Abstract：
BACKGROUND: The role of chronic occupational exposures to irritants in asthma remains not well-defined. Few studies have examined their associations with asthma and its control.
OBJECTIVE: To study the associations of occupational exposures with asthma and its control, with specific interest for irritants, including disinfectants and cleaning products (DCPs) and solvents.
METHODS: Analyses included 4,469 adults (3,792 with neither asthma nor respiratory symptoms, 677 with current asthma; 75.9% women, mean age 54 years) of a case-control study (2018) from the French NutriNet-Santé cohort. Current asthma was defined by ever asthma with symptoms, medication or asthma attacks in the past 12 months, adult-onset asthma by age at first asthma attack older than 16 years, and uncontrolled asthma was defined by an Asthma Control Test score less than 20. Ever/current exposures were assessed with the Occupational Asthma-specific Job Exposure Matrix. Associations were evaluated by multinomial logistic regressions adjusted for sex, age, smoking status, and body mass index.
RESULTS: Ever exposures to sensitizers (high molecular weight [HMW]: OR 1.53, 95% CI 1.18-2.00; and low molecular weight [LMW]: OR 1.42; 95% CI 1.09-1.87), irritants (OR 1.32; 95% CI 1.03-1.68), and DCPs (OR 1.43; 95% CI 1.10-1.85) were associated with current adult-onset asthma. Significant associations between ever exposures and uncontrolled adult-onset asthma were observed for high molecular weight (OR 2.69; 95% CI 1.52-4.78) and low molecular weight (OR 2.27; 95% CI 1.24-4.37) sensitizers, irritants (OR 2.32; 95% CI 1.36-3.95), and DCPs (OR 2.59; 95% CI 1.48-4.54). Results were similar for current exposures, with higher ORs. No association was observed with solvents.
CONCLUSIONS: Occupational exposures to both sensitizers and irritants were associated with current adult-onset asthma and uncontrolled asthma. Irritant and sensitizing agents should be carefully considered in asthma management.
OBJECTIVE: To study the associations of occupational exposures with asthma and its control, with specific interest for irritants, including disinfectants and cleaning products (DCPs) and solvents.
METHODS: Analyses included 4,469 adults (3,792 with neither asthma nor respiratory symptoms, 677 with current asthma; 75.9% women, mean age 54 years) of a case-control study (2018) from the French NutriNet-Santé cohort. Current asthma was defined by ever asthma with symptoms, medication or asthma attacks in the past 12 months, adult-onset asthma by age at first asthma attack older than 16 years, and uncontrolled asthma was defined by an Asthma Control Test score less than 20. Ever/current exposures were assessed with the Occupational Asthma-specific Job Exposure Matrix. Associations were evaluated by multinomial logistic regressions adjusted for sex, age, smoking status, and body mass index.
RESULTS: Ever exposures to sensitizers (high molecular weight [HMW]: OR 1.53, 95% CI 1.18-2.00; and low molecular weight [LMW]: OR 1.42; 95% CI 1.09-1.87), irritants (OR 1.32; 95% CI 1.03-1.68), and DCPs (OR 1.43; 95% CI 1.10-1.85) were associated with current adult-onset asthma. Significant associations between ever exposures and uncontrolled adult-onset asthma were observed for high molecular weight (OR 2.69; 95% CI 1.52-4.78) and low molecular weight (OR 2.27; 95% CI 1.24-4.37) sensitizers, irritants (OR 2.32; 95% CI 1.36-3.95), and DCPs (OR 2.59; 95% CI 1.48-4.54). Results were similar for current exposures, with higher ORs. No association was observed with solvents.
CONCLUSIONS: Occupational exposures to both sensitizers and irritants were associated with current adult-onset asthma and uncontrolled asthma. Irritant and sensitizing agents should be carefully considered in asthma management.
摘要：
背景：慢性职业暴露在哮喘中的作用尚不明确。很少有研究检查它们与哮喘及其控制的关系。
目的：研究职业暴露与哮喘及其控制的关系，对刺激物特别感兴趣，包括消毒剂和清洁产品(DCP)和溶剂。
方法：分析包括4,469名成年人（3,792名既无哮喘也无呼吸道症状，677患有当前哮喘；75.9％的女性，平均年龄54岁）来自法国NutriNet-Santé队列的病例对照研究（2018年）。目前的哮喘被定义为有症状的哮喘，过去12个月的药物治疗或哮喘发作，成人发作哮喘按首次哮喘发作年龄超过16岁，未控制的哮喘定义为哮喘控制测试评分小于20分.使用职业性哮喘特异性工作暴露矩阵评估曾经/当前暴露。协会通过多项逻辑回归对性别进行了调整，年龄,吸烟状况,和体重指数。
结果：曾经暴露于敏化剂（高分子量[HMW]：OR1.53，95％CI1.18-2.00；低分子量[LMW]：OR1.42；95％CI1.09-1.87），刺激物（OR1.32；95%CI1.03-1.68），和DCP(OR1.43;95%CI1.10-1.85)与当前成人发作哮喘相关。对于高分子量（OR2.69;95％CI1.52-4.78）和低分子量（OR2.27;95％CI1.24-4.37）致敏剂，观察到了暴露与未控制的成人发作哮喘之间的显着关联。刺激物（OR2.32；95%CI1.36-3.95），和DCP（OR2.59；95%CI1.48-4.54）。当前暴露的结果相似，较高的OR。未观察到与溶剂的关联。
结论：致敏剂和刺激剂的职业暴露与目前成人发作的哮喘和未控制的哮喘相关。在哮喘管理中应仔细考虑刺激性和致敏剂。
目的：研究职业暴露与哮喘及其控制的关系，对刺激物特别感兴趣，包括消毒剂和清洁产品(DCP)和溶剂。
方法：分析包括4,469名成年人（3,792名既无哮喘也无呼吸道症状，677患有当前哮喘；75.9％的女性，平均年龄54岁）来自法国NutriNet-Santé队列的病例对照研究（2018年）。目前的哮喘被定义为有症状的哮喘，过去12个月的药物治疗或哮喘发作，成人发作哮喘按首次哮喘发作年龄超过16岁，未控制的哮喘定义为哮喘控制测试评分小于20分.使用职业性哮喘特异性工作暴露矩阵评估曾经/当前暴露。协会通过多项逻辑回归对性别进行了调整，年龄,吸烟状况,和体重指数。
结果：曾经暴露于敏化剂（高分子量[HMW]：OR1.53，95％CI1.18-2.00；低分子量[LMW]：OR1.42；95％CI1.09-1.87），刺激物（OR1.32；95%CI1.03-1.68），和DCP(OR1.43;95%CI1.10-1.85)与当前成人发作哮喘相关。对于高分子量（OR2.69;95％CI1.52-4.78）和低分子量（OR2.27;95％CI1.24-4.37）致敏剂，观察到了暴露与未控制的成人发作哮喘之间的显着关联。刺激物（OR2.32；95%CI1.36-3.95），和DCP（OR2.59；95%CI1.48-4.54）。当前暴露的结果相似，较高的OR。未观察到与溶剂的关联。
结论：致敏剂和刺激剂的职业暴露与目前成人发作的哮喘和未控制的哮喘相关。在哮喘管理中应仔细考虑刺激性和致敏剂。
