Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey
Theodore Lytras, Manolis Kogevinas, Hans Kromhout, et al.
Thorax 2018; published online 24 March 2018
Smoking is a well-known risk factor for chronic obstructive pulmonary disease (COPD), but the role of occupational exposure to other irritants is less well characterised. Few studies have prospectively assessed the association of occupational exposure with incidence of COPD. The European Community Respiratory Health Survey (ECRHS) is a longitudinal population-based study with a long follow-up duration, and this paper by Theodore Lytras (Barcelona, Spain) and colleagues analysed the ECFRS data to examine the effect of occupational exposure on COPD incidence after 20 years of follow-up.
In total, 3,443 participants were analysed, originating from 24 study centres in 12 countries. Participants were enrolled in 1991–1993, and followed up in 1998–2002 and again in 2010–2012. Anyone reporting current asthma was excluded from the analysis.
After adjusting for covariates, there was a significant association between biological dust exposure and COPD incidence. There was also a significant effect for all pesticides, specifically insecticides; however, these effects were based on a small number of cases. Exposure to ‘gases and fumes’ was also significant, but there was no significant effect associated with mineral dust or ‘vapours, gases, dusts and fumes’ overall. There was weak evidence of a dose – response relationship for biological dust, but the intensity of exposure did not affect results for any other irritants.
This was the first study to show a link between occupational exposure to biological dust and increased incidence of spirometrically determined COPD. It also supported previous studies linking pesticide exposure with respiratory disease. As worldwide smoking prevalence declines, the role of occupational exposure may become more important and should be critically re-examined.