Browsing by Author "Baatjies, Roslynn"

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    Open Access
    A prospective cohort study on ambient air pollution and respiratory morbidities including childhood asthma in adolescents from the western Cape Province: study protocol
    (BioMed Central, 2017-09-16) Olaniyan, Toyib; Jeebhay, Mohamed; Röösli, Martin; Naidoo, Rajen; Baatjies, Roslynn; Künzil, Nino; Tsai, Ming; Davey, Mark; de Hoogh, Kees; Berman, Dilys; Parker, Bhawoodien; Leaner, Joy; Dalvie, Mohamed A
    Background: There is evidence from existing literature that ambient air pollutant exposure in early childhood likely plays an important role in asthma exacerbation and other respiratory symptoms, with greater effect among asthmatic children. However, there is inconclusive evidence on the role of ambient air pollutant exposures in relation to increasing asthma prevalence as well as asthma induction in children. At the population level, little is known about the potential synergistic effects between pollen allergens and air pollutants since this type of association poses challenges in uncontrolled real life settings. In particular, data from sub-Sahara Africa is scarce and virtually absent among populations residing in informal residential settlements. Methods/design: A prospective cohort study of 600 school children residing in four informal settlement areas with varying potential ambient air pollutant exposure levels in the Western Cape in South Africa is carried-out. The study has two follow-up periods of at least six-months apart including an embedded panel study in summer and winter. The exposure assessment component models temporal and spatial variability of air quality in the four study areas over the study duration using land-use regression modelling (LUR). Additionally, daily pollen levels (mould spores, tree, grass and weed pollen) in the study areas are recorded. In the panel study asthma symptoms and serial peak flow measurements is recorded three times daily to determine short-term serial airway changes in relation to varying ambient air quality and pollen over 10-days during winter and summer. The health outcome component of the cohort study include; the presence of asthma using a standardised ISAAC questionnaire, spirometry, fractional exhaled nitric-oxide (FeNO) and the presence of atopy (Phadiatop). Discussion: This research applies state of the art exposure assessment approaches to characterize the effects of ambient air pollutants on childhood respiratory health, with a specific focus on asthma and markers of airway inflammation (FeNO) in South African informal settlement areas by considering also pollen counts and meteorological factors. The study will generate crucial data on air pollution and asthma in low income settings in sub-Sahara Africa that is lacking in the international literature.
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    Allergic sensitization and work related asthma among poultry workers in South Africa
    (2016) Ngajilo, Dorothy; Jeebhay, Mohamed; Baatjies, Roslynn
    Objective: The aim of the study was to determine the risk factors associated with allergic sensitisation and various asthma phenotypes in poultry workers. Methods: A cross-sectional study of 230 currently employed poultry workers used a modified ECRHS questionnaire, spirometry, fractional exhaled nitric oxide, Phadiatop and ImmunoCAP for specific IgE to poultry farming associated allergens (chicken meat, feathers, serum protein, droppings, sunflower seeds, storage mite) and mould mix to investigate workrelated asthma. Results: The mean dust particulate concentration (geometric mean (GM) =11.04mg/m³) was highest in the rearing department while mean (1-3)-ß-D-glucan (GM=148 ng/ m³) and endotoxin levels (GM=2298 EU/m³) were highest in the catching department. Worker's mean age was 37±9 years, 68% were male, 43% current smokers, 34% atopic and 5% casual workers. The prevalence of non-atopic asthma (NAA=10%) was higher than atopic asthma (AA=6%) or probable occupational asthma (OA=5%). Sensitisation to at least one poultry work related allergen was 24%, with sunflower seed and storage mite sensitisation being the most prevalent (13%). In multivariate adjusted models, workers sensitised to chicken specific allergens were more likely to be atopic (OR=20.9, 95% CI: 4.7-93.2) or have casual job status (OR=6.0, 95% CI: 1.1-35.9). Workers with work-related chest symptoms were more likely to work in the rearing department (OR=3.2, 95% CI: 1.2-8.3) and to report episodes of high gas/dust/fume exposures causing asthma symptoms (OR=4.8, 95%CI: 2.4-9.6). Reversible obstructive airway obstruction was more strongly associated with employment in small broiler farms (OR=11.6, 95% CI: 1.0-129.0) as well as casual work (OR=6.4, 95% CI: 1.4-28.0). Furthermore, NAA was strongly associated with casual work (OR=5.0, 95% CI: 1.3-19.0) as well as working in the automated egg laying system (OR=8.0, 95% CI: 1.0-68.6). Further analysis revealed that the proportion of workers sensitised to at least one poultry work related allergen declined with increasing years of service (chi-square trend p=0.023), with workers having <2 years employment demonstrating a higher risk compared to those with >6 years employment (OR=4.0, 95% CI: 1.2-13.8). Conclusion: Non-atopic asthma is the most common asthma phenotype among poultry workers with work in the rearing department demonstrating an increased respiratory risk. The increased risk of reversible airway obstruction among workers in small broiler farms and the declining prevalence of sensitisation with increasing employment duration suggests a healthy worker effect. Preventive measures, including appropriate training, are recommended to reduce respiratory health risks, particularly in novice workers.
