Abstract
Recent studies suggest that occupational inhalant exposures trigger exacerbations of asthma and chronic obstructive pulmonary disease, but findings are conflicting. We included 7,768 individuals with self-reported asthma (n = 3,215) and/or spirometric airflow limitation (forced expiratory volume in 1 second (FEV1)/ forced expiratory volume (FVC) <0.70) (n = 5,275) who participated in The Copenhagen City Heart Study or The Copenhagen General Population Study from 2001-2016. Occupational exposure was assigned by linking job codes with job exposure matrices, and exacerbations were defined by register data on oral corticosteroid treatment, emergency care unit assessment or hospital admission. Associations between occupational inhalant exposure each year of follow-up and exacerbation were assessed by Cox regression with time varying exposure and age as the underlying time scale. Participants were followed for a median of 4.6 years (interquartile range, IQR 5.4), during which 870 exacerbations occurred. Exacerbations were not associated with any of the selected exposures (high molecular weight sensitizers, low molecular weight sensitizers, irritants or low and high levels of mineral dust, biological dust, gases & fumes or the composite variable vapours, gases, dusts or fumes). Hazards ratios ranged from 0.8 (95% confidence interval: 0.7;1.0) to 1.2 (95% confidence interval: 0.9;1.7). Exacerbations of obstructive airway disease were not associated with occupational inhalant exposures assigned by a job exposure matrix. Further studies with alternative exposure assessment are warranted.
Highlights
Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent and common causes of morbidity and mortality [1,2,3]
Occupational exposure was assigned by linking job codes with job exposure matrices, and exacerbations were defined by register data on oral corticosteroid treatment, emergency care unit assessment or hospital admission
Data from the two cohorts, the Copenhagen City Heart Study and the Copenhagen General Population Study may be available for researchers who meet the criteria for access to confidential data
Summary
Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent and common causes of morbidity and mortality [1,2,3]. Airborne particles include ambient air pollution with well-described associations to exacerbations of COPD [15] and asthma [16,17,18], and occupational inhalant exposures with much less evident associations. Occupational studies have largely focused on new-onset asthma or COPD [19,20,21,22] It is, possible that workplace hazards are associated with exacerbations of asthma and COPD, and that these may cause greater morbidity [23]. Possible that workplace hazards are associated with exacerbations of asthma and COPD, and that these may cause greater morbidity [23] Exacerbations of both diseases might be associated with the same inhalant hazards at work but are rarely studied together. Updated information on the risk of exacerbations is important for evidence-based guidance of asthma and COPD patients in general
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