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; Johan Ohlander; Hans Kromhout; Roel Vermeulen; Sandra Söhler; Katja Radon; Dennis Nowak; Stefan Karrasch; Nina Adaskina; Claus Vogelmeier; Uta Ochmann; Rudolf A Jörres

doi:10.1136/oemed-2023-108908

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

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

Authors

Jessica Gerlich^{1

2}, Johan Ohlander^{3

4}, Hans Kromhout⁴, Roel Vermeulen⁴, Sandra Söhler⁵, Katja Radon^{3

2}, Dennis Nowak^{3

2}, Stefan Karrasch^{3

6}, Nina Adaskina⁷, Claus Vogelmeier⁵, Uta Ochmann³, Rudolf A Jörres^{3

2}

Affiliations

¹ Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany Jessica.Gerlich@med.uni-muenchen.de.
² Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
³ Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
⁴ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
⁵ Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Philipps-Universität Marburg, Marburg, Germany.
⁶ Institute of Epidemiology, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Germany.
⁷ CAPNETZ STIFTUNG, Hannover, Germany.

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.

Associated data

ClinicalTrials.gov/NCT01245933