[Show abstract][Hide abstract]ABSTRACT: The prolonged period required for maturation of the respiratory system makes it vulnerable to environmental exposure. This study aimed to investigate the association between early-life factors and lung function in preschool children. Children aged 4 years, who were included in a prospective birth cohort, underwent lung function testing at baseline (n = 535) and after bronchodilation (n = 498) by forced oscillations. Information on symptoms and exposures was collected through half-yearly questionnaires. Allergen-specific serum IgE was quantified at 1 and 4 years. Multiple linear regression analysis showed that the baseline respiratory resistance and reactance area were larger in the children with previous wheeze, those with early-onset sensitisation to inhalant allergens and those who were smaller. Furthermore, children with previous lower respiratory tract infections exhibited higher baseline resistance values. The baseline resistance was the only independent determinant of the bronchodilator-induced change in resistance, whereas current height and baseline reactance area were independently associated with the change in reactance area. In conclusion, previous lower respiratory tract infections, the timing of previous wheeze, inhalant sensitisation and current height independently influence the baseline lung function of 4-year-old children, whereas baseline lung function is the principal determinant of the bronchodilator response.
Full-text Article · Jun 2014 · European Respiratory Journal
[Show abstract][Hide abstract]ABSTRACT: Industrial composting is a relatively new and expanding activity. Several studies indicate that compost workers are at risk to develop health symptoms. The aim of this study was to assess the prevalence of work-related health symptoms among compost workers compared with control subjects.
A questionnaire was distributed among 62 workers (31 exposed and 31 non-exposed workers). Data were analyzed using simple and multiple logistic regression analyses.
Workers exposed to organic dust reported significantly more often respiratory, irritation (e.g., eyes, nose and throat), gastrointestinal, and skin symptoms than the non-exposed group. Moreover, all work-related symptoms were significantly more often reported by exposed than non-exposed workers. After adjustment for smoking status and age, the associations between exposure and respiratory, gastrointestinal, and skin symptoms remained statistically significant, in particular if these symptoms were work-related.
This study confirms that workers at compost facilities are at risk to develop occupational health problems, most likely related to organic dust exposure.
[Show abstract][Hide abstract]ABSTRACT: Oxidative stress and kidney effects in workers with low occupational exposure to cadmium
*R. Hambach1,2, J. Droste1, G. François1, P. D’Haese3, D. Lison4, B. Manuel-Y-Keenoy5, A. De Schryver1, M. van Sprundel1
1Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium 2Occupational Health Service Mensura, Brussels, Belgium 3Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium 4Unit of Toxicology and Applied Pharmacology, Catholic University of Louvain, Brussels, Belgium 5Laboratory of Nutrition and Functional Food Science, University of Antwerp, Antwerp, Belgium
* presenter of the abstract: Ramona Hambach, firstname.lastname@example.org
Keywords: cadmium, low exposure, renal and oxidative stress markers, occupational
Silver solder activities potentially expose workers to cadmium (Cd). Recent research reports adverse health effects at Cd concentrations in urine below 2.0 µg/g creatinine. The objectives of this study were to assess cadmium exposure in workers using silver solder and to investigate the effects of cadmium exposure on markers of oxidative stress and renal dysfunction.
Concentrations of cadmium in blood (Cd-B) and urine (Cd-U) were determined in 36 workers frequently brazing with silver alloys and in 29 non-exposed control subjects. Concentrations of renal markers (NAG, IAP, µAlb, β2MG, RBP in urine) and oxidative stress markers (d-ROM, AOPP, GPX, SOD in blood, and 8-OHdG, 8-isoprostanes in urine) were measured as well.
Exposed workers had significantly higher concentrations of Cd-B and Cd-U as compared with non-exposed subjects: 1.63 µg/l (95% CI: 1.29-2.06) and 0.82 µg/g creatinine (95% CI: 0.52-1.27), respectively, versus 0.21 µg/l (95% CI: 0.15-0.29) and 0.14 µg/g creatinine (95% CI: 0.10-0.19), respectively. Pearson correlation analysis showed a statistically significant positive correlation between IAP and Cd-B / Cd-U. In addition, a statistically significant positive correlation was found between concentrations of Cd-U and β2MG / dROM / SOD / 8OHdG. In contrast, an inverse, significant correlation was observed between Cd-U and GPX concentrations. Multiple regression analysis with adjustment for age, pack-years of smoking, hypertension, and urine creatinine concentrations indicated that IAP and 8-OHdG concentrations were both significantly associated with Cd-B and Cd-U concentrations. In addition, 8-isoprostane levels were inversely and significantly associated with Cd-B and Cd-U levels. GPX concentrations were inversely and significantly associated with only Cd-U concentrations.
