Occupational Exposure to Dust and Fumes Increases Risk for Future Adverse Clinical Outcomes

Abstract Rationale Occupational exposures to dust and fumes are associated with increased respiratory symptoms and worse lung function, however, their effect on future clinical outcomes has been incompletely explored. Objectives To examine the associations between self-reported occupational exposure to dust and fumes on future respiratory exacerbations, cardiovascular events, and other clinical outcomes in smokers. Methods Current and former smokers, aged 45-80, enrolled in COPDGene were assigned to four mutually-exclusive occupational exposure groups (No Exposure, Dust-Only, Fumes-Only, Dust-and-Fumes Exposure) based on questionnaire responses at baseline. Clinical outcomes were assessed prospectively for up to 15 years. Respiratory exacerbations (REs) were defined as worsening respiratory symptoms requiring treatment with steroids and/or antibiotics; binary outcomes included atherosclerotic cardiovascular disease (ASCVD), cancer, pneumonia, and blood clots. Multivariable-adjusted models estimated the association between occupational exposure category and each clinical outcome. Measurements and Main Results Among 8,991 participants (mean ± SD age 60.1 ± 9.0 years, 51.7% male, 49.3% current smokers), the prevalence of dust-only, fumes-only, and dust-and-fumes exposure was 12.0%, 12.4%, and 34.4%, respectively. Self-reported occupational exposure to both dust-and-fumes was associated with increased risk of future REs (adjusted rate ratio, aRR [95% CI] 1.38 [1.26-1.52]) relative to those reporting no exposures. Exposure to both dust-and-fumes was also associated with an increased risk (adjusted odds ratio, aOR, [95%CI]) for future ASCVD (1.35 [1.17-1.56]) and pneumonia (1.39 [1.19-1.63]), but was not associated with future cancer or blood clots. Conclusion Self-reported occupational exposure to dust-and-fumes is associated with increased future risk for multiple clinically-relevant outcomes among tobacco-exposed individuals. ClinicalTrials.gov NCT00608764 (COPDGene)