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Copyright ©ERS Journals Ltd 2003
The occupational burden of chronic obstructive pulmonary disease
Divisions of 1 Rheumatology, 2 Occupational and Environmental Medicine and 3 Pulmonary and Critical Care, and 4 Cardiovascular Research Institute, University of California, San Francisco, CA, USA
CORRESPONDENCE: L. Trupin, University of California, Box 0920, San Francisco, CA, 94143-0920, USA. Fax: 1 4154769030. E-mail: trupin@itsa.ucsf.edu
Keywords: airflow limitation, chronic bronchitis, chronic obstructive pulmonary disease, emphysema, occupational health, work-related
Received: October 15, 2002
Accepted April 12, 2003
This study was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the US National Institutes of Health (HL677438). M.D. Eisner was also supported by K23 HL04201 (NHLBI).
Although chronic obstructive pulmonary disease (COPD) is attributed predominantly to tobacco smoke, occupational exposures are also suspected risk factors for COPD. Estimating the proportion of COPD attributable to occupation is thus an important public health need.
A randomly selected sample of 2,061 US residents aged 55–75 yrs completed telephone interviews covering respiratory health, general health status and occupational history. Occupational exposure during the longest-held job was determined by self-reported exposure to vapours, gas, dust or fumes and through a job exposure matrix. COPD was defined by self-reported physician's diagnosis.
After adjusting for smoking status and demography, the odds ratio for COPD related to self-reported occupational exposure was 2.0 (95% confidence interval (CI) 1.6–2.5), resulting in an adjusted population attributable risk (PAR) of 20% (95% CI 13–27%). The adjusted odds ratio based on the job exposure matrix was 1.6 (95% CI 1.1–2.5) for high and 1.4 (95% CI 1.1–1.9) for intermediate probability of occupational dust exposure; the associated PAR was 9% (95% CI 3–15%). A narrower definition of COPD, excluding chronic bronchitis, was associated with a PAR based on reported occupational exposure of 31% (95% CI 19–41%).
Past occupational exposures significantly increased the likelihood of chronic obstructive pulmonary disease, independent of the effects of smoking. Given that one in five cases of chronic obstructive pulmonary disease may be attributable to occupational exposures, clinicians and health policy-makers should address this potential avenue of chronic obstructive pulmonary disease causation and its prevention.
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