Occupational exposures are associated with worse morbidity in patients with chronic obstructive pulmonary disease.

TitleOccupational exposures are associated with worse morbidity in patients with chronic obstructive pulmonary disease.
Publication TypePublication
Year2015
AuthorsPaulin LM, Diette GB, Blanc PD, Putcha N, Eisner MD, Kanner RE, Belli AJ, Christenson S, Tashkin DP, Han ML, R Barr G, Hansel NN
Corporate AuthorsSPIROMICS Research Group
JournalAm J Respir Crit Care Med
Volume191
Issue5
Pagination557-65
Date Published2015 Mar 01
ISSN1535-4970
KeywordsAged, Disease Progression, Effect Modifier, Epidemiologic, Female, Humans, Male, Middle Aged, Multivariate Analysis, Occupational Exposure, Pulmonary Disease, Chronic Obstructive, quality of life, smoking
Abstract

RATIONALE: Links between occupational exposures and morbidity in individuals with established chronic obstructive pulmonary disease (COPD) remain unclear.OBJECTIVES: To determine the impact of occupational exposures on COPD morbidity.METHODS: A job exposure matrix (JEM) determined occupational exposure likelihood based on longest job in current/former smokers (n = 1,075) recruited as part of the Subpopulations and Intermediate Outcomes in COPD Study, of whom 721 had established COPD. Bivariate and multivariate linear regression models estimated the association of occupational exposure with COPD, and among those with established disease, the occupational exposure associations with 6-minute-walk distance (6MWD), the Modified Medical Research Council Dyspnea Scale (mMRC), the COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), 12-item Short-Form Physical Component (SF-12), and COPD exacerbations requiring health care utilization, adjusting for demographics, current smoking status, and cumulative pack-years.MEASUREMENTS AND MAIN RESULTS: An intermediate/high risk of occupational exposure by JEM was found in 38% of participants. In multivariate analysis, those with job exposures had higher odds of COPD (odds ratio, 1.44; 95% confidence interval, 1.04-1.97). Among those with COPD, job exposures were associated with shorter 6MWDs (-26.0 m; P = 0.006); worse scores for mMRC (0.23; P = 0.004), CAT (1.8; P = 0.003), SGRQ (4.5; P = 0.003), and SF-12 Physical (-3.3; P < 0.0001); and greater odds of exacerbation requiring health care utilization (odds ratio, 1.55; P = 0.03).CONCLUSIONS: Accounting for smoking, occupational exposure was associated with COPD risk and, for those with established disease, shorter walk distance, greater breathlessness, worse quality of life, and increased exacerbation risk. Clinicians should obtain occupational histories from patients with COPD because work-related exposures may influence disease burden.

DOI10.1164/rccm.201408-1407OC
Alternate JournalAm. J. Respir. Crit. Care Med.
PubMed ID25562375
PubMed Central IDPMC4384767
Grant ListHHSN268200900017C / / PHS HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
HHSN268200900009C / WH / WHI NIH HHS / United States
HHSN268200900015C / / PHS HHS / United States
HHSN268200900020C / / PHS HHS / United States
K12 HL119997 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / / PHS HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / / PHS HHS / United States
K24 ES021098 / ES / NIEHS NIH HHS / United States
F32 ES022115 / ES / NIEHS NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
HHSN2682009000019C / / PHS HHS / United States
HHSN268200900013C / / PHS HHS / United States
F32ES022115-01 / ES / NIEHS NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / / PHS HHS / United States
MS#: 
MS013
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Baltimore (Johns Hopkins University)
ECI: 
Manuscript Status: 
Published