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    Assessing the health impact of intervention in supermarket bakeries using fractional exhaled nitric oxide (FeNO) and other clinical endpoints for baker’s allergy and asthma
    (2018) Al-Badri, Faisal; Jeebhay, Mohamed; Baatjies, Roslynn
    Aim: To assess the health impact of an intervention in supermarket bakeries using fractional exhaled nitric oxide and other clinical endpoints for baker’s allergy and asthma after a one-year follow-up period. Methods: A field randomised controlled trial of 31 bakeries initially assigned to one of two intervention groups (bakery mixer lid and training) (n=244) and a control group (n=93). Health data prior to and after the intervention included a modified ECRHS questionnaire; Phadiatop ® and serum specific IgE to cereal flours (wheat, rye, alpha-amylase); and FeNO performed during the work shift using NIOX MINO®. The data of the two intervention groups was combined into one intervention group for the analysis. Data was analysed using STATA (version 12). Results: The two groups were comparable with regard to age (32-33 years), proportion of females (55%-57%) and smoking status (38%-40%). The intervention group had a significantly higher prevalence of workers with atopy (42%, p=0.025), work-related chest symptoms (25%, p=0.044) and sensitisation to cereal flour allergens (35%, p=0.042) at baseline than the control group (25%, 15%, 23% respectively). At one year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO >25ppb) was similar in the two groups. The mean difference in FeNO was similar across the two groups (2.2ppb vs 1.7ppb, p=0.860). However, when stratifying according to baseline FeNO >25ppb, the FeNO decline was greater in the intervention group (16.9 ppb) than in the control group (7.7ppb), although not statistically significant (p=0.237). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO >25ppb) did not demonstrate an appreciable decline in FeNO (>10%) in the intervention compared to the control group. However, stratification according to the presence of work related ocular-nasal symptoms at baseline demonstrated a significant decline (>10%) in FeNO in the intervention group compared to the control group (OR=3.73, CI: 1.22-11.42). Conclusion: This study demonstrates some evidence of an intervention effect on exhaled nitric oxide (FeNO) one year after the intervention, particularly among bakers reporting work-related ocular-nasal symptoms at baseline. The lack of a demonstrably stronger effect on other clinical endpoints can be attributable to the short follow-up period.
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    Health-Related Quality of Life (HRQoL) of Residents with Persistent Lower Respiratory Symptoms or Asthma Following a Sulphur Stockpile Fire Incident
    (Multidisciplinary Digital Publishing Institute, 2022-03-02) Adams, Shahieda; Rajani, Mayuri; Baatjies, Roslynn; Omar, Faieza; Jeebhay, Mohamed Fareed
    Background: This study evaluated health-related quality of life (HRQoL) in residents with persistent lower respiratory symptoms (PLRS) or asthma six years after exposure to sulphur dioxide vapours emanating from an ignited sulphur stockpile. Methods:A cross-sectional study was carried out, using interview data collected at three time points (prior to, one- and six-years post incident), medical history, respiratory symptoms and HRQOL using the Medical Outcomes Study Form 36 (SF-36). Results: A total of 246 records, 74 with and 172 without PLRS or asthma, were analysed. The mean age was 42 (SD:12) years in the symptomatic group and 41 (SD:13) years in the asymptomatic group. Mean SF-36 scores were significantly lower for the symptomatic group in the Physical Functioning (24 vs. 39), Role—Physical (33 vs. 48) and General Health (GH) domains (24 vs. 37). Symptomatic residents experienced a significant decline in their Role—Physical (OR = 1.97; CI 1.09, 3.55) and GH (OR = 3.50; CI 1.39, 8.79) at year 6 compared to asymptomatic participants. Residents with co-morbid reactive upper airways dysfunction syndrome demonstrated stronger associations for GH (OR = 7.04; CI 1.61, 30.7) at year 1 and at year 6 (OR = 8.58; CI 1.10, 65.02). Conclusions:This study highlights the long-term adverse impact on HRQoL among residents with PLRS or asthma following a sulphur stockpile fire disaster.
