Occupational chronic obstructive pulmonary disease: a systematic literature review

Øyvind Omland, Else Toft Würtz, Tor Brøvig Aasen, Paul Blanc, Jonas Brisman Brisman, Martin Reginald Miller, Ole Find Pedersen, Vivi Schlünssen, Torben Sigsgaard, Charlotte Suppli Ulrik, Sven Viskum
2013 Scandinavian Journal of Work, Environment and Health  
Occupational chronic obstructive pulmonary disease: a systematic literature review by Omland Ø, Würtz ET, Aasen TB, Blanc P, Brisman J, Miller MR, Pedersen OF, Schlünssen V, Sigsgaard T, Ulrik CS, Viskum S This review on occupational chronic obstructive pulmonary disease (COPD) addresses some of the potential limitations of earlier assessments by restricting the studies included to high quality epidemiological analysis involving only spirometrically confirmed air-flow obstruction as the
more » ... tion as the outcome. The authors combined this with minimal requirements for exposure characterization allowing for analysis of population-based studies. Objective Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures. Methods We used PubMed and Embase to identify relevant original epidemiological peer-reviewed articles, supplemented with citations identified from references in key review articles. This yielded 4528 citations. Articles were excluded for lack of lung function measurement, insufficient occupational exposure classification, lack of either external or internal referents, non-accounting of age or smoking effect, or major analytic inadequacies preventing interpretation of findings. A structured data extraction sheet was used for the remaining 147 articles. Final inclusion was based on a positive qualitative Scottish Intercollegiate Guidelines Network (SIGN) score (≥2+) for study quality, yielding 25 population-wide and 34 industry/occupation-specific studies, 15 on inorganic and 19 on organic dust exposure, respectively. Results There was a consistent and predominantly significant association between occupational exposures and COPD in 22 of 25 population-based studies, 12 of 15 studies with an inorganic/mineral dust exposure, and 17 of 19 studies on organic exposure, even though the studies varied in design, populations, and the use of measures of exposure and outcome. A nearly uniform pattern of a dose-response relationship between various exposures and COPD was found, adding to the evidence that occupational exposures from vapors, gas, dust, and fumes are risk factors for COPD. Conclusion There is strong and consistent evidence to support a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups. Chronic obstructive pulmonary disease (COPD) represents serious morbidity and has emerged as a leading cause of death worldwide (1). Although tobacco smoking is the leading factor in the etiology of COPD, the disease may be caused by inhalation of different gases and aerosols among both smokers and non-smokers (2). Various occupational exposures have been associated with COPD often in combination with tobacco smoking. As much as 15% of prevalent cases have been attributed to occupational exposures (3). Chronic airflow obstruction (or limitation) is the main defining characteristic of COPD. However, the terminology and diagnostic criteria of respiratory disease characterized by chronic obstruction has varied
doi:10.5271/sjweh.3400 pmid:24220056 fatcat:k67wvmaggnacxdlwftqfgpdsnm