Work-related asthma (WRA)
- The American Thoracic Society, the National Center for Environmental Health (supporting 33 states) and the National Center for Health Statistics are revising their standardized respiratory questionnaires with the assistance of RDRP.
- Serial spirometry software for EasyOne™ portable spirometer that was developed by RDRP staff is now available, and is being used by independent investigators to study WRA.
- Professional organizations championed RDRP recommendations presented in the NIOSH Natural Rubber Latex (NRL) Alert. Awareness of NRL-induced WRA increased.
- RDRP documented a low prevalence of NRL asthma among 1,959 members of staff at 3 VA hospitals following the NRL Alert recommendations. In Germany, mandated reductions in powdered NRL glove usage were paralled by reductions in NRL asthma.
- Alerts from 2 States both cite the RDRP 1996 Isocyanate Alert.
- Identifying asthma as WRA is often difficult. The association between asthma and workplace exposures may not be obvious, workplace exposures are frequently occult, and there are a growing number of asthmagens, often present in complex mixtures.
Indoor-air quality (IEQ)
- Many RDRP recommendations have been adopted, especially through the Health Hazard Evaluation Program.
- An RDRP Partnership with Maine schools won a USEPA award (2005).
- Surgeon General released report on Healthy Buildings that used RDRP information (2005), and two Institute of Medicine reports followed (2005, 2006), which cited RDRP findings.
- RDRP contributed to CDC dissemination of mold recommendations after hurricane Katrina.1
- There is increasing recognition of building dampness as an important IEQ problem. However, IEQ remains a major and often controversial issue.
Fixed Obstructive Airways Diseases
Chronic obstructive pulmonary disease (COPD)
- An authoritative American Thoracic Society statement (2003) that summarizes an “impressive body of scientific literature [showing that] occupational exposures contribute to the development of COPD” was based in part on RDRP findings.
- Lung function prediction equations developed by RDRP have been widely adopted in clinical and occupational venues.
- RDRP-developed SPIROLA software for assessment of longitudinal lung function data has been well-received by stakeholders. The product is available for download from the NIOSH web site.
- Long latency for diseases such as COPD limits the ability to demonstrate association with work and the benefits of preventive impacts.
- Due to the long latency of COPD, the full impact of advances such as improved early detection will not be apparent for many years.
Byssinosis (brown lung and the cotton dust standard)
- Based in part on RDRP findings, OSHA promulgated a comprehensive cotton dust standard (1978). Requirements for medical monitoring included criteria for spirometry standards and requirement for training spirometry technicians.
- Additional research on washed cotton led to revisions of the cotton dust standard in 1985 and 2001.
- Based in part on RDRP findings, the American Thoracic Society adopted criteria for spirometry standardization in 1979 and later promulgated updates. Many of these standards continue to be reflected in the current joint American Thoracic Society/ European Respiratory Society guidelines on lung function testing.
- RDRP endotoxin findings helped to motivate exposure reduction strategies in the biotechnology industry.
- RDRP helped to reduce rates of byssinosis (brown lung) in workers engaged in yarn and fabric manufacture from ~20% in 1974 to <1% by 1980s.
- The economic cost to industry of the cotton dust standard was less than half of original estimates; there was a low economic impact on small business and productivity increased with improved dust control technologies.
- Spirometry, spirometry training, and its oversight have been improved and standardized.
- Spirometry courses, for which RDRP provides oversight and training, are taught in 41 locations across the U.S., and internationally; these were established under cotton dust standard.
Flavorings-induced lung disease (bronchiolitis obliterans syndrome; butter flavorings)
- RDRP recommendations led to use of PPE and installation of engineering controls to reduce exposures to butter flavorings; companies are independently exploring engineering to closed processes and other measures to maximally reduce exposures, such as ventilation. Several microwave popcorn manufacturing companies have indicated that they will stop using diacetyl in their products.
- RDRP documented reduced exposures (100 to 1000-fold) at the index microwave popcorn production plant.
- Based on RDRP research, two flavoring companies revised Material Safety Data Sheets to add warnings concerning diacetyl.
