Impact of occupational exposures on exacerbation of asthma: a population-based asthma cohort study

Abstract

BackgroundAsthma is a prevalent chronic disease and occupation contributes to approximately 15 % of cases among adults. However, there are still few studies on risk factors for work-exacerbated asthma. The current study investigated the association between asthma exacerbations and occupational exposures.MethodsThe study comprised all currently working adults (n = 1356) who reported ever asthma in prior population-based cohorts. All subjects completed a questionnaire about exposures, occupations and exacerbations of asthma. Exposure to high and low molecular weight agents, irritating agents and asthmagens were classified using the asthma-specific job exposure matrix for northern Europe (N-JEM). Severe exacerbation of asthma was defined as sought emergency care at a hospital, admitted to a hospital overnight, or made an urgent visit to a primary care physician or district medical office due to breathing problems during the last 12 months. Moderate exacerbation was defined as both being not severe exacerbation and an additional visit to a primary care physician or district medical office, or had extra treatments with corticosteroid tablets. Mild exacerbation was defined as being neither severe nor moderate exacerbation, and increasing usage of inhaled corticosteroids.Multiple logistic regression was applied to investigate the association between exacerbation of asthma and occupational exposures while adjusting for potential confounders.ResultsApproximately 26 % of the working asthmatics reported exacerbation, and more than two-thirds of them had moderate or severe exacerbation. From 23 to 49 % of the asthmatics reported occupational exposure to a variety of different types of agents. Exposure to any gas, smoke or dust (OR 1.7[95 % CI 1.2–2.6]) was associated with severe exacerbation of asthma, as were organic dust (OR 1.7[1.2–2.5]), dampness and mold (OR 1.8[1.2–2.7]), cold conditions (OR 1.7[1.1–2.7]), and a physically strenuous job (OR 1.6[1.03–2.3]). Asthmagens and low molecular weight agents classified by the N-JEM were associated with mild exacerbation, with OR 1.6[1.1–2.5] and OR 2.2[1.1–4.4], respectively.ConclusionsSelf-reported exposure to any gas, smoke or dust, organic dust, dampness and mold, cold conditions and physically strenuous work, and jobs handling low molecular weight agents were associated with exacerbation of asthma. Reduction of these occupational exposures may help to reduce exacerbation of asthma.

Possible risk factors for poor asthma control assessed in a cross-sectional population-based study from Telemark, Norway

“…with a JEM-based exposure categorization [9,10]. Few studies have assessed occupation as a possible risk factor for poor asthma control [4], but our finding is consistent with those of previous studies reporting exacerbation of asthma from such exposure, and the LIAISON study, which found that self-reported occupational exposure to allergens/irritants was associated with poor asthma control [6,[16][17][18]. This cumulative evidence emphasizes the need for further efforts to reduce this possible risk factor, and for physicians to address occupational exposure in all asthma patients.…”

“…Each question is rated on a scale from 1-5 and values are summed for the ACT score. A low ACT score [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] indicates poorly controlled asthma, and a score of 20-25 indicates well-controlled asthma.…”

Association Between Organic Dust Exposure and Adult-Asthma: A Systematic Review and Meta-Analysis of Case-Control Studies

“…Self-reported exposure to any gas, smoke or dust, organic dust, dampness and mold, cold conditions and physically strenuous work, and jobs handling low molecular weight agents were associated with exacerbation of asthma. Reduction in such occupational exposures may help reduce exacerbation of asthma 28. A study from Norway revealed that dust exposure was associated with an increased incidence of work-related asthma-like symptoms 29.…”

Causes and Phenotypes of Work-Related Asthma

“…From the ECRHS, severe exacerbation of asthma was associated with different JEM-assigned exposures: high dust, gas, or fumes; high gas and fumes; high mineral dust; and both low and high biological dust [5]. Another study used data from five existing investigations conducted in Sweden, modeled three levels of exacerbation (i.e., mild, moderate, and severe), and assessed exposure with both self-reports and a JEM [9]. Severe exacerbation of asthma was associated with self-reported gas, smoke, or dust; organic dust; dampness and mold; cold conditions; and physically strenuous work.…”