Faculty of Medicine

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Exercise-induced bronchoconstriction in female cleaners: effect of smoking
(Арбилис - София, 2007)
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Risteska-Kuc, Snezana
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Stojanovski, Zoran
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Background. Airborne particles and pollutants, such as dust, tobacco smoke and automobile exhaust, are considered as stimulants that contribute to the development of exercise-induced bronchoconstriction (EIB). Objective. To evaluate prevalence of EIB and its relation to smoking in female cleaners. Methods. We performed a cross-sectional study including 43 female cleaners aged 26 to 57 (mean age 36.9±7.6), with duration of exposure 5 to 24 years (mean duration 11.6±5.5). In addition, 45 female office workers (aged 27 to 58, mean age 38.1±5.7) were studied as a control. Evaluation of exposed and unexposed workers included completion of a questionnaire, skin prick tests to common aeroallergens, spirometry, and constant submaximal exercise challenge test (ECT) on cycle ergometer. Results. We found similar EIB prevalence in both cleaners and office workers (9.3% vs. 6.7%; P=0.276). Bronchial reaction to exercise, expressed as a mean fall index FEV1, was significantly greater in ECT positive cleaners (23.4% vs. 16.1%, P=0.041). EIB was strongly linked to atopy and positive family history for asthma in both groups. EIB was non-significantly associated with daily smoking in office workers (P=0.276), whereas in cleaners that association just missed significance (P=0.074). Association between EIB and daily mean of cigarettes consumed was significant in smoking cleaners (P=0.039), whereas its association with smoking experience was non-significant in both groups. Bronchial reaction to exercise was significantly greater in exposed than in unexposed smokers (9.4% vs. 4.5%; P=0.036). Association of EIB with exand passive smoking was non-significant in both occupation groups. Conclusions. Our data suggest that daily smoking could interact with workplace exposure in development and severity of EIB in female cleaners.
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CHRONIC RESPIRATORY SYMPTOMS AND VENTILATORY FUNCTION IN WORKERS EXPOSED TO TEA DUST: EFFECT OF DURATION OF EXPOSURE AND SMOKING
(University of Niš, 2005)
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Risteska-Kuc, Snezana
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Many studies reviewed show that both workplace exposure to organic dust and smoking may cause chronic respiratory symptoms and airflow limitation in susceptible subjects. We performed a case-control study including 63 tea workers (36 male and 27 female, aged 36-55, duration of employment 3–30 years) and an equal number of office workers, matched by sex and age. Chronic respiratory symptoms (chronic cough, phlegm, dyspnea gr. 3-4, wheezing, wheezing with dyspnea, and chest tightness) were recorded by questionnaire. Skin prick tests and spirometric measurements were carried out. Environmental measurements were performed on site during the work shifts. Prevalence of chronic respiratory symptoms in exposed workers was insignificantly higher (44.8% vs. 33.6%). Significantly higher prevalence of individual chronic respiratory symptoms was found for phlegm (P<0.05) and dyspnea gr. 3-4 (P<0.05). Chronic respiratory symptoms in exposed workers were significantly associated with duration of exposure (P<0.05) and current smoking (P<0.05, P=0.011), whereas relation of chronic respiratory symptoms and current smoking in controls just missed the significance (P=0.056). Values of FVC, FEV1, FEV1/FVC% and small airways indices in exposed workers were significantly lower. Small airways changes in exposed workers were strongly linked to duration of exposure (P<0.05) and current smoking (P<0.01), whereas relation of small airways changes and current smoking in controls was not significant. Our data suggest interactive influence of workplace exposure to tea dust and current smoking in development of chronic respiratory symptoms and airflow limitation with predominantly smaller airways affecting.
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Exposure to environmental tobacco smoke in the workplace in Macedonia: where are we now?
(Walter de Gruyter GmbH, 2008-06)
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Risteska-Kuc, Snezana
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To assess the prevalence and the level of exposure to environmental tobacco smoke (ETS) in the workplace after the enactment of the law restricting indoor smoking in Macedonia, we performed a cross-sectional, self-administered questionnaire study including 372 never-smoking workers recruited from six workplaces. We found a high prevalence of workers exposed to ETS in the workplace (27.4 %) with no significant difference between particular occupation groups. We found no significant difference in the prevalence of passive smokers in the workplace between this study and our study conducted before the law was enacted (31.5 % vs. 27.4 %, P=0.324). The prevalence of workers exposed to ETS for less than three hours a day was significantly lower than of passive smokers with longer exposure (28.4 % vs. 71.6 %, P=0.038). The prevalence of workers exposed to ETS from less than 10 cigarettes smoked by coworkers per day was lower than the prevalence of workers with higher exposure, but statistical significance was not reached (37.9 % vs. 62.1 %, P=0.087). Our findings indicate a high prevalence and a high level of exposure to ETS in the workplace, which calls for stricter adherence to smoking-free legislation or even the total ban of smoking in the workplace.
