Margaret S. Filios

Cleaning products and work-related asthma.

To describe the characteristics of individuals with work-related asthma associated with exposure to cleaning products, data from the California-, Massachusetts-, Michigan-, and New Jersey state-based surveillance systems of work-related asthma were used to identify cases of asthma associated with exposure to cleaning products at work. From 1993 to 1997, 236 (12%) of the 1915 confirmed cases of work-related asthma identified by the four states were associated with exposure to cleaning products. Eighty percent of the reports were of new-onset asthma and 20% were work-aggravated asthma. Among the new-onset cases, 22% were consistent with reactive airways dysfunction syndrome. Individuals identified were generally women (75%), white non-Hispanic (68%), and 45 years or older (64%). Their most likely exposure had been in medical settings (39%), schools (13%), or hotels (6%), and they were most likely to work as janitor/cleaners (22%), nurse/nurses’ aides (20%), or clerical staff (13%). However, cases were reported with exposure to cleaning products across a wide range of job titles. Cleaning products contain a diverse group of chemicals that are used in a wide range of industries and occupations as well as in the home. Their potential to cause or aggravate asthma has recently been recognized. Further work to characterize the specific agents and the circumstances of their use associated with asthma is needed. Additional research to investigate the frequency of adverse respiratory effects among regular users, such as housekeeping staff, is also needed. In the interim, we recommend attention to adequate ventilation, improved warning labels and Material Safety Data Sheets, and workplace training and education.

A descriptive study of work aggravated asthma

Background and Aims: Work related asthma (WRA) is one of the most frequently reported occupational lung diseases in a number of industrialised countries. A better understanding of work aggravated asthma (WAA), as well as work related new onset asthma (NOA), is needed to aid in prevention efforts. Methods: WAA and NOA in the United States were compared using cases reported to the National Institute for Occupational Safety and Health (NIOSH) from four state Sentinel Event Notification Systems for Occupational Risks (SENSOR) surveillance programmes for 1993–95. Results: A total of 210 WAA cases and 891 NOA cases were reported. WAA cases reported mineral and inorganic dusts as the most common exposure agent, as opposed to NOA cases, in which diisocyanates were reported most frequently. A similar percentage of WAA and NOA cases still experienced breathing problems at the time of the interview or had visited a hospital or emergency room for work related breathing problems. NOA cases were twice as likely to have applied for workers’ compensation compared with WAA cases. However, among those who had applied for worker compensation, approximately three-fourths of both WAA and NOA cases had received awards. The services and manufacturing industrial categories together accounted for the majority of both WAA (62%) and NOA (75%) cases. The risk of WAA, measured by average annual rate, was clearly the highest in the public administration (14.2 cases/105) industrial category, while the risk of NOA was increased in both the manufacturing (3.2 cases/105) and public administration (2.9 cases/105) categories. Conclusions: WAA cases reported many of the same adverse consequences as NOA cases. Certain industries were identified as potential targets for prevention efforts based on either the number of cases or the risk of WAA and NOA.

Work-related reactive airways dysfunction syndrome cases from surveillance in selected US states.

Learning ObjectivesDistinguish between reactive airways dysfunction syndrome (RADS) and other cases of work-related asthma (WRA) associated with a known asthma-inducing agent.Contrast the clinical features, severity, and course of RADS with those of other WRA related to an identified asthma inducer.Identify differences in outcome and disposition between RADS and other WRA. The objective was to elaborate the descriptive epidemiology of work-related cases of reactive airways dysfunction syndrome (RADS). Cases of work-related asthma (WRA) were identified in four states in the United States during 1993–1995 as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR). Information gathered by follow-back interview was used to describe 123 work-related RADS cases and to compare them to 301 other WRA cases whose onset of disease was associated with a known asthma inducer. RADS represented 14% of all new-onset WRA cases identified by the state SENSOR surveillance systems. RADS cases had significant adverse medical and occupational outcomes identified by follow-back interview. In particular, 89% still had breathing problems, 78% had ever sought emergency care and 39% had ever been hospitalized for work-related breathing problems, 54% had applied for worker compensation benefits, and 41% had left the company where they experienced onset of asthma. These values equaled or exceeded the comparable figures for those WRA cases whose onset was attributed to a known inducer. Work-related RADS represents a minority of all WRA cases, but the adverse impact of this condition appears to equal that of other WRA cases.

The proportion of self-reported asthma associated with work in three states : California, Massachusetts, and Michigan, 2001

Objectives. To assess the proportion of adult asthma at the state level that may be related to work. Design. Work-related asthma questions were added to the 2001 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire in California, Massachusetts, and Michigan. Results. Findings indicate 7.4–9.7% of those with current asthma reported that their asthma may be work related. These results estimate that approximately 137,000 adults in California, 39,000 in Massachusetts, and 63,000 in Michigan have asthma that may be work related. Conclusions. These findings are unique in providing population-based estimates at the state level that illustrate that a substantial portion of adult asthma morbidity is due to exposures in the work environment.

