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Clinical outcomes were assessed prospectively for up to 15\u2009years. Respiratory exacerbations were defined as worsening respiratory symptoms requiring treatment with steroids and\/or antibiotics; binary outcomes included atherosclerotic cardiovascular disease (ASCVD), cancer, pneumonia, and blood clots. Multivariable-adjusted models estimated the association between occupational exposure category and each clinical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Among 8991 participants (mean\u2009\u00b1\u2009SD age, 60.1\u2009\u00b1\u20099.0\u2009years; 51.7% male; 49.3% with a current smoking status), the prevalence of dust-only, fumes-only, and dust-and-fumes exposure was 12.0%, 12.4%, and 34.4%, respectively. Self-reported occupational exposure to both dust and fumes was associated with increased risk of future respiratory exacerbations (adjusted rate ratio, 1.38 [95% CI, 1.26-1.52]) relative to those reporting no exposures. Exposure to both dust and fumes was also associated with an increased risk (adjusted odds ratio [95% CI]) for future ASCVD (1.35 [1.17-1.56]) and pneumonia (1.39 [1.19-1.63]), but was not associated with future cancer or blood clots.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Self-reported occupational exposure to dust and fumes is associated with increased future risk for multiple clinically relevant outcomes among tobacco-exposed individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>ClinicalTrials.gov<\/jats:title>\n                    <jats:p>NCT00608764 (COPDGene)<\/jats:p>\n                  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