scholarly journals Increased respiratory symptoms in COPD patients living in the vicinity of livestock farms

2015 ◽  
Vol 46 (6) ◽  
pp. 1605-1614 ◽  
Author(s):  
Floor Borlée ◽  
C. Joris Yzermans ◽  
Christel E. van Dijk ◽  
Dick Heederik ◽  
Lidwien A.M. Smit
Keyword(s):  
Respiratory Symptoms ◽  
Respiratory Health ◽  
Personal Characteristics ◽  
Chronic Obstructive ◽  
Livestock Farming ◽  
Obstructive Pulmonary Disease ◽  
Livestock Farm ◽  
Copd Patients ◽  
Increased Risk ◽  
Livestock Farms

Several studies have investigated the effect of livestock farm emissions on the respiratory health of local residents, but results are inconsistent. This study aims to explore associations between the presence of livestock farms and respiratory health in an area of high-density livestock farming in the Netherlands. We focused especially on associations between farm exposures and respiratory symptoms within subgroups of potentially susceptible patients with a pre-existing lung disease.In total, 14 875 adults (response rate 53.4%) completed a questionnaire concerning respiratory health, smoking habits and personal characteristics. Different indicators of livestock farm exposures relative to the home address were computed using a geographic information system.Prevalence of chronic obstructive pulmonary disease (COPD) and asthma was lower among residents living within 100 m of a farm (OR 0.47, 95% CI 0.24–0.91 and OR 0.65, 95% CI 0.45–0.93, respectively). However, >11 farms in 1000 m compared to fewer than four farms in 1000 m (fourth quartileversusfirst quartile) was associated with wheezing among COPD patients (OR 1.71, 95% CI 1.01–2.89). Using general practitioners' electronic medical records, we demonstrated that selection bias did not affect the observed associations.Our data suggest a protective effect of livestock farm emissions on the respiratory health of residents. Nonetheless, COPD patients living near livestock farms reported more respiratory symptoms, suggesting an increased risk of exacerbations.

scholarly journals LINC01414/LINC00824 genetic polymorphisms in association with the susceptibility of chronic obstructive pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoman Zhou ◽  
Yunjun Zhang ◽  
Yutian Zhang ◽  
Quanni Li ◽  
Mei Lin ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Genetic Polymorphisms ◽  
Chronic Obstructive ◽  
Nucleotide Polymorphisms ◽  
Obstructive Pulmonary Disease ◽  
Logistic Analysis ◽  
Copd Patients ◽  
Increased Risk ◽  
And Gender

Abstract Objective Chronic obstructive pulmonary disease (COPD) is a complicated multi-factor, multi-gene disease. Here, we aimed to assess the association of genetic polymorphisms in LINC01414/ LINC00824 and interactions with COPD susceptibility. Methods Three single nucleotide polymorphisms (SNPs) in LINC01414/LINC00824 was genotyped by Agena MassARRAY platform among 315 COPD patients and 314 controls. Logistic analysis adjusted by age and gender were applied to estimate the genetic contribution of selected SNPs to COPD susceptibility. Results LINC01414 rs699467 (OR = 0.73, 95% CI 0.56–0.94, p = 0.015) and LINC00824 rs7815944 (OR = 0.56, 95% CI 0.31–0.99, p = 0.046) might be protective factors for COPD occurrence, while LINC01414 rs298207 (OR = 2.88, 95% CI 1.31–6.31, p = 0.008) risk-allele was related to the increased risk of COPD in the whole population. Rs7815944 was associated with the reduced risk of COPD in the subjects aged > 70 years (OR = 0.29, p = 0.005). Rs6994670 (OR = 0.57, p = 0.007) contribute to a reduced COPD risk, while rs298207 (OR = 7.94, p = 0.009) was related to a higher susceptibility to COPD at age ≤ 70 years. Rs298207 (OR = 2.54, p = 0.043) and rs7815944 (OR = 0.43, p = 0.028) variants was associated COPD risk among males. Rs7815944 (OR = 0.16, p = 0.031) was related to the reduced susceptibility of COPD in former smokers. Moreover, the association between rs298207 genotype and COPD patients with dyspnea was found (OR = 0.50, p = 0.016), and rs7815944 was related to COPD patients with wheezing (OR = 0.22, p = 0.008). Conclusion Our finding provided further insights into LINC01414/LINC00824 polymorphisms at risk of COPD occurrence and accumulated evidence for the genetic susceptibility of COPD.

