title: Redemption of asthma pharmaceuticals among stainless steel and mild steel welders: a nationwide follow-up study.
abstract: OBJECTIVE
  The purpose was to examine bronchial asthma according to cumulative exposure to fume particulates conferred by stainless steel and mild steel welding through a proxy of redeemed prescribed asthma pharmaceuticals.
  
  
  METHODS
  A Danish national company-based historical cohort of 5,303 male ever-welders was followed from 1995 to 2011 in the Danish Medicinal Product Registry to identify the first-time redemption of asthma pharmaceuticals including beta-2-adrenoreceptor agonists, adrenergic drugs for obstructive airway diseases and inhalable glucocorticoids. Lifetime exposure to welding fume particulates was estimated by combining questionnaire data on welding work with a welding exposure matrix. The estimated exposure accounted for calendar time, welding intermittence, type of steel, welding methods, local exhaustion and welding in confined spaces. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox proportional hazards model adjusting for potential confounders and taking modifying effects of smoking into account.
  
  
  RESULTS
  The average incidence of redemption of asthma pharmaceuticals in the cohort was 16 per 1,000 person year (95% CI 10-23 per 1,000 person year). A moderate nonsignificant increased rate of redemption of asthma medicine was observed among high-level exposed stainless steel welders in comparison with low-level exposed welders (HR 1.54, 95% CI 0.76-3.13). This risk increase was driven by an increase risk among non-smoking stainless steel welders (HR 1.46, 95% CI 1.06-2.02). Mild steel welding was not associated with increased risk of use asthma pharmaceuticals.
  
  
  CONCLUSIONS
  The present study indicates that long-term exposure to stainless steel welding is related to increased risk of asthma in non-smokers.
authors.affiliation: Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Copenhagen, Denmark, pernillecom@hotmail.com.
authors.forename: Pernille
authors.initials: P
authors.lastname: Kristiansen
authors.forename: Kristian Tore
authors.initials: KT
authors.lastname: Jørgensen
authors.forename: Johnni
authors.initials: J
authors.lastname: Hansen
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Bonde
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000633:toxicity*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D059366:Asthma, Occupational / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000633:toxicity*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012907:Smoking; D013232:Steel; D011795:Surveys and Questionnaires; D013997:Time Factors; D014896:Welding
chemical_list: D000395:Air Pollutants, Occupational; D018927:Anti-Asthmatic Agents; D052638:Particulate Matter; D013232:Steel