The role of cleaning and sterilizing agents in work-related asthma (WRA) has been increasingly recognized since early case reports of occupational asthma (OA) over 30 years ago. Cleaning agents have become a more important causative factor in reported series of recognized WRA. The exposures leading to asthma-like symptoms have been reported from among domestic cleaners, and among healthcare workers both among those with primary use of cleaning/disinfecting agents, and among those with likely bystander exposure. In many cases the exposures have included multiple chemical agents in various cleaning products. This is the reason this category of agents is introduced as a new chapter in the current edition of Asthma in the Workplace. Apart from select carefully documented case reports, the causative chemical(s) have often been difficult to determine and in addition, in epidemiologic studies it is often unclear as to whether symptoms have been due to sensitization or an airway irritant response with production of OA, or due to work-exacerbated asthma, or in some cases to another disorder such as a laryngeal syndrome or chronic obstructive pulmonary disease (COPD), mimicking asthma from questionnaire responses. While exposure to these chemicals in the occupational setting is important, additional concern relates to the fact that many of these agents are used in the home and in public buildings including schools. This chapter reports on epidemiological studies, agents involved, and possible mechanisms (immune response to cleaning chemicals, airway epithelial response, toxicity, role of oxidative stress, and neurogenic inflammation). Diagnostic and possible prevention means are also proposed.

Systemic sclerosis is a rare systemic autoimmune disease characterized by microvascular impairment and fibrosis of the skin and other organs with poor outcomes. Toxic causes may be involved. We reported the case of a 59-year-old woman who developed an acute systemic sclerosis after two doses of adjuvant chemotherapy by docetaxel and cyclophosphamide for a localized hormone receptor + human epithelial receptor 2-breast cancer. Docetaxel is a major chemotherapy drug used in the treatment of breast, lung, and prostate cancers, among others. Scleroderma-like skin-induced changes (morphea) have been already described for taxanes. Here, we report for the first time a case of severe lung and kidney flare with thrombotic microangiopathy after steroids for acute interstitial lung disease probably induced by anti-RNA polymerase III + systemic sclerosis after docetaxel.

Background. - Scant data are currently available about a potential link between comorbid chronic lung diseases (CLD) and the risk and severity of the coronavirus disease 2019 (COVID-19) infection. Methods. - To describe the clinical characteristics of and outcomes for patients with COVID-19 infection, including patients with comorbid respiratory diseases, who have been primarily hospitalized in the pulmonology department of Strasbourg University Hospital, France. In this retrospective, single-center study, we included all confirmed cases of COVID-19 from March 3 to April 15, 2020. We then compared the symptoms, biological and radiological findings, and outcomes for patients with and without CLD. Results. - Of the 124 patients that were enrolled, the median age was 62 years, and 75 patients (60%) were male. Overall, 40% of patients (n = 50) had preexisting CLD, including chronic obstructive pulmonary disease (COPD) (n = 15, 12%) and asthma (n = 19, 15%). Twenty-eight patients were transferred to the intensive care unit (ICU), and six patients died in our unit. CLD were not predictive of ICU hospitalization, but a significantly higher total mortality was observed (17.6% vs. 5.5%, P < 0.05) in these patients. Conclusions. - Our results suggest the lack of an over-representation of CLD in COVID-19, representing 40% of patients in this cohort and even within a pulmonology department. CLD were not a risk factor for ICU management. However, a tendency to higher global mortality was observed in COVID-19 patients with CLD. Further studies are warranted to determine the risk of COVID-19 for patients with comorbid CLD.

BACKGROUND: Viral infections are known to exacerbate asthma in adults. Previous studies have found few patients with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases. However, the relationship between SARS-CoV-2 infection and severe asthma exacerbation is not known. OBJECTIVE: To assess the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia and compare symptoms and laboratory and radiological findings in patients with and without asthma with SARS-CoV-2 pneumonia. METHODS: Weincluded 106 patients between March 4 and April 6, 2020, who were hospitalized in the Chest Diseases Department of Strasbourg University Hospital; 23 had asthma. To assess the patients' asthma status, 3 periods were defined: the last month before the onset of COVID-19 symptoms (p1), prehospitalization (p2), and during hospitalization (p3). Severe asthma exacerbations were defined according to Global INitiative for Asthma guidelines during p1 and p2. During p3, we defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled beta 2 agonist. RESULTS: We found no significant difference between patients with and without asthma in terms of severity (length of stay, maximal oxygen flow needed, noninvasive ventilation requirement, and intensive care unit transfer); 52.2% of the patients with asthma had Global INitiative for Asthma step 1 asthma. One patient had a severe exacerbation during p1, 2 patients during p2, and 5 patients were treated with systemic corticosteroids and inhaled b2 agonist during p3. CONCLUSIONS: Our results demonstrate that patients with asthma appeared not to be at risk for severe SARS-CoV-2 pneumonia. Moreover, SARS-CoV-2 pneumonia did not induce severe asthma exacerbation. (C) 2020 American Academy of Allergy, Asthma & Immunology.

