Association of respiratory health with occupational exposures in the Burden of Obstructive Lung Disease (BOLD) cohort: a multinational longitudinal study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background: Occupational exposures are contributors to chronic respiratory diseases, particularly in low- and middle-income countries (LMICs), where regulatory policies are limited. We investigated associations between occupational exposures and respiratory outcomes using longitudinal data from the Burden of Obstructive Lung Disease study.
Methods: We analysed data from 4,237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+ Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents, and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume-in-1-second (FEV₁), forced vital capacity (FVC), the FEV₁/FVC, and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index, and baseline FVC. We further explored sex differences and non-linear relationships for symptoms.
Results: Over a median 10 years of follow-up, FEV₁/FVC decline was associated with moderate (β=–1.34; 95%CI: –2.32, –0.35) and high (β=–1.79; 95%CI: –3.33, –0.20) exposure to VGDF and low (β=–1.11; 95%CI: –2.11, –0.08) and high (β =–2.16; 95%CI: –4.08, –0.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (RR=1.45; 95%CI: 1.05-2.15) and high (RR=1.89; 95%CI: 1.100-3.26) exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure–response relationships, and no associations with solvents or metals.
Conclusions: A significant decline in FEV1/FVC was associated with exposure to VGDF and pesticides. Increased risk wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.
Methods: We analysed data from 4,237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+ Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents, and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume-in-1-second (FEV₁), forced vital capacity (FVC), the FEV₁/FVC, and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index, and baseline FVC. We further explored sex differences and non-linear relationships for symptoms.
Results: Over a median 10 years of follow-up, FEV₁/FVC decline was associated with moderate (β=–1.34; 95%CI: –2.32, –0.35) and high (β=–1.79; 95%CI: –3.33, –0.20) exposure to VGDF and low (β=–1.11; 95%CI: –2.11, –0.08) and high (β =–2.16; 95%CI: –4.08, –0.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (RR=1.45; 95%CI: 1.05-2.15) and high (RR=1.89; 95%CI: 1.100-3.26) exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure–response relationships, and no associations with solvents or metals.
Conclusions: A significant decline in FEV1/FVC was associated with exposure to VGDF and pesticides. Increased risk wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.
Date Issued
2026-07-24
Date Acceptance
2026-07-02
Citation
BMJ Open Respiratory Research, 2026, 31 (1)
ISSN
2052-4439
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open Respiratory Research
Volume
31
Issue
1
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Identifier
10.1136/bmjresp-2026-004213
Publication Status
Published
Article Number
e004213
Date Publish Online
2026-07-24