Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)

Manolis Kogevinas; Jan Paul Zock; Debbie Jarvis; Hans Kromhout; Linnéa Lillienberg; Estel Plana; Katja Radon; Kjell Torén; Ada Alliksoo; Geza Benke; Paul D. Blanc; Anna Dahlman-Hoglund; Angelo D'Errico; Michel Héry; Susan Kennedy; Nino Kunzli; Bénédicte Leynaert; Maria C. Mirabelli; Nerea Muniozguren; Dan Norbäck; Mario Olivieri; Félix Payo; Simona Villani; Marc van Sprundel; Isabel Urrutia; Gunilla Wieslander; Jordi Sunyer; Josep M. Antó; M. Abramson; R. Woods; E. H. Walters; F. Thien; P. Vermeire; J. Weyler; M. Van Sprundel; V. Nelen; R. Jogi; A. Soon; F. Neukirch; R. Liard; M. Zureik; I. Pin; J. Ferran-Quentin; J. Heinrich; M. Wjst; C. Frye; I. Meyer; T. Gislason; M. Bugiani; P. Piccioni; A. Carosso; W. Arossa; E. Caria; G. Castiglioni; E. Migliore; C. Romano; D. Fabbro; G. Ciccone; C. Magnani; P. Dalmasso; R. Bono; G. Gigli; A. Giraudo; M. C. Brussino; C. Bucca; G. Rolla; R. de Marco; G. Verlato; E. Zanolin; S. Accordini; A. Poli; V. Lo Cascio; M. Ferrari; A. Marinoni; M. Ponzio; F. Frigerio; M. Comelli; M. Grassi; I. Cerveri; A. Corsico; J. Schouten; A. Gulsvik; E. Omenaas; C. Svanes; B. Laerum; X. Basagana; A. Jaen; F. Burgos; J. Maldonado; A. Pereira; J. L. Sanchez; J. Martinez-Moratalla Rovira; E. Almar; I. Urritia; C. Janson; G. Boman; D. Norback; M. Gunnbjornsdottir; K. Toren; A. Dahlman-Höglund; R. Sundberg; E. Norrman; M. Soderberg; K. Franklin; B. Lundback; B. Forsberg; L. Nystrom; N. Künzli; B. Dibbert; M. Hazenkamp; M. Brutsche; U. Ackermann-Liebrich; P. Burney; S. Chinn; B. Harrison; R. Hall; D. Seaton; M. Osborne; S. Buist; W. Vollmer; L. Johnson

doi:10.1016/S0140-6736(07)61164-7

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)

Manolis Kogevinas, Jan Paul Zock, Debbie Jarvis, Hans Kromhout, Linnéa Lillienberg, Estel Plana, Katja Radon, Kjell Torén, Ada Alliksoo, Geza Benke, Paul D. Blanc, Anna Dahlman-Hoglund, Angelo D'Errico, Michel Héry, Susan Kennedy, Nino Kunzli, Bénédicte Leynaert, Maria C. Mirabelli, Nerea Muniozguren, Dan NorbäckMario Olivieri, Félix Payo, Simona Villani, Marc van Sprundel, Isabel Urrutia, Gunilla Wieslander, Jordi Sunyer, Josep M. Antó, M. Abramson, R. Woods, E. H. Walters, F. Thien, P. Vermeire, J. Weyler, M. Van Sprundel, V. Nelen, R. Jogi, A. Soon, F. Neukirch, R. Liard, M. Zureik, I. Pin, J. Ferran-Quentin, J. Heinrich, M. Wjst, C. Frye, I. Meyer, T. Gislason, M. Bugiani, P. Piccioni, A. Carosso, W. Arossa, E. Caria, G. Castiglioni, E. Migliore, C. Romano, D. Fabbro, G. Ciccone, C. Magnani, P. Dalmasso, R. Bono, G. Gigli, A. Giraudo, M. C. Brussino, C. Bucca, G. Rolla, R. de Marco, G. Verlato, E. Zanolin, S. Accordini, A. Poli, V. Lo Cascio, M. Ferrari, A. Marinoni, M. Ponzio, F. Frigerio, M. Comelli, M. Grassi, I. Cerveri, A. Corsico, J. Schouten, A. Gulsvik, E. Omenaas, C. Svanes, B. Laerum, X. Basagana, A. Jaen, F. Burgos, J. Maldonado, A. Pereira, J. L. Sanchez, J. Martinez-Moratalla Rovira, E. Almar, I. Urritia, C. Janson, G. Boman, D. Norback, M. Gunnbjornsdottir, K. Toren, A. Dahlman-Höglund, R. Sundberg, E. Norrman, M. Soderberg, K. Franklin, B. Lundback, B. Forsberg, L. Nystrom, N. Künzli, B. Dibbert, M. Hazenkamp, M. Brutsche, U. Ackermann-Liebrich, P. Burney, S. Chinn, B. Harrison, R. Hall, D. Seaton, M. Osborne, S. Buist, W. Vollmer, L. Johnson

