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 Effect of Occupational Exposures on Decline of Lung Function in Early COPDPhilip I Harber1*,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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