Marina Otelea

By Marina Oțelea

Incidence of insulin resistance continues to grow, becoming a major public health concern worldwide. Besides the classical risk factors (obesity, unhealthy nutrition and lack of exercise), extensive research about some occupational hazards supports their association with insulin resistance and metabolic syndrome. On the one hand, the classical risk factors for insulin resistance are augmented by the changes of the working conditions: the occupational level of physical activity has a tendency to decrease, reducing its contribution to the overall level of physical activity and favouring a sedentary lifestyle and the occupational stress became the second most common work‐related health issue, contributing to the increase of the maladaptive habits, such as unhealthy nutrition. On the other hand, some insulin resistance risk factors are primarily occupational hazards: desynchronization of the circadian rhythm and sleep disruption during the night shifts, workplace air pollution (particles, solvents), heavy metals (arsenic, mercury) or persistent organic pollutants exposure. Meantime, workplaces are excellent settings for health‐promotion programmes and metabolic risk reduction, if there is managerial commitment and support. Therefore, assessment of the risk, screening and workplace intervention programmes to reduce insulin resistance incidence should be included in the occupational health service provision.

Part of the book: Occupational Health

By Marina Ruxandra Oțelea and Agripina Rașcu

Asthma is a very heterogeneous disease, with two major asthma phenotypes, the allergic and the late onset asthma, differentiated by the triggers, the cellular dominance, the Th1/Th2 inflammation pattern and the local and serological markers. As there were many overlapping biological markers between these two phenotypes, different types of tentative classification followed. A clinical one makes a difference between the predominant eosinophilic one (with better response to glucocorticoid) and the predominant neutrophilic one with more severe evolution and low rate of therapeutical improvement. Another approach was based on cluster analysis of asthma characteristics (onset, atopic status, and body mass index (BMI)), sensitivity to methacholine test, peak flow variability, bronchodilatation response, postbronchodilator level of FEV1, sputum eosinophil and neutrophil count, FeNO test, clinical symptom scores, treatment scheme to control symptoms, exacerbations, and severity. Emerging data suggest a distinct late onset obese-asthma phenotype, with a specific pathophysiology, comorbidities, and clinical evolution. This chapter reviews the main characteristics of this phenotype: the specific lung function impairment, the underlying inflammation, the adipokine profile, the comorbidities and the therapeutical approach. The mutual influence between obesity and asthma will be illustrated, whenever scientific data are available.

Part of the book: Asthma Diagnosis and Management