Lifetime Occupational Exposure to Dusts, Gases and Fumes Is Associated with Bronchitis Symptoms and Higher Diffusion Capacity in COPD Patients

Background Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients. Methods We studied 338 patients hospitalized for a first exacerbation of COPD in 9 Spanish hospitals, obtaining full occupational history in a face-to-face interview; job codes were linked to a job exposure matrix for semi-quantitative estimation of exposure to mineral/biological dust, and gases/fumes for each job held. Patients underwent spirometry, diffusing capacity testing and analysis of gases in stable conditions. Quality of life, dyspnea and chronic bronchitis symptoms were determined with a questionnaire interview. A high- resolution CT scan was available in 133 patients. Results 94% of the patients included were men, with a mean age of 68(8.5) years and a mean FEV1% predicted 52 (16). High exposure to gases or fumes was associated with chronic bronchitis, and exposure to mineral dust and gases/fumes was associated with higher scores for symptom perception in the St. George’s questionnaire. No occupational agent was associated with a lower FEV1. High exposure to all occupational agents was associated with better lung diffusion capacity, in long-term quitters. In the subgroup with CT data, patients with emphysema had 18% lower DLCO compared to those without emphysema. Conclusions In our cohort of COPD patients, high exposure to gases or fumes was associated with chronic bronchitis, and high exposure to all occupational agents was consistently associated with better diffusion capacity in long-term quitters.

[1]  R. Pellegrino,et al.  Assessment of emphysema in COPD: a functional and radiologic study. , 2004, Chest.

[2]  D. Jarvis,et al.  The European Community Respiratory Health Survey. , 1994, The European respiratory journal.

[3]  J. Connett,et al.  Effect of occupational exposures on decline of lung function in early chronic obstructive pulmonary disease. , 2007, American journal of respiratory and critical care medicine.

[4]  D. Dockery,et al.  Occupational exposures and chronic respiratory symptoms. A population-based study. , 1987, The American review of respiratory disease.

[5]  M. Kogevinas,et al.  Lung function decline, chronic bronchitis, and occupational exposures in young adults. , 2005, American journal of respiratory and critical care medicine.

[6]  T. Robins,et al.  Longitudinal and cross sectional analyses of exposure to coal mine dust and pulmonary function in new miners. , 1993, British journal of industrial medicine.

[7]  W. Jędrychowski,et al.  Occupational exposure and incidence of chronic respiratory symptoms among residents of Cracow followed for 13 years , 1990, International archives of occupational and environmental health.

[8]  D. Gompertz,et al.  CADMIUM FUME INHALATION AND EMPHYSEMA , 1988, The Lancet.

[9]  F. Gómez,et al.  [Phenotypic characterization and course of chronic obstructive pulmonary disease in the PAC-COPD Study: design and methods]. , 2009, Archivos de bronconeumologia.

[10]  J. Garcia-Aymerich,et al.  Caracterización fenotípica y evolución de la EPOC en el estudio PAC-COPD: diseño y metodología , 2009 .

[11]  C. Y. Li,et al.  A review of the healthy worker effect in occupational epidemiology. , 1999, Occupational medicine.

[12]  J. Wagner,et al.  POST-MORTEM STUDY OF EMPHYSEMA IN COALWORKERS AND NON-COALWORKERS , 1982, The Lancet.

[13]  A. Churg,et al.  Functional and morphologic comparison of silica- and elastase-induced airflow obstruction. , 1989, Experimental lung research.

[14]  E. Piitulainen,et al.  Effect of age and occupational exposure to airway irritants on lung function in non-smoking individuals with alpha 1-antitrypsin deficiency (PiZZ). , 1997, Thorax.

[15]  E. Hnizdo,et al.  Emphysema type in relation to silica dust exposure in South African gold miners. , 1991, The American review of respiratory disease.

[16]  H. Jonai,et al.  Occupational exposure and chronic respiratory symptoms--a population based study in Vietnam. , 1997, Industrial health.

[17]  J. Zock,et al.  Impact of occupational exposure on severity of COPD. , 2008, Chest.

[18]  J. Harkema,et al.  In vivo effects of endotoxin on DNA synthesis in rat nasal epithelium , 1993, Microscopy research and technique.

[19]  T. Driscoll,et al.  Quantitative relation between emphysema and lung mineral content in coalworkers. , 1994, Occupational and environmental medicine.

[20]  Mustafa Dosemeci,et al.  RE: “DOES NONDIFFERENTIAL MISCLASSIFICATION OF EXPOSURE ALWAYS BIAS A TRUE EFFECT TOWARD THE NULL VALUE?” , 1991 .

[21]  M. Krzyzanowski,et al.  The relation of respiratory symptoms and ventilatory function to moderate occupational exposure in a general population. Results from the French PAARC study of 16,000 adults. , 1988, International journal of epidemiology.

