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 |
|---|---|
| Pages (from-to) | 22-32 |
| Number of pages | 11 |
| Journal | Thorax |
| Volume | 81 |
| Issue number | 1 |
| Early online date | 29 Apr 2025 |
| DOIs | |
| Publication status | Published - 15 Dec 2025 |
Bibliographical note
Publisher Copyright:© Author(s) (or their employer(s)) 2025.
Funding
Financial support for ECRHS1, for the local centres included in this study: Australia: Asthma Foundation of Victoria, Allen and Hanbury's, Belgium: Belgian Science Policy Office, National Fund for Scientific Research, Estonia: Estonian Science Foundation (grant no 1088), France: Minist\u00E8re de la Sant\u00E9, Glaxo France, Institut Pneumologique d'Aquitaine, Contrat de Plan Etat-R\u00E9gion Languedoc-Rousillon, CNMATS, CNMRT (90MR/10, 91AF/6), Ministre d\u00E9l\u00E9gu\u00E9 de la sant\u00E9, RNSP, France; GSF, Germany: Bundesminister f\u00FCr Forschung und Technologie, Italy: Ministero dell'Universit\u00E0 e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF n. 381/05.93, Norway: Norwegian Research Council project no. 101422/310, Spain: Fondo de Investigaci\u00F3n Sanitaria (#91/0016-060-05/E, 92/0319 and #93/0393), Hospital General de Albacete, Hospital General Juan Ram\u00F3n Jim\u00E9nez, Direcci\u00F3n Regional de Salud P\u00FAblica (Consejer\u00EDa de Sanidad del Principado de Asturias), CIRIT (1997 SGR 00079) and Servicio Andaluz de Salud; Sweden: The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy; Switzerland: Swiss National Science Foundation (grant 4026-28099); UK: National Asthma Campaign, British Lung Foundation, Department of Health, South Thames Regional Health Authority, USA: United States Department of Health, Education and Welfare Public Health Service (grant #2 S07 RR05521-28). Financial Support for ECRHS3, for the local centres included in this study: Australia: National Health & Medical Research Council (GNT1007965), Belgium: Antwerp South, Antwerp City: Research Foundation Flanders (FWO), grant code G041008N10 (both sites), Estonia: Tartu- SF0180060s09 from the Estonian Ministry of Education. France: (All) Minist\u00E8re de la Sant\u00E9. Programme Hospitalier de Recherche Clinique (PHRC) national 2010. Bordeaux: INSERM U897 Universit\u00E9 Bordeaux Segalen, Grenoble: Comit\u00E9 Scientifique AGIRadom 2011. Paris: Agence Nationale de la Sant\u00E9, R\u00E9gion Ile de France, domaine d\u2019int\u00E9r\u00EAt majeur (DIM) Germany: Erfurt: German Research Foundation HE 3294/10-1 Hamburg: German Research Foundation MA 711/6-1, NO 262/7-1 Iceland: Reykjavik, The Landspitali University Hospital Research Fund, University of Iceland Research Fund, ResMed Foundation, California, USA, Orkuveita Reykjavikur (Geothermal plant), Vegager\u00F0in (The Icelandic Road Administration (ICERA)). Italy: All Italian centres were funded by the Italian Ministry of Health, Chiesi Farmaceutici SpA. In addition, Verona was funded by the Cariverona foundation, Education Ministry (MIUR). Norway: Norwegian Research Council (grant number 214123), Western Norway Regional Health Authorities (grant no 911631), Bergen Medical Research Foundation. Spain: Fondo de Investigaci\u00F3n Sanitaria (PS09/02457, PS09/0071609/01511, PS09/02185 PS09/03190), Servicio Andaluz de Salud, Sociedad Espa\u00F1ola de Neumolog\u00EDa y Cirurg\u00EDa Tor\u00E1cica (SEPAR 1001/2010); Sweden: All centres were funded by The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Association, The Swedish Association against Lung and Heart Disease. Fondo de Investigaci\u00F3n Sanitaria (PS09/02457) Barcelona: Fondo de Investigaci\u00F3n Sanitaria (FIS PS09/00716) Galdakao: Fondo de Investigaci\u00F3n Sanitaria (FIS 09/01511) Huelva: Fondo de Investigaci\u00F3n Sanitaria (FIS PS09/02185) and Servicio Andaluz de Salud Oviedo: Fondo de Investigaci\u00F3n Sanitaria (FIS PS09/03190) G\u00F6teborg: Also received further funding from the Swedish Council for Working Life and Social Research. Ume\u00E5 also received funding from V\u00E4sternorrland Country Council ALF grant. Switzerland: The Swiss National Science Foundation (grants no 33CSCO-134276/1, 33CSCO-108796, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247-065896, 3100-059302, 3200-052720, 3200-042532, 4026-028099) The Federal Office for Forest, Environment and Landscape, The Federal Office of Public Health, The Federal Office of Roads and Transport, the canton\u2019s government of Aargau, Basel-Stadt, Basel-Land, Geneva, Luzern, Ticino, Valais and Z\u00FCrich, the Swiss Lung League, the canton's Lung League of Basel Stadt/ Basel, Landschaft, Geneva, Ticino, Valais and Zurich, SUVA, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH, Abbott Diagnostics, European Commission 018996 (GABRIEL), Wellcome Trust WT 084703MA, UK: Medical Research Council (Grant Number 92091). Support is also provided by the National Institute for Health Research through the Primary Care Research Network. The coordination of the ECRHS3 was funded through the Medical Research Council (Grant Number 92091). MJA reports investigator-initiated grants from Pfizer, Boehringer-Ingelheim, Sanofi and GSK for unrelated research. He has conducted an unrelated consultancy for Sanofi. He has also received a speaker\u2019s fee from GSK. DJ reports grants from the European Commission, during the conduct of the study. VS reports grants from The Wood Dust Foundation (Project No. 444508795), during the conduct of the study. The remaining authors have nothing to disclose.
