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. 2023 Dec 30;81(1):26-33.
doi: 10.1136/oemed-2023-108908. Online ahead of print.

Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort

Jessica Gerlich  1   2 , Johan Ohlander  3   4 , Hans Kromhout  4 , Roel Vermeulen  4 , Sandra Söhler  5 , Katja Radon  3   2 , Dennis Nowak  3   2 , Stefan Karrasch  3   6 , Nina Adaskina  7 , Claus Vogelmeier  5 , Uta Ochmann  3 , Rudolf A Jörres  3   2
Affiliations

Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort

Jessica Gerlich et al. Occup Environ Med. .

Abstract

Objectives: The impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking.

Methods: Data from 1283 men and 759 women (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 or former grade 0, without alpha-1-antitrypsin deficiency) of the COPD and Systemic Consequences Comorbidities Network cohort were analysed. Cumulative exposure to gases/fumes, biological dust, mineral dust or the combination vapours/gases/dusts/fumes was assessed using the ALOHA job exposure matrix. The effect of both occupational and smoking exposure on lung function and disease-specific QoL (St George's Respiratory Questionnaire) was analysed using linear regression analysis adjusting for age, body mass index, diabetes, hypertension and coronary artery disease, stratified by sex.

Results: In men, exposure to gases/fumes showed the strongest effects among occupational exposures, being significantly associated with all lung function parameters and QoL; the effects were partially stronger than of smoking. Smoking had a larger effect than occupational exposure on lung diffusing capacity (transfer factor for carbon monoxide) but not on air trapping (residual volume/total lung capacity). In women, occupational exposures were not significantly associated with QoL or lung function, while the relationships between lung function parameters and smoking were comparable to men.

Conclusions: In patients with COPD, cumulative occupational exposure, particularly to gases/fumes, showed effects on airway obstruction, air trapping, gas uptake capacity and disease-related QoL, some of which were larger than those of smoking. These findings suggest that lung air trapping and QoL should be considered as outcomes of occupational exposure to gases and fumes in patients with COPD.

Trial registration number: NCT01245933.

Keywords: Dust; Epidemiology; Lung Diseases, Interstitial; Nicotine; Occupational Health.

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Conflict of interest statement

Competing interests: DN received honoraria for lectures from Bristol Myers Squibb, Berlin Chemie, Boehringer Ingelheim, Chiesi, GlaxoSmithKline (GSK), Mundipharma, Novartis, Hexal and Lilly. Moreover, he received payments for expert testimony from courts and social accident insurances and institutional travel support from LMU Munich and reports personal stocks (mixed). SK received grants (82DZL083B2) from the German Center for Lung Research (DZL). Within the past 36 months, CV received grants or contracts from the German Ministry of Education and Science (BMBF) and from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GSK, Grifols and Novartis. Moreover, he received consulting fees from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GSK, Insmed, Menarini, Novartis and Nuvaira, and payments for lectures, presentations, speaker bureaus, manuscript writing or educational events from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GSK, Insmed, Menarini, Novartis, Roche and Sanofi. UO is the chair of the Committee for Maternity Protection (Ausschuss für Mutterschutz), Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ). She received payments from GSK for a lecture on vaccination in health settings, from Sozial- und Arbeitsmedizinische Akademie Baden-Württemberg (SAMA) for a lecture on maternity protection and from Akademie für Gesundheit und Lebensmittelsicherheit im Bayerischen Landesamt für Gesundheit und Lebensmittelsicherheit for a lecture on maternity protection. She received support for attending meetings/travel from BMJSFJ and from the LMU University Hospital, LMU Munich. HK is the editor-in-chief of Occupational and Environmental Medicine.

Figures

Figure 1
Figure 1
Percentage change in lung function parameters (FEV1 %predicted, RV/TLC %, TLCO %predicted) and health-related quality of life (SGRQ score) corresponding to interquartile increases in the cumulative occupational exposure to gases and fumes in the patients’ last four jobs and to pack years, respectively, in (A) men (n=1283) and (B) women (n=759). The vertical axis shows the changes in %predicted for FEV1 and TLCO, the changes in RV/TLC expressed as per cent without reference to prediction equations, and for the SGRQ the change in score points. FEV1 %predicted, percentage of predicted value of forced expiratory volume in 1 s; RV/TLC %, per cent ratio of residual volume to total lung capacity; SGRQ, St George’s Respiratory Questionnaire; TLCO %predicted, percentage of predicted value of transfer factor for carbon monoxide from single-breath measurements.
See this image and copyright information in PMC

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