Work related asthma. A causal analysis controlling the healthy worker effect

Dumas, Orianne; Moual, Nicole Le; Siroux, Valérie; Heederik, Dick; Garcia‐Aymerich, Judith; Varraso, Raphäelle; Kauffmann, F.; Basagaña, Xavier

doi:10.1136/oemed-2013-101362

Cited by 41 publications

(34 citation statements)

References 34 publications

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“…Other behavioral changes influenced by the disease may impact the level of physical activity [143], avoidance of polluted places, or domestic habits (e.g., the use of cleaning sprays) [94]. Such interplay between risk factors and the disease may create complex situations of time-varying confounding [144,145]. Prospective studies with precise assessment of asthma history as well as several lifetime risk factors are needed to disentangle these complex phenomena.…”

Section: Interrelationship Between Environmental and Behavior Factorsmentioning

confidence: 97%

Environment and asthma in adults

et al. 2013

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Section: Interrelationship Between Environmental and Behavior Factorsmentioning

confidence: 97%

Environment and asthma in adults

et al. 2013

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“…A healthy worker effect, potentially more pronounced for irritant exposures [32], may partly prevent evidence for their role. In the current study, the odds ratios were relatively elevated and generally higher for current exposure, suggesting that the results were not strongly affected by a healthy worker effect.…”

Section: Discussionmentioning

confidence: 99%

Occupational irritants and asthma: an Estonian cross-sectional study of 34 000 adults

et al. 2014

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Occupational exposures make important contributions to asthma morbidity. The role of low/ moderate level irritant exposures remains unclear. We aimed to determine which occupational exposures are associated with asthma in an eastern European country with low asthma prevalence.The Estonian Genome Center of University of Tartu collected data from 50 077 adults in 2002-2011. Asthma was assessed through a questionnaire regarding diagnosed diseases, current health status and medication. Exposures to 22 agents during the current and longest held jobs were estimated using an asthma-specific job-exposure matrix.Analyses included 34 015 subjects (aged 18-65 years, 67.0% females), of which 1209 (3.6%) reported asthma (608 with physician-confirmed diagnosis). After adjusting for age, sex and smoking habits, lifetime occupational exposure to known asthmagens (20.4%) was significantly associated with physician-diagnosed asthma (OR 1.28, 95% CI 1.03-1.59), especially high molecular weight agents (flour: OR 2.36, 95% CI 1.31-4.27; animals: OR 1.62, 95% CI 1.00-2.60). Exposure to low/moderate levels of irritants (17.4%) was associated with physician-diagnosed asthma (OR 1.88, 95% CI 1.48-2.37). More pronounced associations were observed in subjects reporting current treated asthma.Beyond confirming the effect of known asthmagens (which are well-known, mostly from observations in western countries), the results provide evidence for a role of low/moderate exposure to irritants. This finding, observed in a country with a low prevalence of asthma and atopy, provides new insight into the understanding of asthma heterogeneity. @ERSpublications Increased asthma risk was associated with occupational exposure to moderate levels of irritants in an Estonian study

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“…The control group comprised 50 subjects with negative preliminary verification and they also were given the detailed WRA questionnaire. To evaluate the impact of occupational exposure on WRA recognition, the risk ratio (RR) Dumas et al also support the role of irritants in work-related asthma [7]. However, there were 15 WRA subjects who reported aggravation of asthma symptoms in exposure-free environment.…”

Section: Resultsmentioning

confidence: 99%

The prevalence of asthma work relatedness: Preliminary data

Dudek¹,

Kupryś‐Lipińska²,

Wittczak³

et al. 2015

Int J Occup Med Environ Health

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Objectives: About 5-10% of asthmatics do not respond well to standard treatment plan. Occupational exposure may be one of the factors that can be linked with treatment failure. The aim of the study was to assess the prevalence of workrelated asthma (WRA) among adult asthmatics under follow up in an outpatient allergy clinic and to create a useful tool for detecting individuals with possible WRA. Material and Methods: Preliminary 5-question questionnaire designed to recognize WRA was presented to 300 asthmatics. All patients with positive preliminary verification along with 50 subjects from control group were asked to fill up a detailed questionnaire. The WRA was diagnosed by positive match for asthma symptoms in combination with workplace exposure indicated in the detailed WRA questionnaire followed by confirmation of each WRA case by detailed exposure analysis. Results: Work-related asthma was recognized in 63 subjects (21% of study group). The preliminary questionnaire has 76.9% sensitivity and 94% specificity in recognition of WRA. Occupational exposure to irritants is a risk factor of WRA recognition (relative risk (RR) = 2.09 (1.44:3.03)). Working in exposure-free environment is a factor against WRA recognition (RR = 0.38 (0.24:0.61)). Among subjects with work-related asthma, the uncontrolled course of the disease is significantly more frequent (p = 0.012). Subjects with WRA more often report sickness absenteeism due to asthma than those without WRA (9.6% vs. 3.2%, respectively), but the observed differences did not reach the statistical significance. Conclusions: Short 5-question questionnaire seems to be a promising tool to detect individuals with possible work-related asthma in the outpatient setting for further evaluation and additional attention.

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Work related asthma. A causal analysis controlling the healthy worker effect

Abstract: The healthy worker effect has an important impact in risk assessment in work-related asthma studies. Marginal structural models are useful to eliminate imbalances in exposure due to disease-driven selection. Results support the role of irritants in work-related asthma.

Cited by 41 publications

References 34 publications

Environment and asthma in adults

Environment and asthma in adults

Occupational irritants and asthma: an Estonian cross-sectional study of 34 000 adults

The prevalence of asthma work relatedness: Preliminary data

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