Occupational Asthma Reference

Cramer C, Schlünssen V, Bendstrup E, Stokholm ZA, Vestergaard JM, Frydenberg M, Kolstad HA, Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders, Eur Respir J, 2016;48:818-825,10.1183/13993003.00376-2016
(Plain text: Cramer C, Schlunssen V, Bendstrup E, Stokholm ZA, Vestergaard JM, Frydenberg M, Kolstad HA, Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders, Eur Respir J)

Keywords: denmark, pigeon, bird, hp, incidence, ep

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Vivi Schlunssen, Aarhus Vivi Schlunssen

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Abstract

We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.

This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276?800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977–2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.

The overall incidence rate of ILD was 77.4 per 100?000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26–1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10–25.44) and 1.33 (95% CI 1.05–1.69), respectively.

This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.

Plain text: We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders. This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276?800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977-2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease. The overall incidence rate of ILD was 77.4 per 100?000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26-1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10-25.44) and 1.33 (95% CI 1.05-1.69), respectively. This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.

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Comments

Many studies estimating the risks of hypersensitivity pneumonitis in pigeon breeders are confounded by selection bias including the over-inclusion of "survivors". This study overcomes this by includeding an inception cohort of 807 pigeon breeders and their general population referents, with a median follow-up period of 7 years (range <1–13 years). The incidence rate of all ILDs was 122.9 per 100?000 person-years among the pigeon breeders and 25.6 per 100?000 person-years among the referents, corresponding to a HR of 4.68 (95% CI 2.12–10.30). The adjusted HR of hypersensitivity pneumonitis was 113.11 (95% CI 22.82–560.66). The mean time from enrolement to first diagnosis of ILD was 38.6 months (95% CI 8.0–69.2 months). The study has not been going long enough to estimate any increased risk of Usual Interstitial Pneumonitis due to chronic HP, which many believe is contributing to the increasing incidence of "idiopathic" pulmonary fibrosis
9/1/2016

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