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COPD, airflow limitation and chronic bronchitis in farmers: a systematic review and meta-analysis
  1. Alicia Guillien1,
  2. Thibaud Soumagne2,
  3. Jean-Charles Dalphin2,3,
  4. Bruno Degano4,5
  1. 1Equipe d’Epidémiologie Environnementale, Institute for Advanced Biosciences, Centre de Recherche UGA, INSERM U1209, CNRS UMR 5309, Grenoble, France
  2. 2Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
  3. 3UMR CNRS Chrono-Environment, Franche-Comté University, Besançon, France
  4. 4Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, Grenoble, France
  5. 5Université Grenoble Alpes, Grenoble, France
  1. Correspondence to Dr Alicia Guillien, Equipe d’Epidémiologie Environnementale Institute for Advanced Biosciences, Centre de Recherche UGA, INSERM U1209, CNRS UMR 5309 Grenoble France; alicia.guillien{at}


Introduction The current definition of chronic obstructive pulmonary disease (COPD) associates persistent airflow limitation and chronic respiratory symptoms. Agricultural work has been associated with an increased risk of developing COPD, but the prevalence and definition of the disease vary greatly between studies. This meta-analysis aimed to assess the association between agricultural work and COPD using the most widely used definitions of the disease.

Methods Inclusion criteria were: (1) design: cross-sectional or longitudinal, (2) groups: at least one group of farmers and a control group of non-farmers, (3) outcome: prevalence or unadjusted OR of COPD, airflow limitation and/or chronic bronchitis, (4) study subjects: groups of exposed subjects comprising ≥30 individuals and with a mean age ≥40 years and (5) language: English and French language, full-length, original publications in peer-reviewed journals.

Results In total, 22 manuscripts were included in the meta-analysis. Eight studies assessed only the prevalence of airflow limitation, nine assessed only the prevalence of chronic bronchitis and four assessed the prevalence of both these parameters. Only one assessed the prevalence of COPD according to its current definition, and this study also provided the prevalence of airflow limitation. Ten studies showed a positive association between farming exposure and airflow limitation or chronic bronchitis, and 12 showed no association (OR (95% CI)=1.77 (1.50 to 2.08), p<0.001). Cattle, swine, poultry and crop farming were associated with either airflow limitation or chronic bronchitis.

Conclusion Although some features of COPD are associated with some agricultural work, well-designed studies with appropriate diagnostic criteria should be conducted to draw strong conclusions about the relationship between COPD and farming.

  • chronic obstructive pulmonary disease
  • farming
  • meta-analysis
  • chronic bronchitis

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  • Contributors AG and BD has contributed to the literature search, the identification of relevant articles, full-text screening, drafting the article and final approval of the version to be published. TS and J-CD have contributed to revising the article critically for important intellectual content and final approval of the version to be published. AG and BD are responsible for the overall content as guarantor(s).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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