scholarly journals Chronic obstructive pulmonary disease and rheumatic diseases: A systematic review on a neglected comorbidity

2019 ◽  
Vol 9 ◽  
pp. 2235042X1882020 ◽  
Author(s):  
Irini Gergianaki ◽  
Ioanna Tsiligianni
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Primary Sjögren Syndrome ◽  
Copd Patients ◽  
Increased Risk ◽  
Health Quality

Background: Although, both chronic obstructive pulmonary disease (COPD) and rheumatic diseases (RDs) are common, and each has significant impact on patients’ overall health/quality of life, their co-occurrence has received little attention, while 15% of COPD remains undiagnosed in RDs. Objective: To update the information regarding the comorbid state of RD/COPD (prevalence, incidence), to examine whether patients with RD have increased risk of developing COPD and vice versa, and what implications this comorbidity has on patients’ outcomes (mortality, hospitalizations, exacerbations). Methods: We performed a systematic literature review regarding the comorbidity of an RD (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), primary Sjogren syndrome disease (pSS), and systemic sclerosis (SSc)) with COPD. From 2803 reports retrieved, 33 articles were further screened. Finally, 27 articles were included. Results: Robust evidence supports that COPD develops up to 68% more frequently in patients with RA, as compared to the general population. Similarly, COPD is increased in every other RD that was studied. Further, self-referred arthritis is more common in COPD patients versus non-COPD controls and a predictor of worst self-rated health status. Patients with inflammatory arthritis/COPD have increased mortality (threefold in RA-COPD, irrespectively of which is first diagnosed), hospitalizations, and emergency visits. Conclusion: COPD is more common in patients with RA, AS, PsA, SLE, pSS, and SSc; yet, the association, vice versa, warrants further investigation. Nevertheless, COPD/RDs coexistence has significant prognostic value for worst outcomes; therefore, awareness is required to track early identification, especially in primary care.

scholarly journals Differential Genomic Profile in TERT, DSP, and FAM13A Between COPD Patients With Emphysema, IPF, and CPFE Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Javier Guzmán-Vargas ◽  
Enrique Ambrocio-Ortiz ◽  
Gloria Pérez-Rubio ◽  
Marco Antonio Ponce-Gallegos ◽  
Rafael de Jesus Hernández-Zenteno ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Association Studies ◽  
Genetic Association Studies ◽  
Simultaneous Presentation ◽  
Chronic Obstructive ◽  
Nucleotide Polymorphisms ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Increased Risk ◽  
Comparison Groups

Background: Genetic association studies have identified single nucleotide polymorphisms (SNPs) associated with lasting lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) and Idiopathic Pulmonary Fibrosis (IPF), as well as the simultaneous presentation, known as Combined Pulmonary Fibrosis and Emphysema (CPFE) Syndrome. It is unknown if these diseases share genetic variants previously described in an independent way. This study aims to identify common or differential variants between COPD, IPF, and CPFE.Materials and methods: The association analysis was carried out through a case-control design in a Mexican mestizo population (n = 828); three patients' groups were included: COPD smokers (COPD-S, n = 178), IPF patients (n = 93), and CPFE patients (n = 16). Also, two comparison groups were analyzed: smokers without COPD (SWOC, n = 367) and healthy subjects belonging to the Mexican Pulmonary Aging Cohort (PAC, n = 174). Five SNPs in four genes previously associated to interstitial and obstructive diseases were selected: rs2609255 (FAM13A), rs2736100 (TERT), rs2076295 (DSP) rs5743890, and rs111521887 (TOLLIP). Genotyping was performed by qPCR using predesigned Taqman probes.Results: In comparing IPF vs. PAC, significant differences were found in the frequency of the rs260955 G allele associated with the IPF risk (OR = 1.68, p = 0.01). Also, the genotypes, GG of rs260955 (OR = 2.86, p = 0.01) and TT of rs2076295 (OR = 1.79, p = 0.03) were associated with an increased risk of IPF; after adjusting by covariables, only the rs260955 G allele remain significant (p = 0.01). For the CPFE vs. PAC comparison, an increased CPFE risk was identified since there is a difference in the rs2736100 C allele (OR = 4.02, p < 0.01; adjusted p < 0.01). For COPD-S, the rs2609255 TG genotype was associated with increased COPD risk after adjusting by covariables.Conclusion: The rs2736100 C allele is associated with decreased IPF risk and confers an increased risk for CPFE. Also, the rs2076295 TT genotype is associated with increased IPF risk, while the GG genotype is associated with CFPE susceptibility. The rs2609255 G allele and GG genotype are associated with IPF susceptibility, while the TG genotype is present in patients with emphysema.

