Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey

Sheikh M Alif; Geza Benke; Hans Kromhout; Michael J Abramson; Manolis Kogevinas; Debbie Jarvis; Nicole Le Moual; Shyamali Dharmage; Vivi Schlünssen; Kjell Torén; Dan Norback; Theodore Lytras; Anne-Elie Carsin; Cecilie Svanes; Mario Olivieri; Sandra Dorado-Arenas; Isabel Urrutia; Silvia Pascual Erquicia; Sofie Acke; Hayat Bentouhami; Gunilla Wieslander; Nicola Murgia; Jesús Martínez-Moratalla; Bénédicte Leynaert; Katja Radon; Jessica Gerlich; Dennis Nowak; Simona Villani; Mathias Holm; Giuseppe Verlato; Angelo D'Errico; Per Bakke; Trude Duelien Skorge; Torgeir Storaas; Anna Dahlman-Höglund; Johan Hellgren; David Miedinger; Torben Sigsgaard; Paul D Blanc; Jan-Paul Zock

doi:10.1136/thorax-2024-222307

Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey

Sheikh M Alif, Geza Benke, Hans Kromhout, Michael J Abramson, Manolis Kogevinas, Debbie Jarvis, Nicole Le Moual, Shyamali Dharmage, Vivi Schlünssen, Kjell Torén, Dan Norback, Theodore Lytras, Anne-Elie Carsin, Cecilie Svanes, Mario Olivieri, Sandra Dorado-Arenas, Isabel Urrutia, Silvia Pascual Erquicia, Sofie Acke, Hayat BentouhamiGunilla Wieslander, Nicola Murgia, Jesús Martínez-Moratalla, Bénédicte Leynaert, Katja Radon, Jessica Gerlich, Dennis Nowak, Simona Villani, Mathias Holm, Giuseppe Verlato, Angelo D'Errico, Per Bakke, Trude Duelien Skorge, Torgeir Storaas, Anna Dahlman-Höglund, Johan Hellgren, David Miedinger, Torben Sigsgaard, Paul D Blanc, Jan-Paul Zock

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: While short-term occupational exposures to many agents are associated with increased risk of asthma, the long-term consequences of exposure have not been well understood. We investigated the effects of occupational exposures over two decades on the incidence of asthma.

METHODS: This population-based, multicentre cohort was assessed at baseline (European Community Respiratory Health Survey (ECRHS)1) and followed up twice over 20 years (ECRHS2 and ECRHS3). This analysis included data for 5591 participants with complete work histories and free of asthma at baseline. Incident adult-onset asthma was defined as either an asthma attack, woken by an attack of shortness of breath and/or current asthma medication in the last 12 months before each timepoint, without asthma at a previous survey. An updated asthma-specific job exposure matrix was used to estimate exposures to asthmagens. Adjusted Poisson models were fitted with generalised estimating equations to estimate asthma incidence.

RESULTS: Ever high exposure to high molecular weight sensitisers (rate ratio (RR)=1.31; 95% CI 1.15 to 1.63), irritants (RR=1.29; 1.09-1.54), biocides (RR=1.42; 1.12-1.79), only low exposure to low molecular weight sensitisers (RR=1.26; 1.08-1.47), mites (RR=1.48; 1.12-1.94) and reactive chemicals (RR=1.24; 1.06-1.45) were associated with increased incidence of asthma. Asthma incidence also increased with ever high or cumulative exposure to these exposures and for specific exposure to wood dust, cleaning agents and bleach. The population-attributable fraction for adult-onset asthma due to occupational exposures was 18% (16.9-19.4%).

CONCLUSION: This strengthens the evidence that occupational exposures to sensitisers and chemical irritants contribute substantial risk and a substantive attributable fraction of adult-onset asthma. Control of implicated hazardous exposures and periodic screening of exposed workers should be considered.

Original language	English
Journal	Thorax
DOIs	https://doi.org/10.1136/thorax-2024-222307
Publication status	E-pub ahead of print - 29 Apr 2025

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Alif, S. M., Benke, G., Kromhout, H., Abramson, M. J., Kogevinas, M., Jarvis, D., Le Moual, N., Dharmage, S., Schlünssen, V., Torén, K., Norback, D., Lytras, T., Carsin, A.-E., Svanes, C., Olivieri, M., Dorado-Arenas, S., Urrutia, I., Pascual Erquicia, S., Acke, S., ... Zock, J.-P. (2025). Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey. Thorax. Advance online publication. https://doi.org/10.1136/thorax-2024-222307