Relatively low Cd-B and Cd-U levels were found, besides significant associations between cadmium concentrations in blood and urine on the one side and markers of oxidative stress and renal dysfunction on the other side. This suggests early effects and offers opportunities to develop biomarkers of oxidative stress as tools for health effect surveillance.
[Show abstract][Hide abstract]ABSTRACT: Objectives
Silver brazing activities expose workers to metal fumes of which the health effects are not well studied yet. The aim of this study was to assess a number of biochemical parameters (heavy metals, renal markers, and oxidative stress markers) in workers performing brazing with silver alloys.
Blood (B) concentrations of Pb, Cd, Mn and urine (U) concentrations of Cd, Mn, Cu and Zn were determined in 40 refrigeration industry workers frequently brazing with silver alloys and 31 non-exposed control subjects. Renal markers (NAG, IAP, microalbumin, β2micro, RBP) and oxidative stress markers (d-ROM, AOPP, GPx, SOD, 8-OHdG) were measured as well.
Significantly higher geometric mean levels (s.e.m.) of Cd-B (1.64 (1.11) vs 0.23 (1.17) µg/l), Cd-U (0.71 (1.24) vs 0.14 (1.16) µg/g creatinine) and Cu-U (5.55 (1.08) vs 4.55 (1.06) µg/g creatinine) were found in exposed workers than in control subjects. In addition, significantly increased levels of IAP were found among exposed workers. Also, higher levels (not statistically significant) of d-ROM, AOPP, SOD, and 8-OHdG were detected in exposed subjects than in control subjects.
The results suggest relatively low occupational exposure levels to heavy metals. Nevertheless, Cd-B, Cd-U and Cu-U were significantly higher in exposed subjects, as well as levels of IAP, a marker associated with Cd toxicity. In addition, elevated levels of oxidative stress markers were found among exposed workers, though not significantly higher than among non-exposed subjects.
[Show abstract][Hide abstract]ABSTRACT: The aim of this research project was to learn more about work-related health risks among dental assistants in Flanders, Belgium. Forty-seven dental assistants completed an extensive questionnaire concerning ionized radiation, protection against infection and exposure to chemicals such as mercury, disinfectants and acrylates. Collective and personal means of protection, musculoskeletal disorders and work-related stress were also evaluated. Pain in the lower back, neck pain and shoulder pain were reported by, respectively, 15%, 17% and 22% of the respondents. Eczema resulting from skin irritation or contact-allergy was reported by 13%. Twenty-three percent of the assistants did not consistently make use ofa radiation badge; 80% wore a mouth mask and 33% wore protective glasses; and 82% was vaccinated against hepatitis B. Almost 10% reported verbal or physical aggression by patients. The mean stress score was 3.95 on a scale from 0 to 10. The results may contribute to the formulation of a number of recommendations for the improvement of the health of dental assistants.
Full-text Article · Jul 2011 · Nederlands tijdschrift voor tandheelkunde
[Show abstract][Hide abstract]ABSTRACT: Little data are available on the relationship between indirect antibiotic exposure of the child in utero or during lactation and allergic diseases. On the other hand, several studies have been conducted on the association with direct post-natal antibiotic exposure, but the results are conflicting.
The aim of this study was to investigate pre- and post-natal antibiotic exposure and the subsequent development of eczema, recurrent wheeze and atopic sensitization in children up to the age of 4 years.
We conducted an aetiologic study in 773 children based on a prospective birth cohort project in which environmental and health information were collected using questionnaires. Antibiotic exposure was assessed as maternal antibiotic intake during pregnancy and during lactation and as medication intake of the child. The chronology of exposures and outcomes was taken into account during the data processing. At the age of 1 and 4 years, a blood sample was taken for the quantification of specific IgE.
