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Original Article
Longitudinal decline in lung function among older construction workers
  1. John M Dement1,
  2. Laura S Welch2,
  3. Knut Ringen2,
  4. Kim Cranford3,
  5. Patricia Quinn2
  1. 1 Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
  2. 2 Center for Construction Research and Training, Silver Spring, Maryland, USA
  3. 3 Zenith American Solutions, Oak Ridge, Tennessee, USA
  1. Correspondence to Dr John M Dement, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, 2200 W. Main Street, Suite 400 Durham, NC 27705, USA; john.dement{at}


Background Occupational exposures to vapours, gasses, dusts and fumes (VGDF) and chest X-ray abnormalities by the International Labour Office (ILO) classification system are associated with reduced lung function, with the majority of published studies being cross-sectional. We examined the effects of VGDF exposures, as well as ILO parenchymal changes, pleural plaque and diffuse pleural thickening (DPT) on reduction in lung function in a longitudinal study.

Methods Chest radiographs and spirometry for 3150 ageing construction workers enrolled in a medical screening programme with a baseline and at least one follow-up examination were studied. Indices for VGDF exposure, parenchymal changes, pleural plaque and DPT severity were developed and used in longitudinal mixed models of lung function.

Results Smoking and VGDF exposure were associated with decreased FEV1 and FVC at baseline as well as accelerated rates of annual decline. High VGDF exposure was associated with a yearly decline of −19.5 mL for FEV1 and −15.7 mL for FVC. Parenchymal abnormalities, pleural plaque and DPT were more strongly associated with reduced FVC. An increase of one unit in the pleural plaque severity index resulted in approximately −5.3 mL loss of FVC and −3.3 mL loss of FEV1, with a possible non-linear effect of plaque on FEV1.

Conclusions Increasing pleural plaque severity was associated with progressively greater loss of FVC and FEV1, supporting a causal association. VGDF exposures were associated with reduced FVC and FEV1 at baseline as well as accelerated annual loss of lung function.

  • Pulmonary function
  • chest radiography
  • vapors
  • gasses
  • dusts and fumes

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  • Contributors All authors participated in the collection and quality control of all data used for this study. JMD, LSW and KR co-generated study hypothesis and study analytical design. JMD conducted the statistical analyses. JMD, LSW, KR, PQ and KC developed and edited the manuscript.

  • Funding This work was supported by the US Department of Energy under Cooperative Agreement Number DE-FC01-06EH06004.

  • Competing interests None declared.

  • Ethics approval Central DOE Institutional Review Board. the CPWR Institutional Review Board, and the Duke University Health System Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.