Abstract
BackgroundFor individual exposures, effect modification by atopy or smoking has been reported on the occurrence of occupational airway disease. It is unclear if effect modification can be studied in a general population by an aggregated exposure measure. Assess relationship between airway obstruction and occupational exposure using a job-exposure-matrix (JEM) classifying jobs into 3 broad types of exposure, and test for effect modification by atopy, and smoking.MethodsData from 1,906 subjects were analyzed, all participants of the European Community Respiratory Health Survey. Job titles were categorized by an a priori constructed job exposure matrix into three classes of exposure to respectively organic dust, mineral dust, and gases/ fumes. Relationships were assessed for 'current wheeze', bronchial hyperresponsiveness (BHR), 'current asthma' (wheeze+BHR), and 'chronic bronchitis' (morning phlegm or morning cough), and lung function.ResultsSubjects with organic dust exposure in their work environment more frequently had 'current asthma' (OR 1.48, 95% C.I. 0.95;2.30), and a lower FEV1 (-59 mL, 95% C.I. -114;-4). The relationship was only present in asthmatic workers, and their risk was four-fold greater than in subjects with either atopy or exposure alone. Mineral dust exposure was associated with 'chronic bronchitis' (OR 2.22, 95% C.I. 1.16;4.23) and a lower FEV1/FVC ratio (-1.1%, 95% C.I. -1.8;-0.3). We observed an excess risk in smokers, greater than the separate effects of smoking or mineral dust exposure together.ConclusionOccupational exposure to organic dust is associated with an increased risk of asthma, particularly in atopics. Chronic bronchitis occurs more frequently among individuals exposed to mineral dust, and smoking doubles this risk.
Highlights
Exposure to agents in the work environment may be involved in the aetiology or aggravation of asthma in adults [1,2,3,4,5]
We have studied the relationship between occupational exposure and obstructive airway disease in the Dutch contribution of the European Community Respiratory Health Survey (ECRHS)
For the analyses presented in this paper, we included subjects with complete data on symptoms of airway obstruction, working history, smoking history, atopic status, and bronchial challenge test, leaving a study population of 1,906 subjects
Summary
Exposure to agents in the work environment may be involved in the aetiology or aggravation of asthma in adults [1,2,3,4,5]. The mechanism of occupational asthma depends on the causal agent [9]. In asthma due to low-molecular weight agents (e.g. isocyanates, anhydrides), an IgE or IgG-mediated response may be involved [11]. Effect modification by atopy or smoking has been reported on the occurrence of occupational airway disease. It is unclear if effect modification can be studied in a general population by an aggregated exposure measure. Assess relationship between airway obstruction and occupational exposure using a job-exposure-matrix (JEM) classifying jobs into 3 broad types of exposure, and test for effect modification by atopy, and smoking
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