Chest
Volume 134, Issue 6, December 2008, Pages 1237-1243
Journal home page for Chest

Original Research
COPD
Impact of Occupational Exposure on Severity of COPD

https://doi.org/10.1378/chest.08-0622Get rights and content

Background

The relationship between occupational exposures and COPD has been analyzed in population-based and occupational cohort studies. However, the influence of these exposures on the clinical characteristics of COPD is not well known. The aim of this study was to analyze the impact of occupational exposures on respiratory symptoms, lung function, and employment status in a series of COPD patients.

Methods

We conducted a cross-sectional study of 185 male COPD patients. Patients underwent baseline spirometry and answered a questionnaire that included information on respiratory symptoms, hospitalizations for COPD, smoking habits, current employment status, and lifetime occupational history. Exposure to biological dust, mineral dust, and gases and fumes was assessed using an ad hoc job exposure matrix.

Results

Having worked in a job with high exposure to mineral dust or to any dusts, gas, or fumes was associated with an FEV1 of < 30% predicted (mineral dust: relative risk ratio, 11; 95% confidence interval [CI], 1.4 to 95; dusts, gas, or fumes: relative risk ratio, 6.9; 95% CI, 1.1 to 45). High exposure to biological dust was associated with chronic sputum production (odds ratio [OR], 4.3; 95% CI, 1.6 to 12), dyspnea (OR, 2.7; 95% CI, 1.1 to 6.7), and work inactivity (OR, 2.4; 95% CI, 1.4 to 4.2). High exposure to dusts, gas, or fumes was associated with sputum production (OR, 2.8; 95% CI, 1.2 to 6.7) and dyspnea (OR, 1.2; 95% CI, 1.1 to 1.4).

Conclusions

Occupational exposures are independently associated with the severity of airflow limitation, respiratory symptoms, and work inactivity in patients with COPD.

Section snippets

Study Population

Patients with COPD and/or emphysema who visited a specialized outpatient unit in a tertiary care hospital between March 2002 and January 2004 were consecutively enrolled into the study. The hospital covers an area population of 500,000, and the patients studied did not predominantly work in any particular large industry. Patients were referred to us by other doctors belonging to the primary care department or several departments of the same hospital that were not involved in the study.

Patient Characteristics and Frequencies of Exposure

A total of 194 patients (185 men, 9 women) visited the outpatient clinic during the study period. Because of the small number of women, it was decided not to include their data in the analysis. All had normal α1-antitrypsin levels. Thirteen of the patients included had emphysema without airflow obstruction. The corresponding demographic, clinical, smoking, lung function, and employment characteristics are shown in Table 1. The mean age of the patients was 66.2 years (SD, 10.7 years). Among

Discussion

This is the first patient series in which the effect of occupational exposure on the clinical and functional characteristics of COPD patients without α1-antitrypsin deficiency has been investigated. Our findings show that exposure to mineral dust, biological dust, and dust or gas and fumes was independently associated with at least one of the following variables: COPD severity; clinical symptoms; and employment status.

Exposure to mineral dust and to any dusts, gases, or fumes was associated

References (35)

  • A Senthilselvan et al.

    Excess respiratory symptoms in full-time male and female workers in large-scale swine operations

    Chest

    (2007)
  • PD Blanc et al.

    The prevalence and predictors of respiratory-related work limitation and occupational disability in an international study

    Chest

    (2003)
  • RJ Korn et al.

    Occupational exposures and chronic respiratory symptoms: a population-based study

    Am Rev Respir Dis

    (1987)
  • 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

    Int J Epidemiol

    (1988)
  • X Xu et al.

    Exposure-response relationships between occupational exposures and chronic respiratory illness: a community-based study

    Am Rev Respir Dis

    (1992)
  • WK Post 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

    Eur Respir J

    (1994)
  • J Sunyer et al.

    Pulmonary ventilatory defects and occupational exposures in a population-based study in Spain: Spanish Group of the European Community Respiratory Health Survey

    Am J Respir Crit Care Med

    (1998)
  • RG Love et al.

    Longitudinal study of lung function in coal-miners

    Thorax

    (1982)
  • NS Seixas et al.

    Longitudinal and cross sectional analyses of exposure to coal mine dust and pulmonary function in new miners

    Br J Ind Med

    (1993)
  • E Hnizdo et al.

    Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners

    Scand J Work Environ Health

    (1990)
  • E Meijer et al.

    Respiratory effects of exposure to low levels of concrete dust containing crystalline silica

    Am J Ind Med

    (2001)
  • IA Bergdahl et al.

    Increased mortality in COPD among construction workers exposed to inorganic dust

    Eur Respir J

    (2004)
  • J Balmes et al.

    American Thoracic Society statement: occupational contribution to the burden of airway disease

    Am J Respir Crit Care Med

    (2003)
  • E Piitulainen et al.

    Environmental correlates of impaired lung function in non-smokers with severe α1-antitrypsin deficiency (PiZZ)

    Thorax

    (1998)
  • AS Mayer et al.

    Occupational exposure risks in individuals with PI*Z α1-antitrypsin deficiency

    Am J Respir Crit Care Med

    (2000)
  • American Thoracic Society et al.

    American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with α1-antitrypsin deficiency

    Am J Respir Crit Care Med

    (2003)
  • PD Blanc et al.

    The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease

    Occup Environ Med

    (2004)
  • Cited by (0)

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    View full text