Occupational Exposure to Dusts/Gases/Fumes Is Contributed to Chronic Obstructive Pulmonary Disease and Respiratory Symptoms_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHOU Yumin , WANG Chen , YAO Wanzhen , CHENPing , KANG Jian , HUANG Shaoguang , CHENBaoyuan , WANGChangzheng , NI Diantao , WANG Xiaoping , WANGDali , LIUShengming , LV Jiachun , ZHENG Jingping , ZHONG Nanshan , RAN Pixin.

The State Key Lab of Respiratory Disease,Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical College. Guangzhou,Guangdong, 510120, China.;

Corresponding author：

Keywords：

Chronic obstructive pulmonary disease; Epidemiology; Occupational exposure; Dust; Smog

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【Abstract】Objective To investigate the contribution of occupational exposure to dusts / gases / fumes to chronic obstructive pulmonary disease( COPD) and respiratory symptoms in China. Methods Based on the crosssectional survey of COPD which was conducted in urban and rural areas of Beijing, Shanghai, Guangdong,Liaoning, Tianjin, Chongqing and Shanxi for residents aged 40 years or older, the association between the occupational exposure to dusts/ gases/ fumes and COPD and respiratory symptoms was analyzed. The recruited populations were interviewed with questionnaire and were tested with spirometry. The post-bronchodilators FEV1 /FVC lt; 70% was used as diagnostic criteria of COPD. Having any cough, sputum, wheezing and dyspnea was defined as having respiratory symptoms. Results The prevalence of occupational exposure to dusts/ gases /fumes was 20. 5% . As shown by multiple-variables Logistic regression analyses, occupational exposure to dusts / fumes /gases [ OR = 1. 20 ( 1. 04, 1. 39) ] and dusts of grain [ 1. 48 ( 1. 18, 1. 86) ] were associated with COPD;occupational exposure to dusts / fumes / gases [ OR = 1. 37( 1. 25, 1. 49) ] , hard-rock mining [ OR = 2. 31( 1. 67,3. 20) ] , coal mining [ OR = 1. 71( 1. 09, 2. 70) ] , dusts of cement [ OR = 1. 92( 1. 47, 2. 52) ] , chemical or plastics manufacturing [ OR =1. 58( 1. 37, 1. 83) ] , spray painting [ OR= 1. 46( 1. 16, 1. 84) ] , and other dusts or fumes [ OR = 1. 46 ( 1. 29, 1. 64 ) ] were associated with the respiratory symptoms. Smoking and occupational exposure to dusts / gases / fumes had synergic effects on the increasing risk of respiratory symptoms. The populationattributable risk ( PAR) of exposure to dusts / gases / fumes was 3. 94% and 7. 05% for COPD and respiratory symptoms respectively. Conclusions Occupational exposure to dusts /gases /fumes is associated with COPD and respiratory symptoms. Smoking and occupational exposure to dusts/ gases /fumes may have synergic effects on respiratory symptoms.

Citation： ZHOU Yumin,WANG Chen,YAO Wanzhen,CHENPing,KANG Jian,HUANG Shaoguang,CHENBaoyuan,WANGChangzheng,NI Diantao,WANG Xiaoping,WANGDali,LIUShengming,LV Jiachun,ZHENG Jingping,ZHONG Nanshan,RAN Pixin.. Occupational Exposure to Dusts/Gases/Fumes Is Contributed to Chronic Obstructive Pulmonary Disease and Respiratory Symptoms. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(1): 6-11. doi: Copy