Gender differences in work-related asthma: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993–2008

ABSTRACT Objective: To characterize work-related asthma by gender. Methods: We analyzed state-based sentinel surveillance data on confirmed work-related asthma cases collected from California, Massachusetts, Michigan, and New Jersey during 1993–2008. We used Chi-square and Fisher’s Exact Test statistics to compare select characteristics between females and males. Results: Of the 8239 confirmed work-related asthma cases, 60% were female. When compared to males with work-related asthma, females with work-related asthma were more likely to be identified through workers’ compensation (14.8% versus 10.6%) and less likely to be identified through hospital data (14.2% versus 16.9%). Moreover, when compared to males, females were more likely to have work-aggravated asthma (24.4% versus 13.5%) and less likely to have new-onset asthma (48.0% versus 56.5%). Females were also more likely than males with work-related asthma to work in healthcare and social assistance (28.7% versus 5.2%), educational services (11.8% versus 4.2%), and retail trade (5.0% versus 3.9%) industries and in office and administrative support (20.0% versus 4.0%), healthcare practitioners and technical (13.4% versus 1.6%), and education training and library (6.2% versus 1.3%) occupations. Agent groups most frequently associated with work-related asthma were miscellaneous chemicals (20.3%), cleaning materials (15.3%), and indoor air pollutants (14.9%) in females and miscellaneous chemicals (15.7%), mineral and inorganic dusts (13.2%), and pyrolysis products (12.7%) in males. Conclusions: Among adults with work-related asthma, males and females differ in terms of workplace exposures, occupations, and industries. Physicians should consider these gender differences when diagnosing and treating asthma in working adults.

Isocyanates and work-related asthma: Findings from California, Massachusetts, Michigan, and New Jersey, 1993-2008

BACKGROUND Isocyanates remain a leading cause of work-related asthma (WRA). METHODS Two independent data systems were analyzed for the period 1993-2008: (1) State-based WRA case surveillance data on persons with isocyanate-induced WRA from four states, and (2) Occupational Safety and Health Administration (OSHA) Integrated Management Information System (IMIS) isocyanate air sampling results. RESULTS We identified 368 cases of isocyanate-induced WRA from 32 industries and 678 OSHA isocyanate air samples with detectable levels from 31 industries. Seventeen industries were unique to one or the other dataset. CONCLUSION Isocyanate-induced WRA continues to occur in a wide variety of industries. Two data systems uncovered industries with isocyanate exposures and/or illness. Improved control measures and standards, including medical surveillance, are needed. More emphasis is needed on task-specific guidance, spill clean-up procedures, skin and respiratory protection, and targeted medical monitoring to mitigate the hazards of isocyanate use.

Recommendations for a Clinical Decision Support System for Work-Related Asthma in Primary Care Settings

Objective: The aim of this study was to describe a recommended clinical decision support (CDS) approach for work-related asthma for incorporation in electronic health records (EHRs) for primary care health care providers. Methods: Subject matter experts convened by the American Thoracic Society reviewed available guidelines and published literature to develop specific recommendations. Results: It is important to recognize possible work-related asthma among persons with new-onset or worsening asthma. The work group recommends incorporating three simple questions about temporal relations between asthma symptoms and work in EHR systems and identified specific clinical conditions to trigger this intervention. Patients with positive responses to the three questions should have the asthma diagnosis documented and have further evaluation, education, and possible referral. Conclusion: An effective CDS system for improving recognition of work-related asthma may help reduce morbidity and mortality of asthma in adults.

Recognition of the Relationship between Patients' Work and Health

Objective: The aim of this study was to determine the perceived value and feasibility of increased access to information about workers’ health for primary care providers (PCPs) by evaluating the need for clinical decision support (CDS) related to worker health in primary care settings. Methods: Qualitative methods, including semi-structured interviews and observations, were used to evaluate the value and feasibility of three examples of CDS relating work and health in five primary care settings. Results: PCPs and team members wanted help addressing patients’ health in relation to their jobs; the proposed CDS examples were perceived as valuable because they provided useful information, promoted standardization of care, and were considered technically feasible. Barriers included time constraints and a perceived inability to act on the findings. Conclusion: PCPs recognize the importance and impact of work on their patients’ health but often lack accessible knowledge at the right time. Occupational health providers can play an important role through contributions to the development of CDS that assists PCPs in recognizing and addressing patients’ health, as well as through the provision of referral guidelines.