ETIOLOGY OF COPD AMONG CONSTRUCTION WORKERS

描述（由申请人提供）：美国有1200万人被诊断为慢性阻塞性肺疾病（COPD）。慢性阻塞性肺病是美国第四大死因，每年造成超过13万人死亡。至少15%的COPD病例可归因于职业暴露；然而，对于增加慢性阻塞性肺病风险的特定职业暴露剂或职业暴露与其他风险因素（如吸烟）的相互作用所知相对较少。我们建议在通过初步研究确定为COPD高风险的建筑和工艺工人中开展COPD病例对照研究。该研究包括广泛的建筑工艺与众多的和不同的暴露于职业代理人感兴趣。这项研究将包括大约1500例慢性阻塞性肺病病例和1500组匹配的对照，这些患者是从接受美国能源部支持的建筑行业国家医疗筛查计划（BTMED）提供的职业医学检查的15,000多名工人中挑选出来的。病例和对照组将完成一个电话访谈，以确定所有工作超过6个月，在这些工作中特定任务的表现，以及暴露于被认为会增加COPD的药物。一个由三名经验丰富的工业卫生学家组成的小组将对研究参与者报告的工作和任务进行接触评估。详细分析将确定增加COPD风险的暴露，并评估职业风险因素与个人因素（如吸烟、既往呼吸史、爱好相关暴露和COPD家族史）的相互作用。将BTMED检查数据与访谈问卷中暴露的详细信息相结合是一种创新，并提供了一个独特的机会，可以更多地了解增加COPD风险的特定暴露。本研究解决了先前COPD和职业研究的许多局限性，包括：1)由于COPD病例数量少，人口少，统计能力低；2)COPD病例不基于肺活量测定法；3)暴露评估通常简单地基于职称、职业或行业；4)关于非职业风险因素（如吸烟、肥胖、病史、家族史和爱好相关活动）的数据有限。研究小组由经验丰富的职业性肺病研究人员组成，具有长期的富有成效的合作历史。

DESCRIPTION (provided by applicant): Twelve million people in the US have diagnosed chronic obstructive pulmonary disease (COPD). COPD is the fourth leading cause of death in the US and is responsible for more than 130,000 deaths annually. At least 15% of COPD cases are attributable to occupational exposures; however, relatively little is known about specific occupational exposure agents that increase the risk of COPD or interactions of occupational exposures and other risk factors such as cigarette smoking. We propose to conduct a case-control study of COPD among construction and craft workers identified at high risk of COPD through preliminary studies. The study includes a broad spectrum of construction crafts with numerous and varied exposures to occupational agents of interest. This study will include approximately 1500 COPD cases and 1500 grouped-matched controls selected from a population of over 15,000 workers undergoing occupational medicine examinations provided by the Building Trades National Medical Screening Program (BTMED), supported by the US Department of Energy. Cases and controls will complete a telephone interview to determine all jobs held more than six months, performance of specific tasks in these jobs, and exposures to agents thought to increase COPD. A panel of three experienced industrial hygienists will conduct exposure assessments of jobs and tasks reported by study participants. Detailed analyses will identify exposures that increase COPD risk and evaluate interactions of occupational risk factors with personal factors such as smoking, prior respiratory history, hobby- related exposures, and family history of COPD. Combining data from the BTMED examinations with detailed information on exposures from the interview questionnaire is innovative and provides a unique opportunity to learn more about specific exposures increasing COPD risk. This study addresses many of the limitations of prior studies of COPD and occupation including: 1) low statistical power due to small populations with low numbers of COPD cases, 2) COPD cases not based on spirometry, 3) exposure assessments often simply based on job title, occupation, or industry, and 4) limited data on non-occupational risk factors such as cigarette smoking, obesity, medical history, family history, and hobby-related activities. The research team is comprised of experienced occupational lung disease researchers with a long history of productive collaboration. PUBLIC HEALTH RELEVANCE: COPD is a major public health problem with an estimated 12 million people in the US with diagnosed COPD and 12 million with undiagnosed COPD. More than 130,000 deaths occur annually in the US due to COPD. Occupational exposures are estimated to cause at least 15% of all COPD cases; however, little is known about specific agents and combinations of agents that increase risk. Knowledge of causative agents is key to development of appropriate prevention programs. This study addresses this public health information gap.