The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

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European Position Paper on Rhinosinusitis and Nasal Polyps 2020

I. Executive summary BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. Methods ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. Conclusion This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Occupational asthma (OA) and occupational rhinitis (OR) are closely associated and share aetiological agents [1,2]. The prevalence of OR in subjects with OA is 76±92% [2,3]. Although the prevalence and determinants of OA have been widely studied, the epidemiology of OR has been investigated less, mainly because it is not considered such a serious disease. In the general population rhinitis is three times more prevalent than asthma [4,5] and tends to occur three times more frequently in occupational settings [6]. OR may be a marker of the likelihood of developing OA. In fact, when asthma and rhinitis are present concomitantly, symptoms of rhinitis often develop before those of asthma, as reported in occupational [2,7] and nonoccupational settings [4]. However we do not know why some patients with OR develop OA and some do not. A standard definition of OR for epidemiological studies is not available. Only very recently has the European Community provided a definition of `Occupationally caused allergic rhinitis' [8] which unfortunately excludes some cases of OR caused by low molecular weight agents, because an allergic mechanism has not been identified. For the purpose of this review we considered as OR any rhinitic symptom reported as work-related, with the exclusion of malignant diseases. This manuscript reviews the prevalence and more common aetiological agents of OR and its relationship with OA. Exposure, atopy, and smoking are also reviewed as potential determinants of OR.

Epidemiology of occupational rhinitis: prevalence, aetiology and determinants.

Long term exposure to solvents and air pollutants can lead to deleterious effects on respiratory, haematological and thyroid functioning. The aim of this study was to investigate whether chronic exposure to solvents like benzene and pollutants like carbon monoxide in petrol filling workers had adverse effect on blood parameters, thyroid and respiratory functions. The study group consisted of 42 healthy, non-smoker petrol filling workers, aged 20–50 years with work (exposure) duration from 2–15 years while 36 healthy subjects of the same age group served as controls. Physical examination and measurement of pulmonary functions by portable electronic spirometer were performed. Complete blood pictures (CBP) were determined by normal haematology lab procedure and hormones by Chemiluminescence immunoassay (CLIA) light absorption techniques. There was a significant decrease in the lung volumes and capacities; the restrictive pattern was more prevalent in the workers when compared with the control groups. But in the workers exposed for long period (more than 10 years) the restrictive pattern was changed to mixed pattern. A significant increase in haemoglobin (Hb) (>16 mg %) and red blood cells (RBC) (5.4 million cells/mm3) were observed in workers with longer period of exposure when compared with the control subjects (14.483 mg% and 4.83 million cells/mm3 for Hb and RBC respectively). White blood cell count except eosinophils and platelets were significantly lower in workers compared to controls. Marked increase in the tetra iodothyroinine (T4), free thyroxine (T4F) level and significant decrease in thyroid stimulating hormones (TSH), and tri-iodothyronine (T3) were observed between long term exposed and non – exposed groups. Till now researchers focused only on the effect of solvents in workers professionally exposed to solvents without considering the effect of concomittant air pollution. The result obtained from present study indicates that there is a significant toxic effect of solvents and air pollutants on workers exposed for longer duration. Improved detection and prevention technologies are needed to answer environmentally related health questions for petrol filling workers.

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Impact of Organic Solvents and Environmental Pollutants on the Physiological Function in Petrol Filling Workers

Chronic inflammation of the upper airways is common and can arbitrarily be divided into rhinitis and rhinosinusitis. Infection and allergy represent two well-characterized and most frequently diagnosed etiologies of upper airway inflammation. Persistent upper airway inflammation caused by agents inhaled in the work environment represents a diagnostic challenge in clinical practice, and its pathophysiology has been little studied. Occupational rhinitis is a recognized medical condition with diagnostic and therapeutic guidelines. In contrast, only limited evidence is available about the relationship between work exposures and rhinosinusitis. This review aims at providing a comprehensive overview of the available literature on occupational upper airway disease with a focus on pathophysiological mechanisms and with an emphasis on the current unmet needs in work-related upper airway disease.

Occupational upper airway disease: how work affects the nose

A study of respiratory findings was performed on 376 female workers employed in a shoe manufacturing plant. The mean age of the workers was 32 years and the mean duration of their employment was 12 years. These workers were predominantly nonsmokers. Acute and chronic respiratory symptoms were recorded for each worker, and lung function was measured before and after the work shift. Maximum expiratory flow-volume (MEFV) curves were performed on which forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and flow rates at 50% and the last 25% (FEF50, FEF25) were measured. Significantly higher prevalences of all chronic respiratory symptoms were recorded in exposed compared to control workers; in particular, chest tightness (exposed: 44.7%; control: 0%), dyspnea (exposed: 42.6%; control: 2.0%), and rhinitis (exposed: 46.3%; control: 2.4%) were far more prevalent in workers than in controls. Among the shoe workers, there was also a high prevalence of acute symptoms that developed during the work shift, being most pronounced for nose and throat irritation (61.4%). The prevalence of acute and chronic respiratory symptoms increased with duration of employment. Statistically significant across-shift reductions were recorded for all ventilatory capacity tests for the group as a whole. In comparison to predicted, the measured ventilatory capacity parameters were significantly lower for all workers (p < 0.01). Lung function abnormalities increased with duration of employment. Environmental measurements demonstrated that benzene, fur, and synthetic fibers were found at higher than allowable maximal concentrations (Croatian standards). The data suggest that work in the shoe manufacturing industry may be responsible for the development of acute and chronic respiratory impairment. Am. J. Ind. Med. 31:50–55 © 1997 Wiley-Liss, Inc.

Respiratory function in shoe manufacturing workers.

Respiratory Findings in Pharmaceutical Workers

Orijentacijske medicinske tablice za procjenu smanjenja životne aktivnosti

The respiratory health status was studied in 376 female shoe workers. The mean age of workers was 32 years and the mean exposure 12 years. A significantly higher prevalence of all chronic respiratory symptoms and diseases was found in exposed compared to control workers. This was particularly pronounced for chest tightness (exposed: 44.7%; control: 0%), dyspnoea (exposed: 42.6%; control: 2.0%) and rhinitis (exposed: 46.3%; control: 2.4%). In exposed workers there was also a high prevalence of acute symptoms which developed during work shift, particularly irritation of the throat (56.6%), dryness of the throat (61.4%), dryness of the nose (56.4%), and eye irritation (63.6%). The prevalence of acute and chronic respiratory symptoms and diseases increased with duration of exposure. There were also statistically significant acute reductions in all ventilatory capacity tests (FVC, FEV1, FEF50, FEF25) during work shift. The measured ventilatory capacity values in exposed workers were significantly lower in comparison with the predicted values (P < 0.01). Lung function severity increased with duration of employment. The data suggest that occupational exposure to atmospheric pollution in the shoe manufacturing industry may be responsible for the development of acute and chronic respiratory impairment.

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Viktorija Bradić

Papers

Respiratory function in shoe manufacturing workers.

Respiratory Findings in Pharmaceutical Workers

Orijentacijske medicinske tablice za procjenu smanjenja životne aktivnosti

[Respiratory symptoms, diseases and ventilatory function in shoe industry workers].

Uvod u medicinsko vještačenje u građanskim parnicama