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title = "Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey",

abstract = "BACKGROUND: While short-term occupational exposures to many agents are associated with increased risk of asthma, the long-term consequences of exposure have not been well understood. We investigated the effects of occupational exposures over two decades on the incidence of asthma.METHODS: This population-based, multicentre cohort was assessed at baseline (European Community Respiratory Health Survey (ECRHS)1) and followed up twice over 20 years (ECRHS2 and ECRHS3). This analysis included data for 5591 participants with complete work histories and free of asthma at baseline. Incident adult-onset asthma was defined as either an asthma attack, woken by an attack of shortness of breath and/or current asthma medication in the last 12 months before each timepoint, without asthma at a previous survey. An updated asthma-specific job exposure matrix was used to estimate exposures to asthmagens. Adjusted Poisson models were fitted with generalised estimating equations to estimate asthma incidence.RESULTS: Ever high exposure to high molecular weight sensitisers (rate ratio (RR)=1.31; 95% CI 1.15 to 1.63), irritants (RR=1.29; 1.09-1.54), biocides (RR=1.42; 1.12-1.79), only low exposure to low molecular weight sensitisers (RR=1.26; 1.08-1.47), mites (RR=1.48; 1.12-1.94) and reactive chemicals (RR=1.24; 1.06-1.45) were associated with increased incidence of asthma. Asthma incidence also increased with ever high or cumulative exposure to these exposures and for specific exposure to wood dust, cleaning agents and bleach. The population-attributable fraction for adult-onset asthma due to occupational exposures was 18% (16.9-19.4%). CONCLUSION: This strengthens the evidence that occupational exposures to sensitisers and chemical irritants contribute substantial risk and a substantive attributable fraction of adult-onset asthma. Control of implicated hazardous exposures and periodic screening of exposed workers should be considered.",

author = "Alif, {Sheikh M} and Geza Benke and Hans Kromhout and Abramson, {Michael J} and Manolis Kogevinas and Debbie Jarvis and {Le Moual}, Nicole and Shyamali Dharmage and Vivi Schl{\"u}nssen and Kjell Tor{\'e}n and Dan Norback and Theodore Lytras and Anne-Elie Carsin and Cecilie Svanes and Mario Olivieri and Sandra Dorado-Arenas and Isabel Urrutia and {Pascual Erquicia}, Silvia and Sofie Acke and Hayat Bentouhami and Gunilla Wieslander and Nicola Murgia and Jes{\'u}s Mart{\'i}nez-Moratalla and B{\'e}n{\'e}dicte Leynaert and Katja Radon and Jessica Gerlich and Dennis Nowak and Simona Villani and Mathias Holm and Giuseppe Verlato and Angelo D'Errico and Per Bakke and Skorge, {Trude Duelien} and Torgeir Storaas and Anna Dahlman-H{\"o}glund and Johan Hellgren and David Miedinger and Torben Sigsgaard and Blanc, {Paul D} and Jan-Paul Zock",

note = "{\textcopyright} Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.",

year = "2025",

month = apr,

day = "29",

doi = "10.1136/thorax-2024-222307",

language = "English",

journal = "Thorax",

issn = "0040-6376",

publisher = "BMJ Publishing Group",

}

Alif, SM, Benke, G, Kromhout, H, Abramson, MJ, Kogevinas, M, Jarvis, D, Le Moual, N, Dharmage, S, Schlünssen, V, Torén, K, Norback, D, Lytras, T, Carsin, A-E, Svanes, C, Olivieri, M, Dorado-Arenas, S, Urrutia, I, Pascual Erquicia, S, Acke, S, Bentouhami, H, Wieslander, G, Murgia, N, Martínez-Moratalla, J, Leynaert, B, Radon, K, Gerlich, J, Nowak, D, Villani, S, Holm, M, Verlato, G, D'Errico, A, Bakke, P, Skorge, TD, Storaas, T, Dahlman-Höglund, A, Hellgren, J, Miedinger, D, Sigsgaard, T, Blanc, PD & Zock, J-P 2025, 'Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey', Thorax. https://doi.org/10.1136/thorax-2024-222307

