Tobacco Documents Online

he ones in mewhat ~mokers, work in results. .era, but and Rt not, but slightly .re closer Ks and ire small al values on about ~seg and and non thyoung .onfirmed they are' ,r clinical Kntt SaM, ALFA-ONE ANTITRYPSINE PHENOTYPES AND INHALATORY PULMONARY PATHOLOGY (~) R. A~^R~L-M~aQvI~s, R. AVtLX, H. Ggxv~ M. L. CocmTo, C. M^NSO~ T. G. V~LL^g ~" (Lisbon) One hundred and ewe'hey nine workers in the fork industry, 69 rural workers, 66 carpet makers, 58 workers in a granite query and 51 workers in a rice husking factory were studied from an epidemiologic point of view.. All were submitted to a standard questionnaire planned to detect respiratory disease due to 'inhalatory causes. They were submitted to a clinical examination, summary ventilatory [unction tests, a 70 mm microradiograph, and blood w~ taken to determine M/a-one antilrypsine and its phenoty~es and, in the cork industry workers and rice husking workers, the level of fgA, ~gG and lgM. The results are ~resenled and an attempt is made to correlate the various parameters among them~elvez, and namely al/a-one AT phenotypes with the exis- tence of re¢~irafory pathology. FinaEy the results are discussed. INTRODUOTIOh' An increasing number of diseases of the respirator3, tract have been appearing in Portugal dde to the inhalation of organic, inorganic and other dusts. A revision of 1000 patient files from the Department of Chest Diseases of Lisbon Faculty of Medicine showed ~ that the incidence of Extrinsic Pulmonary Granulomatoses caused by the inhalation of such dusts was 18 % only slightly lower than that of Chronic Bronchitis (22 %). In the present study an attempt is made to determine the incidence of respiratory pathology in various professional groups exposed to the inhalation of dusts. Simultaneously the g-1 antitrypsine phenotypes of the same populations were determined and a correlation between these and the respiratory pathology, was looked for. (*) Partially supported by Centro CnLs - INIC - Lisbon (Portugal), T!04231195

530 Re Amaral-.~forqTw~ c! coll. With the snmo ol@c~ ~-I muitD'psine and imnmnn~ohulin leveb were de~ernfined h~ ~he subject's serum. i~[A'I'I:RIALS AND METHOD:g Six professional groups were studied from the epidenfiological pr, int.- of view : -- 129 workers in the cork industry, 41 males and 88 females; fi9 rural workers, 42 males and 27 females; 66 carpet makers, all women; 58 workers in a granit quary, all men; 51 workers in a rice hu~king fatteD-, 39 males and 12 females. Tahle 1 shows the characteristics of these 5 professional groups. correH~onding to a total of 373 workers, as tn their distribution by age and sex, duration of exposure and smoking habiLq. The epidemiologic stud)' consisted ~ a standardised questionnaire for the study of resplrato~, diseases of inhalation origin used at the Deparmwnt of Chest Diseases Lisbon Faculty of Medicine; TAI~LE I. -- Characteristics o/ the pro/essional groups blale~ .... l:'emale~ . . . A~e tyearf~ Males .... Exposure lyears) Malet .... Smoking hal,hs Cork 1'2.9 41 46 06.641 44 11-531 tl.481 26 'Rurnls 12 -13 116-6;~ 2O Carpet Granh 6fi 5~ 29 7.2 37 O6.62~ 15 41 Rite Torah. 51 3T3 3~ 180 12 193 -15 42 t.19.6% ¢16-671 39 38 (22-61~ ~1~-68~ _ t).22~ I0 f5.22, and radi. anti.-" of tl R.Es: by t Nasal ] frcqu, incidc $111okt "1 IllajOl the rt metrit airwa, T!04231196

