Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-007718, 2005 Nov; :1-32
COPD is the 4th leading cause of death with 12.1 million prevalent cases and there are indications that morbidity and mortality from COPD will be more prevalent in the coming years. Preliminary evidence suggests that carpenters experience excess risk of work related COPD. Tobacco smoking is a known causal factor but there is growing evidence that occupational exposures to vapor, gas, dust and fumes increases COPD risk with occupational attributable risks of 15-20%. Very few studies have data to investigate quantitative exposure-COPD relations or modification by smoking and little is known about risk from more moderate exposures to particulate mixtures. Studying effects of mixed exposures is important since mixtures are typical of many work environments especially for carpenters. Evidence of a relationship between occupational dust exposures and chronic airway disease, including chronic obstructive pulmonary disease (COPD), has been demonstrated in a number of studies in occupational and community settings. Apart from studies focused on the classical dusty trades, however, very little is known about the possibility of risk from more moderate exposures to a diverse mixture of different types of particulates. Evidence is mounting for mechanisms that might underlie a relatively nonspecific toxic effect from particulate exposures. In addition to respiratory tract irritation, high particulate exposures can overload the clearance mechanisms of the lung, producing a cascade of responses that may culminate in chronic lung injury. To contribute to the study of risk associated with exposure to a mixture of particulates, the investigators propose to target a working population of union carpenters. Carpenters have a diversity of aerosol (wood dust being only one) and chemical exposures and excess risk for pulmonary disease. Apart from studies of occupational asthma, there have been few investigations of respiratory disease associated with this trade, despite the fact that carpentry is one of the largest specialty trades among construction workers. This is a pilot investigation of the risk among carpenters of chronic airway obstruction other than asthma. We have been able to develop methods to (1) identify incident cases of COPD in the Carpenters Combined Benefits Fund of Massachusetts medical insurance records database and (2) develop a job-specific matrix that characterizes a diverse range of aerosol and gas exposures associated with carpenter jobs and job task. In addition we have determined the feasibility of carrying out a case-control study by matching COPD incident cases to members of the fund who were eligible for insurance coverage at the time of diagnosis of the case. This has permitted us to submit a grant proposal for undertaking this case control investigation to provide quantitative data on the associations between COPD and different aerosol exposures experienced by carpenters while adjusting appropriately for cigarette smoking history.
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