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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

NIOSH Programs > Respiratory Diseases > Evidence Package > 2. Introduction to the Program

2.1 Overview

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Work-related respiratory diseases are a problem of major magnitude. Recent information indicates that deaths from work-related respiratory disease and malignancies account for about 70 percent of all occupational disease mortality. 6 In 2004, 11.4 million U.S. adults (aged 18 and over) were estimated to have COPD.7 In the interval from 1997-1999, an estimated 7.4 million people in the U.S. aged 15 and greater reported an episode of asthma or asthma attack in the previous 12 months. 8 A 2003 statement by ATS estimated that 15 percent of COPD and adult asthma were work-related, with a conservative annual estimated cost of nearly $7 billion in the U.S. alone.9 In 1996, it was estimated that approximately 9,000-10,000 men and 900-1,900 women developed lung cancer annually in the U.S. due to past exposure to occupational carcinogens. More than half of these lung cancers were attributed to asbestos.10 Even though the capability has existed for many years to prevent pneumoconiosis, the condition still causes or contributes to in excess of 3000 deaths per year.11

In addition to well known, long standing problems in occupational respiratory disease, new problems continue to emerge. Severe obstructive lung disease and constrictive bronchiolitis caused by artificial butter flavorings,12 interstitial lung disease caused by respirable particles of nylon flock,13 and acute respiratory distress syndrome caused by leather conditioning spray14 are all examples of previously unanticipated conditions that NIOSH has been called upon to investigate.

Protecting workers from occupational lung disease has become a critical national security concern. In the wake of the anthrax attacks of 2001, the potential for exposure to weaponized airborne microbiological agents has become a new reality for public service first responders and first receivers in health care facilities. These working populations are also at risk for exposure to naturally-occurring emerging infectious diseases. SARS- coronavirus, avian influenza, and pandemic influenza have all emerged as important concerns. A particularly troubling aspect of these emerging pathogens is their still poorly defined potential for airborne transmission, an issue of obvious importance in designing prevention strategies.

This chapter provides a brief introduction to the NIOSH RDRP. This is the program within NIOSH most directly responsible for meeting the important challenge of preventing and reducing work-related respiratory diseases. As discussed in chapter 1, RDRP was created in 2005 as a formal organizational component of the NIOSH matrix management structure. Much of the time since then has been devoted to developmental issues. However, throughout this evidence package, the term “RDRP” will be used to describe the broad range of individuals and groups supported by NIOSH to do work that is relevant to occupational respiratory diseases. This broad view of all NIOSH respiratory diseases research is the one most relevant to the societal impact that NIOSH has had in this area.

The RDRP mission statement is, “to provide national and international leadership for the prevention of work-related respiratory diseases, using a scientific approach to gather and synthesize information, create knowledge, provide recommendations, and deliver products and services to those who can effect prevention.” RDRP has developed five strategic goals. Four are based on disease category. One is based on exposure, since it is currently unknown if that exposure will induce respiratory or other work-related disease.

  1. Prevent and reduce work-related airways diseases
  2. Prevent and reduce work-related interstitial lung diseases
  3. Prevent and reduce work-related respiratory infectious diseases
  4. Prevent and reduce work-related respiratory malignancies
  5. Prevent respiratory and other diseases potentially resulting from occupational exposures to nanomaterials

The evidence package adheres to the following hierarchy: intermediate goals support strategic goals; objectives support intermediate goals; and aims support objectives.

Although this evidence package is primarily organized by disease and has a strong disease focus, it should be understood that many types of activities are embodied within the strategic goals. Multidisciplinary research, surveillance, development of authoritative recommendations, health communications, and training and education are all of critical importance to preventing and reducing work-related respiratory disease. These activities may be carried out either specifically by RDRP or within the context of broader NIOSH programs that address the full range of occupational safety and health problems.

RDRP encompasses a group that is rich in disciplinary diversity, but united by a common passion for protecting the respiratory health of workers. As this package will demonstrate, RDRP has a strong history of performing relevant research that makes a difference and we are committed to continue doing so.

6. Steenland K, Burnett C, Lalich N, Ward E, Hurrell J [2003]. Dying for work: The magnitude of U.S. mortality from selected causes of death associated with occupation. Am J Ind Med 43(5):461-82.

7. National Center for Health Statistics.Raw Data from the National Health Interview Survey, U.S., 2003.  (Analysis by the American Lung Association, Using SPSS and SUDAAN software).
External link: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35020

8. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC [2002]. Surveillance for asthma--United States, 1980-1999. MMWR Surveill Summ 29;51(1):1-13.

9. Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, Milton D, Schwartz D, Toren K, Viegi G [2003].Environmental and Occupational Health Assembly, American Thoracic Society. American Thoracic Society Statement: Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med 1;167(5):787-97.

10. Steenland K, Loomis D, Shy C, Simonsen N [2004].Review of occupational lung carcinogens. Am J Ind Med 29(5):474-90.

11. Centers for Disease Control and Prevention [2004]. Changing patterns of pneumoconiosis mortality-U.S., 1968-2000. MMWR 23;53(28):627-32.

12. Kreiss K, Gomaa A, Kullman G, Fedan K, Simoes EJ, Enright PL [2002]. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N Engl J Med 1;347(5):330-8.

13. Eschenbacher WL, Kreiss K, Lougheed MD, Pransky GS, Day B, Castellan RM [1999]. Nylon flock-associated interstitial lung disease. Am J Respir Crit Care Med 159(6):2003-8.

14. Hubbs AF, Castranova V, Ma JY, Frazer DG, Siegel PD, Ducatman BS, Grote A, Schwegler-Berry D, Robinson VA, Van Dyke C, Barger M, Xiang J, Parker J [1997]. Acute lung injury induced by a commercial leather conditioner. Toxicol Appl Pharmacol 143(1):37-46.