Research output: Contribution to journal › Article › peer-review

318 Scopus citations

Abstract

Background: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. Methods: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. Findings: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1·6, 95% CI 1·1-2·3, p=0·017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2·4, 1·3-4·6, p=0·008). Of common occupations, a significant excess risk of asthma was seen for nursing (2·2, 1·3-4·0, p=0·007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3·3, 95% CI 1·0-11·1, p=0·051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. Interpretation: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

Original language	English (US)
Pages (from-to)	336-341
Number of pages	6
Journal	Lancet
Volume	370
Issue number	9584
DOIs	https://doi.org/10.1016/S0140-6736(07)61164-7
State	Published - Jul 29 2007
Externally published	Yes

ASJC Scopus subject areas

Medicine(all)

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10.1016/S0140-6736(07)61164-7

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Kogevinas, M., Zock, J. P., Jarvis, D., Kromhout, H., Lillienberg, L., Plana, E., Radon, K., Torén, K., Alliksoo, A., Benke, G., Blanc, P. D., Dahlman-Hoglund, A., D'Errico, A., Héry, M., Kennedy, S., Kunzli, N., Leynaert, B., Mirabelli, M. C., Muniozguren, N., ... Johnson, L. (2007). Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II). Lancet, 370(9584), 336-341. https://doi.org/10.1016/S0140-6736(07)61164-7

Kogevinas, M, Zock, JP, Jarvis, D, Kromhout, H, Lillienberg, L, Plana, E, Radon, K, Torén, K, Alliksoo, A, Benke, G, Blanc, PD, Dahlman-Hoglund, A, D'Errico, A, Héry, M, Kennedy, S, Kunzli, N, Leynaert, B, Mirabelli, MC, Muniozguren, N, Norbäck, D, Olivieri, M, Payo, F, Villani, S, van Sprundel, M, Urrutia, I, Wieslander, G, Sunyer, J, Antó, JM, Abramson, M, Woods, R, Walters, EH, Thien, F, Vermeire, P, Weyler, J, Van Sprundel, M, Nelen, V, Jogi, R, Soon, A, Neukirch, F, Liard, R, Zureik, M, Pin, I, Ferran-Quentin, J, Heinrich, J, Wjst, M, Frye, C, Meyer, I, Gislason, T, Bugiani, M, Piccioni, P, Carosso, A, Arossa, W, Caria, E, Castiglioni, G, Migliore, E, Romano, C, Fabbro, D, Ciccone, G, Magnani, C, Dalmasso, P, Bono, R, Gigli, G, Giraudo, A, Brussino, MC, Bucca, C, Rolla, G, de Marco, R, Verlato, G, Zanolin, E, Accordini, S, Poli, A, Lo Cascio, V, Ferrari, M, Marinoni, A, Ponzio, M, Frigerio, F, Comelli, M, Grassi, M, Cerveri, I, Corsico, A, Schouten, J, Gulsvik, A, Omenaas, E, Svanes, C, Laerum, B, Basagana, X, Jaen, A, Burgos, F, Maldonado, J, Pereira, A, Sanchez, JL, Martinez-Moratalla Rovira, J, Almar, E, Urritia, I, Janson, C, Boman, G, Norback, D, Gunnbjornsdottir, M, Toren, K, Dahlman-Höglund, A, Sundberg, R, Norrman, E, Soderberg, M, Franklin, K, Lundback, B, Forsberg, B, Nystrom, L, Künzli, N, Dibbert, B, Hazenkamp, M, Brutsche, M, Ackermann-Liebrich, U, Burney, P, Chinn, S, Harrison, B, Hall, R, Seaton, D, Osborne, M, Buist, S, Vollmer, W & Johnson, L 2007, 'Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)', Lancet, vol. 370, no. 9584, pp. 336-341. https://doi.org/10.1016/S0140-6736(07)61164-7

