The occupational contribution to severe exacerbation of asthma

Abstract

The goal of this study was to identify occupational risk factors for severe exacerbation of asthma and estimate the extent to which occupation contributes to these events.The 966 participants were working adults with current asthma who participated in the follow-up phase of the European Community Respiratory Health Survey. Severe exacerbation of asthma was defined as self-reported unplanned care for asthma in the past 12 months. Occupations held in the same period were combined with a general population job-exposure matrix to assess occupational exposures.74 participants reported having had at least one severe exacerbation event, for a 1-yr cumulative incidence of 7.7%. From regression models that controlled for confounders, the relative risk (RR) was statistically significant for low (RR 1.7, 95% CI 1.1-2.6) and high (RR 3.6, 95% CI 2.2-5.8) biological dust exposure, high mineral dust exposure (RR 1.8, 95% CI 1.02-3.2), and high gas and fumes exposure (RR 2.5, 95% CI 1.2-5.5). The summary category of high dust, gas, or fumes exposure had RR 3.1 (95% CI 1.9-5.1). Based on this RR, the population attributable risk was 14.7% among workers with current asthma.These results suggest occupation contributes to approximately one in seven cases of severe exacerbation of asthma in a working population, and various agents play a role.

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

“…Occupational exposures have also been associated with late-onset, and often severe asthma [26]. Obesity is associated with both childhood and adult onset severe asthma, but the impact of obesity may differ by age at onset and degree of allergic inflammation [27,28].…”

Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II

“…In ECRHS II, significant associations were found between occupational exposure to dusts, gases and fumes in general (evaluated by the ALOHA JEM) and severe asthma exacerbation [21]. In the present analysis we evaluated occupational exposure to specific asthmagens by an asthma-specific JEM combined with an expert review step [13,19].…”

“…Oral corticosteroid used continuously may also be considered as a marker of asthma severity. In previous studies, exacerbations were defined only by hospitalisation or emergency aspects [31], or in addition to the ''use of oral corticosteroids when needed'' to evaluate severe exacerbations [21]. In ECRHS both aspects of exacerbations seem to be linked to occupational exposure to asthmagens [21].…”

“…Both exposures to LMW and HMW agents and to cleaning agents seem related to uncontrolled asthma. Occupational exposure is a preventable risk factor and the importance of prevention has been recently underlined [21,30,34]. Preventing asthma exacerbations, an important asthma control domain [4,11], is essential since severe asthma exacerbations have been related to accelerated decline in lung function [2].…”

“…Potential heterogeneity among areas (English speaking (UK and USA), northern, central or southern areas in Europe) was evaluated using the Q statistic. All analyses were adjusted for age, sex and smoking status with area included as a random effect [21]. Other additional analyses are described in the online supplementary material.…”