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Occup Environ Med. 2019 Jan 30. pii: oemed-2018-105274. doi: 10.1136/oemed-2018-105274. [Epub ahead of print]

Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey.

Author information

1
Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.
2
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
3
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
4
Hospital del Mar Medical Research Institute, Barcelona, Spain.
5
IRAS, University of Utrecht, Utrecht, The Netherlands.
6
Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium.
7
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany.
8
Pulmonology Department, Galdakao Hospital, Galdakao, Spain.
9
Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.
10
Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain.
11
Respiratory Department, Hospital Universitario San Agustín, Avilés, Spain.
12
Pulmonology and Allergy Clinical Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain.
13
Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Université de Bordeaux, Bordeaux, France.
14
Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.
15
U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, Grenoble, France.
16
Université Grenoble Alpes, Grenoble, France.
17
University Hospital of Montpellier, Montpellier, France.
18
Sorbonne Universités, Paris, France.
19
Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France.
20
Section of Epidemiology and Medical Statistics, Department of Health Sciences, University of Pavia, Pavia, Italy.
21
Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.
22
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
23
Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
24
Department of Clinical Science, University of Bergen, Bergen, Norway.
25
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
26
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
27
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
28
Office of Research and Evaluation, Boston Public Health Commission, Boston, Massachusetts, USA.
29
Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
30
Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
31
Lung Clinic, Tartu University Hospital, Tartu, Europe.
32
Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
33
Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.
34
National Research Center for the Working Environment, Copenhagen, Denmark.
35
Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy.
36
San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA.
37
School of Medicine, Cardiff University, Cardiff, Wales, UK.
38
Public Health Wales, Cardiff, Wales, UK.
39
Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
40
Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA.
41
Population Health and Occupational Disease, National Heart and Lung Institute, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.
42
MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.

Abstract

OBJECTIVES:

Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey.

METHODS:

Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations.

RESULTS:

8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides.

CONCLUSIONS:

Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.

KEYWORDS:

epidemiology; longitudinal studies; respiratory; retrospective exposure assessment

PMID:
30700596
DOI:
10.1136/oemed-2018-105274

Conflict of interest statement

Competing interests: DJ reports grants from European Commission during the conduct of the study. VS reports grants from the Wood Dust Foundation (Project No 444508795) during the conduct of the study. IP reports non-financial support and other from Novartis, personal fees and other from Astra Zeneca, non-financial support and other from Chiesi, outside the submitted work. PD reports personal fees from ALK, Stallergènes Greer, Chiesi, Thermo Fisher Scientific, Ménarini, Bausch&Lomb and Mylan, outside the submitted work. RJ reports grants from Estonian Research Council (personal research grant number 562) during the conduct of the study, personal fees and non-financial support from GSK, personal fees from Novartis and Boehringer, outside the submitted work.

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