@article{ab8dff2fae394aa2a8d4394a8edbccf6,

title = "Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)",

abstract = "Background: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. Methods: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. Findings: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1·6, 95% CI 1·1-2·3, p=0·017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2·4, 1·3-4·6, p=0·008). Of common occupations, a significant excess risk of asthma was seen for nursing (2·2, 1·3-4·0, p=0·007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3·3, 95% CI 1·0-11·1, p=0·051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. Interpretation: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.",

author = "Manolis Kogevinas and Zock, {Jan Paul} and Debbie Jarvis and Hans Kromhout and Linn{\'e}a Lillienberg and Estel Plana and Katja Radon and Kjell Tor{\'e}n and Ada Alliksoo and Geza Benke and Blanc, {Paul D.} and Anna Dahlman-Hoglund and Angelo D'Errico and Michel H{\'e}ry and Susan Kennedy and Nino Kunzli and B{\'e}n{\'e}dicte Leynaert and Mirabelli, {Maria C.} and Nerea Muniozguren and Dan Norb{\"a}ck and Mario Olivieri and F{\'e}lix Payo and Simona Villani and {van Sprundel}, Marc and Isabel Urrutia and Gunilla Wieslander and Jordi Sunyer and Ant{\'o}, {Josep M.} and M. Abramson and R. Woods and Walters, {E. H.} and F. Thien and P. Vermeire and J. Weyler and {Van Sprundel}, M. and V. Nelen and R. Jogi and A. Soon and F. Neukirch and R. Liard and M. Zureik and I. Pin and J. Ferran-Quentin and J. Heinrich and M. Wjst and C. Frye and I. Meyer and T. Gislason and M. Bugiani and P. Piccioni and A. Carosso and W. Arossa and E. Caria and G. Castiglioni and E. Migliore and C. Romano and D. Fabbro and G. Ciccone and C. Magnani and P. Dalmasso and R. Bono and G. Gigli and A. Giraudo and Brussino, {M. C.} and C. Bucca and G. Rolla and {de Marco}, R. and G. Verlato and E. Zanolin and S. Accordini and A. Poli and {Lo Cascio}, V. and M. Ferrari and A. Marinoni and M. Ponzio and F. Frigerio and M. Comelli and M. Grassi and I. Cerveri and A. Corsico and J. Schouten and A. Gulsvik and E. Omenaas and C. Svanes and B. Laerum and X. Basagana and A. Jaen and F. Burgos and J. Maldonado and A. Pereira and Sanchez, {J. L.} and {Martinez-Moratalla Rovira}, J. and E. Almar and I. Urritia and C. Janson and G. Boman and D. Norback and M. Gunnbjornsdottir and K. Toren and A. Dahlman-H{\"o}glund and R. Sundberg and E. Norrman and M. Soderberg and K. Franklin and B. Lundback and B. Forsberg and L. Nystrom and N. K{\"u}nzli and B. Dibbert and M. Hazenkamp and M. Brutsche and U. Ackermann-Liebrich and P. Burney and S. Chinn and B. Harrison and R. Hall and D. Seaton and M. Osborne and S. Buist and W. Vollmer and L. Johnson",

note = "Funding Information: The co-ordination of the occupational asthma component was supported by grant 1 R01 HL62633-01 from the US National Institutes for Health, National occupational research agenda (NORA), and National Heart, Lung, and Blood Institute. Study co-ordination was supported by the European Commission, as part of their Quality of Life programme and from research contract FOOD_CT_2004_506378, from Global Allergy and Asthma European Network. We also had local study funding from Fondo de Investigaciones Santarias grants 97/0035-01, 99/0034-01 and 99/0034-02; Hospital Universitario de Albacete; Consejeria de Sanidad; FWO (Fund for Scientific Research) grant G.0402.00; University of Antwerp; the Flemish Health Ministry; Sociedad Espa{\~n}ola de Neumolog{\'i}a y Cirug{\'i}a Tor{\'a}cica (SEPAR), Public Health Service grant R01 HL62633-01; Consell Interdepartamental de Recerca i Innovaci{\'o} Tecnol{\`o}gica (CIRIT) grant 1999SGR 00241; Red Respira Instituto de Salud Carlos III (ISCIII); Swiss National Science Foundation; Swiss Federal Office for Education & Science; Swiss National Accident Insurance Fund; University of Southern California National Institute of Environmental Health Sciences (NIEHS) grant 5P30 ES07048; Norwegian Research Council; Norwegian Asthma & Allergy Association; GlaxoSmithKline; Norway Research Fund; Forschungszentrum f{\"u}r Umwelt und Gesundheit (GSF) National Research Centre for Environment and Health; Deutsche Forschungsgemeinschaft grant FR 1526/1-1; Basque Health Dept; Swedish Heart Lung Foundation; Swedish Foundation for Health Care Sciences and Allergy Research; Swedish Asthma & Allergy Foundation; Swedish Cancer and Allergy Foundation; Programme Hospitalier de Recherche Clinique de Grenoble 2000 no. 2610, French Ministry of Health; Direction de la Recherche Clinique; Minist{\`e}re de l'Emploi et de la Solidarit{\'e}; Direction G{\'e}n{\'e}rale de la Sant{\'e}; Centre Hospitalier Universitaire de Grenoble; Comit{\'e} des Maladies Respiratoires de l'Is{\`e}re; National Reasearch Centre for Environment and Health; Deutsche Forschungsgemeinschaft grant MA 711/4-1; Asthma UK (formerly National Asthma Campaign); National Health and Medical Research Council of Australia; Minist{\`e}re de l'Emploi et de la Solidarit{\'e}; Direction G{\'e}n{\'e}rale de la Sant{\'e}; UCB Pharmaceuticals; Sanofi-Aventis; Glaxo France; Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610; CHU de Grenoble; Italian Ministry of University and Scientific and Technological Research; Local University Funding for research 1998 & 1999 (Pavia, Italy); Estonian Science Foundation; Azienda Sanitaria Locale, 4 Regione Piemonte (Italy); AO CTO/ICORMA Regione Piemonte (Italy); University of Verona; United States Department of Health, Education and Welfare Public Health Service grant #2 S07RR05521-28.",