[22]  D. Schwartz,et al.  The role of endotoxin in grain dust-induced lung disease. , 1995, American journal of respiratory and critical care medicine.

[23]  L. Irwig,et al.  The predictors of emphysema in South African gold miners. , 2015, The American review of respiratory disease.

[24]  J. Stoller,et al.  Occupational exposure risks in individuals with PI*Z alpha(1)-antitrypsin deficiency. , 2000, American journal of respiratory and critical care medicine.

[25]  H. Kromhout,et al.  Chronic non-specific lung disease and occupational exposures estimated by means of a job exposure matrix: the Zutphen Study. , 1989, International journal of epidemiology.

[26]  N. Probst-Hensch,et al.  Occupational exposure to dusts, gases, and fumes and incidence of chronic obstructive pulmonary disease in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults. , 2012, American journal of respiratory and critical care medicine.

[27]  Edwin K Silverman,et al.  An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease. , 2010, American journal of respiratory and critical care medicine.

[28]  F. Martinez,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. , 2007, American journal of respiratory and critical care medicine.

[29]  C. Watanakunakorn.  Cardiac surgery and bacterial endocarditis. , 1969, Lancet.

[30]  L. Trupin,et al.  The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease , 2004, Occupational and Environmental Medicine.

[31]  Jürgen H. P. Hoffmeyer-Zlotnik,et al.  Computerunterstützte Vercodung der International Standard Classification of Occupations (ISCO-88) , 2004 .

[32]  N. Pearce,et al.  Chronic bronchitis, shortness of breath, and airway obstruction by occupation in New Zealand. , 1997, American journal of respiratory and critical care medicine.

[33]  C. Mathers,et al.  Projections of Global Mortality and Burden of Disease from 2002 to 2030 , 2006, PLoS medicine.

[34]  J. Harkema,et al.  Ozone- and endotoxin-induced mucous cell metaplasias in rat airway epithelium: novel animal models to study toxicant-induced epithelial transformation in airways. , 1993, Toxicology letters.

[35]  M Dosemeci,et al.  Does nondifferential misclassification of exposure always bias a true effect toward the null value? , 1990, American journal of epidemiology.

[36]  D. Morgan,et al.  Airway fibrosis in rats induced by vanadium pentoxide. , 2000, American journal of physiology. Lung cellular and molecular physiology.

[37]  R Hanoa,et al.  Occupational dust or gas exposure and prevalences of respiratory symptoms and asthma in a general population. , 1991, The European respiratory journal.

[38]  David Kriebel,et al.  Bias in occupational epidemiology studies , 2006, Occupational and Environmental Medicine.

[39]  M. Kogevinas,et al.  Pulmonary ventilatory defects and occupational exposures in a population-based study in Spain. Spanish Group of the European Community Respiratory Health Survey. , 1998, American journal of respiratory and critical care medicine.

[40]  F. Gómez,et al.  Characteristics of patients admitted for the first time for COPD exacerbation. , 2009, Respiratory medicine.

[41]  Kathleen Kreiss,et al.  American Thoracic Society Statement: Occupational contribution to the burden of airway disease. , 2003, American journal of respiratory and critical care medicine.

[42]  M. Becklake,et al.  Relationship between chronic dyspnea and expiratory flow limitation in patients with chronic obstructive pulmonary disease. , 1996, American journal of respiratory and critical care medicine.

[43]  E. Hnizdo,et al.  Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. , 1990, Scandinavian journal of work, environment & health.

[44]  L. Kobzik,et al.  Increased airway responsiveness to inhaled methacholine in a rat model of chronic bronchitis. , 1995, American journal of respiratory and critical care medicine.

[45]  H. Kromhout,et al.  Occupational exposures estimated by a population specific job exposure matrix and 25 year incidence rate of chronic nonspecific lung disease (CNSLD): the Zutphen Study. , 1994, The European respiratory journal.

[46]  D. Johns,et al.  Biological dust exposure in the workplace is a risk factor for chronic obstructive pulmonary disease , 2005, Thorax.

[47]  D. Coggon,et al.  Coal mining and chronic obstructive pulmonary disease: a review of the evidence , 1998, Thorax.

[48]  D. Jarvis,et al.  The European Community Respiratory Health Survey II , 1994, European Respiratory Journal.

[49]  S. Leeder,et al.  A population based study , 1993, The Medical journal of Australia.

[50]  J. Stoller,et al.  Occupational Exposure Risks in Individuals with PI*Z α1-Antitrypsin Deficiency , 2000 .

[51]  E Monsó,et al.  Validity and reliability of the St George's Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example. , 1996, The European respiratory journal.