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Published ahead of print on June 16, 2005, doi:10.1164/rccm.200501-111OC
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American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 440-445, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200501-111OC

Original Article

Asthma Severity and Exposure to Occupational Asthmogens

Nicole Le Moual, Valérie Siroux, Isabelle Pin, Francine Kauffmann, Susan M. Kennedy on behalf of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA)

INSERM U472-IFR69, Villejuif; INSERM U578, and Département de Médecine Aiguë Spécialisée, CHU, Grenoble, France; and University of British Columbia, Vancouver, British Columbia, Canada

Correspondence and requests for reprints should be addressed to Nicole Le Moual, INSERM U472, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. E-mail: lemoual{at}vjf.inserm.fr

Rationale: Severe asthma is a public health problem with limited information regarding preventable causes. Although occupational exposures have been implicated as important risk factors for asthma and asthma exacerbations, associations between occupational exposures and asthma severity have not been reported. Objective: To examine associations between occupational exposures and asthma severity. Methods: The Epidemiological Study on the Genetics and Environment of Asthma combines a case-control study with a family study of relatives of patients with asthma. Adult patients (n = 148) were recruited in chest clinics and control subjects without asthma (n = 228) were population-based. Occupational exposures to nonasthmogenic irritants and asthmogens (classified as "any asthmogen" including three broad groups: high-molecular-weight agents, low-molecular-weight agents, and mixed environments) were assessed by an asthma-specific job exposure matrix. Asthma severity was defined from an 8-grade clinical score (frequency of attacks, persistent symptoms, and hospitalization). Patients with severe (score >= 2) and mild asthma were compared with control subjects using nominal logistic regression. Main Results: Significant associations were observed between severe adult-onset asthma and exposure to any occupational asthmogen (odds ratio [OR], 4.0; 95% confidence interval [CI], 2.0–8.1), high-molecular-weight agents (OR, 3.7; CI, 1.3–11.1), low-molecular-weight agents (OR, 4.4; CI, 1.9–10.1), including industrial cleaning agents (OR, 7.2; CI, 1.3–39.9), and mixed environments (OR, 7.5; CI, 2.4–23.5). No significant associations were found between nonasthmogenic irritants and asthma severity, nor between asthmogens and childhood-onset asthma or mild adult-onset asthma. Conclusions: Our results suggested a strong deleterious role of occupational asthmogens in severe asthma. Clinicians should consider occupational exposures in patients with moderate to severe asthma.

Key Words: asthma severity • epidemiology • occupational exposure




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