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

Abstract

Occupational exposures make important contributions to asthma morbidity. The role of low/ moderate level irritant exposures remains unclear. We aimed to determine which occupational exposures are associated with asthma in an eastern European country with low asthma prevalence.The Estonian Genome Center of University of Tartu collected data from 50 077 adults in 2002-2011. Asthma was assessed through a questionnaire regarding diagnosed diseases, current health status and medication. Exposures to 22 agents during the current and longest held jobs were estimated using an asthma-specific job-exposure matrix.Analyses included 34 015 subjects (aged 18-65 years, 67.0% females), of which 1209 (3.6%) reported asthma (608 with physician-confirmed diagnosis). After adjusting for age, sex and smoking habits, lifetime occupational exposure to known asthmagens (20.4%) was significantly associated with physician-diagnosed asthma (OR 1.28, 95% CI 1.03-1.59), especially high molecular weight agents (flour: OR 2.36, 95% CI 1.31-4.27; animals: OR 1.62, 95% CI 1.00-2.60). Exposure to low/moderate levels of irritants (17.4%) was associated with physician-diagnosed asthma (OR 1.88, 95% CI 1.48-2.37). More pronounced associations were observed in subjects reporting current treated asthma.Beyond confirming the effect of known asthmagens (which are well-known, mostly from observations in western countries), the results provide evidence for a role of low/moderate exposure to irritants. This finding, observed in a country with a low prevalence of asthma and atopy, provides new insight into the understanding of asthma heterogeneity. @ERSpublications Increased asthma risk was associated with occupational exposure to moderate levels of irritants in an Estonian study

Irritants and asthma

“…They confirm previous reports on the association between occupational exposure to known asthmagens and asthma onset [19][20][21][22]. Nevertheless, the most relevant observation reported by DUMAS et al [17] is the evidence of significant associations between repetitive exposures to low-to-moderate levels of irritants and asthma.…”

“…In this study [17], 1062 individuals reported ever having asthma, with half of them reporting physiciandiagnosed asthma, almost three quarters reporting current asthma and half reporting current asthma treatment. The prevalence of exposure to known asthmagens was 20%, and 17% were repeatedly exposed to low levels of irritants in their workplace.…”

“…As shown by DUMAS et al [17], repeated exposure to low-to-moderate levels of irritants at work is common. Almost two out of 10 workers in this Estonian study population were exposed.…”

“…This issue of the European Respiratory Journal contains an article by DUMAS et al [17], who investigated, in a cross-sectional study of a large sample of Estonian adults, the associations between asthma and occupational exposure to known asthmagens or irritants. From about 50 000 individuals recruited between 2002 and 2011 at the Estonian Genome Center of the University of Tartu, DUMAS et al [17] included 34 015 adults aged 18-65 years, excluding participants who had never worked, those without job codes and those with imprecise job codes.…”

“…From about 50 000 individuals recruited between 2002 and 2011 at the Estonian Genome Center of the University of Tartu, DUMAS et al [17] included 34 015 adults aged 18-65 years, excluding participants who had never worked, those without job codes and those with imprecise job codes. ''Asthma ever'' was determined by self-report using a standardised questionnaire, with more rigorous asthma definitions also being considered, such as (reported) doctor-diagnosed asthma and currently treated asthma.…”