Jobs and Exposures That Increase Risk for Developing COPD Later in LifePosted on by
The 19th annual World COPD Day is November 18, 2020. COPD – chronic obstructive pulmonary disease – includes the chronic lung conditions of chronic bronchitis and emphysema, which are characterized by airflow obstruction and breathing-related problems. COPD is a major cause of illness, with an estimated 300 million cases worldwide, and is the 3rd leading cause of death globally. There is no cure for COPD.
Cigarette smoking is the leading preventable cause of COPD. Efforts to prevent COPD focus on limiting exposure to smoking. Occupational exposures are important causes of COPD, contributing to an estimated 14% of all cases and 31% of cases among never smokers.[I]
Workplace agents associated with COPD include:
- mineral dusts (coal mine dust, silica, asbestos),
- organic dusts (cotton, wood, grains),
- metal/welding fumes (cadmium),
- diesel/engine exhaust fumes,
- asphalt/tar fumes or vapors in road and roofing operations,
- smoke from fires, and
- other chemical gases or vapors.
Prevention efforts specific to the industry or agent involved can minimize exposures to these work-related COPD agents and prevent the onset of new cases and worsening of existing cases.
NIOSH recently published new research in the American Journal of Industrial Medicine that suggests working in certain industries and occupations can increase the risk of developing COPD just before or during retirement. Additionally, exposure to specific chemicals appears to increase risk within some industries and occupations.
The research used survey data that followed nearly 8,000 people for 20 years into retirement, allowing researchers to examine the downstream effects of occupational exposures occurring during the working years.
The study found risks for COPD were significantly elevated for several industries:
- blast furnaces
- rolling and finishing mills
- groceries and related products
- automotive repair shops
Occupations with significantly elevated risk for COPD were:
- maids and housemen
- vehicle/mobile equipment mechanics and repair workers
- material-moving equipment operators
- non-construction laborers
Elevated risks were observed among workers in several industries and occupations reporting specific exposures to:
- asbestos in the blast furnace/steelworks/rolling/finishing mills industries,
- aerosol paint in automotive repair shops,
- pesticide among farmworkers, and
- dust and ash in both material moving equipment operators and non-construction laborers.
Following a sizeable group of respondents for more than two decades allowed researchers to look at industry and occupation in more detail, clarifying the role of workplace exposures in COPD risk. The study was not without limitations, however. Participants may have had additional exposures not identified in the survey. In addition, not all exposures occurring within industries and occupations could be evaluated.
COPD is associated with significant disability and economic costs. This study highlights that exposure prevention and medical monitoring are warranted for groups of workers at increased risk of COPD.
Sharon R. Silver, MS, MA, is lead research epidemiologist in the NIOSH Division of Field Studies and Engineering
Walter A. Alarcon MD, MSc, is lead research epidemiologist in the NIOSH Division of Field Studies and Engineering
Jia Li, MS, is a statistician in the NIOSH Division of Field Studies and Engineering
More information from NIOSH:
Silver SR; Alarcon WA; Li J. Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study. Am J Ind Med. 2020 Oct; :[Epub ahead of print] https://doi.org/10.1002/ajim.23196
World COPD Day – November 18th
Online video series Faces of Work-related COPD
Spirometry Longitudinal Data Analysis (SPIROLA) Software
[i] Blanc PD, Annesi-Maesano I, Balmes JR, et al. The occupational burden of nonmalignant respiratory diseases: An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med;199:1312–1334.
8 comments on “Jobs and Exposures That Increase Risk for Developing COPD Later in Life”
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I am curious as to whether livestock and poultry producers and associated occupations such as veterinarians have been included in these studies. Organic dust generated from various large-scale livestock and poultry production systems is as harmful as from any other source. I see that farm workers have been named in the significantly elevated risk category, but I think the reference here is to grain and vegetable/fruit production that creates organic dust and potential exposure to pesticide or herbicide use. Insecticides, rodenticides, bactericides, and fungicides are all commonly used agents in large-scale livestock and poultry production systems and occupations in these industries may be an overlooked category for risk of COPD.