,. levels points .les; females. groups, t by age diseases s Lisbon Totals 373 1~3 42 (16-671 311 114-68i i(s8 %~ Alia-one antitrypsine phenotypes 531 -- clinical examination; --elementaD' ventilatory function tests using a Vitalograph wit[t measurement of V.C., FEV1. FEV~/VC X 100 and M.E.F. 25-75/VC; -- nticroradiography of the chest; -- blood sampling for ~x-I antitrypsine phenotypes using the Teclmi- que described by Geada ~ and for determining the ~-1 autitrypsine levels as well as those immunoglobulins G, A and M using Manclnl, Cadmnari and Hermans techniques. Due to reasons beyond our control it was not possible to obtain micro- radiographs of the cork workers and it was only possible to obtain the ~-1 antitrypsine phenotypes levels as well as the intmunoglobulln levels in some of the professional groups. RESULTS AND DISCUSSIO.N Table II shows the respiratory, nasal and systemic syrnptoms referred by the workers, according to their sex. Table If. -- Respiratory, nasal and systemic symptoms referred by the workers, according to their sex [~ ~ymptoms: Respiratory (46.7 Na~al (40.2 ~) .... Cork Rurals 41 88 42 2~ male fem male fem 49 56 36 26 60 -- 47 -- 39 46 24 30 15 13 5 4 Carpet Cranil Rice 66 58 39 '12 fem male male fem 33 55 56 511 ~ 81 45 -- 45 36 49 50. 15 14 15 II Both in males and females the respiratory symptoms were the most frequently referred ~ 46.7 % -- followed by the nasal symptoms. The incidence of respirator), symptoms was higher in smokers than in non- smokers. The results of the spirometric study (tab. III) revealed that the great majority of workers had normal functional patterns (79.2 %). However, the results of MEF 25-75/VC showed that 80 (27.6 %) of these spiro- metrically normal subjects already showed changes suggestive of small airway obstruction. The workers in the cork industry and in granite Ti04231197

532 ]~..4mnrnl-~4nrtlue.~ rt extraction showed an incidence of obstructive vcnfilatoD, changes that varied from 14.6 to 19.3 %, the higher incidence being found in the non- smoking female population. Restrictive ventilatory changes were found in only 9 c~ of the cases, the highest incidence being found aznong the male workers of the rice husking factor),, 18 %. Thirty three percent of the total population studied (366 subjects) showed signs of peripheral airway obstruction. T^snz 1II. -- Splrometric ~tudy o[ lhe workers according to the #e.v and smoking habits Cork Rurals Carpet Granit Rirc M F It[ F F M M F Normal ~ {79.21 . . . 70.7 69.9 85.7 85.2 89.0 ~1.0 76.9 83.3 (P.A.O. %: 27.6) Smokers . . 61.5 -- 80.0 -- ~ 75.6 64.7 -- Ob.~lrurlive % (10.7) . . 14.6 19.3 4.8 3.7 [ 4.; 17.2 2.6 0.0 Smokers . . 19.2 ~ 10.0 ~ ~ 22.0 5.9 ~ Restrictive ~ (9.0) . . . 32.2 9.6 9.5 11.1 [ 6.3 1.7 18.0 8.5 Smokers . . ]l.S -- 10.0 __ i __ 2.4 23.5 ~ Mixte % II,lt 2.4 1.2 0.0 0.0 i 0.0 0.0 2.6 8.3 Smokers . . 3.9 ..... $.9 ~ P.A.O. % (33.9) .... 51.2 44.6 g3,8 18.5 12.1 53.5 28.2 8.3 Smokers . . 53.9 -- 50.0 -- I ~ 61.0 35,3 ~ P.A.O. = Peripheral Airway Ob,~tructi, on. The predominant roentgenologic patterns on microradiography of the workers in the granite extraction and rice husking industries were increased lung markings, hilar enlargement and mieronodular dissemi- nations. In the other workers normal patterns predominated. An attempt was made to correlate the various parameters studied among themselves such as the presence or absence of symptoms with ventl- latory function patterns and radiographic patterns in each of the profes- sional groups, by sexes and smoking habits, but nothing remarkable was noted. and not popt with (p < TA % Lung: lnfil: % M|cr, % liilar .. T!04231198

