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Published ahead of print on June 16, 2005, doi:10.1164/rccm.200501-111OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 4, August 2005, 440-445

A more recent version of this article appeared on August 15, 2005
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Submitted on January 25, 2005
Accepted on May 17, 2005

Asthma Severity and Exposure to Occupational Asthmagens

Nicole Le Moual1*, Valerie Siroux2, Isabelle Pin3, Francine Kaufmann1, and Susan M Kennedy4

1 U472-IFR69, INSERM, Villejuif, France, 2 U472-IFR69, INSERM, Villejuif, France; U578, INSERM, Grenoble, France, 3 U578, INSERM, Grenoble, France; Departement de Medecine Aigue Specialisee, CHU Grenoble, Grenoble, France, 4 University of British Columbia, Vancouver, Canada

* To whom correspondence should be addressed. E-mail: lemoual{at}vjf.inserm.fr.

Rationale: Severe asthma is a public health problem with limited information regarding preventable causes. Although occupational exposures have been implicated as important risk factors for asthma and asthma exacerbations, associations between occupational exposures and asthma severity have not been reported. Objective: To examine associations between occupational exposures and asthma severity. Methods: The Epidemiological study on the Genetics and Environment of Asthma combines a case control study with a family study of relatives of asthmatic cases. Adult cases (n=148) were recruited in chest clinics and non-asthmatic controls (n=228) were population-based. Occupational exposures to non-asthmagenic irritants and asthmagens (classified as 'any asthmagen' and 3 broad groups (high molecular weight agents, low molecular weight agents, mixed environments)) were assessed by an asthma-specific job exposure matrix. Asthma severity was defined from a 7-grade clinical score (frequency of attacks, persistent symptoms and hospitalisation). Severe (score ≥2) and mild asthmatics were compared to controls using nominal logistic regression. Main Results: Significant associations were observed between severe adult onset asthma and exposure to any occupational asthmagen (odds ratio 4.0 [95% CI 2.0-8.1]); high molecular weight agents (3.7 [1.3-11.1]); low molecular weight agents (4.4 [1.9-10.1]), including industrial cleaning agents (7.2 [1.3-39.9]); and mixed environments (7.5 [2.4-23.5]). No significant associations were found between non-asthmagenic irritants and asthma severity, nor between asthmagens and childhood onset asthma or mild adult onset asthma. Conclusions: Our results suggested a strong deleterious role of occupational asthmagens in severe asthma. Clinicians should consider occupational exposures in patients with moderate to severe asthma.
Key words: epidemiology, asthma severity, occupational exposure




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