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Rationale: Occupational exposures to vapors, gas, dust, or fumes have been shown to be a risk factor of airway obstruction in cross-sectional studies in the general population.Objectives: Our aim was to study the relationships between specific occupations and occupational exposures during a 9-yr follow-up period and changes in lung function and symptoms of chronic bronchitis.Methods: Subjects from the general population aged 20 to 45 yr were randomly selected in 1991-1993 within the European Community Respiratory Health Survey. Follow-up took place from 1998 to 2002 among 4,079 males and 4,461 females in 27 study centers. A total of 3,202 men and 3,279 women twice completed lung function measurements. Job history during follow-up was linked to a job exposure matrix and consequently translated into cumulative exposure estimates.Main Results: Individuals exposed to dusts, gases, and fumes during the period of follow-up did not have a steeper decline of FEV[1] than did individuals with consistently white-collar occupations without occupational exposures (relative change among men and women, + 1.4 and-3.1 ml/yr, respectively; p > 0.2), nor an increase of prevalence or incidence of airway obstruction defined as an FEV[1]/FVC ratio of less than 0.7. The incidence of chronic phlegm increased in men exposed to mineral dust (relative risk, 1.94 [1.29-2.91]) and gases and fumes (relative risk, 1.53 [0.99-2.36]), which was not modified by smoking.Conclusion: Occupational exposures to dusts, gases, and fumes occurring during the 1990s are associated with incidence of chronic bronchitis, although these did not impair lung function in a population of relatively young age. [ABSTRACT FROM AUTHOR]

Background: Atopy may impair ventilatory function, but results are controversial. We assess the association between individual reactivity to allergens and the level of baseline maximal one-second forced expiratory volume (FEV1), by smoking and respiratory symptoms.Methods: The 1472 participants (response 44.5%) of the five Spanish areas of the European Community Respiratory Health Survey (ECRHS) who performed respiratory function tests, skin prick tests and/or specific IgE against common aeroallergens (e.g. mites, pets, mould, pollens) are included. Bronchial hyperreactivity (BHR) was measured with a methacholine challenge.Results: After adjusting for BHR and smoking, in addition to the other allergens, skin reactivity to Alternaria (-208 ml; 95% CI :-451, 35) and IgE antibodies against cat (-124 ml; 95% CI:-269, 21) and Timothy grass (-115 ml, 95% CI:-190, -40) were associated with a decrease in FEV1 in females. Among males, skin reactivity to olive showed the strongest association (-111 ml; 95% CI: -261, 38). The associations were stronger in females. Smoking modifies the association for Alternaria and cat (P for interaction < 0.05). While cat is associated with a decrease in FEV1 in current smokers (-190 ml), Alternaria (-336 ml) was associated among never smokers. The exclusion of subjects with asthma symptoms, or adjustment for respiratory symptoms, led to similar results.Conclusions: We conclude that immunoresponse to individual allergens (particularly outdoor) is associated with the level of FEV1, and this association occurred independently of asthma, and in smokers and non-smokers, which may be of interest in natural history of chronic obstructive pulmonary disease (COPD). [ABSTRACT FROM AUTHOR]

Objective: The rise in the prevalence of asthma in the second half of the 20th century has not been evenly distributed according to recent surveys. We assessed changes in the prevalence of asthma after a period of 9 to 10 years in a cohort of young adults in the Spanish arm of the European Community Respiratory Health Survey (ECRHS)., Material and Methods: The ECRHS-II is a multicenter cohort study taking place in 27 centers around Europe, with Spanish centers located in Albacete, Barcelona, Galdakao, Huelva, and Oviedo. The ECRHS questionnaire was administered to individuals who had participated in the first phase of the survey; spirometry and methacholine challenge tests were also performed according to the published protocol., Results: Among new smokers, the prevalence of wheezing in the last 12 months increased from 10% to 33%, while the frequency of phlegm production rose from 8% to 22% (P< .05). In ex-smokers, the prevalences of wheezing and phlegm production decreased from 21% to 12% and from 15% to 8%, respectively (P< .05). Symptom prevalences remained similar for never smokers, although the frequency of diagnosed asthma rose from 4% to 7% (P< .05). After adjusting for smoking, age, sex, and center, we found no significant differences in the frequency of symptoms or asthma, even when the phrase bronchial hyperreactivity was included in the definition. However, the rate of reported asthma rose annually by 0.34% (95% confidence interval [CI], 0.20%-0.48%), while diagnosed asthma rose by 0.26% (95% CI, 0.13%-0.39%) and treated asthma by 0.16% (95% CI, 0.07%-0.25%)., Conclusions: Increased prevalence rates of asthma diagnosis and treatment have been detected, but the rates of reported symptoms have remained similar, consistent with the assumption that more persons are being classified as asthmatics.

