DISCUSSION
pulmonary disease, asthma, COPD, airway diseases
DISEASE, AIRWAY DISEASES, COPD, ASTHMA, PULMONARY DISEASE, DISEASES
The present study includes a 24-year prospective follow-up of a random population cohort collected in 1996 from Helsinki region in Finland. We found that JEM-assessed occupational exposure influences the overall mortality in all subjects. We also found that high exposure combined to self-reported coexisting physician diagnosed asthma and COPD had a higher hazard of overall mortality after a 24-year follow-up. Furthermore, we found that self-reported asthma and COPD coexistence had higher sub-HR of mortality due to respiratory causes.Previous researchThe attributable risk of occupational exposure to airway diseases is estimated to be somewhere approximately 10% to 20%.In an earlier study,The effect of smoking on development of COPD is well known.A recent meta-analysis, including 26 observational study articles,The Finnish Social Security Institution is responsible for all medication reimbursements in Finland and finances its own research as well as uses the current research knowledge available in determining the guidelines in which medication costs are reimbursed in Finland. Because of this system, most diseases need a thorough examination to fulfill their criteria. This is also true for asthma as well as for COPD, both of which have needed measurement data (PEF surveillance or spirometry for asthma and spirometry for COPD), to be eligible for the reimbursement of medical costs. Because of this, most of the diagnoses self-reported by Finnish citizen have a modicum of reliance on not only symptoms but instrumental measurements as well. This medical compensation system has previously been somewhat problematic for those with COPD as they have not as easily been able to get reimbursement for their medication because of more strict diagnostic lung function criteria (FEV1 < 40% of predicted) compared with those with asthma diagnosis (the confirmation of reversibility of any level of obstruction), which may have affected the adherence to the treatment in those with COPD.Occupational exposure can induce asthma or COPD or worsen an existing disease,According to Finnish law, an employer must offer all its employees occupational health care. The purpose of occupational health care is to prevent work-related illnesses and accidents, promote the safety of the work environment, and maintain the health of workers throughout their working lives. High exposure alone had a significant hazard of mortality, and high exposure combined with asthma and COPD had even higher hazards as well as a sub-hazards of respiratory-related mortality. These results highlight the role of occupational legislation and occupational health care in prevention of premature or respiratory mortality. Further guidance and development are needed to minimize occupational respiratory exposure. Both exposure measurements and different kinds of methods to reduce any exposure are recommended.We recommend that individuals with a preexisting pulmonary disease should be protected by further exposure by both PPE and other equipment if environmental exposure cannot be removed from the workplace air.