Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 553-558

Occupational Exposure Risks in Individuals with PI*Z ₁-Antitrypsin Deficiency

ANNYCE S. MAYER, JAMES K. STOLLER, BECKI BUCHER BARTELSON, A. JAMES RUTTENBER, ROBERT A. SANDHAUS, and LEE S. NEWMAN

Division of Environmental and Occupational Health Sciences and Pulmonary Division, Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado; Division of Pulmonary and Critical Care Sciences, Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado; and Section of Respiratory Therapy, Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio

We obtained questionnaire and spirometry data from 128 ₁-antitrypsin (₁AT)-deficient individuals with phenotype PI*Z to examine the relationship between chronic respiratory symptoms, airflow limitation, treatment requirements, and semiquantitative estimates of occupational exposure to dust, fumes, smoke, and gas. After adjusting for age, smoking, and prior lower respiratory tract infections, increased prevalence of chronic cough (OR = 4.69, 95% CI = 1.57-13.74, p = 0.006) and having left a job due to breathlessness (OR = 2.72, 95% CI = 1.07-6.92, p = 0.036) were seen in individuals reporting high mineral dust exposure compared with those with no exposure. Subjects reporting high mineral dust exposure also had significantly lower FEV₁ (31% predicted for high exposure versus 36% for low and 40% for unexposed, p = 0.032). The excess risk of chronic cough seen with occupational fumes or smoke exposure disappeared after adjusting for mineral dust exposure, but the association with lower FEV₁/FVC ratio persisted (p = 0.022). Personal tobacco use was a significant risk factor for most outcome measures, but no interaction with occupational exposure was seen. These results suggest that occupational inhalational exposures are independently associated with respiratory symptoms and airflow limitation in severely ₁AT-deficient individuals.

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