Swiss Tropical and Public Health Institute, Basel, Switzerland.
Am J Respir Crit Care Med. 2012 Jun 15;185(12):1292-300. doi: 10.1164/rccm.201110-1917OC. Epub 2012 Apr 6.
There is limited evidence from population-based studies demonstrating incidence of spirometric-defined chronic obstructive pulmonary disease (COPD) in association with occupational exposures.
We evaluated the association between occupational exposures and incidence of COPD in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA).
Prebronchodilator ratio of forced expiratory volume in 1 second over forced vital capacity (FEV(1)/FVC) was measured in 4,267 nonasthmatic SAPALDIA participants ages 18-62 at baseline in 1991 and at follow-up in 2001-2003. COPD was defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion (FEV(1)/FVC < 0.70) and Quanjer reference equation (FEV(1)/FVC < lower limit of normal [LLN]), and categorized by severity (≥ 80% and <80% predicted FEV(1) for stage I and stage II+, respectively). Using a job-exposure matrix, self-reported occupations at baseline were assigned exposures to biological dusts, mineral dusts, gases/fumes, and vapors, gases, dusts, or fumes (VGDF) (high, low, or unexposed as reference). Adjusted incident rate ratios (IRRs) of stage I and stage II+ COPD were estimated in mixed Poisson regression models. Statistically significant (P < 0.05) IRRs of stage II+ GOLD and LLN-COPD, indicating risks between two- and fivefold, were observed for all occupational exposures at high levels. Occupational exposure-associated risk of stage II+ COPD was observed mainly in males and ages ≥ 40 years, and remained elevated when restricted to nonsmokers.
In a Swiss working adult population, occupational exposures to biological dusts, mineral dusts, gases/fumes, and VGDF were associated with incidence of COPD of at least moderate severity.
仅有少量基于人群的研究证据表明职业暴露与肺功能指标界定的慢性阻塞性肺疾病（COPD）发病率相关。
我们评估了职业暴露与瑞士成人空气污染与肺部和心脏疾病队列研究（SAPALDIA）中 COPD 发病率之间的相关性。
在 1991 年基线和 2001-2003 年随访时，4267 名无哮喘的 SAPALDIA 参与者使用支气管扩张剂前 1 秒用力呼气量（FEV1）与用力肺活量（FVC）的比值（FEV1/FVC）进行了测量，年龄为 18-62 岁。COPD 按照全球慢性阻塞性肺疾病倡议（GOLD）标准（FEV1/FVC < 0.70）和 Quanjer 参考方程（FEV1/FVC < 正常值下限[LLN]）定义，并按照严重程度（I 期和 II+期分别为 FEV1 预测值的≥80%和 <80%）进行分类。使用职业暴露矩阵，根据基线时的自我报告职业，将暴露于生物性粉尘、矿物性粉尘、气体/烟雾和蒸气、气体、粉尘或烟雾（VGDF）赋值为高、低或未暴露（作为参考）。在混合泊松回归模型中，估算了 I 期和 II+期 COPD 的调整发病率比（IRR）。所有高水平的职业暴露均观察到 II+期 GOLD 和 LLN-COPD 的发病率比（IRR）具有统计学意义（P < 0.05），表明风险为 2 至 5 倍。在男性和年龄≥40 岁中观察到与职业相关的 II+期 COPD 发病风险，当仅限于非吸烟者时，该风险仍然较高。
在瑞士成年劳动人群中，生物性粉尘、矿物性粉尘、气体/烟雾和 VGDF 职业暴露与至少为中度严重程度的 COPD 发病率相关。
