title: The association between occupational factors and adverse health outcomes in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Despite recognition that occupational exposures may make a substantive contribution to the aetiology of COPD, little is known about the potential role of work related factors in COPD related health outcomes.
  
  
  METHODS
  Prospective cohort study using structured telephone interviews among a random sample of adults aged 55-75 reporting a COPD condition (emphysema, chronic bronchitis, or COPD). Using multivariate models adjusting for smoking and demographic factors, the separate and combined associations were estimated between occupational exposure to vapours, gas, dust, or fumes (VGDF) and leaving work due to lung disease (respiratory related work disability) with health outcomes and utilisation ascertained at one year follow up.
  
  
  RESULTS
  Of 234 subjects, 128 (55%) reported exposure to VGDF on their longest held jobs, 58 (25%) reported respiratory related work disability, and 38 (16%) subjects reported both. Combined exposure to VGDF and respiratory related work disability (rather than either factor alone) was associated with the greatest risk at follow up of frequent (everyday) restricted activity days attributed to a breathing or lung condition (OR 3.8; 95% CI 1.4 to 10.1), emergency department (ED) visit (OR 3.9; 95% CI 1.4 to 10.5), and hospitalisation (OR 7.6; 95% CI 1.8 to 32).
  
  
  CONCLUSIONS
  Among persons with COPD, past occupational exposures and work disability attributed to lung disease, particularly in combination, appear to be risk factors for adverse health related outcomes.
authors.affiliation: Division of Occupational and Environmental Medicine, University of California San Francisco, 350 Parnassus Avenue, Suite 609, San Francisco, CA 94117, USA. blancp@itsa.ucsf.edu
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
authors.forename: M D
authors.initials: MD
authors.lastname: Eisner
authors.forename: L
authors.initials: L
authors.lastname: Trupin
authors.forename: E H
authors.initials: EH
authors.lastname: Yelin
authors.forename: P P
authors.initials: PP
authors.lastname: Katz
authors.forename: J R
authors.initials: JR
authors.lastname: Balmes
mesh_terms: D000368:Aged; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D001991:Bronchitis / Q000209:etiology; D002908:Chronic Disease; D004185:Disability Evaluation; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D015386:Hazardous Substances / Q000506:poisoning; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology*; D011656:Pulmonary Emphysema / Q000209:etiology; D012307:Risk Factors
chemical_list: D000395:Air Pollutants, Occupational; D015386:Hazardous Substances