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Chronic obstructive pulmonary disease
Original Article
Occupational exposure to pesticides are associated with fixed airflow obstruction in middle-age
  1. Sheikh M Alif1,
  2. Shyamali C Dharmage1,2,
  3. Geza Benke3,
  4. Martine Dennekamp3,4,
  5. John A Burgess1,
  6. Jennifer L Perret1,5,
  7. Caroline J Lodge1,
  8. Stephen Morrison6,
  9. David Peter Johns7,
  10. Graham G Giles1,2,8,
  11. Lyle C Gurrin1,2,
  12. Paul S Thomas9,
  13. John Llewelyn Hopper1,
  14. Richard Wood-Baker7,
  15. Bruce R Thompson10,
  16. Iain H Feather11,12,
  17. Roel Vermeulen13,
  18. Hans Kromhout13,
  19. E Haydn Walters1,3,7,
  20. Michael J Abramson3,
  21. Melanie Claire Matheson1,2
  1. 1 Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  3. 3 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  5. 5 Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
  6. 6 Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
  7. 7 School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
  8. 8 Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
  9. 9 Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  10. 10 Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
  11. 11 Gold Coast University Hospital, Southport, Queensland, Australia
  12. 12 Bond University, Robina, Queensland, Australia
  13. 13 Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Professor Shyamali C Dharmage, Head of the Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 3, 207 Bouverie St, Carlton 3010; s.dharmage{at}unimelb.edu.au

Abstract

Rationale Population-based studies have found evidence of a relationship between occupational exposures and Chronic Obstructive Pulmonary Disease (COPD), but these studies are limited by the use of prebronchodilator spirometry. Establishing this link using postbronchodilator is critical, because occupational exposures are a modifiable risk factor for COPD.

Objectives To investigate the associations between occupational exposures and fixed airflow obstruction using postbronchodilator spirometry.

Methods One thousand three hundred and thirty-five participants were included from 2002 to 2008 follow-up of the Tasmanian Longitudinal Health Study (TAHS). Spirometry was performed and lifetime work history calendars were used to collect occupational history. ALOHA plus Job Exposure Matrix was used to assign occupational exposure, and defined as ever exposed and cumulative exposure unit (EU)-years. Fixed airflow obstruction was defined by postbronchodilator FEV1/FVC <0.7 and the lower limit of normal (LLN). Multinomial logistic regressions were used to investigate potential associations while controlling for possible confounders.

Results Ever exposure to biological dust (relative risk (RR)=1.58, 95% CI 1.01 to 2.48), pesticides (RR=1.74,95% CI 1.00 to 3.07) and herbicides (RR=2.09,95% CI 1.18 to 3.70) were associated with fixed airflow obstruction. Cumulative EU-years to all pesticides (RR=1.11,95% CI 1.00 to 1.25) and herbicides (RR=1.15,95% CI 1.00 to 1.32) were also associated with fixed airflow obstruction. In addition, all pesticides exposure was consistently associated with chronic bronchitis and symptoms that are consistent with airflow obstruction. Ever exposure to mineral dust, gases/fumes and vapours, gases, dust or fumes were only associated with fixed airflow obstruction in non-asthmatics only.

Conclusions Pesticides and herbicides exposures were associated with fixed airflow obstruction and chronic bronchitis. Biological dust exposure was also associated with fixed airflow obstruction in non-asthmatics. Minimising occupational exposure to these agents may help to reduce the burden of COPD.

  • Occupational exposure
  • Pesticide
  • Job exposure matrix
  • ALOHA JEM
  • Chronic obstructive pulmonary disease
  • Airflow obstruction

https://doi.org/10.1136/thoraxjnl-2016-209665

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    Footnotes

    • Contributors Study concept and design: SMA, SCD, GB, RV, HK, EHW, MJA, MCM. Acquisition of data: SMA, SCD, JLP, PST, RWB, BRT, IHF, RV, HK, EHW, MJA, MCM.Analysis and interpretation of data: SMA, SCD, GB, MD, LCG, RV, HK, MJA, MCM. Drafting of the manuscript: SMA, SCD, GB, MD, MCM. Critical revision of the manuscript for important intellectual content: All Authors. Statistical analysis: SMA, LCG, MCM. Obtained funding: SCD, GB, DPJ, LCG, PST, JLH, RWB, BRT, IHF, EHW, MJA, MCM. Study supervision: SMA, SCD, GB, MD, MCM. SMA and MCM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding Supported by the National Health and Medical Research Council of Australia; Clifford Craig Medical Research Trust of Tasmania; Victorian, Queensland, and Tasmanian Asthma Foundations; and the Australian Lung Foundation. SCD is supported by the NHMRC.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.