{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Discipline of Public Health, Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria, Australia",
        "Melbourne School of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia",
        "School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Sheikh M Alif"
    },
    {
      "affiliations": [
        "School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Geza Benke"
    },
    {
      "affiliations": [
        "Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands"
      ],
      "name": "Hans Kromhout"
    },
    {
      "affiliations": [
        "School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Michael J Abramson"
    },
    {
      "affiliations": [
        "ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain"
      ],
      "name": "Manolis Kogevinas"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Debbie Jarvis"
    },
    {
      "affiliations": [
        "Respiratory and Environmental Epidemiology, Inserm CESP/U1018, Villejuif, France"
      ],
      "name": "Nicole Le Moual"
    },
    {
      "affiliations": [
        "School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Shyamali Dharmage"
    },
    {
      "affiliations": [
        "Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus Universitet, Aarhus, Denmark"
      ],
      "name": "Vivi Schlünssen"
    },
    {
      "affiliations": [
        "Occupational and Environmental Medicine, School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden"
      ],
      "name": "Kjell Torén"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Dan Norback"
    },
    {
      "affiliations": [
        "School of Medicine, European University Cyprus, Nicosia, Cyprus"
      ],
      "name": "Theodore Lytras"
    },
    {
      "affiliations": [
        "ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain",
        "RTI Health Solutions Barcelona, Barcelona, Spain"
      ],
      "name": "Anne-Elie Carsin"
    },
    {
      "affiliations": [
        "Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"
      ],
      "name": "Cecilie Svanes"
    },
    {
      "affiliations": [
        "Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy"
      ],
      "name": "Mario Olivieri"
    },
    {
      "affiliations": [
        "Pulmonology Department, Hospital Galdakao-Usansolo, Galdacano, Spain"
      ],
      "name": "Sandra Dorado-Arenas"
    },
    {
      "affiliations": [
        "Pulmonology Department, Hospital Galdakao-Usansolo, Galdacano, Spain"
      ],
      "name": "Isabel Urrutia"
    },
    {
      "affiliations": [
        "Pulmonology Department, Hospital Galdakao-Usansolo, Galdacano, Spain"
      ],
      "name": "Silvia Pascual Erquicia"
    },
    {
      "affiliations": [
        "Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium"
      ],
      "name": "Sofie Acke"
    },
    {
      "affiliations": [
        "Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium"
      ],
      "name": "Hayat Bentouhami"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Uppsala University, Uppsala, Sweden"
      ],
      "name": "Gunilla Wieslander"
    },
    {
      "affiliations": [
        "Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Nicola Murgia"
    },
    {
      "affiliations": [
        "Pulmonology Service, University Hospital Complex, Albacete, Spain"
      ],
      "name": "Jesús Martínez-Moratalla"
    },
    {
      "affiliations": [
        "Respiratory and Environmental Epidemiology, Inserm CESP/U1018, Villejuif, France"
      ],
      "name": "Bénédicte Leynaert"
    },
    {
      "affiliations": [
        "Institute and Clinic for Occupational and Environmental Medicine, Occupational and Environmental Epidemiology Unit, Ludwig-Maximilians-University of Munich, University Hospital, Comprehensive Pneumology Center (CPC) Munich, Deutsches Zentrum für Lungenforschung (DZL), Munich, Germany"
      ],
      "name": "Katja Radon"
    },
    {
      "affiliations": [
        "Institute and Clinic for Occupational and Environmental Medicine, Occupational and Environmental Epidemiology Unit, Ludwig-Maximilians-University of Munich, University Hospital, Comprehensive Pneumology Center (CPC) Munich, Deutsches Zentrum für Lungenforschung (DZL), Munich, Germany"
      ],
      "name": "Jessica Gerlich"
    },
    {
      "affiliations": [
        "Institute and Clinic for Occupational and Environmental Medicine, Occupational and Environmental Epidemiology Unit, Ludwig-Maximilians-University of Munich, University Hospital, Comprehensive Pneumology Center (CPC) Munich, Deutsches Zentrum für Lungenforschung (DZL), Munich, Germany"
      ],
      "name": "Dennis Nowak"
    },
    {
      "affiliations": [
        "Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy"
      ],
      "name": "Simona Villani"
    },
    {
      "affiliations": [
        "Occupational and Environmental Medicine, School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden"
      ],
      "name": "Mathias Holm"
    },
    {
      "affiliations": [
        "Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy"
      ],
      "name": "Giuseppe Verlato"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Azienda Sanitaria Locale Torino 3, Turin, Italy, Azienda Sanitaria Locale Torino 1, Torino, Italy"
      ],
      "name": "Angelo D’Errico"
    },
    {
      "affiliations": [
        "Department of Clinical Science, University of Bergen, Bergen, Norway"
      ],
      "name": "Per Bakke"
    },
    {
      "affiliations": [
        "Department of Clinical Science, University of Bergen, Bergen, Norway"
      ],
      "name": "Trude Duelien Skorge"
    },
    {
      "affiliations": [
        "Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway"
      ],
      "name": "Torgeir Storaas"
    },
    {
      "affiliations": [
        "Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden"
      ],
      "name": "Anna Dahlman-Höglund"
    },
    {
      "affiliations": [
        "Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden"
      ],
      "name": "Johan Hellgren"
    },
    {
      "affiliations": [
        "Occupational Health Office, Roche, Basel, Switzerland"
      ],
      "name": "David Miedinger"
    },
    {
      "affiliations": [
        "Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus Universitet, Aarhus, Denmark"
      ],
      "name": "Torben Sigsgaard"
    },
    {
      "affiliations": [
        "Division of Occupational, Environmental, and Climate Medicine, University of Califronia San Francisco, San Francisco, California, USA"
      ],
      "name": "Paul D Blanc"
    },
    {
      "affiliations": [
        "National Institute for Public Health and the Environment, Bilthoven, The Netherlands"
      ],
      "name": "Jan-Paul Zock"
    }
  ],
  "title": "Occupational exposures and incidence of asthma over two decades in the European Community Respiratory Health Survey",
  "uid": "9d68867e-2c86-5c74-891d-3233131ec2eb"
}