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

Abstract

Occupational exposure is a well-recognised modifiable risk factor for asthma, but the relationship between occupational exposure and asthma control has not been studied. We aimed to study this association among working-age adults from the European Community Respiratory Health Survey (ECRHS).Data were available for 7077 participants (mean age 43 years, 45% never-smokers, 5867 without asthma and 1210 with current asthma). Associations between occupational exposure to specific asthmagens and asthma control status (33% with uncontrolled asthma, based on the Global Initiative for Asthma guidelines) were evaluated using logistic and multinomial regressions, adjusted for age, sex and smoking status, with study areas included as a random effect.Statistically significant positive associations were observed between uncontrolled adult-onset asthma and both past 12-month and 10-year exposure to any occupational asthmagens (OR (95% CI) 1.6 (1.0-2.40) and 1.7 (1.2-2.5), respectively); high (1.7 (1.0-2.8) and 1.9 (1.3-2.9), respectively) and low (1.6 (1.0-2.7) and 1.8 (1.2-2.7), respectively) molecular weight agents; and cleaning agents (2.0 (1.1-3.6) and 2.3 (1.4-3.6), respectively), with stronger associations for long-term exposures. These associations were mainly explained by the exacerbation domain of asthma control and no associations were observed between asthmagens and partly controlled asthma.These findings suggest that occupational exposure to asthmagens is associated with uncontrolled adult-onset asthma. Occupational risk factors should be quickly identified to prevent uncontrolled asthma. @ERSpublications Occupational exposure to asthmagens is associated with uncontrolled adult-onset asthma in ECRHS II

Asthma control in the workplace

“…In the present study, such associations were stronger for the previous 10-year than 12-month occupational exposures for adult-onset uncontrolled asthma [10], in keeping with a previous report [12]. This poorer asthma control with prolonged exposure may result from the development of a more severe form of asthma, as suggested in a previous analysis of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA) cohort [13].…”

“…Another intriguing observation in the study reported by LE MOUAL et al [10] is the lack of association between asthmagen exposure and partly controlled asthma, as previously reported [10,23]. This may be explained by the fact that it mostly involved exacerbations, which also suggests a stronger effect of this type of exposure on asthma control and/or an increased delay in reporting symptoms, with workers preferring staying at work rather than consulting a physician, and raising the possibility of being asked to consider to another type of work.…”

“…This poorer asthma control with prolonged exposure may result from the development of a more severe form of asthma, as suggested in a previous analysis of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA) cohort [13]. The increased use of inhaled and oral corticosteroids in the uncontrolled asthma group from the study conducted by LE MOUAL et al [10] is in keeping with this possibility, and suggests that these workers may have stayed at work at the expense of increased use of these agents, although even in that case, asthma remained still poorly controlled.…”

“…Search for contributing and causal factors in the uncontrolled asthmatic patient should, therefore, not only include respiratory infections, common airborne allergen exposures and other factors, such as non-adherence to therapy, but workplace exposures should also be carefully documented. In this regard, the report from LE MOUAL et al [10] further stresses the role of occupational exposures on exacerbations. Interestingly, such influence of the workplace on asthma control seems particularly important for cleaning agents [14,[26][27][28].…”

“…In this issue of the European Respiratory Journal, LE MOUAL et al [10] looked at the relationship between occupational exposures and asthma control, as defined by the Global Initiative for Asthma criteria, in workers who took part in ECRHS II. Out of the 7077 participants (mean age 43 years, 45% never-smokers) 1210 were considered to have current asthma.…”