Exposure to substances in the workplace and new-onset asthma:: an international prospective population-based study (ECRHS-II)
Exposure to substances in the workplace and new-onset asthma:: an international prospective population-based study (ECRHS-II)
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DOI：
10.1016/s0140-6736(07)61164-7
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发表时间：
2007-07-01
期刊：
影响因子：
168.9
通讯作者：
Anto, Josep M.
中科院分区：
文献类型：
--
作者：
Kogevinas, Manolis;Zock, Jan-Paul;Anto, Josep M.
背景：在基于人群的研究中，工作场所接触物质在新发哮喘中的作用没有得到很好的描述。因此，我们的目标是估计与职业、工作相关暴露和吸入事故有关的新发哮喘的相对和归因风险。方法我们前瞻性地研究了来自13个国家的6837名参与者，他们以前参加了欧洲共同体呼吸健康调查(1990-95)，在第一次研究时没有报告呼吸道症状或哮喘病史。哮喘评定采用乙酰甲胆碱激发试验和哮喘症状问卷调查。暴露由高危职业、哮喘特有的工作暴露矩阵和额外的专家判断以及急性吸入事件的自我报告来定义。根据年龄、性别、吸烟和研究中心调整的对数二项模型计算了新发哮喘的相对风险。结果发现，暴露于已知的导致职业性哮喘的物质后，哮喘风险显著增加(相对风险=1.6，95%CI1.1-2.3，p=0.017)。哮喘的风险最高，除症状外，还包括支气管高反应性(2.4，1.3-4.6p=0.008)。在常见职业中，护理职业患哮喘的风险显著高于其他职业(2.2，1.3-4.0，p=0.007)。报告有急性症状性吸入事件如火灾、混合清洁产品或化学品泄漏的参与者哮喘风险也增加(RR=3.395%CI1.0-11.1，p=0.051)。职业性接触致成人哮喘的人群归因危险度为10%~25%，相当于每年每百万人新发职业性哮喘250~300例，占成人哮喘发病率的相当大比例。吸入事故后患哮喘的风险增加，这表明发生此类事故的工人应该受到密切监测。
Background The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents.Methods We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study Centre.Findings A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4,1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2,1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year.Interpretation Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.