Executive SummaryPreface | Abbreviations
The National Institute for Occupational Safety and Health (NIOSH) is the federal agency responsible for conducting research and making recommendations for the prevention of occupational injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (DHHS). The Respiratory Diseases Research Program (RDRP) is the broad range of individuals and groups supported by NIOSH to do work that is relevant to occupational respiratory disease.
RDRP has a long history of strategic planning to reduce the burden of work-related respiratory disease. In the 1980s, occupational lung diseases were identified as a top-ranked concern of NIOSH. By the mid-1980s, RDRP published national strategies to prevent occupational lung diseases. RDRP has conducted its planning within the context of broader planning exercises in NIOSH, CDC, and DHHS. Other formal planning exercises involving RDRP have included Healthy People 2000 in 1990; formation of the National Occupational Research Agenda (NORA) in 1996; Healthy People 2010 in 2000; and the second generation of NORA, starting this year. In addition, as noted in evidence package, a variety of disease- and exposure-specific planning exercises have occurred to guide activities in areas such as silica-induced lung disease, fiber-induced lung disease, and tuberculosis.
RDRP and others who were influenced or enabled by RDRP’s work have made important achievements in protecting workers from occupational respiratory diseases. Coal mine dust levels have been reduced and coal workers’ pneumoconiosis has been reduced. Silica exposures have been reduced and deaths from silicosis have declined. The special hazards of freshly-fractured silica have been identified. Identification of dermal exposure as a potential cause of beryllium sensitization lead to changes in work practices that promise to markedly reduce sensitization, and potentially chronic beryllium disease, in beryllium production workers. An epidemic of latex-induced asthma in health care workers has largely been extinguished. Outbreaks of previously-unrecognized occupational lung diseases, including flavoring-induced lung disease and flock workers’ lung disease, have been addressed and findings widely disseminated. This, in turn, has enabled others to recognize additional outbreaks and effect correction of hazardous conditions.
RDRP has documented the contribution of occupational exposures to the burden of lung cancer both nationally and worldwide. RDRP has studied occupational exposures to cadmium, chromium, silica, and diesel exhaust, and has determined that these exposures are human lung carcinogens. Some of RDRP’s findings have been used by the International Agency for Research on Cancer (IARC), the Occupational Safety and Health Administration (OSHA), the Mining Safety and Health Administration (MSHA) and others to take official positions or issue rules to protect workers from the dangers of such exposures.
By contributing its expertise in respiratory protection and engineering controls to broader CDC efforts, RDRP has played a role protecting workers in hospitals, correctional facilities, and homeless shelters from the outbreaks of tuberculosis that came with the human immunodeficiency virus (HIV) epidemic. RDRP has also contributed its expertise to the emergency responses to anthrax, severe acute respiratory syndrome (SARS) and avian influenza. It is playing an important role in planning for the potential threat of pandemic influenza. Some of RDRP’s recommendations have been adopted by organizations including the Department of Homeland Security (DHS) and the Federal Bureau of Investigation (FBI).
RDRP has assumed a leading role in anticipating and preventing potential adverse outcomes arising from exposure of workers to nanoparticulates in the growing nanotechnology industry. RDRP developed a Nanotechnology Research Center (NTRC) to study the physiocochemical properties of nanoparticles and their interactions with biological systems. RDRP has published landmark research and has been instrumental in generating and disseminating information that provides early guidance for those working in occupational settings that are likely to generate nanoparticulate materials.
Despite all that has been accomplished, work-related respiratory diseases remain an important concern. Recent information indicates that deaths from work-related respiratory disease and malignancies account for about 70 percent of all occupational disease mortality. Work-related respiratory disease is also the source of significant morbidity and cost. For example, a 2003 statement by the American Thoracic Society (ATS) estimated that 15 percent of Chronic Obstructive Pulmonary Diseases (COPD) and adult asthma were work-related, with a conservative annual estimated cost of nearly $7 billion in the U.S. alone. RDRP has developed and will maintain a strong surveillance program that evaluates national data sources and works with states to obtain data that quantifies both problems and improvements in prevention of work-related respiratory diseases.
To address the continuing challenge of occupational safety and health, NIOSH has developed a new matrix management structure to provide leadership for programmatic activities that cut across all of NIOSH’s traditional organizational units. RDRP is one of the programs in this matrix management structure. It is inclusive of all NIOSH divisions and laboratories. RDRP has developed a mission statement, a logic model to guide its strategic planning, and an initial set of disease-focused strategic goals. RDRP is committed to continuing data-based, outward-looking strategic planning and implementation that is focused on the usefulness of its program to society at large.