1.	National Heart, Lung, and Blood Institute and World Health Organization.Global initiative for chronic obstructive lung disease: a collaborative project of the National, Heart, Lung, and Blood Institute and the World Health ganization. Bethesda, MD: National Institutes of Health, 2001.
2.	王曾礼. 更新对慢性阻塞性肺疾病认识的观念. 中国呼吸与危重监护杂志, 2007, 6: 401-402.
3.	白冲. 慢性阻塞性肺疾病的危险因素、流行情况及未来发展趋势. 中国呼吸与危重监护杂志, 2007, 6: 403-405.
4.	刘辉国, 徐永健. 慢性阻塞性肺疾病: 从气道慢性炎症到全身慢性炎症. 中国呼吸与危重监护杂志, 2007, 6: 410-4412.
5.	Meijer E, Kromhoult H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med, 2001, 40: 133-140.
6.	Buist AS, Vollmer W, Weiss KB, et al. Burden of Obstructive Lung Disease ( BOLD) . Portland: University of Oregon, 2004. Available at: http: / /www. kpchr. org/ boldcopd/ apps / protocol. pdf ( accessed Apr 2005) .
7.	Rothman K, Greenland S. Modern epidemiology. Philadelphia:Lippin-456. cott-Raven, 1998, 295.
8.	Love RG, Miller BG. Longitudinal study of lung function in coalminers.Thorax, 1982, 37: 193-197.
9.	Hnizdo E, Baskind E, Sluis-Cremer GK. Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. Scand J Work Environ Health,1990, 16: 411-422.
10.	Ulvestad B, Bakke B, Eduard W, et al. Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers. Occup Environ Med, 2001, 58: 663-669.
11.	Irslinger GB, Visser PJ, Spangenberg PA. Asthma and chronic bronchitis in vanadium workers. Am J Ind Med, 1999, 35: 366 -374.
12.	Wang ML, McCabe L, Hankison JL, et al. Longitudinal and crosssectional analyses of lung function in steelworkers. Am J Respir Crit Care Med, 1996, 153: 1907-1913.
13.	Nemery B, Van Leemputten R, Goemaere E, et al. Lung function measurements over 21 days shiftwork in steelworkers from a standcasting department. Br J Ind Med, 1985, 42: 601-611.
14.	Mastrangelo G, Tartari M, Fedeli U, et al. Ascertaining the risk of chronic obstructive pulmonary diseases in relation to occupation using a case-control design. Occup Med ( Lond ) , 2003, 53: 165 -172.
15.	Kirkhorn SR, Garry VF. Agriculture lung diseases. Environ Health Perspect, 2000, 108( suppl 4) : 705-712.
16.	Piirila PL, Nordman H, Korhonen OS, et al. A thirteen-year follow-up of respiratory effects of acute exposure to sulfur dioxide. Scand J Work Environ Health, 1996 , 22: 191 -196.
17.	Becklake MR, Goldman HI, Bosman AR, et al. The long-term effects of exposure to nitrous fumes. Am Rev Tuberc, 1957, 76: 398-409.
18.	Davison AG, Fayers PM, Newman Taylor AJ, et al. Cadmium fume inhalation and emphysema. Lancet, 1988, 1: 663-667.
19.	Nakadate T, Aizawa Y, Yagami T, et al. Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by agnetopneumography in Japanese arc welders. Occup Environ Med, 1998, 55: 673-677.
20.	Hammond SK, Gold E, Baker R, et al. Respiratory Health Effects Related to Occupational Spray Painting and Welding. J Occup Environ Med, 2005, 47: 728-739.
21.	Bradshaw LM, Fishwick D, Slater T, et al. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med, 1998, 55: 150 -154.
22.	Sobaszek A, Boulenguez C, Frimat P, et al. Acute respiratory effects of exposure to stainless steel and mild steel welding fumes. J Occup Environ Med, 2000, 42: 923-931.
23.	刘春涛, 冯玉麟. 慢性阻塞性肺疾病全球创议慢性阻塞性肺疾病诊断、管理和预防袖珍指南( 2006 年修订版) . 中国呼吸与危重监护杂志, 2007, 6: 230-237.
24.	Trupin L, Earnest G, San Pedro M, et al. The occupational burden of chronic obstructive pulmonary disease. Eur Respir J, 2003, 22:462 -469.
25.	Balmes J, Becklake M, Blanc P, et al. Occupational contribution to the burden of airway disease ( an official statement of the American Thoracic Society) . Am J Respir Crit Care Med, 2003, 167: 787-797.
26.	Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the U. S. population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol, 2002 ,156: 738-746.
27.	Attfield MD. Longitudinal decline in FEV1 in United States coalminers. Thorax, 1985, 40: 132-137.
28.	Kauffmann F, Drouet D, Lellouch J, et al. Occupational exposure and 12 year spirometric changes among Paris area workers. Br J Ind Med,1982, 39: 221-232.
29.	Bergdahl IA, Toren K, Eriksson K, et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J,2004, 23: 402-406.
30.	Leigh JP, Romano PS, Schenker MB, et al. Costs of occupational chronic obstructive pulmonary disease and asthma. Chest, 2002, 121:264 -272.
31.	Gomes J, Lloyd OL, Norman NJ, et al. Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country.Occup Environ Med, 2001, 58, 656-662.
32.	Olenchock SA,May JJ, Pratt DS, et al. Presence of endotoxins in different agriculture environments. Am J Ind Med, 1990, 18: 279-284.
33.	Jagielo PJ, Thorne PS, Watt JL, et al. dust and endotoxin inhalation challenges produce similar inflammatory responses in normal subjects. Chest, 1996, 110: 263-270.

