title: Occupational exposures are associated with worse morbidity in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Links between occupational exposures and morbidity in individuals with established chronic obstructive pulmonary disease (COPD) remain unclear.
  
  
  OBJECTIVE
  To determine the impact of occupational exposures on COPD morbidity.
  
  
  METHODS
  A job exposure matrix (JEM) determined occupational exposure likelihood based on longest job in current/former smokers (n = 1,075) recruited as part of the Subpopulations and Intermediate Outcomes in COPD Study, of whom 721 had established COPD. Bivariate and multivariate linear regression models estimated the association of occupational exposure with COPD, and among those with established disease, the occupational exposure associations with 6-minute-walk distance (6MWD), the Modified Medical Research Council Dyspnea Scale (mMRC), the COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), 12-item Short-Form Physical Component (SF-12), and COPD exacerbations requiring health care utilization, adjusting for demographics, current smoking status, and cumulative pack-years.
  
  
  RESULTS
  An intermediate/high risk of occupational exposure by JEM was found in 38% of participants. In multivariate analysis, those with job exposures had higher odds of COPD (odds ratio, 1.44; 95% confidence interval, 1.04-1.97). Among those with COPD, job exposures were associated with shorter 6MWDs (-26.0 m; P = 0.006); worse scores for mMRC (0.23; P = 0.004), CAT (1.8; P = 0.003), SGRQ (4.5; P = 0.003), and SF-12 Physical (-3.3; P < 0.0001); and greater odds of exacerbation requiring health care utilization (odds ratio, 1.55; P = 0.03).
  
  
  CONCLUSIONS
  Accounting for smoking, occupational exposure was associated with COPD risk and, for those with established disease, shorter walk distance, greater breathlessness, worse quality of life, and increased exacerbation risk. Clinicians should obtain occupational histories from patients with COPD because work-related exposures may influence disease burden.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Paulin
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blanc
authors.forename: Nirupama
authors.initials: N
authors.lastname: Putcha
authors.forename: Mark D
authors.initials: MD
authors.lastname: Eisner
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kanner
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Belli
authors.forename: Stephanie
authors.initials: S
authors.lastname: Christenson
authors.forename: Donald P
authors.initials: DP
authors.lastname: Tashkin
authors.forename: MeiLan
authors.initials: M
authors.lastname: Han
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Hansel
mesh_terms: D000368:Aged; D018450:Disease Progression; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D011788:Quality of Life; D012907:Smoking / Q000453:epidemiology
keywords: chronic obstructive pulmonary disease; job exposure matrix; occupational exposure; quality of life; work-related