scholarly journals Chronic Obstructive Pulmonary Disease Patients Have Increased Levels of Plasma Inflammatory Mediators Reported Upregulated in Severe COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Nathalie Acevedo ◽  
Jose Miguel Escamilla-Gil ◽  
Héctor Espinoza ◽  
Ronald Regino ◽  
Jonathan Ramírez ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Plasma Proteins ◽  
Viral Infections ◽  
Chronic Obstructive ◽  
Healthy Controls ◽  
Obstructive Pulmonary Disease ◽  
Asthmatic Patients ◽  
Copd Patients ◽  
Increased Risk

BackgroundChronic obstructive pulmonary disease (COPD) is associated with increased risk of severe COVID-19, but the mechanisms are unclear. Besides, patients with severe COVID-19 have been reported to have increased levels of several immune mediators.MethodsNinety-two proteins were quantified in 315 plasma samples from 118 asthmatics, 99 COPD patients and 98 healthy controls (age 40-90 years), who were recruited in Colombia before the COVID-19 pandemic. Protein levels were compared between each disease group and healthy controls. Significant proteins were compared to the gene signatures of SARS-CoV-2 infection reported in the “COVID-19 Drug and Gene Set Library” and with experimentally tested protein biomarkers of severe COVID-19.ResultsForty-one plasma proteins showed differences between patients and controls. Asthmatic patients have increased levels in IL-6 while COPD patients have a broader systemic inflammatory dysregulation driven by HGF, OPG, and several chemokines (CXCL9, CXCL10, CXCL11, CX3CL1, CXCL1, MCP-3, MCP-4, CCL3, CCL4 and CCL11). These proteins are involved in chemokine signaling pathways related with response to viral infections and some, were found up-regulated upon SARS-CoV-2 experimental infection of Calu-3 cells as reported in the COVID-19 Related Gene Sets database. An increase of HPG, CXCL9, CXCL10, IL-6, MCP-3, TNF and EN-RAGE has also been experimentally detected in patients with severe COVID-19.ConclusionsCOPD patients have altered levels of plasma proteins that have been reported increased in patients with severe COVID-19. Our study suggests that COPD patients have a systemic dysregulation in chemokine networks (including HGF and CXCL9) that could make them more susceptible to severe COVID-19. Also, that IL-6 levels are increased in some asthmatic patients (especially in females) and this may influence their response to COVID-19. The findings in this study depict a novel panel of inflammatory plasma proteins in COPD patients that may potentially associate with increased susceptibility to severe COVID-19 and might be useful as a biomarker signature after future experimental validation.

scholarly journals Predictive Factors for the Effect of Treatment by Noninvasive Ventilation in Patients with Respiratory Failure as a Result of Acute Exacerbation of the Chronic Obstructive Pulmonary Disease

2015 ◽  
Vol 3 (4) ◽  
pp. 655-660 ◽  
Author(s):  
Sava Pejkovska ◽  
Biserka Jovkovska Kaeva ◽  
Zlatica Goseva ◽  
Zoran Arsovski ◽  
Jelena Jovanovska Janeva ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Upper Airway ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Failure Group ◽  
Copd Patients ◽  
Arterial Ph ◽  
Increased Risk ◽  
Group 2

