Published ahead of print on July 12, 2007, doi:10.1164/rccm.200605-730OC
Am. J. Respir. Crit. Care Med., Volume 176, Number 10, November 2007, 994-1000
A more recent version of this article appeared on November 15, 2007
Submitted on May 31, 2006
Accepted on July 12, 2007
Effect of Occupational Exposures on Decline of Lung Function in Early COPD
Philip I Harber1*, Donald P Tashkin2, Michael Simmons1, Lori Crawford1, Eva Hnizdo3, and John Connett4
1 Division of Occupational and Environmental Medicine, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, United States,
2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA,
3 Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, WV, USA,
4 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
* To whom correspondence should be addressed. E-mail: pharber{at}mednet.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 COPD studied in a population-based study. Methods: Participants were 5724 participants in the Lung Health Study (LHS), a multi-center study of smoking cessation and anticholinergic bronchodilator administration in smokers with early COPD (3592 men, 2132 women); average post-bronchodilator FEV1 at entry was 78.4% predicted for men and 78.2% predicted for women; all participants had FEV1/FVC ratio < 0.70. Measurements:
Participants underwent a baseline evaluation and five annual follow-up assessments including questionnaires and spirometry. Main Results: The effect of ongoing dust or
fume exposure upon FEV1 in each follow-up year was statistically evaluated with a mixed effects regression model which adjusted for FEV1 at entry, age, airway
responsiveness to methacholine, baseline smoking intensity, and for 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 postbronchodilator
% predicted FEV1. 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: Pulmonary Disease, Chronic Obstructive; Longitudinal Studies; Fume; Occupational Exposure
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