| Funders | Funder number |
|---|---|
| Lungenliga Schweiz | |
| SUVA | |
| Ministero dell'Università e della Ricerca | |
| Hospital General de Albacete | |
| Sanofi | |
| Cariverona foundation | |
| Federal Office of Roads and Transport | |
| Asthma Foundation of Victoria | |
| Department of Health, South Thames Regional Health Authority | |
| GSF | |
| Compagnie Nationale du Rhône | |
| Education Ministry | |
| Servicio Andaluz de Salud | |
| National Institute for Health and Care Research | |
| Belgian Federal Science Policy Office | |
| Estonian Ministry of Education | |
| Consejería de Sanidad del Principado de Asturias | |
| Forskningsrådet för Arbetsliv och Socialvetenskap | |
| Ministère de la santé | |
| Glaxo France | |
| Ministero della Salute | |
| UBS Wealth Foundation | |
| National Asthma Campaign | |
| Institut Pneumologique d'Aquitaine | |
| Regione del Veneto | |
| Basel, Landschaft, Geneva, Ticino, Valais and Zurich | |
| canton's Lung League of Basel Stadt | |
| British Lung Foundation | |
| Medicinska Forskningsrådet | |
| Bundesministerium für Forschung und Technologie | |
| Boehringer-Ingelheim | |
| Chiesi Farmaceutici | |
| Federal Office for Forest | |
| Freiwillige Akademische Gesellschaft | |
| Fonds De La Recherche Scientifique - FNRS | |
| Pfizer | |
| CNMATS | |
| GSK | |
| Bundesamt für Gesundheit | |
| Hjärt-Lungfonden | |
| European Commission | |
| RSF | 381/05.93 |
| Norges Forskningsråd | 101422/310 |
| Fonds Wetenschappelijk Onderzoek | G041008N10, SF0180060s09 |
| CNMRT | 91AF/6, 90MR/10 |
| Helse Vest Regionalt Helseføretak | PS09/0071609/01511, 911631, PS09/02185 PS09/03190, PS09/02457 |
| National Health and Medical Research Council | GNT1007965 |
| Landstinget Västernorrland | 33CSCO-134276/1, 3247-065896, 3100-059302, 4026-028099, 3247BO-104288, 3247BO-104283, 3247BO-104284, 3200-052720, 3200-042532, 33CSCO-108796 |
| Servicio Andaluz de Salud Oviedo | FIS PS09/03190 |
| Sociedad Española de Neumología y Cirugía Torácica | SEPAR 1001/2010 |
| U.S. Public Health Service | 2 S07 RR05521-28 |
| Ministero dell’Istruzione, dell’Università e della Ricerca | 214123 |
| Comissió Interdepartamental de Recerca i Innovació Tecnològica | 1997 SGR 00079 |
| Medical Research Council | 92091 |
| Wellcome Trust | WT 084703MA |
| Talecris Biotherapeutics GmbH | 018996 |
| Eesti Teadusfondi | 1088 |
| Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung | 4026-28099 |
| Wood Dust Foundation | 444508795 |
| Fondo de Investigación Sanitaria | 91/0016-060-05/E, 92/0319, 93/0393 |
| Astma- och Allergiförbundet | FIS PS09/02185, FIS PS09/00716, FIS 09/01511 |