year = "2007",

month = jul,

day = "29",

doi = "10.1016/S0140-6736(07)61164-7",

language = "English (US)",

volume = "370",

pages = "336--341",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier Limited",

number = "9584",

}

TY - JOUR

T1 - Exposure to substances in the workplace and new-onset asthma

T2 - an international prospective population-based study (ECRHS-II)

AU - Kogevinas, Manolis

AU - Zock, Jan Paul

AU - Jarvis, Debbie

AU - Kromhout, Hans

AU - Lillienberg, Linnéa

AU - Plana, Estel

AU - Radon, Katja

AU - Torén, Kjell

AU - Alliksoo, Ada

AU - Benke, Geza

AU - Blanc, Paul D.

AU - Dahlman-Hoglund, Anna

AU - D'Errico, Angelo

AU - Héry, Michel

AU - Kennedy, Susan

AU - Kunzli, Nino

AU - Leynaert, Bénédicte

AU - Mirabelli, Maria C.

AU - Muniozguren, Nerea

AU - Norbäck, Dan

AU - Olivieri, Mario

AU - Payo, Félix

AU - Villani, Simona

AU - van Sprundel, Marc

AU - Urrutia, Isabel

AU - Wieslander, Gunilla

AU - Sunyer, Jordi

AU - Antó, Josep M.

AU - Abramson, M.

AU - Woods, R.

AU - Walters, E. H.

AU - Thien, F.

AU - Vermeire, P.

AU - Weyler, J.

AU - Van Sprundel, M.

AU - Nelen, V.

AU - Jogi, R.

AU - Soon, A.

AU - Neukirch, F.

AU - Liard, R.

AU - Zureik, M.

AU - Pin, I.

AU - Ferran-Quentin, J.

AU - Heinrich, J.

AU - Wjst, M.

AU - Frye, C.

AU - Meyer, I.

AU - Gislason, T.

AU - Bugiani, M.

AU - Piccioni, P.

AU - Carosso, A.

AU - Arossa, W.

AU - Caria, E.

AU - Castiglioni, G.

AU - Migliore, E.

AU - Romano, C.

AU - Fabbro, D.

AU - Ciccone, G.

AU - Magnani, C.

AU - Dalmasso, P.

AU - Bono, R.

AU - Gigli, G.

AU - Giraudo, A.

AU - Brussino, M. C.

AU - Bucca, C.

AU - Rolla, G.

AU - de Marco, R.

AU - Verlato, G.

AU - Zanolin, E.

AU - Accordini, S.

AU - Poli, A.

AU - Lo Cascio, V.

AU - Ferrari, M.

AU - Marinoni, A.

AU - Ponzio, M.

AU - Frigerio, F.

AU - Comelli, M.

AU - Grassi, M.

AU - Cerveri, I.

AU - Corsico, A.

AU - Schouten, J.

AU - Gulsvik, A.

AU - Omenaas, E.

AU - Svanes, C.

AU - Laerum, B.

AU - Basagana, X.

AU - Jaen, A.

AU - Burgos, F.

AU - Maldonado, J.

AU - Pereira, A.

AU - Sanchez, J. L.

AU - Martinez-Moratalla Rovira, J.

AU - Almar, E.

AU - Urritia, I.

AU - Janson, C.

AU - Boman, G.

AU - Norback, D.

AU - Gunnbjornsdottir, M.