Prenatal antibiotic exposure was significantly positively associated with eczema, whereas no association was found with recurrent wheeze and atopic sensitization. We found a positive, although statistically not significant, association between antibiotic exposure through breastfeeding and recurrent wheeze. Neither eczema nor atopic sensitization was significantly associated with antibiotic exposure through breastfeeding. Finally, we observed a negative association between the use of antibiotics in the first year of life and eczema and atopic sensitization, and also between antibiotic use after the first year of life and recurrent wheeze, eczema and atopic sensitization.
Indirect exposure to antibiotics (in utero and during lactation) increases the risk for allergic symptoms in children, while direct exposure to antibiotics appears to be protective. The biological mechanisms underlying these findings still need to be elucidated.
[Show abstract][Hide abstract]ABSTRACT: Early exposure to solid foods in infancy has been associated with the development of allergic diseases. However, scientific evidence for this is conflicting. The aim of this study was to examine the association between early exposure to solid foods in the infant's diet and the development of eczema up to 4 years of age. We conducted an etiologic case-control study nested in the PIPO cohort (Prospective Cohort on the Influence of Perinatal Factors on the Occurrence of Asthma and Allergies). In this cohort data on nutrition, environmental exposures and parent-reported eczema were collected prospectively starting from 5 months pregnancy by means of questionnaires administered during two home visits and semi-annual postal questionnaires. In addition, detailed information on the timing of introduction of solid foods at individual food item level was collected at 1 year of age. Adjusted odds ratios and 95% confidence intervals were computed using logistic regression analysis as a measure of association between eczema and the timing of exposure to solid foods. Early introduction (within the first 4 months) of solid foods was inversely associated with eczema up to 4 years of age (adj OR: 0.49; 95% CI: 0.32-0.74). Moreover, we found that early exposure to solid foods was associated with a reduced risk for eczema only among children with allergic parents (adj OR: 0.35; 95% CI: 0.20-0.63), whereas no significant effect was found among children with non-allergic parents (adj OR: 0.69; 95% CI: 0.37-1.29). The results of this study show that early exposure to solid foods is associated with less parent-reported eczema in children, particularly among children with allergic parents. Therefore, the current study does not support a delayed introduction of solid foods for the prevention of eczema in childhood.
Full-text Article · Aug 2009 · Pediatric Allergy and Immunology
[Show abstract][Hide abstract]ABSTRACT: Several studies have investigated the association between socioeconomic status and the occurrence of allergies. Nevertheless, the results remain contradictory. The aim of this study was to evaluate the associations between parental education and the occurrence of atopic sensitization, recurrent wheezing and eczema during the first year of life, differentiating between atopic and non-atopic disorders based on specific serum IgE. We conducted an aetiological study in 690 children, based on a prospective birth cohort project in which environmental and health information was gathered using questionnaires. At the age of 1 yr a blood sample was taken for quantification of specific IgE. Adjusted odds ratios and 95% confidence intervals were computed as measures of association between the outcomes and parental education. Parental educational level was positively associated with the occurrence of atopic sensitization (OR: 2.1; 95% CI: 1.0-4.4) and eczema (OR: 1.9; 95% CI: 1.1-3.4), but negatively with the occurrence of recurrent wheezing (OR: 0.4; 95% CI: 0.2-0.8) in the first year of life. Atopic recurrent wheezing was positively associated with the education of the parents, whereas non-atopic recurrent wheezing was negatively associated. When maternal and paternal education were considered separately, only maternal education had a significant influence. Our results suggest that aspects associated with a high maternal educational level may play an important role in the development of atopic disorders.
Article · Mar 2009 · Pediatric Allergy and Immunology
[Show abstract][Hide abstract]ABSTRACT: Purpose of the study: One of the objectives of the registration of cancer is to represent the geographical distribution of the incidence of cancer, which, in combination with other information, could be used to evaluate environmental health effects. This study examines whether a cancer registry could be used to evaluate health effects of point sources, and if so, what the necessary requirements of registration are, and to what extent a (cancer) registry needs to contain geographical information in order to evaluate environmental health effects in a meaningful way. Main findings: To be useful for the investigation of a cancer (disease) cluster, a registry needs to fulfil several conditions, e.g. it should be as complete and as accurate as possible and duplicated data should be avoided. The rapid availability of data is very important. In Flanders, a network of the existing cancer registries with linking of data can represent an important added value for the study of environmental health effects through cancer registration. When a suspected cluster is reported, it often represents a very local increase in incidence of disease. For this reason, the registry needs to contain detailed geographical information. The most appropriate level of registration for the study of a cluster seems to be the statistical code. The inventory of the incident cancer cases on the level of statistical units is possible, but very labour-intensive because of the current privacy-legislation. Principal conclusions: Cancer registration can be used to study the geographical distribution of cancer incidence in relation to environmental exposure to health risk factors. If the authorities consider this to be an important objective of a cancer registry, then a legislation on the registration of cancer is necessary. This legislation should lead to a more efficient organisation of cancer prevention by means of a well-structured cancer registry compiled in an ethically, economically, and scientifically acceptable manner.
