Elsevier

The Lancet

Volume 347, Issue 8997, 3 February 1996, Pages 284-289
The Lancet

Articles
Occupational exposure to metal or wood dust and aetiology of cryptogenic fibrosing alveolitis

https://doi.org/10.1016/S0140-6736(96)90465-1Get rights and content

Abstract

Summary

Background We have previously suggested that cryptogenic fibrosing alveolitis (CFA) may be caused by occupational exposures, particularly to metal or wood dust. We have specifically investigated this hypothesis in a case-control study of patients with CFA.

Methods We obtained lifetime occupational histories by postal questionnaire from 218 patients with CFA and 569 controls matched for age, sex, and community, living in the Trent region of the UK. Information was subsequently verified by telephone interview in 165 cases and 408 controls. Serum IgE, rheumatoid factor, and antinuclear antibodies and skin sensitivity to common allergens were measured in cases and in one matched control for each.

Findings The relative risk of CFA, after adjustment for smoking, was significantly increased in relation to questionnaire-reported exposure to metal dust (odds ratio 1·68 [95% Cl 1·07-2·65], p=0·024) or to wood dust (1·71 [1·01-2·92], p=0·048). Similar results were obtained with the telephone interview data. Significant exposure-response effects were found for both metal-dust and wood-dust exposure. CFA was also associated with the presence of rheumatoid factor or antinuclear antibodies, but not with positive allergen skin tests or raised IgE concentrations. There was no evidence of interaction between the effects of rheumatoid factor, antinuclear antibodies, positive skin allergen tests, or IgE concentrations and exposure to metal or wood dust. The combined aetiological fraction attributable to exposure to metal or wood dust was of the order of 20%.

Interpretation Occupational exposures to metal or wood dust are independent risk factors for CFA. Avoidance or limitation of these exposures may provide an opportunity to prevent the disease.

References (31)

  • Recommendations of the British Thoracic Society and the Association of Respiratory Technicians and Physiologists. Guidelines for the measurement of respiratory function

    Respir Med

    (1994)
  • UK General Register Office

    Classification of occupations, 1966

    (1966)
  • Jj Schlesselman

    Case-control studies: design, conduct, analysis

    (1982)
  • K. Iwai et al.

    Idiopathic pulmonary fibrosis: epidemiologic approaches to occupational exposure

    Am J Respir Crit Care Med

    (1994)
  • Ida Johnston et al.

    The management of cryptogenic fibrosing alveolitis in three regions of the United Kingdom

    Eur Respir J

    (1993)
  • Cited by (0)

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