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O40-4 Lung function decline and copd prevalence in relation to occupational exposures in a prospective cohort study: the ecrhs III
  1. Theodore Lytras1,
  2. Anne-Elie Carsin1,
  3. Hans Kromhout2,
  4. Roel Vermeulen2,
  5. Josep Maria Antó1,
  6. Per Bakke3,
  7. Geza Benke4,
  8. Paul Blanc5,
  9. Sandra Dorado6,
  10. Johan Hellgren7,
  11. Mathias Holm8,
  12. Deborah Jarvis9,
  13. Amar Jayant Mehta10,
  14. David Miedinger11,
  15. Maria C Mirabelli12,
  16. Dan Norbäck13,
  17. Mario Olivieri14,
  18. Vivi Schlünssen15,16,
  19. Isabel Urrutia6,
  20. Simona Villani17,
  21. Manolis Kogevinas1,
  22. Jan-Paul Zock1
  1. 1Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  2. 2Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
  3. 3Department of Clinical Science, University of Bergen, Bergen, Norway
  4. 4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  5. 5Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
  6. 6Pulmonology Department, Galdakao Hospital, Galdakao, Spain
  7. 7Department of Otorhinolaryngology, Institute of Clinical Sciences, Gothenburg, Sweden
  8. 8Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
  9. 9National Heart and Lung Institute, Imperial College, London, UK
  10. 10Department of Environmental Health, Harvard School of Public Health, Boston, USA
  11. 11Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
  12. 12Department of Environmental Health, School of Public Health, Emory University, Atlanta, USA
  13. 13Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
  14. 14Department of Medicine and Public Health, Unit of Occupational Medicine, University of Verona, Verona, Italy
  15. 15Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
  16. 16National Research Centre for the Working Environment, Copenhagen, Denmark
  17. 17Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy


Introduction Few prospective population-based studies have demonstrated a relationship between occupational exposures and the rate of lung function decline. We examined the effect of occupational exposures on lung function decline (FEV1 and FVC) and COPD prevalence in the ECRHS, a multicentre cohort study that has completed its second follow-up after a mean of 19 years.

Methods We used repeated questionnaire and pre-bronchodilator spirometric data from 9175 ECRHS participants in 29 study centres who completed the first follow-up; 4549 (50%) of them completed the second follow-up. COPD was defined using a lower limit of normal criterion for FEV1/FVC. Occupational exposures were assessed from job histories up to the first follow-up using the ALOHA Job-Exposure Matrix. Decline in FEV1 and FVC was analysed using mixed-effects linear models, and change in COPD prevalence using marginal (GEE) logistic regression. All models were adjusted for age, gender, height, BMI, smoking status, passive smoking, current asthma, socioeconomic status, and early-life disadvantage score. To account for differential loss to follow-up and item non-response we used multiple imputation with chained equations (100 imputed datasets).

Results In women, exposure to low levels of dusts, gases or fumes resulted in accelerated declines in FEV1 (−1.4 ml/yr; 95% CI: −2.8 to 0.0) and FVC (−1.7 ml/yr; −3.4 to −0.1); FEV1 decline was higher in female smokers (−3.1 ml/yr; −4.8 to −1.3). In men, the same exposures had a statistically significant effect only in smokers, with accelerated declines in FEV1 (−3.2 ml/yr; −5.1 to −1.2) and the FEV1/FVC ratio (−0.6%/10 years; −1.1% to −0.2%), as well as an increased prevalence of COPD (OR = 1.21; 1.03–1.43). Higher exposures produced similar effects, in both genders.

Conclusions Occupational exposures appear to affect lung function decline and COPD prevalence, and the magnitude of this effect depends on gender and smoking status.

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