Chronic productive cough and inhalant occupational exposure-a study of the general population

PURPOSE

Occupational inhalant exposures have been linked with a higher occurrence of chronic productive cough, but recent studies question the association.

METHODS

We included participants from two general population studies, the Copenhagen City General Population Study and the Copenhagen City Heart Study, to assess contemporary (year 2003-2017) and historical (1976-1983) occupational inhalant hazards. Job titles one year prior to study inclusion and an airborne chemical job-exposure matrix (ACE JEM) were used to estimate occupational exposure. The association between occupational exposures and self-reported chronic productive cough was studied using generalized estimating equations stratified by smoking status and cohort.

RESULTS

The population consisted of 5210 working individuals aged 20-65 from 1976 to 1983 and 64,279 from 2003 to 2017. In smokers, exposure to high levels of mineral dust, biological dust, gases & fumes and the composite variable vapours, gases, dusts or fumes (VGDF) were associated with chronic productive cough in both cohorts with odds ratios in the range of 1.2 (95% confidence interval, 1.0;1.4) to 1.6 (1.2;2.1). High levels of biological dust were only associated with an increased risk of a chronic productive cough in the 2003-2017 cohort (OR 1.5 (1.1;2.0)). In non-smokers, high levels of VGDF (OR 1.5 (1.0;2.3)) and low levels of mineral dust (OR 1.7 (1.1;2.4)) were associated with chronic productive cough in the 1976-1983 cohort, while no associations were seen in non-smokers in the 2003-2017 cohort.

CONCLUSION

Occupational inhalant exposure remains associated with a modestly increased risk of a chronic productive cough in smokers, despite declining exposure levels during the past four decades.

Respiratory Symptoms and Ventilatory Function in Never-Smoking Males Working in Dusty Occupations

AIM: To assess the effect of occupational exposure on respiratory symptoms and ventilatory capacity in never-smoking male workers exposed to mineral or organic dusts.MATERIAL AND METHODS: We performed a cross-sectional study including 138 never-smoking male workers exposed to mineral or organic dust (34 construction workers, 32 furniture manufacturers, 37 agricultural workers, and 35 bakers) and 35 unexposed controls (office workers). Evaluation of all study subjects included completion of a questionnaire and spirometric measurements.RESULTS: The prevalence of the overall respiratory symptoms in the last 12 months was higher in dusty occupation workers than its prevalence in office workers. Statistically significant difference was found between the prevalence of cough in construction workers, agricultural workers and bakers, as well as between the prevalence of phlegm in construction workers, furniture manufacturers and agricultural workers as compared to its prevalence in office workers. The mean values of spirometric parameters were lower in all groups of exposed workers as compared to their mean values in office workers with statistical significance for all measured parameters in construction workers and furniture manufacturers, as well as for small airways indices in agricultural workers and bakers.CONCLUSION: Our findings indicate significant effect of occupational exposure on respiratory symptoms and ventilatory capacity impairment in workers exposed to mineral or organic dusts.

EAACI Position Paper on assessment of cough in the workplace

Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker.

Chronic Obstructive Pulmonary Disease in Never-Smoking Bricklayers

Background: Chronic obstructive pulmonary disease (COPD) due to occupational exposures remains an important public health problem taking significant toll on the global burden of the disease.Aim: In order to assess chronic prevalence and characteristics of COPD in bricklaying we performed a cross-sectional study including 47 never-smoking male bricklayers (aged 34 to 57 years) and an equal number of never-smoking male office workers studied as a control.Methods: Evaluation of examined subjects consisted of completion of a questionnaire, baseline spirometry, and bronchodilator reversibility testing.Results: We found higher prevalence of respiratory symptoms in bricklayers with significant difference for cough and phlegm. Majority of the chronic respiratory symptoms in bricklayers were work-related. The mean values of all measured spirometric parameters in bricklayers were significantly lower than in office workers. The prevalence of COPD was significantly higher in bricklayers than in office workers (14.9% vs. 4.3%, P = 0.034). COPD in both examined groups was close related to age over 45 years, while in bricklayers significant association was registered for duration of occupational exposure longer than 20 years and work-related respiratory symptoms.Conclusion: Our findings support data about relationship between occupational exposure to inorganic dust and fumes in construction workers and persistent airflow limitation.