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    Predictors of discordant latent tuberculosis infection test results amongst South African health care workers
    (BioMed Central, 2019-02-08) Adams, Shahieda; Ehrlich, Rodney; Baatjies, Roslynn; Dendukuri, Nandini; Wang, Zhuoyu; Dheda, Keertan
    Background The tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are utilized in screening programmes for presumed latent tuberculosis infection (LTBI) in health care workers (HCWs). However, inter-test comparison yields high rates of discordance, which is poorly understood. The aim of the study was therefore to identify factors associated with discordance amongst HCWs in a TB and HIV endemic setting. Methods 505 HCWs were screened for LTBI in South Africa using the TST and two IGRA assays (QuantiFERON-TB-Gold-In-Tube (QFT-GIT) and TSPOT.TB). Factors associated with discordance were analyzed using a multinomial logistic regression model. Results TST-IGRA discordance was negatively associated with longer duration of employment for both TSPOT.TB (OR = 0.92; 95% confidence interval (CI) 0.85–0.99) and QFT-GIT (OR = 0.90; 95% CI 0.84–0.96). Marked test discordance occurred in HIV-infected individuals who were more likely to have TSPOT.TB + ve / TST-ve discordance (OR 4.44; 95% CI 1.14–17.27) or TSPOT.TB + ve / QFT-GIT-ve test discordance (OR 5.72; 95% CI 1.95–16.78). Those engaged in home care were less likely to have QFT-GIT + ve/TSPOT.TB -ve / discordance (OR 0.32; 95% CI 0.10–0.95). Conclusion The marked TST-IGRA and IGRA-IGRA discordance in HIV-infected individuals suggest greater sensitivity of TSPOT.TB in immunocompromised persons or potential greater reactivity of TSPOT.TB in this population.
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    Risk factors for work-related asthma in health workers with exposure to diverse cleaning agents in two African health care settings
    (2019) Mwanga, Hussein Hassan; Jeebhay, Mohamed Fareed; Baatjies, Roslynn
    Background: Health workers (HWs) are exposed to a wide range of chemicals used for cleaning and disinfection. This has been largely attributed to the ever-increasing demand for effective cleaning and disinfection in hospital settings in an effort to prevent healthcare associated infections. Over the last two decades, there has been increasing evidence linking cleaning agents to adverse work-related health effects such as rhinitis, asthma and contact dermatitis. There is however little information on the specific cleaning agents and tasks associated with various asthma-related outcomes. Furthermore, limited information exists regarding exposure-response relationships between the frequency of exposure to specific cleaning agents and asthma-related outcomes. This study investigated the prevalence and risk factors for work-related asthma (WRA) among HWs exposed to diverse cleaning agents in two academic tertiary public hospitals in southern Africa - South Africa and Tanzania. Methods: A cross-sectional study of 699 HWs was conducted. Exposure assessment included systematic workplace observations, environmental sampling for aldehydes (orthophthalaldehyde-OPA, glutaraldehyde and formaldehyde) and urine biomonitoring for chlorhexidine. Environmental sampling for aldehydes was conducted more extensively in the South African hospital (SAH). A pilot sampling in the Tanzanian hospital (TAH) revealed very low detectable levels of OPA and glutaraldehyde and as a result extensive measurements were not done. In the SAH, a total of 269 full-shift passive personal samples were collected from 164 HWs randomly selected from 17 different clinical departments. Passive sampling used TraceAir® AT580 monitors (Assay Technology, Livermore, CA). Biomonitoring for chlorhexidine was only conducted in the SAH since none of the HWs in the TAH used chlorhexidine. For the health outcome assessment, a total of 697 HWs completed interviews using the ECRHS questionnaire adapted for occupational contexts, which contained in-depth information on asthma, as well as detailed information on tasks and chemicals used during the course of their work. Sera was successfully collected from 682 HWs and analysed for specific immunoglobulin E (sIgE) antibody reactivity to common aero-allergens (Phadiatop) and specific occupational allergens (NRL - Hevea brasiliensis (Hev b5, Hev b6.02), chlorhexidine and OPA). Methacholine challenge tests (MCT) were performed on all South African HWs (n=318), based on standard inclusion criteria. Spirometry, accompanied by a post-bronchodilator (post-BD) test was conducted on all Tanzanian HWs (n=329) and a small proportion (n=25) of South African HWs where MCT was contraindicated. All HWs from both hospitals (n=654) underwent fractional exhaled nitric oxide (FeNO) testing during the working day prior to spirometry. Results: The prevalence of current asthma was 10% (atopic asthma 6%, non-atopic asthma 4%), while 2% had WRA. The prevalence of atopy was 43%, with 4% of workers being sensitised to OPA, 2% to NRL and only 1% to chlorhexidine. Environmental sampling demonstrated that OPA was detectable in 6 (2%) samples, all