[Show abstract][Hide abstract]ABSTRACT: Breast feeding (BF) provides many advantages to the offspring; however, at present there is an ongoing debate as to whether or not it prevents allergic diseases. The aim of the current study was to investigate the effect of duration of BF on eczema in the first year of life. A birth cohort of 1128 infants was followed prospectively from 5 months of pregnancy. Data were collected using questionnaires, a medical examination and blood tests for allergy at the age of 1 yr. Breast feeding was not statistically significant associated with eczema in the first year of life [adj ORs with 95% CIs: 0.8 (0.4-1.3), 0.8 (0.5-1.3) and 1.0 (0.6-1.5) for BF duration of 1-6 wk, 7-12 wk and > or = 13 wk, respectively]. Eczema was positively associated with atopy and educational level of the mother, use of antibiotics in pregnancy and passive smoking by the child during the first 12 months. Regular postnatal contact of the infants with dogs was inversely associated with eczema. Breast feeding was positively associated with eczema among children with non-atopic parents [adj ORs with 95% CIs: 2.1 (0.4-10.6), 2.2 (0.4-11.3) and 1.9 (0.4-8.5) for BF duration of 1-6 wk, 7-12 wk and > or = 13 wk, respectively], whereas an inverse association was found among children with atopic parents [adj ORs with 95% CIs: 0.6 (0.3-1.3), 0.7 (0.3-1.4) and 0.9 (0.5-1.7) for the same BF durations]. However, these associations were not statistically significant. Breast feeding has no significant effect on the prevalence of eczema in the first year of life. The effect of BF on eczema in children depends on parental atopy.
Article · Aug 2007 · Pediatric Allergy and Immunology
[Show abstract][Hide abstract]ABSTRACT: Two cross sectional surveys (1995/1996 and 2001/2002) were carried out according to the ISAAC protocol among 6-7 and 13-14 year old schoolchildren in Antwerp, Belgium. A total of 8244 children participated in 1996 and 8159 children in 2002. No significant differences in current prevalence of asthma and asthma medication was found in 6-7 year olds and 13-14 year old girls. Significantly less asthma and asthma medication was reported by 13-14 year old boys in 2002. Symptoms of wheeze had lower occurrence in all groups in 2002, which was significant for older age group. Current prevalence of rash was significantly higher in the 6-7 year olds in 2002. No such increase was found for rash in the older age groups but they reported significantly more rhinitis. No differences were found between urban and suburban Antwerp in either survey. No clear changes in the occurrence of asthma were found for school children in Antwerp while wheeze was reported less in 2002 compared to 1996. Allergic disorders had higher occurrences in schoolchildren in 2002.
[Show abstract][Hide abstract]ABSTRACT: The aim of the study is to examine the relationship between exposure to occupational allergens, sensitization, and atopy and several outcome variables and the independent associations of these interrelated risk factors to work-related symptoms in particular.
Data were collected by questionnaire, skin prick tests, lung function tests, and exposure measurements among 246 workers from 74 bakeries and analyzed using logistic and linear regression analyses.
Exposure levels were associated with respiratory symptoms, sensitization to baker's allergens, and lung function. High exposure and sensitization to common and bakers' allergens were independent risk factors for work-related symptoms. However, allergy determinants performed best in predicting work-related symptoms.
Current exposure to occupational allergens is a risk factor for work-related symptoms, but sensitization to occupational allergens and atopy are more adequate and easier obtainable predictors of work-related symptoms.
