title: Airways obstruction among older construction and trade workers at Department of Energy nuclear sites.
abstract: BACKGROUND
  A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken.
  
  
  METHODS
  Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III).
  
  
  RESULTS
  The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints.
  
  
  CONCLUSIONS
  Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers.
authors.affiliation: Duke University Medical Center, Durham, North Carolina 27710, USA. john.dement@duke.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Dement
authors.forename: Laura
authors.initials: L
authors.lastname: Welch
authors.forename: Knut
authors.initials: K
authors.lastname: Ringen
authors.forename: Eula
authors.initials: E
authors.lastname: Bingham
authors.forename: Patricia
authors.initials: P
authors.lastname: Quinn
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003252:Construction Materials / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005160:Facility Design and Construction; D005260:Female; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D055848:Nuclear Power Plants; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D011159:Population Surveillance; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D012129:Respiratory Function Tests; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D037041:United States Government Agencies