| 1. |
- Lytras, T., et al.
(författare)
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Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts
- 2021
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Ingår i: Annals of the American Thoracic Society. - New York : American Thorax Society. - 1546-3222 .- 2329-6933 .- 2325-6621 .- 1943-5665. ; 18:2, s. 238-246
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up. Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts. Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
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| 2. |
- Lytras, T., et al.
(författare)
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Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: The European Community Respiratory Health Survey
- 2019
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Ingår i: Occupational and environmental medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 76:4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. Methods: Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. Results: 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. Conclusions: Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation. © Author(s) (or their employer(s)) 2019.
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| 3. |
- Lytras, T., et al.
(författare)
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Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey
- 2018
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 73:11
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Tidskriftsartikel (refereegranskat)abstract
- Background Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey. Methods General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework. Findings 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%. Interpretation These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
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| 4. |
- Olivieri, M., et al.
(författare)
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Healthy hire effect, job selection and inhalation exposure among young adults with asthma
- 2010
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 36:3, s. 517-523
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to assess whether asthma onset prior to entering the workforce influences whether a person holds a subsequent job with asthma-related inhalation exposures. The data of 19,784 adults from the European Community Respiratory Health Survey were analysed. For each respondent, a current or previously held job was linked to a job exposure matrix assigning high, low or no exposure to dust, gases or fumes. Jobs were also categorised according to the risk of exposures related to occupational asthma. Associations between asthma and subsequent occupational exposures were assessed using logistic regression models, with a random intercept for study centre and fixed adjustment for age, sex, type of study sample and smoking status. Of the respondents, 8% (n=1,619) reported asthma with onset before completion of full-time education. This population was at decreased risk of having a job with high (odds ratio 0.79; 95% confidence interval 0.68-0.92) or low (0.91; 0.80-1.03) exposure to dust, gases or fumes. The associations were consistent across exposure types (dusts, gases or fumes) and for jobs with a high risk of occupational asthma. Adults with asthma onset prior to entering the workforce may be less likely to hold jobs involving inhalation exposures.
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| 5. |
- Torén, Kjell, 1952, et al.
(författare)
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An international prospective general population-based study of respiratory work disability.
- 2009
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Ingår i: Thorax. - : BMJ. - 1468-3296 .- 0040-6376. ; 64:4, s. 339-44
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational exposure to gases, dust and fumes was associated with job change due to breathing problems, although causal inferences have been tempered by the cross-sectional nature of previously available data. There is a need for general population-based prospective studies to assess the incidence of respiratory work disability and to delineate better the roles of potential predictors of respiratory work disability. METHODS: A prospective general population cohort study was performed in 25 centres in 11 European countries and one centre in the USA. A longitudinal analysis was undertaken of the European Community Respiratory Health Survey including all participants employed at any point since the baseline survey, 6659 subjects randomly sampled and 779 subjects comprising all subjects reporting physician-diagnosed asthma. The main outcome measure was new-onset respiratory work disability, defined as a reported job change during follow-up attributed to breathing problems. Exposure to dusts (biological or mineral), gases or fumes during follow-up was recorded using a job-exposure matrix. Cox proportional hazard regression modelling was used to analyse such exposure as a predictor of time until job change due to breathing problems. RESULTS: The incidence rate of respiratory work disability was 1.2/1000 person-years of observation in the random sample (95% CI 1.0 to 1.5) and 5.7/1000 person-years in the asthma cohort (95% CI 4.1 to 7.8). In the random population sample, as well as in the asthma cohort, high occupational exposure to biological dust, mineral dust or gases or fumes predicted increased risk of respiratory work disability. In the random sample, sex was not associated with increased risk of work disability while, in the asthma cohort, female sex was associated with an increased disability risk (hazard ratio 2.8, 95% CI 1.3 to 5.9). CONCLUSIONS: Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures.
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| 6. |
- Henneberger, P K, et al.
(författare)
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The occupational contribution to severe exacerbation of asthma.
- 2010
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Ingår i: The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 36:4, s. 743-50
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Tidskriftsartikel (refereegranskat)abstract
- The goal of this study was to identify occupational risk factors for severe exacerbation of asthma and estimate the extent to which occupation contributes to these events. The 966 participants were working adults with current asthma who participated in the follow-up phase of the European Community Respiratory Health Survey. Severe exacerbation of asthma was defined as self-reported unplanned care for asthma in the past 12 months. Occupations held in the same period were combined with a general population job-exposure matrix to assess occupational exposures. 74 participants reported having had at least one severe exacerbation event, for a 1-yr cumulative incidence of 7.7%. From regression models that controlled for confounders, the relative risk (RR) was statistically significant for low (RR 1.7, 95% CI 1.1-2.6) and high (RR 3.6, 95% CI 2.2-5.8) biological dust exposure, high mineral dust exposure (RR 1.8, 95% CI 1.02-3.2), and high gas and fumes exposure (RR 2.5, 95% CI 1.2-5.5). The summary category of high dust, gas, or fumes exposure had RR 3.1 (95% CI 1.9-5.1). Based on this RR, the population attributable risk was 14.7% among workers with current asthma. These results suggest occupation contributes to approximately one in seven cases of severe exacerbation of asthma in a working population, and various agents play a role.