Article · Jun 2005 · Journal of Occupational and Environmental Medicine
[Show abstract][Hide abstract]ABSTRACT: This study was designed to characterize exposure to inhalable dust, wheat flour and alpha-amylase allergens in industrial and traditional bakeries. The study included 70 bakeries from the northern part of Belgium. Based on the degree of automation and a clear division of individual job tasks, four bakeries were identified as industrial and the remaining 66 were identified as traditional ones. Personal, as well as stationary, samples of inhalable dust were collected during full shift periods, usually 5-7 h. The portable pumps aspirated 2 l/min through Teflon personal dust samplers (Millipore, pore size 1.0 microm) mounted in PAS-6 sampling heads. In the collected samples the inhalable dust, wheat flour and alpha-amylase allergens were determined. Wheat flour allergens were measured using enzyme-linked immunosorbent assay inhibition and an antiwheat IgG4 serum pool. The alpha-amylase allergens were measured using a sandwich enzyme immunoassay with affinity-purified polyclonal rabbit IgG antibodies. In total, 440 samples (300 personal and 140 stationary) were processed. The highest inhalable dust exposure was observed in traditional bakeries among bread [geometric mean (GM) 2.10 mg/m3] and bread and pastry workers (GM 1.80 mg/m3). In industrial bakeries the highest dust exposure was measured in bread-producing workers (GM 1.06 mg/m3). Similar relations were observed for wheat flour and alpha-amylase allergens. Bread baking workers in traditional bakeries had the highest exposure to both allergens (wheat flour GM 22.33 microg/m(3), alpha-amylase GM 0.61 ng/m3). The exposure to wheat flour and alpha-amylase allergens in industrial bakeries was higher in bread baking workers (wheat flour GM 6.15 microg/m3, alpha-amylase GM 0.47 ng/m3) than in bread packing workers (wheat flour GM 2.79 microg/m3, alpha-amylase GM 0.15 ng/m3). The data presented suggest that, on average, exposure in the Belgium bakeries studied-industrial as well as traditional-is lower than or similar to bakeries in The Netherlands, Canada, Sweden, the United Kingdom and Finland. Furthermore, the exposure levels in traditional bakeries seem to be higher than in industrial bakeries.
Article · Feb 2004 · Annals of Occupational Hygiene
[Show abstract][Hide abstract]ABSTRACT: Only few studies have assessed relative risks on occupational asthma and allergy among bakery workers, and none of them have included respiratory and work-related symptoms as well as sensitization to occupational allergens and pulmonary function. A random sample of 246 workers from traditional and industrial bakeries in two regions of Belgium were compared with a reference population of 251 workers from a petrochemical plant in the same region. Data on skin test positivity, symptoms, and lung function were collected by standardized procedures. Differences between the two subpopulations were analyzed using multiple logistic and linear regression analyses. On average, bakery workers did not more often have skin test positivity than reference workers (39.4% and 42.6%, respectively). However, bakery workers had a strongly increased risk of sensitization to specific bakery allergens (OR 22.0, 95% CI = 6.3-77.1.), whereas their risks of positive skin tests to common allergens, including wheat pollen and storage mite, were significantly decreased (OR 0.6, 95% CI = 0.4-0.9). Bakery workers had significantly more often respiratory and work-related symptoms. Accordingly, they had lower lung function parameters. Atopy and sensitization to bakers' allergens were independent and additional risk factors for work-related symptoms. Bakery workers are at increased risk of respiratory and allergic symptoms and skin test reactivity to specific bakers' allergens wheat flour and alpha-amylase. Wheat pollen and storage mite should not be regarded as baker's allergens. Nevertheless, pulmonary function of bakery workers can be characterized as mild airway obstruction only.
Article · Jul 2003 · Journal of Occupational and Environmental Medicine
[Show abstract][Hide abstract]ABSTRACT: One of the mechanisms evoked to explain the increasing prevalences of asthma and allergy, in particular among children, is the 'Western lifestyle' or 'hygiene' hypothesis. As early childhood infections are assumed to hold a protective effect on the development of asthma and allergies, the use of antibiotics at that sensitive age may lead to an increased risk of asthma and allergy.
The aim of this study is to investigate the association between the use of antibiotics in the first year of life and the subsequent development of asthma and allergic disorders.
In a population-based sample of 7-and-8-year-old children questionnaire and skin prick test data were collected from 1206 and 675 subjects, respectively. Prevalence rates of asthma, allergic disorders and skin test positivity were compared between children with and without early life use of antibiotics, taking into account other possible risk factors including early respiratory infections. The effect of genetic predisposition was investigated by stratified analyses of children with and without parental hay fever.
