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Occupational Exposures and Chronic Respiratory Symptoms: A Population-Based Study

The American review of respiratory disease (Impact Factor: 10.19). 08/1987; 136(2):298-304. DOI: 10.1164/ajrccm/136.2.298
Source: PubMed

ABSTRACT Data from a random sample of 8,515 white adults residing in 6 cities in the eastern and midwestern United States were used to examine the relationships between occupational exposures to dust or to gases and fumes and chronic respiratory symptoms; 31% of the population had a history of occupational dust exposure and 30% reported exposure to gas or fumes. After adjusting for smoking habits, age, gender, and city of residence, subjects with either occupational exposure had significantly elevated prevalences of chronic cough, chronic phlegm, persistent wheeze, and breathlessness. The adjusted relative odds of chronic respiratory symptoms for subjects exposed to dust ranged from 1.32 to 1.60. Subjects with gas or fume exposure had relative odds of symptoms between 1.27 and 1.43 when compared with unexposed subjects. Occupational dust exposure was associated with a higher prevalence of chronic obstructive pulmonary disease as defined by an FEV1/FVC ratio of less than 0.6, when comparing exposed and unexposed participants (OR = 1.53, 95% Cl = 1.17-2.08). Gas or fume exposure was associated with a small, but not significant, increase in COPD prevalence. Significant trends were noted for wheeze and phlegm with increasing duration of dust exposure. Although 36% of exposed subjects reported exposure to both dust and fumes, there was no evidence of a multiplicative interaction between the effects of the individual exposures. Smoking was a significant independent predictor of symptoms, but did not appear to modify the effect of dust or fumes on symptom reporting. These data, obtained in random samples of general populations, demonstrate that chronic respiratory symptoms and disease can be independently associated with occupational exposures.

