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Past Occupational Exposures and Respiratory-Related Work Disability Predict Poorer Outcomes in COPD
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Abstract
PURPOSE: There is growing recognition that occupational exposures may contribute to the etiology of chronic bronchitis, emphysema, and airway obstruction. This study estimates the impact of work-related exposure on health outcomes in COPD.
METHODS: In a prospective cohort study, we carried out baseline (2001) and one year follow-up (2002) structured telephone interviews among 234 ever-employed adults aged 55 to 75 at baseline who reported a physician's diagnosis of emphysema, chronic bronchitis,
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Association between occupational exposure and chronic obstructive pulmonary disease and respiratory symptoms in the Spanish population
2024, Archivos de BronconeumologiaThe aim of this study was to analyze the impact of occupational exposure on chronic obstructive pulmonary disease (COPD) and respiratory symptoms in the general Spanish population.
This was a study nested in the Spanish EPISCAN II cross-sectional epidemiological study that included participants who had completed a structured questionnaire on their occupational history, a questionnaire on respiratory symptoms, and forced spirometry. The data were analyzed using Chi-square and Student's t tests and adjusted models of multiple linear regression and logistic regression.
We studied 7502 subjects, 51.1% women, with a mean age of 60 ± 11 years. Overall, 53.2% reported some respiratory symptoms, 7.9% had respiratory symptoms during their work activity, 54.2% were or had been smokers, and 11.3% (851 subjects) met COPD criteria on spirometry. A total of 3056 subjects (40.7%) reported exposure to vapors, gases, dust or fumes (VGDF); occupational exposure to VGDF was independently associated with the presence of COPD (OR 1.22, 95% CI: 1.03–1.44), respiratory symptoms (OR 1.45, 95%: CI 1.30–1.61), and respiratory symptoms at work (OR 4.69, 95% CI: 3.82–5.77), with a population attributable fraction for COPD of 8.2%.
Occupational exposure is associated with a higher risk of COPD and respiratory symptoms in the Spanish population. These results highlight the need to follow strict prevention measures to protect the respiratory health of workers.
Asthma diagnosed in late adulthood is linked to work disability and poor employment status
2019, Respiratory MedicineAge at asthma onset is associated with severity and outcomes of the disease.
We studied if age at asthma diagnosis is related to employment and outcomes in working career.
A questionnaire was sent to 2613 adults with asthma in Tampere, Finland, and a follow-up questionnaire was sent after six years. Asthmatics were divided into groups based on their employment status: working full-time or work disability. Logistic regression was used to study the association of age at asthma diagnosis with employment status at baseline and with the risk of exiting full-time work during follow-up period.
In cross-sectional analysis, asthma diagnosed in late adulthood (50 + years) was associated with higher OR for having work-disability compared to childhood onset asthma (OR [95% CI] 3.60 [1.43–9.06]). During follow-up, asthma diagnosed in late adulthood was associated with higher OR for exiting full time work compared to childhood-onset asthma (OR 10.87 [3.25–36.40]).
Asthma diagnosed in late adulthood is a higher risk for poor employment than asthma diagnosed earlier in life. Adult-onset of asthma is an important factor in view of work ability and early rehabilitation procedures.
Reduced work ability in middle-aged men with asthma from youth- a 20-year follow-up
2011, Respiratory MedicineWe studied, whether asthma diagnosed in childhood or early adulthood affects work ability 20 years later. We used Finnish Defence Force registers, 1986–1990, to select: (1) conscripts with asthma to represent a mild/moderate asthma group (n = 485), (2) asthmatics who were exempted from military service to represent a relatively severe asthma group (n = 393) and (3) a control group (n = 1500) without asthma. A questionnaire consisting of validated questions on asthma and work ability was sent out in 2009. A total of 54% of the men in the first study group, 44% of those in the second study group and 44% of the controls answered. The mean age of the participants was 41 (range 37–51). Self-assessed current work ability compared with lifetime best had decreased in 28.9% of the first asthma group, in 31.1% of the second asthma group, and in 19.7% of the controls (p = 0.0007). Current smoking (OR 2.5), only basic education (OR 2.6), being a manual worker (OR 2.7) and current severe asthma (OR 3.8) associated most strongly with decreased work ability among the asthmatics. Both mild and more severe asthma at the age of around 20 seems to be associated with reduced work ability in 40-year-old males.
