There is growing recognition that occupational exposures may contribute to the etiology of chronic bronchitis, emphysema, and airway obstruction. This study estimates the impact of work-related exposure on health outcomes in COPD.
In a prospective cohort study, we carried out baseline (2001) and one year follow-up (2002) structured telephone interviews among 234 ever-employed adults aged 55 to 75 at baseline who reported a physician’s diagnosis of emphysema, chronic bronchitis, or COPD (together, the study definition of COPD). Subjects were recruited by random digit dialing within the USA (contiguous 48 states), with over-sampling in geographic areas with higher COPD mortality. We used multiple logistic regression analysis to estimate the impact of prior occupational exposure and respiratory-related work disability on restricted activity and health care utilization, controlling for smoking and demographics.
Altogether 128 (55%) reported prior exposure to vapors, gas, dust, or fumes on their longest-held lifetime jobs; 58 (25%) had left work altogether due to their lung disease [respiratory-related work disability]; 38 (16%) reported both work exposure and respiratory-related work disability. Ever smokers comprised 192 (82%) of the cohort. Adjusting for smoking status and demographics, prior work exposure and respiratory-related work disability were associated with a greater risk of respiratory-related restricted activity days (odds ratio [OR] 3.8; 95% CI 1.4–10.1), emergency department (ED) visits (OR 3.9; 95% CI 1.4–10.5), and hospitalization (OR 7.6; 95% CI 1.8–32). Among 215 subjects who had reported neither respiratory-related ED visit nor hospitalization at baseline, new incident health care utilization was related to the combined presence of prior work exposure and respiratory-related work disability (OR 5.4; 95% CI 1.9–15).CONCLUSIONS: Among persons with COPD, prior occupational exposure to vapors, gas, dusts, or fumes and respiratory-related work disability appear to be risk factors for adverse outcomes measured by restricted activity and by health care utilization.
Work-related factors should be taken into account in assessing COPD severity and may influence clinical management.
P.D. Blanc, None.