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Bronchial hyperresponsiveness in women cooks and cleaners
(Walter de Gruyter GmbH, 2007-06)
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Risteska-Kuc, Snezana
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The aim of this cross-sectional study was to assess the prevalence and characteristics of bronchial hyperresponsiveness (BHR) in 43 women cleaners (aged 26 to 57) and 37 women cooks (aged 29 to 55) and compare them with 45 controls (women office workers aged 27 to 58). The evaluation of all subjects included a questionnaire, skin prick tests to common aeroallergens, spirometry, and histamine challenge (PC20 < or = 8 mg mL(-1)). We found higher BHR prevalence in cleaners and cooks than in office workers (30.2 % and 29.7 %, vs. 17.7 %, respectively), but statistical significance was not reached. The prevalence of mild and moderate to severe BHR was similar in all groups. Borderline BHR prevalence was significantly higher in cleaners than in controls (16.2 % vs. 6.6 %, P=0.032) whereas the difference was on the verge of significance in cooks (13.5 % vs. 6.6 %, P=0.081). Moderate to severe BHR was strongly associated with positive family history of asthma and atopy in all groups. Mild BHR was significantly associated with daily smoking in cleaners (P=0.031) and cooks (P=0.021), as well as with the duration of exposure in cleaners (P=0.038). Borderline BHR was closely related to daily smoking and duration of exposure in both cleaners and cooks. Our findings indicate an important role of workplace exposure in borderline BHR development, as well as the significant effect of smoking on mild BHR development in women cleaners and cooks.
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Exercise-induced bronchoconstriction and exercise-induced respiratory symptoms in workers exposed to tea dust
(SCIENDO, 2005-12)
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Risteska-Kuc, Snezana
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Assuming that airborne particles and pollutants are important contributing factors in the development of exercise-induced bronchoconstriction (EIB), we performed a case-control study including 63 tea workers (36 men and 27 women, aged 36-55, duration of employment 3-30 years) and an equal number of office workers, matched by sex and age. Exercise-induced respiratory symptoms were recorded in a questionnaire. Skin prick tests, spirometry, as well as exercise and histamine challenge were carried out. Environmental measurements were performed on site during the work shifts. The prevalence of self-reported exercise-induced respiratory symptoms and EIB did not differ significantly between the exposed and control group (41.6% vs 36.8%, and 6.4% vs 4.8%, respectively). In both exposed and control workers, EIB was strongly linked to asthma (P < 0.01). In the exposed workers it was significantly associated with positive family history of asthma (P < 0.01) and positive family history of atopies (P < 0.05), whereas in the exposed smokers it was significantly related to smoking duration (P < 0.05). Bronchial reaction to exercise in the exposed smokers was significantly greater than in control smokers (P < 0.05). Self-reported exercise-induced respiratory symptoms were weakly associated with EIB, with a large proportion of false positive and a low proportion of false negative results in both groups.
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Exercise-induced bronchoconstriction in textile and agricultural workers and in bakers
(SCIENDO, 2006-12)
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Risteska-Kuc, Snezana
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To assess the prevalence and the characteristics of exercise-induced bronchoconstriction (EIB) in subjects occupationally exposed to organic dusts we performed a cross-sectional study including 152 exposed subjects (67 textile workers, 42 agricultural workers, and 43 bakers) and 72 unexposed controls. Evaluation of exposed and unexposed subjects included a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise challenge tests (ECT). The EIB prevalence found in textile workers was 8.9 %, in agricultural workers 7.1 %, in bakers 6.9 %, and in office workers 5.5 %. The highest bronchial reaction to exercise was found in ECT-positive agricultural workers (26.1+/-6.9), followed by textile workers (25.2+/-7.4), bakers (23.0+/-5.8), and office workers (21.8+/-4.4). EIB was significantly associated with atopy and positive family history of asthma in all exposed groups. EIB was significantly associated with smoking duration in textile workers (P=0.039) and agricultural workers (P=0.027). Bronchial reaction to exercise was significantly greater in smoking than in non-smoking textile (P=0.045) and agricultural workers (P=0.032). Our data suggest that the combination of daily smoking and workplace exposure to certain types of organic dusts could contribute to EIB development and severity.
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POLLEN-FRUIT SYNDROMES: A CASE WITH BIRCH-APPLE-CARROT ASSOCIATION
(Science Publications, 2014-02-01)
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Marsenic, Mimoza
Subjects with sensitivities to certain pollen can experience oral or systemic allergic symptoms associated with ingestion of various fruits, vegetables and nuts. In this case report a birch-apple-carrot association in 23-year-old man suffering from pollinosis who experienced few episodes of oral allergy syndrome, generalized urticaria and bronchospasm immediately time after ingestion of fresh and cooked apple and carrot is presented. Skin Prick Tests (SPT) to standard inhalant and food allergens were positive for birch, lime, apple and carrot. SPT for apricot was also positive, despite the patient did not experienced any allergic symptom after consumption of fresh or cooked apricot. This case report represents the description of an IgE-mediated systemic allergic reaction to both apple and carrot in both fresh and cooked form which is not usual reaction in the patients with birch-food association.
