Association between Occupational Exposure and Lung Function, Respiratory Symptoms, and High-Resolution Computed Tomography Imaging in COPDGene
Association between Occupational Exposure and Lung Function, Respiratory Symptoms, and High-Resolution Computed Tomography Imaging in COPDGene
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DOI：
10.1164/rccm.201403-0493oc
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发表时间：
2014-10-01
影响因子：
24.7
通讯作者：
Crapo, James D.
中科院分区：
文献类型：
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作者：
Marchetti, Nathaniel;Garshick, Eric;Crapo, James D.
理由：虽然职业性接触粉尘和烟雾被认为是慢性阻塞性肺疾病的一个危险因素，但在以男性为主的人群中，仅依靠肺活量测定法来评估疾病严重程度，这一确定受到了限制。目的：确定职业暴露对男性和女性肺功能、呼吸系统症状、肺气肿表现和气道壁厚度的影响。方法：COPDGene是一项多中心研究，对目前和以前的吸烟者进行了标准化的胸部容积计算机断层扫描，以评估气道、肺气肿和气体捕获。还分析了9614名受试者（4496名女性）的肺活量测定和包括职业史的呼吸问卷。使用逻辑回归和协方差分析来评估与暴露的关系。测量结果和主要结果：47.9%的男性和20.1%的女性报告了粉尘和烟雾的职业暴露。调整年龄、种族、体重指数、教育程度、当前和终生吸烟等因素后，暴露于粉尘和烟雾的慢性咳嗽、慢性痰、持续性喘息、慢性阻塞性肺疾病全球倡议2期和更高级别慢性阻塞性肺疾病患者的比值比显著升高，男性（分别为1.83、1.84、2.0、1.61）和女性（分别为1.65、1.82、1.98、1.90）的比值比相似。男性（70.7 +/- 0.8 vs. 76.0 +/- 0.9; P < 0.001）和女性（70.5 +/- 0.8 vs. 77.2 +/- 0.8; P < 0.001）的预测FEV1百分比同样较低。暴露在灰尘和烟雾中的男性和女性患肺气肿和气体捕获的比例更高。在男性中，而不是女性中，暴露者的内周径气道平均平方根壁面积更大，为10毫米。结论：男性和女性职业接触粉尘和烟雾与气流阻塞、呼吸道症状、更多肺气肿和气体困住的关系相似。
Rationale: Although occupational exposure to dust and fumes is considered a risk factor for chronic obstructive pulmonary disease, this determination has been limited by reliance on spirometry alone to assess disease severity in predominantly male populations.Objectives: To determine the effect of occupational exposure on lung function, respiratory symptoms, and findings of emphysema and airway wall thickness measured using quantitative computed tomography in men and women.Methods: COPDGene is a multicenter study of current and former smokers that underwent standardized volumetric chest computed tomography scans to assess airways, % emphysema, and % gas trapping. Spirometry and a respiratory questionnaire including occupational history were also analyzed in 9,614 subjects (4,496 women). Logistic regression and analysis of covariance was used to assess associations with exposure.Measurements and Main Results: Occupational exposure to both dust and fumes was reported by 47.9% of men and 20.1% of women. Adjusting for age, race, body mass index, education, and current and lifetime smoking, the odds ratios for persons with dust and fume exposures for chronic cough, chronic phlegm, persistent wheeze, and Global Initiative for Chronic Obstructive Lung Disease stages 2 and higher chronic obstructive pulmonary disease were significantly elevated and similar for men (1.83, 1.84, 2.0, 1.61, respectively) and women (1.65, 1.82, 1.98, 1.90, respectively). The % predicted FEV1 was similarly lower in those with exposure in men (70.7 +/- 0.8 vs. 76.0 +/- 0.9; P < 0.001) and women (70.5 +/- 0.8 vs. 77.2 +/- 0.8; P < 0.001). Percent emphysema and gas trapping was greater in those exposed to dust and fumes in men and women. In men, but not in women, persons with exposure had a greater mean square root wall area of 10-mm internal perimeter airways.Conclusions: Occupational exposure to dust and fumes in men and women is similarly associated with airflow obstruction, respiratory symptoms, more emphysema, and gas trapping in men and women.