Documente Academic
Documente Profesional
Documente Cultură
1
Introduction
Large proportion of working population have office
work
Estimated annual cost of US$1.4 billion due to
excess respiratory related sick leave in office
workers (Sahakian et al., 2009)
Respiratory health – affected by personal or
environmental factors
Biological parameters, eg. bacteria, fungi, allergens
Endotoxin & (1,3)-β-glucan have pro-inflammatory &
immune stimulatory properties
2
Importance of the Study
Lack of population based studies studied on:
Prevalence of house dust mite (HDM) and
cat allergies among office workers
5
Lung
function
Chemical [forced
expiratory
Office volume in 1 s
•TVOC
characteris (FEV1) & peak
-tics •Ozone
•C2HO flow (PEF)
•Respirable variability]
particulate Sick
•CO Inhalation building
I
•CO2 syndrome
A
Building
Q
occupants Inflammation
Asthma &
& their Physical & Immune
Responds respiratory
activities
•Temperature symptoms
•Relative humidity
Contact
•Ventilation rate Airway
•Skin Cofactors: inflammation
Outdoor •Nose Genetic • FeNO level
Environ- Biological •Eyes susceptibility
ment such as allergy
•Bacteria
(Endotoxin) Confounders:
•Fungi (1-3-β-D- •Gender
glucan) •Allergy
•House dust mites •Smoker
allergens
Key:
Variables Study variables
6
Methodology
Cross-sectional study
7
Study Inclusion criteria:
Population Office
1. Equipped with MVAC system
2. Non-smoking area
3. Admin. office with min. 15 workers
Exclusion criteria:
1. Offices in laboratories and libraries (Hayleeyesus & Manaye,
2014; Righi et al., 2002)
Inclusion criteria:
Workers
1. Admin. office worker
2. Age between 18-60 years old
3. Malaysian
Exclusion criteria:
1. Women who were pregnant (Chen et al., 2008)
2. Asthma attacks two weeks before data collection (Liccardi et
al., 2006)
3. Took antihistamines, antidepressants/ beta-blockers
medications a week before data collection (Australasian Society
of Clinical Immunology and Allergy, 2013)
4. Severe dermographisms (Heinzerling et al., 2013)
8
Sample Size
Formula for one sample problem
𝑍1−𝛼/2 2 𝑃(1−𝑃)
𝑛=
𝑑2
9
Total respondents
required (after
Estimated sample size calculation based on
consider 20% non-
one sample problem
response rate and
design effect)
10
Invitation letter
List of offices was
Screening process was sent to offices
obtained from
for offices which full filled
registrar office
inclusion criteria
13
RESULT & DISCUSSION
14
Specific Objective:
1. To determine the prevalence of respiratory symptoms,
elevated FeNO level, SBS symptoms and allergies in
the office workers.
Figure 1: Bar chart on prevalence of airway symptoms among
office workers (n=695)
50
40
PERCENTAGE (%)
30
26.5
20 18.4
15.5 15.1
0
Wheeze Breathlessness Wheezing when Daytime Daytime Any daytime Nocturnal At least one
during wheeze did not have cold breathlessness at breathlessness breathlessness attacks of airway symptoms
rest after strenuous breathlessness
activity
AIRWAY SYMPTOMS 15
Figure 2: Bar Chart on Prevalence of Asthma and Rhinitis among
Office Workers (n=695)
60
53
50
PERCENTAGE (%)
40
34.3
30
22.2
20
12.2 12.2
9.6 8.8
10 8.1 7.1
< 25 ppb
74.10%
(341)
17
Figure 4: Bar chart on prevalence of sick building syndrome
symptoms among office workers (n=695)
25
23
20
16
Percentage (%)
15
12.9 13.3
11.9
10 9.2
8.5
7.9
7.3
6 6.2
5.3 5.5
5
5 4.5
3.6
2.2 2.6
1.9
HDM/ Cat
No allergy
allergy
177 (38.2%)
173 (37.4%)
41 23
(8.9%) (5.0%)
15
(3.3%)
Seafood Pollen
allergy 5 allergy
(1.1%)
18 (3.9%) 11 (2.4%)
19
Specific Objective:
2. To determine the level of indoor office environmental
parameters (endotoxin, (1,3)-β-glucan, Der p 1, Der f 1,
amount of sieved dust, temperature, relative air humidity,
carbon monoxide and carbon dioxide) in the office.
Significantly
assoc. with
FeNO level
(p<0.001)
Significantly Significantly
assoc. with most assoc. with
HDM weekly dermal
of the
respiratory & symp. (p=0.035)
symptoms Cat & weekly
(p<0.05) mucosal symp.