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Chronic Obstructive Pulmonary Disease in Never-Smoking Bricklayers
(ID Design 2012/DOOEL Skopje, 2013-12-15)
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Risteska-Kuc, Snezana
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Background: Chronic obstructive pulmonary disease (COPD) due to occupational exposures remains an important public health problem taking significant toll on the global burden of the disease. Aim: In order to assess chronic prevalence and characteristics of COPD in bricklaying we performed a cross-sectional study including 47 never-smoking male bricklayers (aged 34 to 57 years) and an equal number of never-smoking male office workers studied as a control. Methods: Evaluation of examined subjects consisted of completion of a questionnaire, baseline spirometry, and bronchodilator reversibility testing. Results: We found higher prevalence of respiratory symptoms in bricklayers with significant difference for cough and phlegm. Majority of the chronic respiratory symptoms in bricklayers were work-related. The mean values of all measured spirometric parameters in bricklayers were significantly lower than in office workers. The prevalence of COPD was significantly higher in bricklayers than in office workers (14.9% vs. 4.3%, P = 0.034). COPD in both examined groups was close related to age over 45 years, while in bricklayers significant association was registered for duration of occupational exposure longer than 20 years and work-related respiratory symptoms. Conclusion: Our findings support data about relationship between occupational exposure to inorganic dust and fumes in construction workers and persistent airflow limitation.
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Effects of passive smoking at work on respiratory symptoms, lung function, and bronchial responsiveness in never-smoking office cleaning women
(Walter de Gruyter GmbH, 2009-09)
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Risteska-Kuc, Snezana
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This cross-sectional study compares respiratory symptoms, lung function, and bronchial responsiveness between 27 office cleaning women exposed to environmental tobacco smoke at work and 57 unexposed controls. The age range of both groups was 24 to 56 years, and none of the women had ever smoked. Information on respiratory symptoms, cleaning work history, and passive smoking in the workplace were obtained with a questionnaire. The subjects also took a skin prick test to common inhalant allergens, a lung function test, and a histamine challenge. Despite smoking restriction in indoor environments, we found a high prevalence of passive smokers in the workplace (32.1 %). In these subjects we found a significantly higher prevalence of wheezing with breathlessness (25.9 % vs. 8.8 %; P=0.036), wheezing without cold (25.9 % vs. 7.0 %; P=0.016), and breathlessness after effort (29.6 % vs. 8.8 %; P=0.014) than in control subjects. Objective measurements showed a significantly lower MEF25 (53.6 % vs. 63.7 %; P=0.001) and a significantly higher prevalence of borderline bronchial hyperresponsiveness (22.2 % vs. 7.0 %; P=0.044) in the passive smokers in the workplace. This study provides evidence of adverse respiratory effects in office cleaning women associated with passive smoking in the workplace. Our findings support a stricter implementation of the current national law to protect respiratory health of all workers.
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Efficacy and Tolerability of Various Antimicrobial Regimens in the Treatment of Exacerbations of Chronic Bronchitis and Chronic Obstructive Pulmonary Disease in Outpatients
(ID Design Press, 2009-06-01)
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Petrova, Tatjana
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Risteska-Kuc, Snezana
Objective. To compare the efficacy and tolerability of different antibiotics empirically administered for exacerbations of chronic bronchitis and chronic obstructive pulmonary disease (COPD). Methods. We performed an observational, non-randomized, open-label study including 226 outpatients with exacerbations of chronic bronchitis and mild or moderate COPD, 123 males and 103 females, aged 24 to 81. All patients were followed up for 30 days, with an intermediate visits at 5 and 10 days at which they were asked about the duration of symptoms (increased expectoration, increased dyspnea and/or presence of purulent sputum) and the side-effects of the drug. Five antibiotic regimens were evaluated: amoxicillin/clavulanic acid 875 mg/125 mg twice daily for 10 days, cefuroxime 250 mg twice daily for 10 days, cefixime 400 mg once daily for 10 days, clarithromycin 500 mg twice daily for 10 days, and ciprofloxacin 500 mg twice daily for 10 days. Results. The clinical success rate, defined as a complete resolution or a return of the symptoms to the baseline severity, in the groups receiving amoxicillin/clavulanic acid, cefuroxime, cefixime, clarithromycin, and ciprofloxacin was 68.9%, 75.0%, 73.5%, 72.7%, and 77.1%, respectively. The mean time to relief of symptoms varied from 6.8 days with amoxicillin/clavulanic acid to 6.1 days with cefuroxime. Relapse within the first month was registered in the group receiving clarithromycin and ciprofloxacin (3.1% and 2.6%, respectively). The prevalence of the adverse events varied from 10.4% with ciprofloxacin, following by 8.9% for amoxicillin/clavulanic acid, 7.5% for cefixime, 6.8% with clarithromycin to 6.1% with cefuroxime. Conclusion. Our findings suggest high efficacy and safety of all studied regimens in the treatment of exacerbations of chronic bronchitis and COPD.

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