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Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

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posted on 2023-02-15, 17:36 authored by Jate Ratanachina, Andre F S Amaral, Sara De Matteis, Herve Lawin, Kevin Mortimer, Daniel O Obaseki, Imed Harrabi, Meriam Denguezli, Emiel F M Wouters, Christer Janson, Rune Nielsen, Amund Gulsvik, Hamid Hacene Cherkaski, Filip Mejza, Padukudru Anand Mahesh, Asma Elsony, Rana Ahmed, Wan Tan, Li Cher Loh, Abdul Rashid, Michael Studnicka, Asaad A Nafees, Terence Seemungal, Althea Aquart-Stewart, Mohammed Al Ghobain, Jinping Zheng, Sanjay Juvekar, Sundeep Salvi, Rain Jogi, David Mannino, Thorarinn Gislason, A Sonia Buist, Paul Cullinan, Peter Burney, BOLD Collaborative Research Group

Background: Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study.

Methods: We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income.

Results: Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19-1.94), wheeze (OR 1.37, 95% CI 1.16-1.63) and dyspnoea (OR 1.83, 95% CI 1.53-2.20), but not lower FVC (β=0.02 L, 95% CI -0.02-0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI -0.49-0.58%). Some findings differed by sex and gross national income.

Conclusion: At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.


Wellcome Trust grant 085790/Z/08/Z for the BOLD (Burden of Obstructive Lung Disease) Study




Boehringer Ingelheim








University of Kentucky (Lexington, KY)



The original article is available at

Published Citation

Ratanachina J. et al. Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study. Eur Respir J. 2023;61(1):2200469.

Publication Date

12 January 2023

PubMed ID



  • RCSI + UCD Malaysia Campus (RUMC)


European Respiratory Society


  • Published Version (Version of Record)