The number of farmworkers who developed COPD during the study period was too small to divide into more specific groups; the same is true for healthcare workers, the group that includes veterinarians. Farmworkers who were exposed to the group of pesticides, herbicides, and rodenticides (but not fertilizers and other agricultural chemicals) had increased risks for COPD. Other studies have looked more specifically at animal farming. The discussion portion of our study notes that “Exposure to other substances, including dust and, for livestock farmers, ammonia and hydrogen sulfide, have been associated with increased risk of COPD or decreased lung function among farmers.”
Some pertinent references include:
Eduard W, Pearce N, Douwes J. Chronic bronchitis, COPD, and lung function in farmers: the role of biological agents. Chest. 2009;136(3):716‐725.
Kraim‐Leleu M, Lesage FX, Drame M, Lebargy F, Deschamps F. Occupational risk factors for COPD: a case–control study. PLOS One. 2016;11(8):e0158719.
Szczyrek M, Krawczyk P, Milanowski J, Jastrzebska I, Zwolak A, Daniluk J. Chronic obstructive pulmonary disease in farmers and agricultural workers—an overview. Ann Agric Environ Med. 2011; 18(2):310‐313.
THANK-YOU!!! Very interesting studies, the references were informative…
Good explanation about this disease. One of the worst enemies of COPD is smoking. Congratulations on the post. It is very useful.
What about healthcare workers exposed to air fresheners,disinfectants, and other chemicals aerosols sprayed in nursing homes and hospitals? I was diagnosed with COPD 3 years ago and I have a suspicion that’s what has caused it.
In our study, we were not able to examine those exposures in specific types of healthcare workplaces. However, we did observe that study participants who worked with cleaning materials were more likely than those who did not work with those materials to develop COPD. We did not see an elevation for the general category of fumes, vapors, and pollution.
A recent study did find associations between occupational exposure to disinfectants and development of COPD.
Dumas O, Varraso R, Boggs KM, et al. Association of Occupational Exposure to Disinfectants With Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses. JAMA Netw Open. 2019;2(10):e1913563. doi:10.1001/jamanetworkopen.2019.13563
The literature on air fresheners focuses more on whether exposure exacerbates existing COPD than on whether that exposure causes development of COPD.
DeVries R, Kriebel D, Sama S. Low level air pollution and exacerbation of existing copd: a case crossover analysis. Environ Health. 2016;15(1):98. Published 2016 Oct 18. doi:10.1186/s12940-016-0179-z
Sama SR, Kriebel D, Gore RJ, et alEnvironmental triggers of COPD symptoms: a case cross-over studyBMJ Open Respiratory Research 2017;4:e000179. doi: 10.1136/bmjresp-2017-000179
Can significant exposure to asbestos for 18 years cause, contribute or aggravate COPD even if I smoked several years (30) ago?
Thank you for your question. Our study showed an increased risk of COPD in former smokers (though that risk was quite a bit lower than the risk in current smokers) and an increased risk of COPD in workers who reported that they had been exposed to asbestos. Unfortunately, the study did not address the effects of a combination of asbestos exposure and a history of smoking on COPD. In addition, not all studies of asbestos and COPD have found the two to be linked. It is known that substantial exposure to asbestos can lead to a worsening in lung function. Additionally, smoking is associated with increased risk of COPD, including in former smokers.
We are sorry to hear of your health issues. Please note that we cannot provide individual medical advice. However, we suggest that you consult with your personal healthcare provider and describe your exposure history. Depending on the symptoms and findings on physical examination, the healthcare provider might order tests to evaluate your lungs, such as a chest x-ray or chest computed tomography (CT) scan and pulmonary function tests such as spirometry. We hope this information is helpful to you.
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