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The Prevalence and Predictors of Respiratory-Related Work Limitation and Occupational Disability in an International Study^*

Paul D. Blanc, MD, FCCP; Peter Burney, MD; Christer Janson, MD and Kjell Torén, MD, PhD

^* From the Division of Occupational and Environmental Medicine (Dr. Blanc), Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, CA; the Division of Primary Care and Public Health Sciences (Dr. Burney), Guy’s, King’s and St. Thomas’ School of Medicine, London, UK; Section of Respiratory Medicine and Allergology (Dr. Janson), Department of Medicine, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden; and the Department Respiratory Medicine and Allergology (Dr. Torén), Sahlgrenska University Hospital, Göteborg, Sweden. A list of the principal participants of the ECRHS study is located in the ^Appendix.

Correspondence to: Paul D. Blanc, MD, FCCP, Occupational and Environmental Medicine, UCSF, 350 Parnassus Ave, No. 609, San Francisco, CA 94117; e-mail: blancp{at}itsa.ucsf.edu

Background: Work-related symptoms and disability due to respiratory disease are common and costly among working-age adults. To investigate this problem, we analyzed data on respiratory symptoms related to the workplace and occupational disability from the European Community Respiratory Health Survey (ECRHS).

Methods: The ECRHS is a population-based sample of adults aged 20 to 44, with oversampling of subjects with symptoms that are consistent with respiratory disease. We analyzed structured interviews from 17,567 subjects, of whom 15,039 were from a general random population sample and 2,528 were from the respiratory symptom oversample. We defined work-related respiratory symptoms as self-reported wheeze or chest tightness at work, and work-related respiratory disability as reported job change due to breathing difficulties at work. We used binary generalized linear modeling with a log link to estimate the risk of symptoms and disability.

Findings: Wheeze at work was reported in the general population sample by 1,552 subject (10%), ranging from 4 to 15% among the 16 countries analyzed. Work-related respiratory disability was reported by 540 subjects (4%), ranging from 1 to 8%. Reported workplace exposure to vapors, gases, dust, or fumes was associated with increased risk of respiratory symptoms at work (prevalence ratio [PR], 2.1; 95% CI 1.8–2.4) and work-related respiratory disability (PR, 3.4; 95% confidence interval [CI], 2.0 to 5.1). Workplace environmental tobacco smoke exposure was associated with symptoms (PR, 1.3; 95% CI, 1.2 to 1.5) but not with disability (PR, 1.1; 95% CI, 0.9 to 1.4).

Interpretation: These data indicated that work-related respiratory symptoms and disability vary widely in this international sample but, nonetheless, are associated with workplace exposures that could be addressed through preventive measures.

Key Words: asthma • occupational health • respiratory disease • wheeze • work disability

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