AU - Toren, K.

AU - Dahlman-Höglund, A.

AU - Sundberg, R.

AU - Norrman, E.

AU - Soderberg, M.

AU - Franklin, K.

AU - Lundback, B.

AU - Forsberg, B.

AU - Nystrom, L.

AU - Künzli, N.

AU - Dibbert, B.

AU - Hazenkamp, M.

AU - Brutsche, M.

AU - Ackermann-Liebrich, U.

AU - Burney, P.

AU - Chinn, S.

AU - Harrison, B.

AU - Hall, R.

AU - Seaton, D.

AU - Osborne, M.

AU - Buist, S.

AU - Vollmer, W.

AU - Johnson, L.

N1 - Funding Information: The co-ordination of the occupational asthma component was supported by grant 1 R01 HL62633-01 from the US National Institutes for Health, National occupational research agenda (NORA), and National Heart, Lung, and Blood Institute. Study co-ordination was supported by the European Commission, as part of their Quality of Life programme and from research contract FOOD_CT_2004_506378, from Global Allergy and Asthma European Network. We also had local study funding from Fondo de Investigaciones Santarias grants 97/0035-01, 99/0034-01 and 99/0034-02; Hospital Universitario de Albacete; Consejeria de Sanidad; FWO (Fund for Scientific Research) grant G.0402.00; University of Antwerp; the Flemish Health Ministry; Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Public Health Service grant R01 HL62633-01; Consell Interdepartamental de Recerca i Innovació Tecnològica (CIRIT) grant 1999SGR 00241; Red Respira Instituto de Salud Carlos III (ISCIII); Swiss National Science Foundation; Swiss Federal Office for Education & Science; Swiss National Accident Insurance Fund; University of Southern California National Institute of Environmental Health Sciences (NIEHS) grant 5P30 ES07048; Norwegian Research Council; Norwegian Asthma & Allergy Association; GlaxoSmithKline; Norway Research Fund; Forschungszentrum für Umwelt und Gesundheit (GSF) National Research Centre for Environment and Health; Deutsche Forschungsgemeinschaft grant FR 1526/1-1; Basque Health Dept; Swedish Heart Lung Foundation; Swedish Foundation for Health Care Sciences and Allergy Research; Swedish Asthma & Allergy Foundation; Swedish Cancer and Allergy Foundation; Programme Hospitalier de Recherche Clinique de Grenoble 2000 no. 2610, French Ministry of Health; Direction de la Recherche Clinique; Ministère de l'Emploi et de la Solidarité; Direction Générale de la Santé; Centre Hospitalier Universitaire de Grenoble; Comité des Maladies Respiratoires de l'Isère; National Reasearch Centre for Environment and Health; Deutsche Forschungsgemeinschaft grant MA 711/4-1; Asthma UK (formerly National Asthma Campaign); National Health and Medical Research Council of Australia; Ministère de l'Emploi et de la Solidarité; Direction Générale de la Santé; UCB Pharmaceuticals; Sanofi-Aventis; Glaxo France; Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610; CHU de Grenoble; Italian Ministry of University and Scientific and Technological Research; Local University Funding for research 1998 & 1999 (Pavia, Italy); Estonian Science Foundation; Azienda Sanitaria Locale, 4 Regione Piemonte (Italy); AO CTO/ICORMA Regione Piemonte (Italy); University of Verona; United States Department of Health, Education and Welfare Public Health Service grant #2 S07RR05521-28.

PY - 2007/7/29

Y1 - 2007/7/29

N2 - Background: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. Methods: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. Findings: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1·6, 95% CI 1·1-2·3, p=0·017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2·4, 1·3-4·6, p=0·008). Of common occupations, a significant excess risk of asthma was seen for nursing (2·2, 1·3-4·0, p=0·007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3·3, 95% CI 1·0-11·1, p=0·051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. Interpretation: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

AB - Background: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. Methods: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. Findings: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1·6, 95% CI 1·1-2·3, p=0·017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2·4, 1·3-4·6, p=0·008). Of common occupations, a significant excess risk of asthma was seen for nursing (2·2, 1·3-4·0, p=0·007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3·3, 95% CI 1·0-11·1, p=0·051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. Interpretation: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

UR - http://www.scopus.com/inward/record.url?scp=34447648124&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447648124&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(07)61164-7

DO - 10.1016/S0140-6736(07)61164-7

M3 - Article

C2 - 17662882

AN - SCOPUS:34447648124

SN - 0140-6736

VL - 370

SP - 336

EP - 341

JO - The Lancet

JF - The Lancet

IS - 9584

ER -

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II)

Abstract

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