Occupational exposure to vapours, gases, dusts, fumes (VGDF) and pesticides is associated with a greater decline in lung function over time, with pesticide exposure also linked to an increased risk of wheezing, according to a longitudinal study of more than 4,000 adults.

Exposure to airborne pollutants in the workplace is a well-established contributor to respiratory disease, yet longitudinal evidence remains limited, particularly in low- and middle-income countries (LMICs), where occupational health protections may be less comprehensive.

A recent study has therefore investigated associations between workplace exposures, changes in lung function and respiratory symptoms, using data from the multinational Burden of Obstructive Lung Disease (BOLD) study.

The analysis, published in BMJ Open Respiratory Research, included 4,237 participants across 17 study sites, predominantly in LMICs, with a median follow-up of 10 years.

Of these, 2,509 completed a detailed occupational history questionnaire used to estimate cumulative exposure to specific occupational agents.

Occupational exposure was assessed using self-reported occupational histories and the ALOHA+ Job Exposure Matrix, which estimates cumulative exposure to VGDF, pesticides, solvents and metals.

Respiratory outcomes included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio and respiratory symptoms.

Researchers used multilevel regression models adjusted for age, sex, smoking status, cumulative smoking exposure, education, body mass index and baseline FVC.

Workplace exposures and declining lung function

Moderate and high cumulative exposure to VGDF were associated with greater reductions in the FEV1/FVC ratio over follow-up.

Compared with the reference exposure group, moderate VGDF exposure was associated with a regression coefficient of −1.34, whereas high exposure was associated with a coefficient of −1.79.

Pesticide exposure showed similar associations, with regression coefficients of −1.11 (95% CI −2.11 to −0.08) for low exposure and −2.16 for high exposure.

These findings suggest that occupational exposure to these substances may contribute to a greater decline in the FEV1/FVC ratio over time, although the observed associations were modest.

No significant associations were observed with changes in FEV1 or FVC alone, or with incident chronic airflow obstruction.

Pesticide exposure was also associated with an increased risk of wheeze, with statistically significant associations reported for both moderate and high cumulative exposure.

Associations did not differ significantly between men and women, and there was weak evidence of non-linear exposure–response relationships for respiratory symptoms.

No significant associations were identified between solvent or metal exposure and the respiratory outcomes examined.

Implications for respiratory surveillance and prevention

The authors noted that the findings reinforce the importance of considering occupational exposures when assessing respiratory symptoms and declining lung function, alongside established risk factors such as smoking.

The potential value of routine occupational history-taking and respiratory surveillance, particularly among workers in high-exposure settings where preventive measures may be limited, was also highlighted.

However, the study had several limitations. The authors acknowledged that occupational exposures were estimated rather than directly measured, and the job exposure matrix may not fully reflect working conditions in LMICs.

In addition, lung function was measured at only two time points, while substantial loss to follow-up, partly linked to the Covid-19 pandemic, may have introduced selection bias. The observational design also prevented causal conclusions, and broad exposure categories made it difficult to identify the specific substances involved.

Although the associations were modest at an individual level, the authors concluded that the findings support continued respiratory monitoring and efforts to reduce potentially harmful occupational exposures, particularly in LMICs.

Reference
Quintero-Santofimio V et al. Association of respiratory health with occupational exposures in the Burden of Obstructive Lung Disease (BOLD) cohort: a multinational longitudinal study. BMJ Open Respir Res 2026;13:e004213.