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Longitudinal predictors of bronchial hyperresponsiveness and FEV1 decline in bakers

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Abstract

Objective

To determine long-term predictors of bronchial hyperresponsiveness (BHR) and forced expiratory volume in one second (FEV1) decline.

Methods

A longitudinal study in 110 bakers in 4 industrial bakeries and 38 non-exposed workers was conducted at the workplace with a mean of 3.3 visits per subject over a period of 13 years and a mean duration of follow-up of 6 years in bakers and 8 years in non-exposed subjects. A respiratory health questionnaire was administered; occupational allergen skin prick tests, spirometry and a methacholine bronchial challenge test were performed at each visit. In each bakery, full-shift dust samples of the inhalable fraction were obtained in order to assess the exposure of each job assignment. The repeated measurements of BHR and FEV1 were analyzed using mixed effects logistic and linear regression models in subjects seen at least twice.

Results

BHR, respiratory symptoms and their simultaneous occurrence depended on the duration of exposure. FEV1 significantly decreased with duration of exposure and BHR at a preceding visit. This result persisted when adjusting for the effect of BHR at the current visit. The measured exposure levels were not a significant predictor for any outcome. Occupational sensitization was only a predictor of a decline in FEV1 when duration of exposure was not included.

Conclusion

In flour-exposed industrial bakers, length of exposure and smoking are long-term determinants of BHR and of the decrease in FEV1. BHR at a preceding visit predicted lower FEV1 even when accounting for the effect of BHR at the current visit.

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Data availability

The data that support the findings of this study are not available for legal reasons. Access to research data must be authorized by the French data protection agency (Commission nationale de l’informatique et des libertés) before the study begins.

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Acknowledgements

The authors are grateful to all workers who participated in the study. They thank all company directors, managers and occupational physicians who were involved. They also thank Régis Colin from INRS for his precious help in the data management.

Funding

The study was not supported by any external specific funding and was entirely funded by INRS.

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Authors and Affiliations

  1. Institut National de Recherche et de Sécurité (INRS), Vandœuvre Les Nancy, France

    Valérie Demange, Michel Grzebyk, Michel Héry, Nicole Massin & Pascal Wild

  2. CHU de Rennes, Rennes, France

    Christophe Paris

  3. INSERM U1085-IRSET, Rennes, France

    Christophe Paris

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  1. Valérie Demange
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  2. Michel Grzebyk
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Correspondence to Valérie Demange.

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The authors have no conflicts of interest to declare.

Ethics approval

The study was approved by the relevant French ethical committee (Comité consultatif de protection des personnes dans la recherche biomédicale de Lorraine) and the French data protection agency (Commission nationale de l’informatique et des libertés) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All the subjects gave free written and informed consent to participate.

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Demange, V., Grzebyk, M., Héry, M. et al. Longitudinal predictors of bronchial hyperresponsiveness and FEV1 decline in bakers. Int Arch Occup Environ Health 94, 751–761 (2021). https://doi.org/10.1007/s00420-020-01628-0

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