Published ahead of print on July 12, 2007, doi:10.1164/rccm.200605-730OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200605-730OC
Effect of Occupational Exposures on Decline of Lung Function in Early Chronic Obstructive Pulmonary Disease1 Division of Occupational and Environmental Medicine, Department of Family Medicine, and 2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; 3 Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia; and 4 Division of Biostatistics, School of Public Health, University of Minnesota, St. Paul, Minnesota Correspondence and requests for reprints should be addressed to Philip Harber, M.D., M.P.H., Division of Occupational and Environmental Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024. E-mail: pharber{at}ucla.edu Rationale: Several occupational exposures adversely affect lung function. Objectives: This study reports the influence of continued occupational dust and fume exposures on the rate of decline of lung function in participants with early chronic obstructive pulmonary disease (COPD) studied in a population-based study. Methods: Subjects consisted of 5,724 participants in the Lung Health Study, a multicenter study of smoking cessation and anticholinergic bronchodilator administration in smokers with early COPD (3,592 men; 2,132 women). Average post-bronchodilator FEV1 at entry was 78.4% predicted for men and 78.2% predicted for women; all participants had an FEV1/FVC ratio less than 0.70. Measurements and Main Results: Participants underwent a baseline evaluation and five annual follow-up assessments, including questionnaires and spirometry. The effect of ongoing dust or fume exposure on FEV1 in each follow-up year was statistically evaluated with a mixed-effects regression model, which was adjusted for FEV1 at entry, age, airway responsiveness to methacholine, baseline smoking intensity, and time-varying (yearly) smoking status during each follow-up year. In men with early COPD, each year of continued fume exposure was associated with a 0.25% predicted reduction in post-bronchodilator FEV1% predicted. Continued smoking and airway hyperresponsiveness were also associated with reduction in FEV1 during each year of follow-up in both men and women. Statistically significant effects of dust exposure on the rate of decline were not found, nor were effects of fume exposure noted in women. Conclusions: These results suggest a need for secondary prevention by controlling occupational fume exposures.
Key Words: forced expiratory volume • longitudinal studies • pulmonary disease, chronic obstructive
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