated cohort.

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          Most cited references56

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          An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications.

          Measurement of fractional nitric oxide (NO) concentration in exhaled breath (Fe(NO)) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. While Fe(NO) measurement has been standardized, there is currently no reference guideline for practicing health care providers to guide them in the appropriate use and interpretation of Fe(NO) in clinical practice. To develop evidence-based guidelines for the interpretation of Fe(NO) measurements that incorporate evidence that has accumulated over the past decade. We created a multidisciplinary committee with expertise in the clinical care, clinical science, or basic science of airway disease and/or NO. The committee identified important clinical questions, synthesized the evidence, and formulated recommendations. Recommendations were developed using pragmatic systematic reviews of the literature and the GRADE approach. The evidence related to the use of Fe(NO) measurements is reviewed and clinical practice recommendations are provided. In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV(1) reversibility or provocation tests are only indirectly associated with airway inflammation. Fe(NO) offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy.
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            Standardisation of the single-breath determination of carbon monoxide uptake in the lung.

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              Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society.


                Author and article information

                J Occup Environ Med
                J Occup Environ Med
                Journal of Occupational and Environmental Medicine
                Lippincott Williams & Wilkins
                September 2022
                28 July 2022
                : 64
                : 9
                : e550-e558
                From the Ramboll Deutschland GmbH, Essen, Germany (Ms Haase, Mr Birk); Regulatory Compliance Limited, Loanhead, Edinburgh (Dr Poland); Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK (Dr Poland); Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany (Dr Holz, Dr Müller); German Center for Lung Research (DZL, BREATH), Hannover, Germany (Dr Holz); Ramboll US Consulting, Inc, Amherst, Massachusetts (Dr Bachand); Cardno ChemRisk, Boston, Massachusetts (Dr Mundt).
                Author notes
                [*]Address correspondence to: Thomas Birk, Dipl. Rer. Soc., Ramboll Deutschland GmbH, City Tower–Limbecker Platz 1, 45127 Essen, Germany ( tbirk@ 123456ramboll.com )
                JOEM_220085 00018
                Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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                Custom metadata

                copper,cross-sectional study,induced sputum,inflammation,lung function,occupational exposures


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