The use of antibiotics during the first year of life was significantly associated with asthma (OR = 1.7, 95% CI 1.0-3.1), hay fever (OR = 2.3, 95% CI 1.3-3.8) and eczema (OR = 1.3, 95% CI 1.0-1.8). No significant relationship was found with skin test positivity (OR = 1.1, 95% CI 0.7-1.7). After stratification for the presence of parental hay fever, children without parental hay fever did not show any significant associations between antibiotics use and asthma or allergy, whereas in children with parental hay fever the use of antibiotics was significantly related with asthma (OR = 2.3, 95% CI 1.1-5.1), hay fever (OR = 2.8, 95% CI 1.5-5.1) and eczema (OR = 1.6, 95% CI 1.0-2.6), and of borderline statistical significance with skin test positivity (OR = 1.6, 95% CI 0.9-3.0).
Early childhood use of antibiotics is associated with an increased risk of developing asthma and allergic disorders in children who are predisposed to atopic immune responses. These findings support recent immunological understanding of the maturation of the immune system.
Article · Dec 2000 · Clinical & Experimental Allergy
[Show abstract][Hide abstract]ABSTRACT: To investigate the relation between lung cancer and exposure to occupational carcinogens in a highly industrialised region in western Europe.
In a case-control study 478 cases and 536 controls, recruited from 10 hospitals in the Antwerp region, were interviewed. Cases were male patients with histologically confirmed lung cancer; controls were male patients without cancer or primary lung diseases. Data were collected by questionnaires to obtain information on occupations, exposures, and smoking history. Job titles were coded with the Office of Populations, Censuses and Surveys industrial classification. Exposure was assessed by self report and by job-task exposure matrix. Exposure odds ratios were calculated with logistic regression analysis adjusted for age, smoking history, and marital and socio-economic status.
A job history in the categories manufacturing of transport equipment other than automobiles (for example, shipyard workers), transport support services (for example, dockers), and manufacturing of metal goods (for example, welders) was significantly associated with lung cancer (odds ratios (ORs) 2.3, 1.6, and 1.6 respectively). These associations were independent of smoking, education, civil, and economic status. Self reported exposure to potential carcinogens did not show significant associations with lung cancer, probably due to nondifferential misclassification. When assessed by job-task exposure matrix, exposure to molybdenum, mineral oils, and chromium were significantly associated with lung cancer. A strong association existed between smoking and lung cancer: OR of ex-smokers 4.2, OR of current smokers 14.5 v non-smokers. However, smoking did not confound the relation between occupational exposure and lung cancer.
The study has shown a significant excess risk of lung cancer among workers in manufacturing of metal goods, manufacturing of transport equipment (other than automobiles), and transport support services. Assessment of exposure to specific carcinogens resulted in significant associations of chromium, mineral oils, and molybdenum with lung cancer. This study is, to our knowledge, the first study reporting a significant association between occupational exposure to molybdenum and lung cancer.
Full-text Article · Jun 1999 · Occupational and Environmental Medicine
[Show abstract][Hide abstract]ABSTRACT: Abnormal pulmonary function in childhood is a well-known risk factor for lung function impairment in adult life. It is therefore of clinical interest to recognize lower pulmonary function in childhood. We investigated the association between asthma-like respiratory symptoms and the lung function parameters FVC, FEV1, and FEF(25-75) in a population-based sample of 402 schoolchildren, aged 7 and 8 years, using linear regression analyses. Without accounting for other respiratory symptoms, wheeze, exercise-induced wheeze, chronic cough, and history of wheezy bronchitis or lower respiratory infections in early childhood were significantly associated with reduced lung function. After stepwise elimination of symptoms from the regression models, only exercise-induced wheeze (FEV1, -15%pred, FEF(25-75), -21%pred) and a history of chronic cough (FEV1, -5%pred; FEF(25-75), -11%pred) remained significant predictors of decreased lung function. After adjustment for different variability, no significant differences were seen between the effects of symptoms on the flow measurements FEV1 and FEF(25-75). We conclude that children who report exercise-induced wheeze and/or chronic cough may have a considerable deficit in lung function at early school age.