samples (Geometric mean (GM) = 0.010 ppm) being higher than the ACGIH exposure limit (0.0001 ppm). Workers with detectable OPA were found to have a longer duration of OPA use (OR = 1.28; 95% CI: 1.10 – 1.50). Formaldehyde was detectable in 103 (38%) samples (GM = 0.005 ppm), with 1% of samples having levels higher than the NIOSH TWA exposure limit (0.016 ppm). Asthmarelated outcomes (increasing asthma symptom score and FeNO) demonstrated consistent positive associations with certain medical instrument cleaning agents (OPA, QACs and enzymatic cleaners) and tasks (pre-cleaning of medical instruments, changing sterilisation solutions and manual disinfection of medical instruments) as well as certain patient care activities (disinfection prior to procedures, cleaning/disinfecting wounds, application of wound dressing, usage of adhesives and adhesive removing solvents). A particularly pronounced dose-response relationship was observed between work-related ocular-nasal symptoms and medical instrument cleaning agents (OPA, glutaraldehdye, QACs, enzymatic cleaners, alcohols and bleach; OR range: 2.50 – 12.08) and tasks (OR range: 2.58 – 3.97). Furthermore, a strong association was observed between higher asthma symptom scores and use of more sprays than wipes for fixed surface cleaning activities (mean ratio = 3.00; 95% CI: 1.50 – 5.98). Conclusion: This study has demonstrated that detectable exposures to OPA are higher and more isolated to certain departments than the more widespread low-level formaldehyde exposures present throughout the hospitals. Furthermore, cleaning agents have replaced NRL as important causes for WRA in health settings. Finally, specific cleaning agents such as OPA, quaternary ammonium compounds and enzymatic cleaners associated with medical instrument cleaning/disinfection as well as patient care activities and the use of sprays for fixed surface cleaning, are important environmental risk factors for various asthma-related outcomes among HWs in health care settings.
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    Skin symptoms (allergic and non-allergic) predicting the development of allergic respiratory outcomes and asthma in bakers
    (20198) Chongo-Faruk, Vânia; Jeebhay, Mohamed; Baatjies, Roslynn
    Background: Recent studies have suggested that aside from the inhalational route, skin exposure may also play an important role in the sensitization to allergens, resulting in adverse allergic respiratory outcomes including asthma in workers exposed to these agents. This appears to be reported more commonly for low molecular weight agents such as isocyanates and some cleaning agents. This study investigated whether skin symptoms, in the presence or absence of allergic sensitization, can predict the development of allergic respiratory outcomes and asthma in bakery workers. Methods: A cohort study investigated 263 bakery workers using a modified ECRHS questionnaire; immunological tests including skin prick tests for common local aeroallergens (ALK-Abello´ A/S, Horsholm, Denmark), Phadiatop and serum-specific IgE to bakery allergens (wheat, rye and fungal α-amylase); and pulmonological tests including spirometry, non-specific bronchial hyperresponsiveness, and fractional exhaled nitric oxide (FeNO), after a 4 year period. Results: Workers’ median age was 32 years (IQR: 26-38), 50% were female, 54% were ever smokers and 32% were atopic. At baseline, 26% of workers were sensitized to bakery allergens, skin symptoms were present in 22% and 11% reported work-related skin symptoms (WRSS). 3 While the incidence of general upper (19%) and lower (22%) respiratory symptoms over the follow-up period were very similar, work-related upper (29%) respiratory symptoms were higher than lower (20%) respiratory symptoms. However, the incidence of allergic sensitization to bakery allergens was only 8% and a new asthma diagnosis present in 4% over this period. In multivariate adjusted (gender, atopy and smoking status) regression models, having a history of skin symptoms was associated with an increased risk of developing work-related lower respiratory symptoms - WRLRS (RR=2.2, 95% CI: 1.03-4.83), while having clinically significant symptoms of eczema or urticaria was associated with an increased risk of reporting general upper respiratory symptoms (RR=5.5, 95% CI: 1.30-24.20) as well as WRLRS (RR= 4.8, 95% CI: 1.60-14.40). Furthermore, WRSS was associated with an increased risk of general upper respiratory symptoms (RR=5.1, 95% CI: 1.31-19.81), WRLRS (RR=4.1, 95% CI: 1.43-11.85) and elevated FeNO levels (FeNO>25ppb: RR=2.9, 95% CI: 1.19-7.28). The association between clinically significant skin symptoms or WRSS and new onset upper or lower respiratory symptoms were modified by use of dermal personal protective equipment. Infrequent or absent glove usage was associated with a higher risk (RR=5.3, 95% CI: 1.54-18.43) of having new onset WRLRS. Conclusion: Skin symptoms, more so if work-related, appear to be associated with future development of general and work-related upper and lower respiratory symptoms and inflammatory markers suggestive of asthma in bakery workers.