Asthma is a chronic inflammatory lung syndrome with an increasing prevalence and a rare but significant risk of death. Its pathophysiology is complex, and therefore we investigated at the systemic level a potential implication of oxidative stress and of peripheral blood mononuclear cells' (PBMC) mitochondrial function. Twenty severe asthmatic patients with severe exacerbation (GINA 4-5) and 20 healthy volunteers participated at the study. Mitochondrial respiratory chain complexes activities using different substrates and reactive oxygen species (ROS) production were determined in both groups by high-resolution respirometry and electronic paramagnetic resonance, respectively. Healthy PBMC were also incubated with a pool of plasma of severe asthmatics or healthy controls. Mitochondrial respiratory chain complexes activity (+52.45%, p = 0.015 for VADP) and ROS production (+34.3%, p = 0.02) were increased in asthmatic patients. Increased ROS did not originate mainly from mitochondria. Plasma of severe asthmatics significantly increased healthy PBMC mitochondrial dioxygen consumption (+56.8%, p = 0.031). In conclusion, such asthma endotype, characterized by increased PMBCs mitochondrial oxidative capacity and ROS production likely related to a plasma constituent, may reflect activation of the immune system. Further studies are needed to determine whether increased PBMC mitochondrial respiration might have protective effects, opening thus new therapeutic approaches.

Professional and domestic cleanings are associated with work-related asthma (WRA). Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Moreover, exposure to cleaning chemicals could be associated with severe uncontrolled asthma. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma or airway respiratory diseases. Their measurements at the workplace could be interesting but hardly feasible. It is still under controversy whether cleaning products are airway irritants or sensitizers. The social consequence of unemployment in this population is one of the most important limitations to the management of occupational in cleaning professionals. The prognosis of the disease depends of removal from exposure, with avoidance of high-risk cleaning products, even at home.

L’asthme est une pathologie bronchique chronique dans laquelle le stress oxydant joue un rôle important, en particulier au niveau local où la production d’espèces réactives de l’oxygène (ERO) est majoré. L’asthme implique également une réponse immune systémique mais le rôle du stress oxydant au niveau des cellules mononuclées du sang périphérique (PBMCs) est inconnu. L’objectif de cette étude est d’évaluer la capacité fonctionnelle mitochondriale au niveau des PBMCs et le niveau d’ERO dans le sang périphérique chez des patients asthmatiques sévères en exacerbation sévère. Au total, 21 asthmatiques sévères non contrôlés (GINA 4–5) en exacerbation sévère et 21 sujets contrôles étaient inclus dans une étude prospective contrôlée au CHU de Strasbourg. Tous les sujets étaient âgés de 18 à 75 ans avec un tabagisme sevré et inférieur à 10 paquets-années. L’étude de la chaîne respiratoire mitochondriale était réalisée par oxymétrie haute résolution sur 5 millions de PBMCs. Les mesures de la production totale et la production mitochondriale d’ERO étaient réalisées respectivement par résonance paramagnétique électronique sur sang total et spectrofluorométrie sur PBMCs isolés. On observait une augmentation significative de la respiration mitochondriale globale (+ 64,9 %, p = 0,007) au niveau des PBMCs des patients asthmatiques sévères en exacerbation sévère, en comparaison aux sujets sains. L’activité du Complexe IV était la plus fortement augmentée (+ 74 %, p = 0,0003). La production totale d’ERO était significativement majorée dans le groupe de patients asthmatiques en comparaison au groupe témoin (+ 34 %, p = 0,0185). Il n’y avait pas de différence de production mitochondriale d’ERO entre les deux groupes. L’augmentation de la respiration mitochondriale des PBMCs et la production totale d’ERO témoignent probablement d’une activation lymphocytaire et monocytaire, et donc du rôle systémique du stress oxydant dans l’asthme sévère exacerbé. La production d’ERO ne semblait pas d’origine mitochondriale. D’autres études sont nécessaires afin de déterminer le rôle physiopathologique de la stimulation de la fonction mitochondriale et de la production d’ERO, ainsi que des facteurs qui y contribuent.