Eileen Storey

Physician-Patient Communication Regarding Asthma and Work

BACKGROUND Healthy People 2020-specific respiratory diseases objectives seek to increase the proportion of people with current asthma who receive appropriate asthma care. For adults, this includes a discussion of whether asthma is work-related. PURPOSE To establish a baseline measure of physician-patient communication regarding asthma and work. METHODS This study used data from 27,157 non-institutionalized U.S. adult respondents of the 2010 National Health Interview Survey (analyzed in 2011). Adults employed at any time in the 12 months prior to the interview with a health-professional diagnosis of current asthma who have been told by a health professional that their asthma was probably work-related or ever discussed the relatedness of asthma and work were identified. Weighted proportions and, using logistic regression analysis, prevalence ORs for factors that may have predicted communication with a health professional regarding an asthma-work relationship were calculated. RESULTS An estimated 6.6% (95% CI=5.1%, 8.2%) of employed adults with current asthma have been told that their asthma is work-related. Among those not so informed, 7.4% (95% CI=5.6%, 9.2%) ever discussed the topic. When responses to both questions were considered, the proportion was 13.5% (95% CI=11.3%, 15.8%). Employed adults aged ≥30 years, those reporting adverse asthma outcomes, and those of Hispanic ethnicity had higher odds of having communication with a health professional about the relation between their asthma and their work. CONCLUSIONS One in seven employed adults with asthma report communicating with their health professional about the role of workplace exposures in their asthma. Opportunities to increase this dialogue should be examined.

Occupational distribution of persons with confirmed 2009 H1N1 influenza.

Objective: To assess the distribution of illness by industry sector and occupation reflected in early 2009 H1N1 influenza surveillance. Methods: We analyzed data reported for April to July 2009, for 1361 laboratory-confirmed 2009 H1N1 influenza-infected persons 16 years or older, with work status information from four states. A North American Industry Classification System 2007 code was assigned to each employed person. For a subset, an occupation code was assigned. Results: Of 898 employed individuals, 611 (68.0%) worked in the non-health care sector. The largest proportions worked in public administration, educational services, and accommodation and food services. In Wisconsin health care personnel, 53.6% were paraprofessionals, 33.6% professionals, and 12.7% other workers; 26.9% worked in ambulatory settings, 46.2% in hospitals, and 26.9% in nursing or residential care facilities. Conclusions: Our findings suggest that industry sectors and occupations should be explored systematically in future influenza surveillance.

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.

Occupation held at the time of asthma symptom development.

BACKGROUND Examining occupations other than those held when asthma symptoms first developed may not correctly identify occupations with higher risk of asthma onset. METHODS To determine the occupation held when individuals first developed asthma symptoms, we examined 2010 National Health Interview Survey data for working adults with current asthma. RESULTS Overall 37.1% of working adults with current asthma developed asthma while employed. Of these, the highest proportions of individuals identified office and administrative support (13.3%), sales and related (9.4%), and management (8.5%) as the occupation held when asthma first developed; 37.8% had a different current occupation than at asthma onset, and estimates of a change in occupation were highest for those who developed asthma while working in business and financial operations (49.3%), sales and related (48.6%), and healthcare support (43.8%) occupations. CONCLUSION Future population-based studies should further examine associations between asthma and occupation held at time of asthma onset.

Pneumoconiosis in carbon electrode workers.

Pneumoconiosis was diagnosed in five workers involved in the manufacture of carbon electrodes. Possible etiologies are discussed. It is generally believed that pneumoconiosis ceased to be a problem in this industry after World War II; however, the reported cases all resulted from exposures after 1940. These findings question the efficacy of recent and current engineering controls and suggest the need for further study of this industry.

Incidence of Occupational Asthma and Exposure to Toluene Diisocyanate in the United States Toluene Diisocyanate Production Industry

Objective: This study examines asthma risk in facilities producing toluene diisocyanate (TDI). Methods: A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures. Results: The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV1). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68). Conclusions: There is evidence that cumulative and peak exposures are associated with TDI-induced asthma.

National Institute for Occupational Safety and Health Nanomaterials and Worker Health Conference--medical surveillance session summary report.

Objectives: The goal of these sessions was to identify current practices and recommendations regarding medical surveillance for nanomaterial workers. Methods: Conference participants met in three discussion groups. Results: There were few existing programs directed to nanomaterial workers. Participants expressed a range of views, from feeling that comprehensive medical surveillance is important currently to suggesting that targeted medical surveillance will become important when more complete data are available to assess risks. Conclusions: Results of health outcomes research for ultrafine air pollution and toxicological information about specific nanomaterials should inform the design of medical surveillance programs. Groups with high exposures should be identified and targeted. Overall, because of uncertainties in the health effects of concern, investments in control measures, exposure assessment efforts, and exposure registries are currently most likely to be important prevention strategies.

Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia

This study describes the demographic and radiographic characteristics of 416 coal miners with progressive massive pulmonary fibrosis (PMF) identified by pneumoconiosis screening as part of the US Coal Workers’ Health Surveillance Program.

Medical Monitoring for Occupational Asthma Among Toluene Diisocyanate Production Workers in the United States

Objective: The aim of this study was to describe a study of medical monitoring methods and lessons learned in detecting health outcomes in U.S. plants producing toluene diisocyanate (TDI). Methods: A multidisciplinary team implemented a medical and environmental monitoring program in three TDI plants. Results: Of 269 eligible workers, 197 (73%) participated and 42 (21%) met symptom and/or lung function criteria that would trigger evaluation for possible asthma over 5 years of data collection. Subsequent evaluation was delayed for most, and a web-based data collection system improved timeliness. Conclusion: Medical monitoring of TDI workers identified workers triggering further assessment per study protocol. Systems and/or personnel to ensure rapid follow-up are needed to highlight when triggering events represent potential cases of asthma needing further evaluation. Implementation of a research protocol requires resources and oversight beyond an occupational health program.

Longitudinal and Cross-sectional Analyses of Lung Function in Toluene Diisocyanate Production Workers

Objective: The aim of this study was to investigate lung function among toluene diisocyanate (TDI) production workers. Methods: One hundred ninety-seven U.S workers performed spirometry from 2006 through 2012. Results were compared within the study cohort and with U.S. population measures. A mixed-effects model assessed factors affecting repeated forced expiratory volume in 1 second (FEV1) measurements. Results: The cohorts mean FEV1 and forced vital capacity (FVC) percent reference values, although greater than 90%, were significantly lower and the prevalence of abnormal spirometry (predominantly restrictive pattern) was significantly higher than in the U.S. population. Differences in lung function among workers with higher cumulative TDI exposure were in the direction of an exposure effect, but not significant. Conclusion: We found little evidence of an adverse effect of TDI exposure on longitudinal spirometry in these workers. The association between TDI exposure and the increasing prevalence of a restrictive pattern needs further exploration.