ETIOLOGY OF COPD AMONG CONSTRUCTION WORKERS

描述(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，每年导致超过13万人死亡。至少15%的慢性阻塞性肺病病例可归因于职业暴露；然而，对于增加慢性阻塞性肺疾病风险的特定职业暴露因素或职业暴露与吸烟等其他危险因素的相互作用，人们知之甚少。我们建议通过初步研究，在被确定为慢性阻塞性肺病高风险的建筑和工艺工人中进行一项慢性阻塞性肺病的病例对照研究。这项研究包括广泛的建筑工艺品，这些工艺品与感兴趣的职业代理人有大量和不同的接触。这项研究将包括大约1500例COPD病例和1500名分组匹配的对照，这些病例是从接受由美国能源部支持的建筑业全国医疗筛查计划(BTMED)提供的职业医学检查的15,000多名工人中挑选出来的。Case and Controls将完成一次电话采访，以确定所有工作时间超过六个月、这些工作中特定任务的表现以及与被认为会增加COPD的代理的接触情况。一个由三名经验丰富的工业卫生师组成的小组将对研究参与者报告的工作和任务进行暴露评估。详细的分析将确定增加COPD风险的暴露，并评估职业风险因素与个人因素的相互作用，如吸烟、既往呼吸系统病史、与爱好有关的暴露以及COPD家族史。将BTMED检查的数据与访谈问卷中关于暴露的详细信息结合起来是创新的，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。这项研究解决了以前对COPD和职业的许多研究的局限性，包括：1)由于COPD病例数量少而统计能力低，2)COPD病例不是基于肺活量测量，3)暴露评估通常简单地基于职称、职业或行业，以及4)关于非职业风险因素的有限数据，如吸烟、肥胖、病史、家族史和与爱好相关的活动。研究团队由经验丰富的职业性肺病研究人员组成，他们有着长期的生产性合作历史。

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.