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| 7. |
- Sunyer, Jordi, et al.
(författare)
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Lung function decline, chronic bronchitis, and occupational exposures in young adults
- 2005
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Ingår i: Am J Respir Crit Care Med. ; 172:9, s. 1139-45.
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Occupational exposures to vapors, gas, dust, or fumes have been shown to be a risk factor of airway obstruction in cross-sectional studies in the general population.Objectives: Our aim was to study the relationships between specific occupations and occupational exposures during a 9-yr follow-up period and changes in lung function and symptoms of chronic bronchitis.Methods: Subjects from the general population aged 20 to 45 yr were randomly selected in 1991-1993 within the European Community Respiratory Health Survey. Follow-up took place from 1998 to 2002 among 4,079 males and 4,461 females in 27 study centers. A total of 3,202 men and 3,279 women twice completed lung function measurements. Job history during follow-up was linked to a job exposure matrix and consequently translated into cumulative exposure estimates.Main Results: Individuals exposed to dusts, gases, and fumes during the period of follow-up did not have a steeper decline of FEV(1) than did individuals with consistently white-collar occupations without occupational exposures (relative change among men and women, + 1.4 and -3.1 ml/yr, respectively; p > 0.2), nor an increase of prevalence or incidence of airway obstruction defined as an FEV(1)/FVC ratio of less than 0.7. The incidence of chronic phlegm increased in men exposed to mineral dust (relative risk, 1.94 [1.29-2.91]) and gases and fumes (relative risk, 1.53 [0.99-2.36]), which was not modified by smoking.Conclusion: Occupational exposures to dusts, gases, and fumes occurring during the 1990s are associated with incidence of chronic bronchitis, although these did not impair lung function in a population of relatively young age.
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| 8. |
- Lillienberg, Linnea, 1942, et al.
(författare)
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A population-based study on welding exposures at work and respiratory symptoms.
- 2008
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Ingår i: The Annals of occupational hygiene. - : Oxford University Press (OUP). - 0003-4878 .- 1475-3162. ; 52:2, s. 107-15
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Tidskriftsartikel (refereegranskat)abstract
- In the first European Community Respiratory Health Survey (ECRHS I), an excess asthma risk was associated with high exposure to gases and fumes, mineral and biological dusts. In a 9-year follow-up study (ECRHS II), the aim was to study if welding at work increases the risk of asthma symptoms, wheeze and chronic bronchitis symptoms. The study also aimed to identify specific welding risk factors. In a random population sample of individuals from 22 European centres in 10 countries, 316 males reported welding at work during the follow-up period. These individuals responded to a supplemental questionnaire about frequency of welding, use of different methods and materials, welding environment and respiratory protection. Cumulative exposure to welding fumes for the follow-up period was estimated by using a database on welding fume exposures. Log-binomial regression models were used to estimate prevalence ratios (PR) with 95% confidence intervals (CIs) for prevalence of asthma symptoms or asthma medication, wheeze and chronic bronchitis symptoms in relation to welding methods and welded materials as well as estimated cumulative welding fume exposure compared to an external reference group. In the study population of 316 males, 62% performed welding <1 h day(-1), 23% 1-3 h day(-1) and 15% >4 h day(-1). Welding was a common task in many occupations and only 7% of the individuals actually called themselves welders and flame cutters, while the largest groups doing welding worked in construction or were motor, agricultural and industrial mechanics and fitters. Welding at work was not associated with an increased prevalence of asthma symptoms or wheeze but there was an association with chronic bronchitis symptoms (PR = 1.33, 1.00-1.76). Using assigned cumulative exposure in tertiles showed that the lowest exposed tertile had the highest PR of bronchitis symptoms. Chronic bronchitis symptoms was significantly higher in those frequently welding in galvanized steel or iron (PR = 2.14, 1.24-3.68) and in those frequently manual welding stainless steel (PR = 1.92, 1.00-3.66). There was also an increase in the prevalence of wheeze in individuals welding painted metal (PR = 1.66, 0.99-2.78; PR = 1.83, 0.90-3.71). Welding with manual metal arc technique <1 day week(-1) showed a prevalence risk of 1.69 for wheeze (CI = 1.16-2.46). In conclusion, the present study shows an association between welding in galvanized material and stainless steel and chronic bronchitis symptoms. There was also an increased prevalence of wheeze and welding in painted metal. The results support that welding in coated material is a respiratory hazard underscoring the importance of preventive actions.
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