d~anges that in the non- were found among the d, ree percent uf peripheral qing 64.~ 2.6 0.0 S.9 18.0 8,5 23.5 2.6 8.3 28.2 8.2 ~radiography of industries were aodular dissemi- rameters studied Jtoms with venti- :h of the profes- hing remarkable Alia-one antltryptine phenotypes 533 The levels of inmaunoglobulins A, G and M studied in workers with and without ~.,mptoms in the cork and rice husk-ing industries, did also not show significant differences among themselves or in relation to a population of normal controls. Only the values of Ig A of the rice huskers with symptoms were significantly different from the norntal controls (p < 0,01) (tab. V). IV. -- Roentgenologic patterns (%) o[ the workers according to the sex Normal : % ~6.~ .... Lung mnrklng: % 3~.6 .... Infiltration." % 1.1 .... Mieronodular dis- semination: % 9.7 .... Hilar enlargement: o, 29.0 Rurals M F 68.4 57.7 26.3 26.9 0.0 0.0 0.0 7.9 81.3 18.8 D.O 0.0 3.1 30.8 31.0 Cranit Rice M M F 20.7 20.0 28.fi 39.7 72.0 57.1 1.7 4.0 0.0 19.0 24.0 0.0 33.5 36.0 28.( TM~Lr" V. -- Immunoglobulins levels of the cork and rice workers with or without symptoms in relation to a population o[ normal controls Cork Normal Conlrols Rice IgA With Without 282.8 257.6 s = ~6.9 s = 78.9 273.1 s = 52.1 p < 0.01 343.7 262.4 s = 134£ s = 143.8 IgM With With Without Without S.~lnptolns I .%vmpt oots 1327.3 1339.8 = 290.2 s = 268.4 1182.2 236.7 1160.4 1180.0 = 347.5 s = 382.2 152.8 169.1 = ~ = 66.6 55.2 156.2 s ~ 56.2 103,4 1119.3 s = 62.5 ,- = 74.6 T104231199

R. Antaro~o.~ffarque~ ~ coll. Similarly, the levels of r,-i antit~'psine of 30 normal controls were contpared with 54 workers in the granite extraction industry, separating those with symptoms from those withouh and these with ventilatory obstruction from those without. Again no significant differences were found between these sub-groups and tile control population (tab. VI). VI. -- Alpha-one antitrypsine levels o/ granlt workers accordin~ with the pre~ence or absence o[ complaint~ and ventilatory obstruction ~n relation to a normal population Standard deviatiou .... Complaints With Without 34 20 255.7 239.9 45.8 43.3 Obstruction With Withou! 9 46 • 2fi9.8 2*7.8 42.2 45.4 Cont rol ~ 36 2] 1.3 98.3 Finally, the ,t-I antitrypsine phenotypes of the professional groups studied were compared with those of a population of blood donors of the southern part of Portugal where this study was undertaken2 and with another of 1025 blood donors from all over the CIountry (tab. \'II). As the phenotypes are genetically determined they have nothing to do with the professional groups, it was curious to note that the workers from the VII. ~ Alpha-one antitrypsine phenotypes o[ the workers compared with two blood donnors populations Phenotypes: MM MS MZ ..... SS SZ ZZ Portugal (10~) 75.03 19.90 2.63 0.88 0.10 0 South 14~6) 77.17 18.48 2.17 0 0 0 Cork 021) 79.34 1..88 0 2.48 0 0 Carpet 93.10 5.17 1.72 0 0 0 Granit (~) 85.19 12,96 1 0 0 Rice (44) 88.10 11.90 o 0 o area of showed front AI of the ( "l'h~ female T^~L~ :- MM Th those systemic T!04231200