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    • "They found that the majority of nonsmoking COPD patients were females with a strong association between female sex and COPD severity in never smokers. Occupational airborne dust is the best documented risk factor for development of COPD after smoking [15], with several studies showing independent associations with decreased lung function in nonsmokers among specific occupational groups [22] [23] [24], and in the general population [25] [26]. In 2003, results of a systematic epidemiological review into occupational factors associated with COPD by the American Thoracic Society (ATS), showed that about 10% to 20% of both symptoms and functional impairment consistent with COPD might be attributable to workplace exposure [27] and a subsequent follow-up provided similar estimates [28]. "
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    ABSTRACT: Background Chronic obstructive pulmonary disease (COPD) is currently the 4th leading cause of death all over the world. Smoking is by far the most important documented (and preventable) cause for COPD. However, COPD can still be recorded among a good percentage of non smoker patients, due to other different causes.Methods This study was performed in the Chest Department, Menoufiya University, in the period from April 2009 to August 2011, on randomly selected 300 COPD patients, 230 patients (76.66%) were men and 70 patients (23.34%) were women. The mean age of the patients was 60.7 ± 5.35 years (range 42–83 years), and all patients were diagnosed as having COPD (FEV1/FVC < 70%), with the use of spirometry (prebronchodilator and postbronchodilator inhalation), according to the GOLD criteria. For each patient, the personal history (including his or her education level), smoking history, health status, and exposure to risk factors for COPD, were assessed according to a prewritten questionnaire.ResultsOut of the 300 COPD patients included in this study, 120 (40%) were never smokers and 180 (60%) were ever smokers. Women made up 41.7% of the never smokers (50 of 120) and 11% of the ever smokers (20 of 180). Never smokers were significantly older than smokers [65.08 ± 5.03 years vs 56.33 ± 5.67 years (P < 0.001)] and were more likely to be women [41.7% vs 11% (P < 0.001)]. Never smokers made up to 40% (120/300) of all COPD cases: 78% (70/90) of all GOLD stage II cases, 45.5% (50/110) of all GOLD stage III cases. Among never smokers, 58.3% (70/120) fulfilled the criteria for GOLD stage II and 41.7% (50/120) fulfilled the criteria for GOLD stage III and no patients fulfilled the criteria of either GOLD stage I or GOLD stage IV. Never smokers were shown to have more occupational exposure to organic and inorganic dust and irritant gases at work place [41.7% (50/120) vs 27.7% (50/180), P < 0.05], more biomass exposure [41.7% (50/120) vs 0% (0/180), P < 0.001], less education [41.7% (50/120) vs 72.2% (130/180), P < 0.001], more exposure to passive smoking [75% (90/120) vs 22.2% (40/180), P < 0.001]. When compared with never smoker patients with moderate COPD (GOLD stage II), never smokers with severe COPD (GOLD stage III) were older in age (70.6 ± 2.44 years vs 61.14 ± 1.25 years, P < 0.001), have a higher female percentage (60% vs 28.6%, P < 0.001), lower BMI (21.2 ± 0.76 vs 26.14 ± 2.43, P < 0.001), more occupational exposure (27.5 ± 2.56 years vs 13.33 ± 2.39 years, P < 0.001), more biomass exposure (35 ± 4.15 years vs 20 ± 10 years, P < 0.001), less education (0% vs 71.4 educated, P < 0.001), more exposure to passive smoking (29 ± 2.02 years vs 13.75 ± 4.19 years, P < 0.001).Conclusions This study revealed that never smokers constitute a significant proportion of the Egyptian COPD patients. When dealing with COPD management, clinicians must be oriented with the different risk factors, other than tobacco smoke, that play a key role in the development and pathogenesis of COPD, because despite smoking is the most important risk factor, its absence doesn’t exclude COPD diagnosis.
    07/2012; 61(3):59–65. DOI:10.1016/j.ejcdt.2012.10.035
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    • "• For asthma, the relative risks for different occupations were taken from Karjalainen et al. (2002), with the exception of work in agriculture , for which the relative risk was taken from Kogevinas et al. (1999). • For COPD, the relative risks for different economic subsectors were taken from Korn et al. (1987). • For noise, relative risks of noise-induced hearing loss were calculated from data on hearing loss in workers with different levels of noise exposure in the United States (NIOSH 1998). "
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    ABSTRACT: Many of the 2.9 billion workers across the globe are exposed to hazardous risks at their workplaces. This chapter examines the disease and injury burden produced by selected occupational risk factors: occupational carcinogens, airborne particulates, noise, ergonomic stressors and risk factors for injuries. Owing primarily to lack of data in developing countries, we were unable to include important occupational risks for some cancers, reproductive disorders, dermatitis, infectious diseases, ischaemic heart disease, musculoskeletal disorders (MSDs) of the upper extremities, and other conditions such as workplace stress. Mesothelioma and asbestosis due to asbestos exposure, silicosis and coal workers’ pneumoconiosis are almost exclusively due to workplace exposure, but limitations in global data precluded a full analysis of these outcomes. The economically active population (EAP) aged ≥15 years, which includes people in paid employment, the self-employed, and those who work to produce goods and services for their own household consumption
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    • "However, only a minority of heavy smokers develop chronic airflow limitation [6] [7] [8]. Other possible predisposing factors include a history of childhood respiratory tract infections [9] [10], occupational exposure [11] [12], low birth weight [13], air pollution [14] [15] and diets low in anti-oxidants [16]. There is increasing recognition that COPD may be an inflammatory disease with systemic consequences [17] [18]. "
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    ABSTRACT: A number of predisposing factors are recognised as increasing the risk of developing chronic pulmonary obstructive disease (COPD). There is increasing recognition that COPD may be an inflammatory disease with systemic consequences. However, the trigger for the transition from 'at risk' (stage 0) to COPD state remains unclear. The current approach to intervention for the 'at risk' group is risk factor avoidance. We propose that if interventions shown to improve chronic respiratory symptoms in COPD sufferers could be applied to the 'at risk' group, then moderation or even reversal of the changes typical of this transition becomes a possibility. Exercise training has been shown to be beneficial at all stages of COPD. Mobility of the chest wall influences lung function. We hypothesise that the application to 'at risk' individuals (stage 0) of therapeutic interventions known to improve chronic respiratory symptoms and cardiovascular function in mild/moderate COPD (stages 1 and 2) could delay progression of the disease (i.e. manifestation of mild/moderate COPD). If the hypothesis were confirmed, the potential to delay or even prevent the onset of COPD would be feasible.
    Medical Hypotheses 03/2009; 72(3):288-90. DOI:10.1016/j.mehy.2008.10.017 · 1.07 Impact Factor
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