Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II).

Abstract

BACKGROUND:

The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents.

METHODS:

We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre.

FINDINGS:

A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year.

INTERPRETATION:

Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

• Authors: Manolis Kogevinas, Jan-Paul Zock, Debbie Jarvis, Hans Kromhout, Linnéa Lillienberg, Estel Plana, Katja Radon, Kjell Torén, Ada Alliksoo, Geza Benke, Paul D Blanc, Anna Dahlman-Hoglund, Angelo D'Errico, Michel Héry, Susan Kennedy, Nino Kunzli, Bénédicte Leynaert, Maria C Mirabelli, Nerea Muniozguren, Dan Norbäck, Mario Olivieri, Félix Payo, Simona Villani, Marc van Sprundel, Isabel Urrutia, Gunilla Wieslander, Jordi Sunyer, Josep M Antó
• Journal: Lancet (London, England) (Lancet) Vol. 370 Issue 9584 Pg. 336-41 (Jul 28 2007) ISSN: 1474-547X [Electronic] England
• PMID: 17662882 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Bronchoconstrictor Agents
• Methacholine Chloride

Topics

• Adult
• Asthma (diagnosis, etiology)
• Bronchoconstrictor Agents
• Female
• Humans
• Male
• Methacholine Chloride
• Occupational Exposure (adverse effects)
• Occupations
• Population Surveillance (methods)
• Risk Factors
• Smoking (adverse effects)