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    The study of occupational risk factors and interventions for baker's allergy and asthma among supermarket bakery workers
    (2013) Baatjies, Roslynn; Jeebhay, Mohamed Fareed; Heederik, Dick; Meijster, Tim
    Background: Baker's asthma is the most serious manifestation of occupational allergy among bakery workers. It is caused by IgE-mediated sensitisation and subsequent allergic reaction in the airways to specific occupational airborne allergens in flour or baking ingredients. Major aims of this study were to: characterise asthma phenotypes and environmental exposure to flour allergens among bakers and modifying factors; study associations between phenotype and environmental exposure and identify potential modifying factors of this association; determine the effectiveness of specific interventions in reducing exposure and the risk of sensitisation or allergic respiratory disease. Methods: A cross-sectional study was conducted among 517 bakery workers employed in 31 supermarkets. Health outcomes were assessed using a standardized questionnaire, immunological tests (sIgE, sIgG), methacholine challenge test and fractional exhaled nitric oxide (FeNO). Exposure assessment conducted pre- and post-intervention entailed determination of inhalable concentration of particulate mass and specific allergen levels. The intervention employed a group-randomised design to evaluate dust control measures. Results: Prevalence of probable occupational asthma (POA, 13%) was higher than atopic (AA, 6%), non-atopic (NAA, 6%) and work-aggravated asthma (WAA, 3%). Sensitisation to flour allergens was a major determinant of elevated FeNO among bakers. Bread bakers had the highest dust particulate (mean = 1.33 mg/m3) and allergen exposures. Exposure response relationships followed a bell-shaped curve, with the prevalence of IgE- sensitisation, allergic symptoms and POA, increasing up to 10-15 μg/m3 of airborne wheat allergen concentrations before declining. The association for IgE sensitization was not modified by IgG4 to wheat. The overall effect of the intervention revealed a 50% decrease in mean flour dust, wheat allergen and rye exposures in bakeries. Conclusion: Occupational asthma is the most common phenotype among supermarket bakery workers, with sensitisation to cereal flour allergens being the main determinant of allergic airway inflammation. The bell-shaped exposure response relationship is not modified by the presence of blocking antibodies and is probably due to a healthy worker effect. The multi-pronged intervention strategy was effective in reducing airborne flour dust and allergen levels. It is recommended that further studies investigate the long term health impact of these interventions in reducing the disease burden.
