Incidence of work-related asthma in members of a health maintenance organization

Work-Related Asthma

OBJECTIVE

Summarize developed evidence-based diagnostic and treatment guidelines for work-related asthma (WRA).

METHODS

Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed.

RESULTS

Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery.

CONCLUSION

Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA.

Occupational asthma incidence: findings from the behavioral risk factor surveillance system asthma call-back survey--United States, 2006-2009

BACKGROUND

Occupational asthma (OA) is new-onset asthma or the recurrence of previously quiescent asthma caused by workplace exposures.

OBJECTIVE

To estimate the incidence of population-based new-onset OA and the proportion of incident asthma that is work-related.

METHODS

Behavioral Risk Factor Surveillance System and Asthma Call-back Survey data collected from persons aged ≥18 years during 2006-2009 in 38 states and the District of Columbia were analyzed. Incident health professional-diagnosed new-onset OA cases were persons whose asthma was diagnosed for the first time within the past 12 months whose health professional indicated their asthma was related to their work. Incident potential new-onset OA cases were persons with asthma diagnosed within the past 12 months who did not have health professional-diagnosed work-related asthma but described their asthma as caused by workplace exposures. The proportion of incident asthma that is work-related was calculated using the 2006-2008 estimate of adult asthma incidence (3800 per million).

RESULTS

The estimated annual incidence of health professional-diagnosed new-onset OA was 179 (95% CI: 113-245) per million population. For combined health professional-diagnosed and potential new-onset OA the incidence was 692 (95% CI: 532-853) per million population. The proportion of incident asthma among adults that is work-related was 4.7% for health professional-diagnosed new-onset OA and 18.2% for combined health professional-diagnosed and potential new-onset OA.

CONCLUSIONS

New-onset asthma in as many as one of six adult patients might be associated with work. Clinicians should consider the role of occupational exposures when evaluating adults with incident asthma which may uncover opportunities for early intervention and reversal of an otherwise chronic disease.

Prevalence of work-related asthma in Michigan, Minnesota, and Oregon

INTRODUCTION

Adults who have asthma that is caused or aggravated by triggers at work experience a reduced quality of life. In this study, the authors sought to estimate the proportion of asthma that is associated with work using a state-based survey of adults with asthma.

METHODS

In 2005, Michigan, Minnesota, and Oregon piloted the Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey, with sample sizes of 867, 469, and 1072, respectively. Six questions addressing work-related asthma (WRA) were analyzed to generate estimates of the proportion of adult asthma that is work-related and compare those with and without WRA.

RESULTS

Over half of all adults with asthma (53%) reported that their asthma was caused or made worse by any job they ever had, and among these respondents reporting WRA, only 21.5% to 25.1% reported ever telling or being told by a health professional that their asthma was work-related. Additionally, adults with WRA consistently reported poorer asthma control and higher health care utilization than adults with non-WRA.

CONCLUSIONS

WRA is a common but frequently unrecognized health problem, and this lack of recognition might contribute to poorer asthma control among adults with WRA. Because early recognition, treatment, and management of WRA are crucial for improving long-term prognosis, clinicians need to include assessment of workplace triggers in both their diagnostic and treatment plans for adult patients with asthma.

Prevalence of lifetime asthma and current asthma attacks in U.S. working adults: an analysis of the 1997-2004 National Health Interview Survey data

OBJECTIVE

To estimate national prevalences of lifetime asthma and asthma attacks among workers by age, sex, race, occupation and industry, and estimate population attributable fraction to employment for asthma attacks in the United States.

METHODS

The 1997-2004 National Health Interview Survey data for currently working adults aged > or = 18 years were analyzed.

RESULTS

Lifetime asthma prevalence was 9.2%; the social services religious and membership organizations industry and the health service occupation had the highest asthma prevalence. Asthma attack prevalence among workers with asthma was 35.4%; the primary metal industry and the health assessment and treating occupation had the highest attack prevalence. Approximately, 5.9% of cases reporting an asthma attack were attributed to employment when considering industries and 3.8% when considering occupations.

CONCLUSIONS

Future studies and intervention strategies should address the higher prevalence of asthma in certain industries and occupations.

Asthma caused by occupational exposures is common - a systematic analysis of estimates of the population-attributable fraction

Background

The aim of this paper is to highlight emerging data on occupational attributable risk in asthma. Despite well documented outbreaks of disease and the recognition of numerous specific causal agents, occupational exposures previously had been relegated a fairly minor role relative to other causes of adult onset asthma. In recent years there has been a growing recognition of the potential importance of asthma induced by work-related exposures

Methods

We searched Pub Med from June 1999 through December 2007. We identified six longitudinal general population-based studies; three case-control studies and eight cross-sectional analyses from seven general population-based samples. For an integrated analysis we added ten estimates prior to 1999 included in a previous review.

Results

The longitudinal studies indicate that 16.3% of all adult-onset asthma is caused by occupational exposures. In an overall synthesis of all included studies the overall median PAR value was 17.6%.

Conclusion

Clinicians should consider the occupational history when evaluating patients in working age who have asthma. At a societal level, these findings underscore the need for further preventive action to reduce the occupational exposures to asthma-causing agents.

Work-related asthma in the educational services industry: California, Massachusetts, Michigan, and New Jersey, 1993-2000

OBJECTIVES

To characterize work-related asthma (WRA) cases working in the educational services industry identified by state-based occupational disease surveillance systems.

METHODS

We examined 2,995 WRA cases reported from 1993 to 2000 to four states: California, Massachusetts, Michigan, and New Jersey.

RESULTS

A total of 265 (9%) WRA cases were employed in the educational services industry; 69% of cases were classified as new-onset asthma and 31% as work-aggravated asthma. New-onset asthma cases were further classified as occupational asthma (61%) or as reactive airways dysfunction syndrome (8%). The most frequently reported occupation was teachers and teachers' aides (54%). The most frequently reported agents were indoor air pollutants (28%), unspecified mold (16%), dusts (14%), and cleaning products (7%).

CONCLUSIONS

Asthma within the educational services industry is an occupational health problem. The health of school employees should also be considered when initiatives addressing asthma among schoolchildren are instituted. The identification, elimination, and/or control of respiratory hazards are important factors for the protection of staff and students alike.

New insights into occupational asthma

PURPOSE OF REVIEW

To examine recent publications on the types of agents involved in occupational asthma, the mechanisms by which they induce asthma, and how best to evaluate and treat workers suspected of this respiratory condition.

RECENT FINDINGS

High rates of occupational asthma and inhalation accidents were found in workers in crafts and related occupations in the manufacturing industries, and in plant and machine operatives; cleaners and construction workers may also be at risk. Further data support a role for CD4 T cells in low-molecular-weight agent-induced asthma, such as with isocyanates, and neurogenic mechanisms may also be involved. The use of noninvasive measures of airway inflammation in the diagnosis and management of occupational asthma such as sputum eosinophils monitoring is promising, although this is less obvious for exhaled nitric oxide. Finally, the persistence of troublesome asthma even after withdrawal from relevant exposure has been re-emphasized and surveillance programs have been proposed.

SUMMARY

Further data have been gathered on the prevalence of occupational asthma in various working populations, its mechanisms of development, the contribution of noninvasive measures of airway inflammation in the diagnosis and management of this condition, and its management and prevention.