Background: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents., Methods: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre., Findings: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year., Interpretation: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

Objectives: To compare two job exposure matrices (JEMs) for the evaluation of asthma risks related to specific occupational exposures in a community-based study., Methods: A questionnaire on self-reported asthma, respiratory symptoms and current occupation was sent to the participants of the European Community Respiratory Health Survey in five areas in Spain. Both an asthma-specific JEM, including expert judgment steps and a general JEM, were applied to occupational codes. Risks of current asthma symptoms and wheeze in the last year associated with the obtained exposure estimates were evaluated. Correlations between specific exposures were investigated using explanatory factor analysis., Results: Occupational exposures to the high-molecular-weight (MW) agents flour dust, enzymes, mites and animal-derived proteins as obtained by the asthma-specific JEM were positively associated with asthma outcomes. The effect of additional expert judgment steps was limited. High exposures to biological dust assessed by the general JEM without expert judgment was also associated with asthma. Many of the exposed individuals worked in environments with multiple exposures., Conclusions: Asthma risks associated with occupational exposures to specific high-MW agents could be identified from a population-based study using an asthma-specific JEM. Application of JEMs can be a useful tool to estimate asthma risks attributable to specific occupational exposures in the general population. However, these specific exposure risks should be interpreted in connection with the whole of concomitant exposures constituting the work environment.

The objective was to measure the incidence of asthma and its determinants in Spain, where the prevalence of asthma is low to medium. A follow-up of subjects participating in the European Community Respiratory Health Survey (ECRHS) was conducted in 1998- 1999 (n = 1,640, 85% of those eligible). Subjects were randomly selected from the general population and were 20 to 44 yr old in 1991-1993. Time of follow-up was on average 6.75 yr (range, 5.3 to 7.9 yr). Asthma was defined as reporting ever having had asthma. The incidence of asthma was 5.53 (95% confidence interval, 4.28- 7.16) per 1,000 person-years (6.88 in females, 4.04 in males). Incidence was highest in subjects who at the baseline survey had bronchial hyperresponsiveness (incidence rate ratio [IRR], 3.85), in those with positive IgE against timothy grass (IRR, 3.16), and in females (IRR, 1.80). These results persisted after adjusting for respiratory symptoms at baseline. There was no significant association (p < 0.2) with high total serum IgE, atopy defined by reactivity to any allergen, smoking, occupational exposure, or maternal asthma. A sensitivity analysis using four definitions of population at risk yielded incidence rates varying from 5.53 to 1.50. In this population of subjects without self-reported asthma or asthma-type symptoms at baseline, bronchial hyperresponsiveness and IgE reactivity to grass appeared as the main determinants of new asthma.

Objectives: Recent studies have shown an excess risk of asthma for cleaners, but it is not clear which cleaning-related exposures induce or aggravate asthma., Methods: Risk factors for asthma were studied among indoor cleaners participating in the Spanish part of the European Community Respiratory Health Survey in 1992. In 1998, 78 of the 91 subjects reporting cleaning-related jobs in 1992 were identified. Of these, 67 indoor cleaners were interviewed by telephone about their cleaning activities and their use of cleaning products in 1992. These data were related to asthma prevalence in 1992, and the cleaners were compared with a reference group of office workers., Results: Asthma prevalence was 1.7 times higher [95% confidence interval (95% CI) 1.1-2.6] among the cleaners than among the referents, being highest among private home cleaners (3.3, 95% CI 1.9-5.8). The prevalence of housedust mite sensitization amounted to 28% for the home cleaners and was significantly (P<0.01) higher than for other indoor cleaners (3%), but similar to the corresponding prevalence of office workers (22%). More than half of the cleaners reported work-related respiratory symptoms. The asthma risk of the home cleaners was mainly associated with kitchen cleaning and furniture polishing, with the use of oven sprays and polishes., Conclusions: The asthma risk of Spanish cleaners is primarily related to the cleaning of private homes. This relationship may be explained by the use of sprays and other products in kitchen cleaning and furniture polishing.

We assessed the association between occupational exposures and symptoms of chronic bronchitis and pulmonary ventilatory defects in a general population-based study of five areas in Spain. This study forms part of the European Community Respiratory Health Study (ECRHS). Subjects (n = 1,735; age range, 20-44 yr; 52.4% of those initially selected) completed a respiratory questionnaire on symptoms and occupation and underwent baseline spirometry. Occupation was translated with an ad hoc developed job-exposure matrix (EM) into none, low, and high exposure to biological dust, mineral dust, and gases and fumes. Exposure to high levels of biological dust was associated with cough for more than 3 mo (odds ratio [OR], 1.9; p = 0.07), a reduction in FEF(25-27) to 478 ml/s (SD 178), and a reduction in FEV1 to 151 mL (SD 71). These associations remained after excluding subjects with asthma symptoms or bronchial responsiveness. Smokers tended to have a higher risk for respiratory symptoms, but smoking did not modify the association of occupation with pulmonary function. Exposure to mineral dust and gases/fumes was less consistently related to pulmonary function or to respiratory symptoms and this association further decreased after excluding subjects with asthma. In conclusion, exposure to high levels of biological dust in young adults is associated with symptoms of chronic bronchitis and pulmonary ventilatory defects, independently of asthma and smoking.