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    Work-related asthma among workers in the Mozambique wood processing industry
    (2021) Chamba, Paulino Samuel; Jeebhay, Mohamed Fareed; Baatjies, Roslynn
    Background: Workers in the wood processing industry are exposed to a heterogeneous mixture of inorganic and organic particles comprising wood fragments, viable and non-viable microorganisms, endotoxins, glucans and allergens, with the potential to cause work-related asthma. While this association has been reported in diverse settings, few studies have comprehensively studied host and environmental risk factors for work-related asthma phenotypes associated with wood dust. The aim of this study was to determine the prevalence and risk factors for work-related asthma among workers in the Mozambiquan wood processing industry. Methods: A cross-sectional study of wood workers was conducted in 21 factories located in three Mozambiquan provinces that processed various indigenous wood species. The environmental exposure assessment component comprised systematic walk-through inspections of all factories and the measurement of inhalable wood dust to determine particulate, (1-3)-β-D-glucan and endotoxin concentrations. A random sample of 30 workers were selected from similarly exposed groups (EGs) working in 9 representative factories for personal environmental sampling using PAS-6 sampling heads connected to Gillian GilAir pumps. A total of 124 of personal inhalable dust samples were collected for analysis. For the health outcome assessment, 450 subjects completed an ECRHS questionnaire adapted for occupational studies and underwent spirometry accompanied with bronchial reversibility and fractional exhaled nitric oxide (FeNO) testing conducted during the work shift. In addition, sera were obtained to determine the atopic status of workers using the Phadiatop test. Multivariate multiple lean and logistic regression was conducted adjusting for known confounders in saturated models using STATA 12 computer software. Results: The environmental exposure assessment demonstrated that the mean inhalable concentrations were 3.29 mg/m3 (GSD: 3.04) dust particulate, 98 endotoxin units (EU)/m3 (GSD: 5.05) and 123 ng/m3 (1-3)-β-D-Glucans (GSD: 5.05). These concentrations are higher compared to international exposure standards, generally ranging between 0.5-5 mg/m3 for dust particulate and 90 EU/m3 for endotoxins. A significant (p<0.05) modest correlation was observed between dust particulate and endotoxin (Pearson r = 0.48) and glucan (r = 0.40) concentrations. In the multivariate models, certain wood species were significantly associated with increased inhalable dust particulate levels - mahogany bean (Afzelia quanzensis Welw) (GM ratio=3.39) and African sandalwood (Spirostachys Africana Sonder) (GM ratio=3.19), as was factory building features (closed and semi-closed buildings, GM ratio=2.14). Additional determinants of elevated endotoxin exposures included African sandalwood (GM ratio=9.21) and working in closed buildings (GM ratio=2.10), while working in semi-closed buildings (GM ratio=2.14) was the main determinant of elevated glucan levels. Damp cloth cleaning methods were associated with lower dust particulate (GM ratio=0.55), endotoxin (GM ratio=0.32) and glucan (GM ratio=0.53) levels. The health outcome assessment of study subjects found the mean age to be 38 years, mostly male (94%), a large proportion non-smokers (76%) and 50% were atopic. The prevalence of current asthma was 7%, with equal proportions of atopic and non-atopic asthma (4%), while 2% had work-related asthma. The main host factors associated with work-related asthma outcomes were age, gender and atopic status. Exposure to Missanda (Erythrophleum suaveolens Brenan), Panga-panga (Millettia Stuhlmannii Taub.) and Mahogany bean (Afzelia quanzensis Welw.) wood species was associated with work-related ocular-nasal symptoms, while Mutondo (Cordyla Africana) species was associated with both work-related ocular-nasal and asthma symptoms. Work-related ocular-nasal symptoms were also associated, in a dose-dependent manner, with EGs categorized according to job titles as well as current dust particulate levels (medium, 4.68-4.71 mg/m3: OR = 3.45, 95% CI: 1.21 – 10.63; high, >4.71 mg/m3: OR = 3.66, 95% CI: 1.19 – 11.26) when compared to the low EG (<4.68 mg/m3) in unadjusted models. A similar trend was observed in the multivariate models adjusted for age, gender and smoking status. A history of work-related asthma symptoms was also positively associated with mean cumulative dust particulate exposure calculated across all jobs in the factory (OR = 1.01, 95% CI: 1.00 – 1.02) in multivariate linear regression models. In both unadjusted and adjusted models, increasing degree of bronchial reversibility was associated with increasing current dust particulate levels (medium, 4.68-4.71 mg/m3: OR = 1.99, 95% CI: 1.25 – 3.22; high, >4.71 mg/m3: OR = 1.73, 95% CI: 1.07 – 2.80) when compared to the low EG (<4.68 mg/m3). Increasing FeNO was associated with cumulative dust exposure quartiles based on current job >10.09 mg/m3-yr in both unadjusted (Q2, OR = 1.23, 95% CI: 1.02 – 1.51; Q3, OR: = 1.11, 95% CI: 0.91 – 1.35, Q4, OR= 1.23, 95% CI: 1.02 – 1.49) and adjusted models. Conclusion: This study demonstrated that exposure to all wood dust components in Mozambiquan wood processing workers were above international standards. The 7% asthma prevalence is consistent with global and specifically African country estimates, while 2% had work-related asthma. Processing of particular indigenous wood species and exposure metrics based on current as well as cumulative inhalable wood dust exposures were associated with an increased risk of work-related ocular-nasal and asthma symptoms, bronchial reversibility and airway inflammation. These risks are modified by host-associated factors of age, gender and atopy.