The Role of occupational exposures in Chronic Obstructive Pulmonary Disease
Introduction: Occupational exposures are considered to be one of the newer and important risk factors for Chronic Obstructive Pulmonary Disease (COPD) besides tobacco smoking. However, the evidence mostly comes from smaller and cross-sectional studies and important questions remain unanswered, such...
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| Tipo de documento: | tese |
| Estado: | Versão publicada |
| Data de publicação: | 2018 |
| País: | España |
| Recursos: | CBUC, CESCA |
| Repositório: | TDR. Tesis Doctorales en Red |
| OAI Identifier: | oai:www.tdx.cat:10803/586017 |
| Acesso em linha: | http://hdl.handle.net/10803/586017 |
| Access Level: | Acceso aberto |
| Palavra-chave: | Occupation COPD Job exposure matrix Chronic bronchitis Smoking Ocupación MPOC Matriu ocupació exposició Bronquitis crónica Tabaquisme 616.2 |
| Resumo: | Introduction: Occupational exposures are considered to be one of the newer and important risk factors for Chronic Obstructive Pulmonary Disease (COPD) besides tobacco smoking. However, the evidence mostly comes from smaller and cross-sectional studies and important questions remain unanswered, such as which specific exposures are responsible, the magnitude of the risk involved, and how the risk varies between men and women and between smokers and nonsmokers. The aim of this thesis was to examine the association between objectively assessed occupational exposures and changes in COPD-related outcomes over two decades in the European Community Respiratory Health Survey (ECRHS), a large multicentre population-based longitudinal study. Methods: General population samples aged 20-44 years were randomly enrolled in the ECRHS between 1991 and 1993, and twice followed up over the course of 20 years. Complete job histories during this follow-up were linked to the ALOHA(+) Job-Exposure Matrix, generating occupational exposures to 12 categories of agents. Spirometries were performed at each study visit. The outcomes of interest were: lung function decline, chronic bronchitis incidence and post-bronchodilator COPD incidence. Results: Exposure to biological dust, gases & fumes and pesticides was associated with higher COPD incidence, with 21% of all COPD cases attributable to these three agents. Pesticides were associated with higher incidence of chronic phlegm but only in women, and gases & fumes and solvents also with chronic phlegm but only in men. Mineral dust exposure was associated with higher chronic phlegm incidence and metals exposure with hicher chronic bronchitis incidence, in both sexes. All studied exposures except solvents were associated with accelerated decline in the FEV1/FVC ratio, particularly in male smokers. Women exposed to biological dust also tended to have higher declines in FVC, as did men exposed to pesticides. Conclusions: A substantial proportion of the total COPD burden is attributable to occupational exposures. The effect of occupation on COPD-related outcomes is complex, and depends on exposure type, sex and smoking status. Further research is warranted to provide more details about the observed associations. |
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