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

Journal article
Authors M. Kogevinas
J. P. Zock
D. Jarvis
H. Kromhout
Linnea Lillienberg
E. Plana
K. Radon
Kjell Torén
A. Alliksoo
G. Benke
Paul D. Blanc
Anna Dahlman-Höglund
A. d'Errico
M. Hery
S. Kennedy
N. Kunzli
B. Leynaert
M. C. Mirabelli
N. Muniozguren
D. Norback
M. Olivieri
F. Payo
S. Villani
M. Van Sprundel
I. Urrutia
G. Wieslander
Jordi Sunyer
J. M. Anto
Published in Lancet
Volume 370
Issue 9584
Pages 336-41
ISSN 1474-547X (Electronic)
Publication year 2007
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine, Department of Internal Medicine
Pages 336-41
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Respiratory Medicine and Allergy

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.

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