Occupational exposures and 20-year incidence of COPD: The European Community Respiratory Health Survey

Theodore Lytras, Manolis Kogevinas, Hans Kromhout, Anne Elie Carsin, Josep M. Antó, Hayat Bentouhami, Joost Weyler, Joachim Heinrich, Dennis Nowak, Isabel Urrutia, Jesús Martinez-Moratalla, José Antonio Gullón, Antonio Pereira-Vega, Chantal Raherison-Semjen, Isabelle Pin, Pascal Demoly, Bénédicte Leynaert, Simona Villani, Thorarinn Gislason, Cecilie SvanesMathias Holm, Bertil Forsberg, Dan Norbäck, Amar J. Mehta, Nicole Probst-Hensch, Geza Benke, Rain Jogi, Kjell Torén, Torben Sigsgaard, Vivi Schlünssen, Mario Olivieri, Paul D. Blanc, Roel Vermeulen, Judith Garcia-Aymerich, Deborah Jarvis, Jan Paul Zock

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52 Citations (Scopus)


Background: Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey. Methods: General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework. Findings: 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%. Interpretation: These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.

Original languageEnglish
Article number211158
Pages (from-to)1008-1015
Number of pages8
Issue number11
Publication statusPublished - 15 Oct 2018


  • copd epidemiology
  • occupational lung disease

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