1. National Heart, Lung, and Blood Institute and World Health Organization.Global initiative for chronic obstructive lung disease: a collaborative project of the National, Heart, Lung, and Blood Institute and the World Health ganization. Bethesda, MD: National Institutes of Health, 2001.
2. 王曾礼. 更新对慢性阻塞性肺疾病认识的观念. 中国呼吸与危重监护杂志, 2007, 6: 401-402.
3. 白冲. 慢性阻塞性肺疾病的危险因素、流行情况及未来发展趋势. 中国呼吸与危重监护杂志, 2007, 6: 403-405.
4. 刘辉国, 徐永健. 慢性阻塞性肺疾病: 从气道慢性炎症到全身慢性炎症. 中国呼吸与危重监护杂志, 2007, 6: 410-4412.
5. Meijer E, Kromhoult H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med, 2001, 40: 133-140.
6. Buist AS, Vollmer W, Weiss KB, et al. Burden of Obstructive Lung Disease ( BOLD) . Portland: University of Oregon, 2004. Available at: http: / /www. kpchr. org/ boldcopd/ apps / protocol. pdf ( accessed Apr 2005) .
7. Rothman K, Greenland S. Modern epidemiology. Philadelphia:Lippin-456. cott-Raven, 1998, 295.
8. Love RG, Miller BG. Longitudinal study of lung function in coalminers.Thorax, 1982, 37: 193-197.
9. Hnizdo E, Baskind E, Sluis-Cremer GK. Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners. Scand J Work Environ Health,1990, 16: 411-422.
10. Ulvestad B, Bakke B, Eduard W, et al. Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers. Occup Environ Med, 2001, 58: 663-669.
11. Irslinger GB, Visser PJ, Spangenberg PA. Asthma and chronic bronchitis in vanadium workers. Am J Ind Med, 1999, 35: 366 -374.
12. Wang ML, McCabe L, Hankison JL, et al. Longitudinal and crosssectional analyses of lung function in steelworkers. Am J Respir Crit Care Med, 1996, 153: 1907-1913.
13. Nemery B, Van Leemputten R, Goemaere E, et al. Lung function measurements over 21 days shiftwork in steelworkers from a standcasting department. Br J Ind Med, 1985, 42: 601-611.
14. Mastrangelo G, Tartari M, Fedeli U, et al. Ascertaining the risk of chronic obstructive pulmonary diseases in relation to occupation using a case-control design. Occup Med ( Lond ) , 2003, 53: 165 -172.
15. Kirkhorn SR, Garry VF. Agriculture lung diseases. Environ Health Perspect, 2000, 108( suppl 4) : 705-712.
16. Piirila PL, Nordman H, Korhonen OS, et al. A thirteen-year follow-up of respiratory effects of acute exposure to sulfur dioxide. Scand J Work Environ Health, 1996 , 22: 191 -196.
17. Becklake MR, Goldman HI, Bosman AR, et al. The long-term effects of exposure to nitrous fumes. Am Rev Tuberc, 1957, 76: 398-409.
18. Davison AG, Fayers PM, Newman Taylor AJ, et al. Cadmium fume inhalation and emphysema. Lancet, 1988, 1: 663-667.
19. Nakadate T, Aizawa Y, Yagami T, et al. Change in obstructive pulmonary function as a result of cumulative exposure to welding fumes as determined by agnetopneumography in Japanese arc welders. Occup Environ Med, 1998, 55: 673-677.
20. Hammond SK, Gold E, Baker R, et al. Respiratory Health Effects Related to Occupational Spray Painting and Welding. J Occup Environ Med, 2005, 47: 728-739.
21. Bradshaw LM, Fishwick D, Slater T, et al. Chronic bronchitis, work related respiratory symptoms, and pulmonary function in welders in New Zealand. Occup Environ Med, 1998, 55: 150 -154.
22. Sobaszek A, Boulenguez C, Frimat P, et al. Acute respiratory effects of exposure to stainless steel and mild steel welding fumes. J Occup Environ Med, 2000, 42: 923-931.
23. 刘春涛, 冯玉麟. 慢性阻塞性肺疾病全球创议慢性阻塞性肺疾病诊断、管理和预防袖珍指南( 2006 年修订版) . 中国呼吸与危重监护杂志, 2007, 6: 230-237.
24. Trupin L, Earnest G, San Pedro M, et al. The occupational burden of chronic obstructive pulmonary disease. Eur Respir J, 2003, 22:462 -469.
25. Balmes J, Becklake M, Blanc P, et al. Occupational contribution to the burden of airway disease ( an official statement of the American Thoracic Society) . Am J Respir Crit Care Med, 2003, 167: 787-797.
26. Hnizdo E, Sullivan PA, Bang KM, et al. Association between chronic obstructive pulmonary disease and employment by industry and occupation in the U. S. population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol, 2002 ,156: 738-746.
27. Attfield MD. Longitudinal decline in FEV1 in United States coalminers. Thorax, 1985, 40: 132-137.
28. Kauffmann F, Drouet D, Lellouch J, et al. Occupational exposure and 12 year spirometric changes among Paris area workers. Br J Ind Med,1982, 39: 221-232.
29. Bergdahl IA, Toren K, Eriksson K, et al. Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J,2004, 23: 402-406.
30. Leigh JP, Romano PS, Schenker MB, et al. Costs of occupational chronic obstructive pulmonary disease and asthma. Chest, 2002, 121:264 -272.
31. Gomes J, Lloyd OL, Norman NJ, et al. Dust exposure and impairment of lung function at a small iron foundry in a rapidly developing country.Occup Environ Med, 2001, 58, 656-662.
32. Olenchock SA,May JJ, Pratt DS, et al. Presence of endotoxins in different agriculture environments. Am J Ind Med, 1990, 18: 279-284.
33. Jagielo PJ, Thorne PS, Watt JL, et al. dust and endotoxin inhalation challenges produce similar inflammatory responses in normal subjects. Chest, 1996, 110: 263-270.

Chinese Journal of Respiratory and Critical Care Medicine

Occupational Exposure to Dusts/Gases/Fumes Is Contributed to Chronic Obstructive Pulmonary Disease and Respiratory Symptoms

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