The relationship between occupational exposures and COPD has been analyzed in population-based and occupational cohort studies. However, the influence of these exposures on the clinical characteristics of COPD is not well known. The aim of this study was to analyze the impact of occupational exposures on respiratory symptoms, lung function, and employment status in a series of COPD patients.
We conducted a cross-sectional study of 185 male COPD patients. Patients underwent baseline spirometry and answered a questionnaire that included information on respiratory symptoms, hospitalizations for COPD, smoking habits, current employment status, and lifetime occupational history. Exposure to biological dust, mineral dust, and gases and fumes was assessed using an ad hoc job exposure matrix.
Having worked in a job with high exposure to mineral dust or to any dusts, gas, or fumes was associated with an FEV1 of < 30% predicted (mineral dust: relative risk ratio, 11; 95% confidence interval [CI], 1.4 to 95; dusts, gas, or fumes: relative risk ratio, 6.9; 95% CI, 1.1 to 45). High exposure to biological dust was associated with chronic sputum production (odds ratio [OR], 4.3; 95% CI, 1.6 to 12), dyspnea (OR, 2.7; 95% CI, 1.1 to 6.7), and work inactivity (OR, 2.4; 95% CI, 1.4 to 4.2). High exposure to dusts, gas, or fumes was associated with sputum production (OR, 2.8; 95% CI, 1.2 to 6.7) and dyspnea (OR, 1.2; 95% CI, 1.1 to 1.4).
Occupational exposures are independently associated with the severity of airflow limitation, respiratory symptoms, and work inactivity in patients with COPD.
Allergy and refractory asthma: New etiological and treatment pathways
2008, Presse MedicaleL’asthme sévère est souvent réfractaire au traitement habituel de la maladie et pose un réel problème de prise en charge.
Il suppose une démarche clinique rigoureuse dans laquelle les facteurs aggravants doivent être identifiés.
Les facteurs allergiques jouent probablement un rôle important mais sont souvent ignorés, l’atopie étant plus souvent associée à des asthmes légers ou modérés.
La prévalence de l’asthme sévère réfractaire reste imprécise du fait de l’absence de définition consensuelle et le rôle des facteurs allergiques a fait l’objet de peu d’études.
Du point de vue physiopathologique, il existe des facteurs génétiques probablement responsables d’une plus grande sévérité et la réponse allergique joue un rôle important dans certains phénotypes d’asthme sévère.
Au plan environnemental, certains aéroallergènes sont associés au caractère réfractaire de la maladie. Les moisissures comme Alternaria sont par exemple mises en cause dans la survenue de crises d’asthme grave, ainsi que certaines expositions professionnelles.
Une meilleure connaissance de la physiopathologie de l’asthme réfractaire et de sa dimension allergique a permis l’utilisation de nouveaux agents thérapeutiques comme l’omalizumab et la découverte de nouvelles cibles thérapeutiques est en cours d’évaluation dans ce domaine.
Severe asthma is often refractory to standard treatments and presents real problems of management.
It necessitates rigorous clinical procedures to identify the aggravating factors.
Allergic factors probably play an important role but are often ignored; atopy is more often associated with mild or moderate asthma.
The prevalence of severe refractory asthma is not known with any precision, in view of the lack of a consensus definition.
Few studies have examined the role of allergic factors.
From a pathophysiologic perspective, genetic factors are probably responsible for greater severity, and allergic response plays an important role in some severe asthma phenotypes.
From an environmental perspective, some airborne allergens are associated with the refractory character of the disease. Molds such as Alternaria are, for example, implicated in the onset of asthma attacks, as are some occupational exposure.
Better knowledge of the pathophysiology of refractory asthma and its allergic dimensions have made it possible to use new treatment agents, such as omalizumab. New treatment targets are being discovered and evaluated in this domain.
An international prospective general populationbased study of respiratory work disability
2009, ThoraxPrevious 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.
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.
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).
Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures.