Occupational exposures and chronic obstructive pulmonary disease: a hospital based case-control study

Abstract

Background Occupational exposures are associated with chronic obstructive pulmonary disease (COPD). This study investigated this association among a population with a high prevalence of tuberculosis and smoking. Methods Cases (n¼110) diagnosed by pulmonologists were selected from specialist respiratory clinics. Frequency sex-and age-matched controls (n¼102) were selected from other clinics at the same institutions. Lifetime occupational exposure histories were obtained through interviews. Exposure variables derived from the ALOHA Job Exposure Matrix (JEM) were used to complement the self-reporting variables. ORs were calculated from logistic regression models, adjusting for smoking and past history of tuberculosis. Percentage population attributable risk (PAR%) was also calculated. Results The adjusted ORs for COPD from the JEMderived high cumulative biological dust exposure, high cumulative mineral dust exposure and high cumulative gas and fumes exposure were 2.1 (95% CI 1.1 to 4.2), 1.1 (95% CI 0.6 to 2.4) and 1.8 (95% CI 0.8 to 3.9), respectively. Self-reported occupational exposures were associated with higher risks, with adjusted ORs for high dust exposure-years and high chemical, gas and fumes exposure-years of 5.9 (95% CI 2.6 to 13.2) and 3.6 (95% CI 1.6 to 7.9), respectively. Among ever smokers, there was an increased risk for COPD, with ORs ranging from 5.0 to 5.5. Tuberculosis was a strong risk factor, with an OR ranging from 7.7 to 8.1. The PAR% was 25% for selfreported high exposures, but lower when the JEM variables were used. Conclusions Lifetime occupational exposures contribute to the risk of COPD, adjusted for smoking. These risks are present in populations with a high burden of tuberculosis, which is considered an important causative factor.

Occupational chronic obstructive pulmonary disease: a systematic literature review

“…The spirometric criteria included were non-uniform. GOLD criteria II+ was the most prevalent (92)(93)(94)(95). The FEV 1 and FEV 1 /FVC were the outcome in two studies (91,97), like FEV 1 /FVC<0.7 and <LLN (96,98).…”

“…Five of these (91)(92)(93)(94)(95) were cross-sectional and three (96)(97)(98) were longitudinal with a follow-up time between 5-13 years. Six studies came from Europe (91,92,94,(96)(97)(98) and one study each from the US (93) and South Africa (95).…”

“…Five of these (91)(92)(93)(94)(95) were cross-sectional and three (96)(97)(98) were longitudinal with a follow-up time between 5-13 years. Six studies came from Europe (91,92,94,(96)(97)(98) and one study each from the US (93) and South Africa (95). Three of the studies (91,92,96) focused on inorganic exposure (cement production and metal melting), one (97) analyzed the association between organic exposure (dairy farming) and COPD, while four studies (93)(94)(95)98) were population-based.…”

“…Six studies came from Europe (91,92,94,(96)(97)(98) and one study each from the US (93) and South Africa (95). Three of the studies (91,92,96) focused on inorganic exposure (cement production and metal melting), one (97) analyzed the association between organic exposure (dairy farming) and COPD, while four studies (93)(94)(95)98) were population-based. These studies comprised a total of 28 618 subjects.…”

“…These studies comprised a total of 28 618 subjects. JEM alone defined exposure in four studies (91,95,96,98); JEM with personal sampling technique was employed in one study (91), and JEM with questionnaire data in two studies (95,98). The exposure was solely characterized by self-report in three studies (93,94,97) and one study defined exposure by area sampling (92).…”