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Original research
Farming, pesticide exposure and respiratory health: a cross-sectional study in Thailand
  1. Jate Ratanachina1,2,
  2. Andre Amaral1,
  3. Sara De Matteis1,3,
  4. Paul Cullinan1,
  5. Peter Burney1
  1. 1 National Heart and Lung Institute, Imperial College London, London, UK
  2. 2 Department of Preventive and Social Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  3. 3 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Sardegna, Italy
  1. Correspondence to Dr Jate Ratanachina, Imperial College London National Heart and Lung Institute, London, SW3 6LR, UK; j.ratanachina17{at}


Objective To assess the association of lung function and respiratory symptoms with farming, particularly pesticide use, in an agricultural province in Thailand.

Methods We undertook a cross-sectional survey of adults aged 40–65 in Nan province, Thailand, between May and August 2019. We randomly recruited 345 villagers and enriched the sample with 82 government employees. All participants performed post-bronchodilator spirometry and completed a questionnaire covering information on respiratory symptoms, farming activities, pesticide use and known risk factors for respiratory disease. Associations of respiratory outcomes with farming and pesticide exposures were examined by multivariable regression analysis.

Results The response rate was 94%. The prevalence of chronic airflow obstruction among villagers was 5.5%. Villagers had, on average, a lower percent predicted post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) than government employees (98.3% vs 100.3%; p=0.04). There was no evidence of association of lung function with farming activities, the use of specific herbicides (glyphosate and paraquat), insecticides (organophosphates and pyrethroids) or fungicides. The exceptions were poultry farming, associated with chronic cough and an increase of FEV1/FVC, and atrazine, for which duration (p-trend <0.01), intensity (p-trend <0.01) and cumulative hours (p-trend=0.01) of use were all associated with higher FEV1/FVC in an exposure–response manner. Cumulative hours (−280 mL/hour), low duration (−270 mL/year) and intensity (−270 mL/hour/year) of atrazine use were associated with lower FVC.

Conclusions Chronic airflow obstruction is uncommon among villagers of an agricultural province in Nan, Thailand. Farming and pesticide use are unlikely to be major causes of respiratory problems there.

  • Agriculture
  • Developing countries
  • Farmers
  • Pesticides
  • Respiratory Function Tests

Data availability statement

Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author, Dr Jate Ratanachina (, on reasonable request.

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Data availability statement

Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author, Dr Jate Ratanachina (, on reasonable request.

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  • Contributors JR, AA, SDM, PC and PB were engaged in the initial design of the study. JR was responsible for data collection and spirometry testing. PB conducted the quality control of the spirometry data. JR analysed all data and drafted the initial manuscript, and all authors contributed to its development and approved the final version.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.