BACKGROUND: Noninvasive mechanical ventilation (NIV) applies ventilator support through the patient’s upper airway using a mask.AIM: The aim of the study is to define factors that will point out an increased risk of NIV failure in patients with exacerbation of Chronic Obstructive Pulmonary Disease (COPD).PATIENTS AND METHODS: Patients over the age of 40, treated with NIV, were prospectively recruited. After data processing, the patients were divided into two groups: 1) successful NIV treatment group; 2) failed NIV treatment group.RESULTS: On admission arterial pH and Glasgow coma scale (GCS) levels were lower (pH: p < 0.05, GCS: p < 0.05), and Acute Physiology and Chronic Health Evaluation II (APACHE) score and PaCO2 were higher (p < 0.05) in the NIV failure group. Arterial pH was lower (p < 0.05) and PaCO2 and respiratory rate were higher (p < 0.05) after 1h, and arterial pH was lower (p < 0.05) and PaCO2 (p < 0.05), respiratory and heart rate were higher (p < 0.05) after 4h in the NIV failure group.CONCLUSION: Measurement and monitoring of certain parameters may be of value in terms of predicting the effectiveness of NIV treatment.

scholarly journals Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease

2018 ◽  
Vol 119 (5) ◽  
pp. 543-551 ◽  
Author(s):  
Arora R. Ingadottir ◽  
Anne M. Beck ◽  
Christine Baldwin ◽  
C. Elizabeth Weekes ◽  
Olof G. Geirsdottir ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Protein Intake ◽  
Nutritional Risk ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Oral Nutritional Supplements

AbstractLow energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.

Abstract 11046: Chronic Obstructive Pulmonary Disease and Sudden Cardiac Death in Hypertensive Patients: The LIFE Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Peter M Okin ◽  
Sverre E Kjeldsen ◽  
Richard B Devereux
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Cardiac Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hypertensive Patients ◽  
Copd Patients ◽  
Increased Risk ◽  
History Of

Background: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular (CV) disease and CV mortality. A recent large, population-based study suggested that COPD is associated with an increased risk of sudden cardiac death (SCD). However, whether COPD predicts SCD in hypertensive patients during aggressive blood pressure (BP) lowering has not been examined. Methods: Risk of SCD was examined in relation to a history of COPD in 9193 hypertensive patients with ECG left ventricular hypertrophy (LVH) who were randomly assigned to losartan- or atenolol-based treatment. A history of COPD was present in 385 patients (4.2%). SCD, a prespecified secondary endpoint in LIFE, was defined as death that was sudden and unexpected, including observed arrhythmic deaths and those not attributable to myocardial infarction (MI), intractable heart failure (HF) or other identifiable cause, occurring within 24 hours of symptom onset or when the subject was last seen alive if unwitnessed SCD. Results: During mean follow-up of 4.8±0.9 years, 178 patients (2.4%) had SCD, with a higher incidence rate per 1000 person-years in those with COPD: 9.0; 95% CI, 6.1-11.9 vs 3.8; 95% CI, 3.4-4.2; p=0.001. In a univariate Cox model, COPD was associated with a > 2-fold increased risk of SCD (HR 2.36, 95% CI 1.42-3.95, p=0.001). In a multivariable Cox regression model that adjusted for other predictors of SCD in this population (randomized treatment, age, gender, race, history of atrial fibrillation, stroke or transient ischemic attack, baseline serum creatinine and glucose entered as standard covariates and incident MI, incident HF and in-treatment diastolic pressure, heart rate, QRS duration, HDL cholesterol, and use of hydrochlorothiazide or a statin entered as time-varying covariates), COPD remained associated with a nearly 2-fold increased risk of SCD (HR, 1.82; 95% CI, 1.04-3.18, p=0.035). Conclusions: COPD is associated with an increased risk of SCD in hypertensive patients. The higher SCD risk in COPD patients persists after adjusting for the higher prevalence of risk factors in COPD patients, in-treatment blood pressure, incident MI and HF, and the established predictive value of in-treatment ECG LVH and heart rate for SCD in this population.

scholarly journals PRISMA-compliant meta-analysis: association of metabolic syndrome and its components with the risk of chronic obstructive pulmonary disease

