Occupational Asthma Reference

Kogevinas M, Zock JP, Jarvis D, Kromhout H, Lillienberg L, Plana E, Radon K, Toren K, Alliksoo A, Benke G, Blanc PD, Dahlman-Hoglund A, D'Errico A, Hery M, Kennedy S, Kunzli N, Leynaert B, Mirabelli MC, Muniozguren N, Norback D, Olivieri M, Payo F, Villani S, van Sprundel M, Urrutia I, Wieslander G, Sunyer J, Anto JM, Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II), Lancet, 2007;370:336-341,

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Known Authors

Josep Antó, Barcelona, Catalonia, Spain Josep Antó

Kjell Toren, Sahlgrenska University Hospital. Goteborg Kjell Toren

Susan Kennedy, Vancouver Susan Kennedy

Katja Radon, Ludwig Maximillian University, Munich Katja Radon

Paul Blanc, University of California San Francisco Paul Blanc

Jan-Paul Zock, Municipal Institute of Medical Research, Barcelona, Spain Jan-Paul Zock

Isabel Urrutia, Hospital de Galdakao, Bizkaia Isabel Urrutia

N Kunzli, Barcelona N Kunzli

Dan Norback, Dan Norback

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Abstract

BACKGROUND: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents.

METHODS: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre.

FINDINGS: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year.

INTERPRETATION: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

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Comments

I have questions about the relationship of firefighting and WRA. Do you have any information on this? JIm Dunn
11/12/2009

There is a lot of work on acute irritant asthma and firefighting, try putting fire into the reference search section and avoid the fire eaters. The world trade center fire generated much of this. There are occasional reports of sensitisation to isocyanates in firefighters involved in large isocyanate fires or spills, there is also work on accelerated FEV1 decline in firefighters
11/12/2009

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