ASSOCIATION OF OCCUPATIONAL EXPOSURES AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE MORBIDITY

Problem Statement: Chronic obstructive pulmonary disease (COPD) is a progressive disease with a high global health burden. Although smoking is the most understood risk factor, other exposures, including occupational exposure to vapors, gases, dusts, and fumes (VGDF), are being recognized. The use of a job exposure matrix or a single question regarding occupational VGDF exposure provides little information for prioritizing workplace exposure reductions. Results: We examined the literature and identified 71 studies with quantified occupational exposures associated with obstructive lung disease. In our first analysis of the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort, we created occupational hazard groups from the employment history: gases and vapors, dusts and fumes, organic and biological dusts, inorganic and mineral dusts and fumes, metal dusts and fumes, and agricultural dusts. Each of the exposure groups resulted in statistically significant increases across a variety of COPD morbidity measures including prevalence odds of COPD, prevalence odds of exacerbations, COPD assessment test (CAT), percent forced expiratory volume in 1 second (%FEV1), St. George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC), and BODE Index. Gases and vapors produced almost double the estimated effect size for SGRQ, CAT, and %FEV1 when compared to the VDGF exposure question. Metal dusts and fumes exposure produced the highest adjusted increase for the BODE Index. In our evaluation of exposure duration, each additional year of exposure for various specific occupational hazards, including wood dust, coal dust, and fire, smoke or other combustion products, resulted in changes to COPD morbidity measured by the BODE Index and computed tomography measures, including percent emphysema, small airway disease, and large airway disease. Smoking history (smoking pack-years) modified some of the associations between exposure and morbidity. Conclusions: Our findings demonstrate that hazard category exposure measures and exposure duration can serve as valid predictors of disease prevalence and morbidity. Reductions in occupational exposures are necessary to reduce disease prevalence and improve health outcomes, in conjunction with smoking cessation and other prevention efforts. Disease prevention must expand beyond the treating physicians and begin in the workplace, involving the occupational communities, the workers, and their organizations