Occupational Asthma Reference

Darby AC, Waterhouse JC, Stevens V, Billings CG, Billings CG, Burton CM, Young C, Wight J, Blanc PD, Fishwick D, Chronic obstructive pulmonary disease among residents of an historically industrialised area, Thorax, 2012;67:901-907,

Keywords: COPD, occupation, England, UK, FEV1, questionnaire, JEM,

Known Authors

David Fishwick, Royal Hallamshire Hospital, Sheffield, UK David Fishwick

Paul Blanc, University of California San Francisco Paul Blanc

Clare Burton, Sheffield University and HSL Buxton Clare Burton

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Abstract

Objective
To assess the contribution of workplace exposures to chronic obstructive pulmonary disease (COPD) risk in a community with a heavy burden of past industrial employment.

Methods
A random population sample of Sheffield, UK residents aged over 55 years (n=4000), enriched with a hospital-based supplemental sample (n=209), was approached for study. A comprehensive self-completed questionnaire elicited physician-made diagnoses, current symptoms, and past workplace exposures. The latter were defined in three ways: self-reported exposure to vapours, gases, dusts and fumes (VGDF); response to a specific exposure checklist; and through a job exposure matrix (JEM) assigning exposure risk likelihood based on job history independent of respondent-reported exposure. A subset of the study group underwent lung function testing. Population attributable risk fractions (PAR%), adjusted for age, sex and smoking, were calculated for association between workplace exposure and COPD.

Results
2001 (50%) questionnaires were returned from the general population sample and 60 (29%) by the hospital supplement. Among 1754 with complete occupational data, any past occupational exposure to VGDF carried an adjusted excess risk for report of a physician's diagnosis of COPD, emphysema, or chronic bronchitis (ORs 3.9; 95% CI 2.7 to 5.8), with a corresponding PAR% value of 58.7% (95% CI 45.6% to 68.7%). The PAR% estimate based on JEM exposure was 31%. From within the subgroup of 571 that underwent lung function testing, VGDF exposure was associated with a PAR% of 20.0% (95% CI -7.2 to 40.3%) for Global initiative for chronic Obstructive Lung Disease (GOLD) 1 (or greater) level of COPD.

Conclusion
This heavy industrial community-based population study has confirmed significant associations between reported COPD and both generic VGDF and JEM-defined exposures. This study supports the predominantly international evidence-based notion that workplace conditions are important when considering the current and future respiratory health of the workforce.

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