COPD Causation and Workplace Exposures: An Assessment of Agreement among Expert Clinical Raters

Fishwick, David; Darby, Alistair C.; Hnizdo, Eva; Barber, Chris; Sumner, Jade; Barraclough, Richard; Bolton, Charlotte E.; Burge, Sherwood; Calverley, Peter; Hopkinson, Nicholas S; Hoyle, Jennifer; Lawson, Rod; Niven, Robert; Pickering, Tony; Prowse, K; Reid, PC; Warburton, Chris; Blanc, Paul D.

doi:10.3109/15412555.2012.737072

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…[12][13][14][15][16] However, the contribution of occupational and environmental exposures to COPD and asthma is often difficult to discern in individual patients; this applies especially to COPD among smokers. 17 Additionally, about 2% of COPD cases 18 are associated with a genetic mutation causing a 1 -antitrypsin deficiency. 19 The most recent estimate of the prevalence of respiratory symptoms and doctor-diagnosed COPD and asthma in the US population using the National Health and Nutrition Examination Survey (NHANES) was reported using data from NHANES III (1988)(1989)(1990)(1991)(1992)(1993)(1994).…”

Section: Introductionmentioning

confidence: 99%

Changes in prevalence of chronic obstructive pulmonary disease and asthma in the US population and associated risk factors

2014

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Chronic lower airway diseases, including chronic obstructive pulmonary disease (COPD) and asthma, are currently the third leading cause of death in the United States. We aimed to evaluate changes in prevalence of and risk factors for COPD and asthma among the US adult population. We evaluated changes in prevalence of self-reported doctor-diagnosed COPD (i.e. chronic bronchitis and emphysema) and asthma and self-reported respiratory symptoms comparing data from the 1988–1994 and 2007–2010 National Health and Nutrition Examination Surveys. To investigate changes in the severity of each outcome over the two periods, we calculated changes in the proportions of spirometry-based airflow obstruction for each outcome. Prevalence of doctor-diagnosed chronic bronchitis and emphysema decreased significantly mainly among males, while asthma increased only among females. The self-reported disease and the respiratory symptoms were associated with increased prevalence of airflow obstruction for both periods. However, the prevalence of airflow obstruction decreased significantly in the second period among those with shortness of breath and doctor-diagnosed respiratory conditions (chronic bronchitis, emphysema, and asthma). COPD outcomes and asthma were associated with lower education, smoking, underweight and obesity, and occupational dusts and fumes exposure. Chronic lower airway diseases continue to be major public health problems. However, decreased prevalence of doctor-diagnosed chronic bronchitis and emphysema (in males) and decreased prevalence of airflow obstruction in those with respiratory symptoms and doctor-diagnosed respiratory diseases may indicate a declining trend and decrease in disease severity between the two periods. Continued focus on prevention of these diseases through public health interventions is prudent.

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Section: Introductionmentioning

confidence: 99%

Changes in prevalence of chronic obstructive pulmonary disease and asthma in the US population and associated risk factors

2014

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“…One relatively recent study approached this problem by posing hypothetical cases to groups of physicians. 28 The aim of the study was to document the views of either occupational lung disease or COPD experts on several cases of likely COPD. The latter were constructed using a matrix based on tobacco smoking levels and likely occupational exposures to agents that might be linked with the development of COPD.…”

Section: Case Attributionmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Work: The Continuing Narrative

Fishwick

Barber

Wiggans

2023

Semin Respir Crit Care Med

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It has long been recognized that harmful inhaled workplace exposures can contribute to the development of chronic obstructive pulmonary disease (COPD). This article, intended for the clinician, summarizes some of this evidence and some areas of controversy. Current estimates based on pooled epidemiological analyses of population-based studies identify that approximately 14% of the burden of COPD (and 13% of the burden of chronic bronchitis) is attributable to such exposures. In addition to these approaches, various studies implicate specific exposures as contributing. Certain of these relating to cadmium, coal, and respirable crystalline silica are discussed in more detail. Despite this amassed evidence to date supporting associations between COPD and workplace exposures, there have been surprisingly few studies that have attempted to assess the attribution by experts of an occupational cause in cases of COPD. One study, using hypothetical cases of COPD, noted that while expert physicians were willing to make such an occupational link, this was only likely in cases with light smoking histories and a priori defined heavy occupational exposures. Relatively recent data relating to computed tomography (CT) scan appearances may give the clinician a further guide. Several studies from populations have now linked potentially harmful occupational exposures specifically with the presence of emphysema on CT scanning. It will be of interest to see if this finding, along with other clinical attributes of cases such as smoking and family histories, exclusion of asthma, genetic data, and the nature of workplace exposures, will increase the future diagnosis by clinicians of occupational COPD. In the interim, while better diagnostic approaches are developed, we suggest that consideration of an occupational cause is an important part of the clinical investigation of cases of COPD. Finally, we suggest that evidence-based workplace preventive strategies for occupational COPD should be informed by knowledge of which exposures are most important to reduce, and whether and when intervention to reduce exposure at an individual worker level is warranted.

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“…Multiple exposure and comorbidities may highlight other diagnoses in which cough and dyspnea are present. However, the diagnostic concordance between different clinicians is relatively good, if exposure is known [ 102 ].…”

Section: Ocopd: Diagnostic Challengesmentioning

confidence: 99%

Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease

et al. 2021

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Occupational chronic obstructive pulmonary disease (oCOPD) represents 15–20% of the global burden of this disease. Even if industrial bronchitis has long been known, new occupational hazards continue to emerge and enlarge the number of people exposed to risk. This review discusses the challenges related to the early detection of oCOPD, in the context of new exposures and of limited usage of methods for an efficient disease occupational screening. It underlines that a better translation into clinical practice of the new methods for lung function impairment measurements, imaging techniques, or the use of serum or exhaled breath inflammation biomarkers could add significant value in the early detection of oCOPD. Such an approach would increase the chance to stop exposure at an earlier moment and to prevent or at least slow down the further deterioration of the lung function as a result of exposure to occupational (inhaled) hazards.

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COPD Causation and Workplace Exposures: An Assessment of Agreement among Expert Clinical Raters

Cited by 6 publications

References 10 publications

Changes in prevalence of chronic obstructive pulmonary disease and asthma in the US population and associated risk factors

Changes in prevalence of chronic obstructive pulmonary disease and asthma in the US population and associated risk factors

Chronic Obstructive Pulmonary Disease and Work: The Continuing Narrative

Challenges in Diagnosing Occupational Chronic Obstructive Pulmonary Disease

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