Læknablaðið - 15.09.1990, Blaðsíða 30

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LÆKNABLAÐIÐ
Niðurstöður blástursprófa sýna að teppa
(obstruction) var algengari hjá bændum
á Suðurlandi en á Ströndum og mun
algengari en fundist hefur í hóprannsóknum
Hjartavemdar (13). Lungnateppa er algeng
við heymæði (14) og hjá heysóttarsjúklingum
hefur einnig verið lýst óeðlilegum histamín og
metakólín þolprófum (15,16).
Líklega verður að telja að færri
lungnaeinkenni og betri lungnastarfsemi
bænda á Ströndum megi rekja til
votheysverkunar, en há tíðni einkenna
og jákvæðra felliprófa meðal bænda
í Víkurumdæmi eigi rót að rekja til
heyverkunaraðferða þeirra ásamt langs
innistöðutíma búfjár og langs dvalartíma
bænda í peningahúsum allt árið um kring.
Síðari könnun á sömu landsvæðum benti
eindregið til þess að bændur rektu mjög
sjaldan öndunarfæraeinkenni til vinnu í
votheyi, en oftast til vinnu í þurrheyi, einkum
mygluðu (17).
Nauðsyn ber til að bændur geri allt sem í
þeirra valdi stendur til að forðast heyryk,
en slíkt ryk virðist nú vera einhver mesti
skaðvaldur í atvinnuumhverfi Islendinga (18).
Nærtækast sýnist að grípa til þess ráðs að nota
heygrímur, en þá kemur á móti að grímur
sem dygðu til að halda sporum M. faeni
þyrftu að vera það þéttar að engum manni
væri vinnandi með þær erfiðisvinnu. í dag
sýnist einfaldasta aðferðin vera sú að nota
þar til gerða rykhjálma. Dýrari aðferðir eru
þær sem snúa að heyverkun þ.e. að vera með
góða súgþurrkun og/eða snúa sér eingöngu að
votheysverkun.
SUMMARY
Respiratory symptoms, lung function and precipitin
tests in two farming communities in Iceland.
The aim of this study was to find prevalence of
respiratory symptoms, do spirometries and measure
precipitins against M.faeni, T. vulgaris and A.
fumigatus in farmers in two different communities
in Iceland. Area A is located at the southem tip
of Iceland where the heaviest rainfall occurs (2-
4000 mm/year). In spite of this, regular haymaking
with outdoor drying of the hay is the most common
method. Area B is located in the northwestem
part of the country. Here the rainfall is less (1-
2000 mm/year) but the summers are very short.
Therefore farmers cannot risk a wet summer and
make silage from most of their harvest. A farmer
living in area A therefore usually has great haydust
exposure but one living in area B little.
We selected everyone living in these areas 16
years or older who listed livestock farming as
their main occupation in the Icelandic National
Registry. A questionnaire based on the British
Medical Research Council questionnaire for
respiratory symptoms, with questions related to
haydust exposure added. was used. Spirometry was
performed and blood drawn for precipitin tests
against M.faeni, T. vulgaris and A. fumigatus.
These were done with double gel diffusion
technique.
In area A, 325 (99,1% of cohort) were studied,
but 126 (84,0% of cohort) in area B. In area A,
3,4% made silage from more than half of their
harvest compared to 92,9% in area B. In area
A, 12,3% had cough for 3 months per year or
longer, 11,4% had phlegm for same length of time,
13,6% had dyspnea walking on level ground and
2,8% had wheezing on most days. Comparable
figures for area B were 14,3%, 14,3%, 5,6% and
2,4% respectively. Only dyspnea was significantly
different in these two areas (p<0,05). In area
A, 19,1% experienced cough after working in
haydust, 14,2% shortness of breath and 18,5%
had experienced fever after such exposure.
Comparable figures for area B were 14,3%,
13,5% and 7,9% respectively. Only the febrile
episodes were significantly different (p<0,01).
In area 72,9% had precipitins against M. faeni
compared to 23,0% in area B (p<0,001). As many
asymptomatic individuals have this test positive,
it is not a valuable diagnotstic tool. No one had
precipitins against T. vulgaris, and only 5 against
A. fumigatus. Cough of phlegm for 3 months or
longer, wheezing on most days or shortness of
breath after working in haydust did not correlate
with precipitins against M. faeni. However,
dyspnea walking on level ground (p<0,05), cough
working in haydust (p<0,02) and febrile reactions
(p<0,001) did correlate with positive precipitins
against M.faeni. Non-smokers were more likely
to form precipitins against M. faeni than smokers
(p<0,01). In area A, 24,8% had FEV1/FVC% less
than 70% compared to 9,5% in area B (p<0,001).
The study shows that farmers, who make silage
mainly, have less febrile episodes and certain
respiratory symptoms. They are also less likely
to have obstructive ventilatory defect.
HEIMILDIR
1. Pálsson S. íslensk sjúkdómanöfn. Tímarit hins
konunglega lærdómslistafélags 1790; 9: 221.
2. Emanuel DA, Kryda MJ. Farmer’s lung disease. Clin
Rev Allergy 1983; 1: 509-32.