@article {Lytras1008, author = {Theodore Lytras and Manolis Kogevinas and Hans Kromhout and Anne-Elie Carsin and Josep M Ant{\'o} and Hayat Bentouhami and Joost Weyler and Joachim Heinrich and Dennis Nowak and Isabel Urrutia and Jes{\'u}s Martinez-Moratalla and Jos{\'e} Antonio Gull{\'o}n and Antonio Pereira-Vega and Chantal Raherison-Semjen and Isabelle Pin and Pascal Demoly and B{\'e}n{\'e}dicte Leynaert and Simona Villani and Thorarinn Gislason and Cecilie Svanes and Mathias Holm and Bertil Forsberg and Dan Norb{\"a}ck and Amar J Mehta and Nicole Probst-Hensch and Geza Benke and Rain Jogi and Kjell Tor{\'e}n and Torben Sigsgaard and Vivi Schl{\"u}nssen and Mario Olivieri and Paul D Blanc and Roel Vermeulen and Judith Garcia-Aymerich and Deborah Jarvis and Jan-Paul Zock}, title = {Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey}, volume = {73}, number = {11}, pages = {1008--1015}, year = {2018}, doi = {10.1136/thoraxjnl-2017-211158}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey.Methods General population samples aged 20{\textendash}44 were randomly selected in 1991{\textendash}1993 and followed up 20 years later (2010{\textendash}2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework.Findings 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95\% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95\% CI 1.0 to 2.2) and pesticides (RR 2.2, 95\% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0\%.Interpretation These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.}, issn = {0040-6376}, URL = {https://thorax.bmj.com/content/73/11/1008}, eprint = {https://thorax.bmj.com/content/73/11/1008.full.pdf}, journal = {Thorax} }