2018 ◽  
Vol 38 (6) ◽  
Author(s):  
Linyang Ye ◽  
Xi Huang ◽  
Qingxiang Wang ◽  
Hualing Yang ◽  
Dongmiao Cai ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Metabolic Syndrome ◽  
Pulmonary Disease ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Chronic Obstructive ◽  
Significant Heterogeneity ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Increased Risk

A preferred reporting items for systematic reviews and meta-analyses-compliant meta-analysis was conducted to test the association of metabolic syndrome and its components with the risk of chronic obstructive pulmonary disease (COPD) based on observational studies. Literature retrieval, article selection and data extraction were done by two researchers independently. Total 16 articles (20 independent studies) were analyzed with 3915 COPD patients and 25,790 control participants. Overall analysis indicated that metabolic syndrome was significantly associated with 1.53-fold (95% confidence interval [CI]: 1.23–1.9, P<0.001) increased risk of COPD, with moderate heterogeneity (I2 = 74.3%). Of four metabolic components, hypertension was significantly associated with 1.55-fold (95% CI: 1.14–2.11, P=0.005) increased risk, and averaged levels of systolic blood pressure (weighted mean difference [WMD] = 3.626 mmHg, 95% CI: 1.537–5.714, P<0.001) and glucose (WMD = 2.976 mmol/l, 95% CI: 0.141–5.812; P=0.04) were significantly higher in COPD patients than in control participants, yet that of body mass index (WMD = −1.463 kg/m2, 95% CI: −2.716 to −0.211, P=0.022) were significantly lower. Gender, race, source of control participants, matched status and sample size were identified as accountable factors for significant heterogeneity. Altogether, the presence of metabolic syndrome, especially its component hypertension, was associated with significantly increased risk of COPD.

scholarly journals Occupational exposure to pesticides and respiratory health

2015 ◽  
Vol 24 (136) ◽  
pp. 306-319 ◽  
Author(s):  
Ali Mamane ◽  
Isabelle Baldi ◽  
Jean-François Tessier ◽  
Chantal Raherison ◽  
Ghislaine Bouvier
Keyword(s):  
Occupational Exposure ◽  
Chronic Bronchitis ◽  
Respiratory Function ◽  
Respiratory Symptoms ◽  
Pesticide Exposure ◽  
Respiratory Health ◽  
Epidemiological Studies ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Increased Risk

This article aims to review the available literature regarding the link between occupational exposure to pesticides and respiratory symptoms or diseases. Identification of epidemiological studies was performed using PubMed. 41 articles were included, 36 regarding agricultural workers and five regarding industry workers.Among the 15 cross-sectional studies focusing on respiratory symptoms and agricultural pesticide exposure, 12 found significant associations with chronic cough, wheeze, dyspnoea, breathlessness or chest tightness. All four studies on asthma found a relationship with occupational exposure, as did all three studies on chronic bronchitis. The four studies that performed spirometry reported impaired respiratory function linked to pesticide exposure, suggestive of either obstructive or restrictive syndrome according to the chemical class of pesticide.12 papers reported results from cohort studies. Three out of nine found a significant relationship with increased risk of wheeze, five out of nine with asthma and three out of three with chronic bronchitis. In workers employed in pesticide production, elevated risks of chronic obstructive pulmonary disease (two studies out of three) and impaired respiratory function suggestive of an obstructive syndrome (two studies out of two) were reported.In conclusion, this article suggests that occupational exposure to pesticides is associated with an increased risk of respiratory symptoms, asthma and chronic bronchitis, but the causal relationship is still under debate.

scholarly journals Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey

2019 ◽  
pp. oemed-2018-105274 ◽  
Author(s):  
Theodore Lytras ◽  
Manolis Kogevinas ◽  
Hans Kromhout ◽  
Anne-Elie Carsin ◽  
Josep Maria Antó ◽  
...  
Keyword(s):  
Chronic Bronchitis ◽  
European Community ◽  
Health Survey ◽  
Mineral Dust ◽  
Respiratory Health ◽  
Occupational Exposures ◽  
Dust Exposure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk

ObjectivesChronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey.MethodsPopulation samples aged 20–44 were randomly selected in 1991–1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations.Results8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides.ConclusionsOccupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.

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