National Heart and Lung Institute, Imperial College London, London, UK
MRC-PHE Centre for Environment and Health, London, UK.
Eur Respir J. 2019 Jul 18;54(1). doi: 10.1183/13993003.00186-2019. Print 2019 Jul.
Occupational exposures are important, preventable causes of chronic obstructive pulmonary disease (COPD). Identification of COPD high-risk jobs is key to focus preventive strategies, but a definitive job-list is unavailable.We addressed this issue by evaluating the association of lifetime job-histories and lung function data in the population-based UK Biobank cohort, whose unprecedented sample size allowed analyses restricted to never-smokers to rule out the most important confounder, tobacco smoking. COPD was spirometrically defined as forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal. Lifetime job-histories were collected OSCAR (Occupations Self-Coding Automatic Recording), a new validated online tool that automatically codes jobs into the UK Standard Occupational Classification v.2000. Prevalence ratios for COPD by employment duration in each job compared to lifetime office workers were estimated using robust Poisson regression adjusted for age, sex, centre and smoking. Only associations confirmed among never-smokers and never-asthmatics were considered reliable.From the 116 375 participants with complete job-histories, 94 551 had acceptable/repeatable spirometry data and smoking information and were included in the analysis. Six occupations showed an increased COPD risk among never-smokers and never-asthmatics; most of these also with positive exposure-response trends. Interesting new findings included sculptors, gardeners and warehouse workers.COPD patients, especially never-smokers, should be asked about their job-history for better disease management. Focussed preventive strategies in COPD high-risk jobs are warranted.
职业暴露是慢性阻塞性肺疾病（COPD）的重要可预防病因。确定 COPD 的高风险职业是集中预防策略的关键，但目前还没有明确的职业清单。我们通过评估基于人群的英国生物库队列中的终身职业史和肺功能数据之间的关联来解决这个问题，该队列的样本量空前，允许对从不吸烟者进行分析，以排除最重要的混杂因素，即吸烟。COPD 通过 1 秒用力呼气量/用力肺活量比低于正常下限的肺活量测定法来定义。终身职业史是通过 OSCAR（职业自我编码自动记录）收集的，这是一种新的经过验证的在线工具，它可以将职业自动编码为英国标准职业分类 v.2000。使用经过年龄、性别、中心和吸烟调整的稳健泊松回归估计与终身办公室工作者相比，每个工作的 COPD 发病持续时间的患病率比，并仅考虑在从不吸烟者和从未患过哮喘者中得到证实的关联是可靠的。从有完整职业史的 116375 名参与者中，有 94551 名参与者有可接受/可重复的肺活量数据和吸烟信息，并纳入分析。有 6 种职业在从不吸烟者和从未患过哮喘者中显示出 COPD 风险增加；其中大多数还存在阳性暴露反应趋势。有趣的新发现包括雕塑家、园丁和仓库工人。COPD 患者，尤其是从不吸烟者，应询问其职业史，以更好地进行疾病管理。有必要针对 COPD 高风险职业制定有针对性的预防策略。
