Asthma and occupation in the 1958 birth cohort

Abstract

Objective To examine the association of adult onset asthma with lifetime exposure to occupations and occupational exposures. Methods We generated lifetime occupational histories for 9488 members of the British 1958 birth cohort up to age 42 years. Blind to asthma status, jobs were coded to the International Standard Classification of Occupations 1988 and an Asthma Specific Job Exposure Matrix (ASJEM) with an expert re-evaluation step. Associations of jobs and ASJEM exposures with adult onset asthma were assessed in logistic regression models adjusting for sex, smoking, social class at birth and childhood hay fever. Results Of the 7406 cohort members with no asthma or wheezy bronchitis in childhood, 639 (9%) reported asthma by age 42 years. Adult onset asthma was associated with 18 occupations, many previously identified as risks for asthma (eg, farmers: OR 4.26, 95% CI 2.06 to 8.80; hairdressers: OR 1.88, 95% CI 1.24 to 2.85; printing workers: OR 3.04, 95% CI 1.49 to 6.18). Four were cleaning occupations and a further three occupations were likely to use cleaning agents. Adult onset asthma was associated with five of the 18 high-risk specific ASJEM exposures (flour exposure: OR 2.12, 95% CI 1.17 to 3.85; enzyme exposure: OR 2.32, 95% CI 1.22 to 4.42; cleaning/disinfecting products: OR 1.67, 95% CI 1.26 to 2.22; metal and metal fumes: OR 1.45, 95% CI 1.02 to 2.07; textile production: OR 1.71, 95% CI 1.12 to 2.61). Approximately 16% (95% CI 3.8% to 27.1%) of adult onset asthma was associated with known asthmagenic occupational exposures. Conclusions This study suggests that about 16% of adult onset asthma in British adults born in the late 1950s could be due to occupational exposures, mainly recognised high-risk exposures.

Occupational irritants and asthma: an Estonian cross-sectional study of 34 000 adults

“…For instance, for exposures to cleaning/disinfecting products and to wood dust, no associations were observed with the JEM, while increased asthma risks, consistent with existing literature [7,26,27], were suggested in the analysis of job categories. For mechanics, electricians and hand packers, the observed associations were similar to previous studies [16,27], although the specific hazardous agent(s) remain unknown. A refined exposure assessment taking into account the specificities of exposure conditions in Estonia, and considering relevant exposure windows in relation to the historical context, may be useful in future studies.…”

“…The exposure level was low to moderate and further exposure to sensitisers was unlikely. In a British longitudinal study [16], occupational exposure to environmental tobacco smoke (evaluated by the same asthma-specific JEM [20]) was associated with adult-onset asthma. In a Taiwanese case-control study [17], also using this asthma-specific JEM [20], associations were observed between exposure to irritant peaks and asthma without atopy, but results for lower levels of exposure to irritants were not reported.…”

“…In a Taiwanese case-control study [17], also using this asthma-specific JEM [20], associations were observed between exposure to irritant peaks and asthma without atopy, but results for lower levels of exposure to irritants were not reported. Finally, the growing literature on the relationship between cleaning exposures and asthma suggests a prominent role for irritants [16,26,31].…”

“…Although the transitional context of eastern European countries provides interesting opportunities to improve understanding of asthma determinants and heterogeneity, few data have been reported in the past decade, especially in adults. Similarly, most, although not all, epidemiological studies of work-related asthma have been conducted in populations of westernised countries [15][16][17]; however, the development of a worldwide perspective in work-related lung disease is needed [18].…”

Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II

“…Asthma control may be difficult to define in epidemiology, although the validity of such a control scale was supported by epidemiological results [7,10]. Although all associations between asthmagens (known risk factors for asthma) and uncontrolled asthma were studied according to a priori hypotheses [5,6,8,13], it may be argued that our results regarding specific asthmagens require cautious interpretation due to multiple testing [33].…”