TY - JOUR

T1 - Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey

AU - Alif, Sheikh M

AU - Benke, Geza

AU - Kromhout, Hans

AU - Abramson, Michael J

AU - Kogevinas, Manolis

AU - Jarvis, Debbie

AU - Le Moual, Nicole

AU - Dharmage, Shyamali

AU - Schlünssen, Vivi

AU - Torén, Kjell

AU - Norback, Dan

AU - Lytras, Theodore

AU - Carsin, Anne-Elie

AU - Svanes, Cecilie

AU - Olivieri, Mario

AU - Dorado-Arenas, Sandra

AU - Urrutia, Isabel

AU - Pascual Erquicia, Silvia

AU - Acke, Sofie

AU - Bentouhami, Hayat

AU - Wieslander, Gunilla

AU - Murgia, Nicola

AU - Martínez-Moratalla, Jesús

AU - Leynaert, Bénédicte

AU - Radon, Katja

AU - Gerlich, Jessica

AU - Nowak, Dennis

AU - Villani, Simona

AU - Holm, Mathias

AU - Verlato, Giuseppe

AU - D'Errico, Angelo

AU - Bakke, Per

AU - Skorge, Trude Duelien

AU - Storaas, Torgeir

AU - Dahlman-Höglund, Anna

AU - Hellgren, Johan

AU - Miedinger, David

AU - Sigsgaard, Torben

AU - Blanc, Paul D

AU - Zock, Jan-Paul

PY - 2025/4/29

Y1 - 2025/4/29

N2 - BACKGROUND: While short-term occupational exposures to many agents are associated with increased risk of asthma, the long-term consequences of exposure have not been well understood. We investigated the effects of occupational exposures over two decades on the incidence of asthma.METHODS: This population-based, multicentre cohort was assessed at baseline (European Community Respiratory Health Survey (ECRHS)1) and followed up twice over 20 years (ECRHS2 and ECRHS3). This analysis included data for 5591 participants with complete work histories and free of asthma at baseline. Incident adult-onset asthma was defined as either an asthma attack, woken by an attack of shortness of breath and/or current asthma medication in the last 12 months before each timepoint, without asthma at a previous survey. An updated asthma-specific job exposure matrix was used to estimate exposures to asthmagens. Adjusted Poisson models were fitted with generalised estimating equations to estimate asthma incidence.RESULTS: Ever high exposure to high molecular weight sensitisers (rate ratio (RR)=1.31; 95% CI 1.15 to 1.63), irritants (RR=1.29; 1.09-1.54), biocides (RR=1.42; 1.12-1.79), only low exposure to low molecular weight sensitisers (RR=1.26; 1.08-1.47), mites (RR=1.48; 1.12-1.94) and reactive chemicals (RR=1.24; 1.06-1.45) were associated with increased incidence of asthma. Asthma incidence also increased with ever high or cumulative exposure to these exposures and for specific exposure to wood dust, cleaning agents and bleach. The population-attributable fraction for adult-onset asthma due to occupational exposures was 18% (16.9-19.4%). CONCLUSION: This strengthens the evidence that occupational exposures to sensitisers and chemical irritants contribute substantial risk and a substantive attributable fraction of adult-onset asthma. Control of implicated hazardous exposures and periodic screening of exposed workers should be considered.

AB - BACKGROUND: While short-term occupational exposures to many agents are associated with increased risk of asthma, the long-term consequences of exposure have not been well understood. We investigated the effects of occupational exposures over two decades on the incidence of asthma.METHODS: This population-based, multicentre cohort was assessed at baseline (European Community Respiratory Health Survey (ECRHS)1) and followed up twice over 20 years (ECRHS2 and ECRHS3). This analysis included data for 5591 participants with complete work histories and free of asthma at baseline. Incident adult-onset asthma was defined as either an asthma attack, woken by an attack of shortness of breath and/or current asthma medication in the last 12 months before each timepoint, without asthma at a previous survey. An updated asthma-specific job exposure matrix was used to estimate exposures to asthmagens. Adjusted Poisson models were fitted with generalised estimating equations to estimate asthma incidence.RESULTS: Ever high exposure to high molecular weight sensitisers (rate ratio (RR)=1.31; 95% CI 1.15 to 1.63), irritants (RR=1.29; 1.09-1.54), biocides (RR=1.42; 1.12-1.79), only low exposure to low molecular weight sensitisers (RR=1.26; 1.08-1.47), mites (RR=1.48; 1.12-1.94) and reactive chemicals (RR=1.24; 1.06-1.45) were associated with increased incidence of asthma. Asthma incidence also increased with ever high or cumulative exposure to these exposures and for specific exposure to wood dust, cleaning agents and bleach. The population-attributable fraction for adult-onset asthma due to occupational exposures was 18% (16.9-19.4%). CONCLUSION: This strengthens the evidence that occupational exposures to sensitisers and chemical irritants contribute substantial risk and a substantive attributable fraction of adult-onset asthma. Control of implicated hazardous exposures and periodic screening of exposed workers should be considered.

U2 - 10.1136/thorax-2024-222307

DO - 10.1136/thorax-2024-222307

M3 - Article

C2 - 40306950

SN - 0040-6376

JO - Thorax

JF - Thorax

ER -

Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey

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