Allergy (p<0.001)
21
Specific Objective:
4. To determine the associations between potential
personal risk factors with respiratory symptoms,
elevated FeNO level, and SBS symptoms among the
office workers
Figure 6: Associations between personal factors with respiratory symptoms &
FeNO level (using multilevel logistic regression with mutual adjustment)
Gender
-positively ass. with
airway symptoms &
rhinitis (p<0.05)
HDM & cat
Age allergy
-negatively ass. with Positively ass. with:
rhinitis (p<0.05) -airway, asthma & rhinitis
symptoms (p<0.05)
Respiratory
symptoms
22
FeNO levels and personal factors
• Allergic to HDM or cat (p<0.001, OR=1.80, 95%CI=1.58-2.05) was
significantly associated with FeNO level but not age, gender, height body mass
index and smoking status
Airway
symptoms
(p<0.05)
SPT
positive &
elevated
FeNO level
Asthma
Rhinitis
symptoms
(p<0.001)
(p<0.001)
23
Figure 8: Analysis of associations between personal factors and
weekly sick building syndrome (SBS) symptoms (using multilevel
logistic regression with mutual adjustment)
Weekly
SBS
symptoms
24
Specific Objective:
5. To study associations between respiratory symptoms,
FeNO level and SBS among the office workers with
indoor office environmental parameters and office
characteristics
25
Table 5: Multilevel logistic regression analysis of associations between
respiratory symptoms and indoor office environmental parameters
Indoor Office
Environmental Respiratory Symptoms
Parameters
(1,3)-β-glucan → Whistling/ whistling when did not have cold
(adj. OR=0.79, 95%CI=0.63-0.99)
27
Table 6: Multilevel logistic regression analysis of associations between sick
building syndrome symptoms, office characteristics and indoor office
environmental parameters
Any weekly Any weekly Any weekly
dermal mucosal general
Study Variables
symptoms symptoms symptoms
OR (95%CI) OR (95%CI) OR (95%CI)
Office
Characteristics
New furniture in
the office 2.25 (1.19-4.25)* 1.46 (0.79-2.69) 1.25 (0.71-2.23)
Passive smoke in
1.39 (0.50-3.88) 2.55 (1.11-5.82)* 3.18 (1.45-6.98)**
the office
Office
measurement
Relative air
humidity 0.75 (0.46-1.23) 0.66 (0.44-0.99)* 0.87 (0.57-1.33)
Der f 1 1.19 (1.09-1.31)*** 1.19 (1.09-1.30)*** 1.14 (1.02-1.28)*
Each model was adjusted for age, gender, current smoker, any sign of home dampness, indoor home painting in the last 12 months and
offices
*p<0.05
**p<0.010
28
***p<0.001
Conclusion
↑ prevalence of rhinitis, HDM allergy and cat allergy
CO2 & CO levels were within the suggested level
by local authority except for indoor temp. & RH
Personal and indoor office environmental exposure
factors associated with health variables in workers
Respiratory & SBS symptoms were due to allergic
inflammation (combined analysis of FeNO
measurement & SPT)
Allergy is an independent risk factor for respiratory
symptoms, FeNO level & SBS symptoms
29
Recommendations
Future Studies
Additional types of common allergies, eg.
indoor environmental allergens (Blomia
tropicalis, cockroach & mouse), mould,
grass, pollen allergens
Determine possible sources of endotoxin
& HDM in office environment
Cohort study in indoor air quality studies
is needed
30
Management of Offices
Functional thermostat (range 24-27°C) at the air-
conditioning system
32
List of Publications
Lim, F.L., Zailina, H., Z., Than, L.T.L.,
Salmiah, M. S., Jamal Hisham, H.,
Norbӓck,D. (2015) Asthma, airway
symptoms and rhinitis in office workers in
Malaysia: Associations with house dust
mite (HDM) allergy, cat allergy and levels
of house dust mite allergens in office dust.
PLoS ONE, 10(4), e0124905.
[IF = 3.23]
33
Lim, F.L., Zailina, H., Than, L.T.L., Salmiah, M.
S., Jamal Hisham, H., Norbӓck, D. (2015)
Sick building syndrome (SBS) among office
workers in a Malaysia university –
Associations with atopy, fractional exhaled
nitric oxide (FeNO) and the office
environment. Science of the Total
Environment, 536, 353-361.
[IF=4.10]
34
Lim, F.L., Zailina, H., Than, L.T.L., Salmiah,
M. S., Jamal Hisham, H., Norbӓck, D.
(2015) Fractional exhaled nitric oxide
(FeNO) among office workers in an
academic institution, Malaysia –
Associations with asthma, allergens and
office environment. Journal of Asthma.
doi: 10.3109/02770903.2015.1077861
[IF= 1.80]
35