rols were cparating entilatory ere found I. wilh Con|rols 36 ~.11.3 98.3 hal groups aors of the and with ~. VII). As to do with 's ~rom the :ompared Ri©e 11.90 0 0 0 0 Alia-one antitrypsine phenotypes 535 area of Alto Alcntejo (carpet makers, granite extraction and rice huskers) showed a higher incidence of MM phenotypes as compared with those from Algarve (cork workers), the southern part of the Country and those of the Country in general. The finding of a particularly low incidence of MS phenotypes in the female carpet makers was interesting as all lived in the same area -- Arraiolos -- where the population is highly inbred. VIII. -- Alpha-one antitrypsine MM and M6 phenotypes o~ the workers. It's incidence according the absence or presence o/ symptoms MM MS No symptoms . . Respiratory . . . Nasal ..... Systemle .... No symptoms Resplralory . Nasal ..... Systemic .... Total Cork 36.9 50.2 44.2 14.2 27.3 63.6 54.6 27,3 34.4 56.3 4L9 ]4.6 38.9 55.6 44.4 27.8 Carpet 46.3 35,2 46.3 ]4.8 0/3 ~/3 2/3 ~/5 Granit 39.1 52.2 34.8 13.0 ]4.3 85.7 S?,4 28.6 27.(} 43.2 13.5 2ILll 60.0 80.1~ 0.0 The comparison of the incidence of the various phenotypes in the professional groups, with or without symptoms (tab. VIII) showed that those with MS phenotypes are more susceptible to respiratory, nasal or systemic symptoms than those with the MM phenotypes. CONGL U SIONS 1. The environment of the rice husking factory where the present study was carried out, as well as that of the granite extraction and cork workers, seems to be aggressive to the resplratoQ, tract. Tobacco increases the incidence of respiratory symptoms. 2. Subjects exposed to the environment of the carpet factor" at Arraiolos did not show evidence of a higher incidence of respirator3." symptoms than the control population, although there was some increase in the incidence of nasal symptoms. 3. As to the spirolnetric chauges the high incidence of subjects with TI04231201

536 ~. Amara~-.Mnrqur-x et m~all airwa}:s obstruction (33.9 %) is notable. It was curious to note that in the cork and granite workers obstructive ventilatory changes predo- minated, while in the rice huskers restrictive changes predominated. Tobacco see,us to play an important role in the increase in the obstructive .syndrome. 4. The high incidence of microradiographic changes, namely increased lung markings hilar enlargement and micronodulation in the rice huskers and granite extractive.s was noted. 5. The lack of interest of the determination of sero immunoglol~ulins aqd ~-1 antitrypsine levels in this type of epidemiological study is evident. 6. The chaqges in the incidence of the various phenotypes of a-1 antitD'psinc, according to the geographical localization of the profess;onal groups studied is probably due to the family tics of the studied ,~, bjccts. 7. The higher incidence of symptoms in the subjects with the MS ~,-I antitrypsine phenotypes should also he noted. Chest Disease Department IDirector: "Prof. T. G. V~A..~a Lisbon Medicine Faculty - Lisbon (Portu.eal) Instituto de Qulmlca Fisioldgica (Director: Prof. C. MAgsol Lisbon Medicine Faculty - Lisbon (Portugal) ~A 5e stad rentilot desk et par degrd; les B IBLIOGRAPHY 1. ARM]JO A. T., Sovs& S., RksMos A., BZaNAR~O T., FR.F.ITAS F. COSTA M.: Fac- totes pro[isslonais na etiopatogenia das doencas broncopulmonares, j. do M6dieo, 1973, 83, 9. 2. G~:ADA H., ALI~INO j., AVlLA. R.# "~t'ENTURA A., ~FoNsECA J.~ VILLAR T. Gq MANSO C.: Enzlmas protolftlcos e seus inibldores, lmport~ncia da antitripsina do soro. J. Soc. Cienc. Med., 1977, 141, 85. 3. M~'qemx G., C^anoto, RA A. O., Hsgrt~s J. F.: Immunochemical quantitation o/antigens by single radial immunodi/lusion. Xmmunochemistry~ 1965, 2, 235. mopat} relative difficik d'o dans le limites Lc Le$ dl Cir Ti04231202