- OSHA Region 7 and Cal-OSHA have taken steps to ensure exposure reduction.
- Obstructive lung disease development in the index microwave popcorn production plant and in the industry in general has been decreased.
- Research on diacetyl has been stimulated at EPA, NIEHS, and in the Netherlands. In the Netherlands bronchiolitis obliterans syndrome has been linked to production of diacetyl.
- OSHA and Cal-OSHA were petitioned by stakeholders to provide a temporary emergency standard for diacetyl.
- A Bill has been passed by a House Committee and submitted to the House of Representatives that would require OSHA to promulgate a standard for diacetyl exposure.
Coal mine dust induced diseases
- RDRP conducted 300,000 x-ray examinations and provided 18,000 miners with letters to exercise rights to less dusty jobs. Three thousand miners exercised those rights.2
- RDRP efforts helped to reduce number of coal mine dust samples exceeding the MSHA PEL (2 mg/m3) and have helped to reduce respirable coal mine dust levels, despite increased production.
- RDRP helped to reduce respirable coal mine dust levels, despite increased production.
- Compared to the 1970s, RDRP helped to reduce the prevalence of pneumoconiosis in coal miners (from ~35% to ~5% in long-tenure miners).
- Declining coal mine employment and unionization.
- Increased mechanization and production.
- Past episodes of fraud in dust sampling affect confidence in hazard surveillance data.
- MSHA PEL for respirable coal mine dust (2 mg/m3) exceeds the NIOSH REL (1 mg/m3).
Silica induced diseases
Also see Malignancies
- RDRP promoted the use of substitute materials for silica sand in abrasive blasting, and use of silica sand for sandblasting dropped from 1.47 million metric tons (MMT) in 1996 to 0.78 MMT in 2004.
- RDRP helped to improve engineering controls for silica dust.
- MSHA established new rule (1994) for enforcing dust standards for rock drilling, which was in part based on RDRP data.
- OSHA is moving forward with rulemaking for a comprehensive silica standard, in part based on RDRP data.
- RDRP helped to reduce silicosis mortality from >1000 per year through 1970 to <200 per year since 1997.
- RDRP helped to reduce the proportion of worksite samples that exceed the PEL.
- The OSHA PEL still exceeds NIOSH REL.
- Only one company has access to specular hematite, the most valuable sandblasting substitute (thus cost is high, which limits use).
Fiber induced diseases
Also see Malignancies
- Based in part on RDRP data OSHA promulgated multiple PELs:
- (1976) 2.0 f/cc
- (1986) 0.2 f/cc
- (1994) 0.1 f/cc.
- Based in part on RDRP data, MSHA also developed PELs:
- PEL (1978) 2 f/cc
- MSHA proposed PEL (2005) 0.1 f/cc
- RDRP helped to reduce asbestos exposures from 1970s through mid-1990s.
- The health impact of exposures is obscured by long disease latency. The U.S. age-adjusted asbestosis death rates (per 106 population) rose steadily over several decades to a peak of 6.85 in 2000; rates for 2001 (6.57) through 2004 (6.34) indicate a plateau and possibly a slight decline.3
Chronic beryllium disease
- Based substantially on RDRP findings, Brush Wellman Inc. implemented a Comprehensive Preventive Program that included skin protection.
- Within four years RDRP documented an 8-fold reduction in beryllium sensitization rates at one plant that implemented the BWI Comprehensive Preventive Program.4
Hypersensitivity pneumonitis (HP) due to metalworking fluid (MWF)
- Based in part on RDRP findings, OSHA produced a best practices document for MWF.
- Based in part on RDRP findings, OSHA and the Independent Lubricant Manufacturers Association formed an alliance and produce “QUICKSTART,” which is a guide on the use of MWF for small businesses.
- Based in part on RDRP findings, NHLBI promulgated HP research priorities.
- Based in part on RDRP strategies, a large company minimized illness in workers and decreased the number of medically restricted workers from 107 to 30.
Infectious Lung Diseases
- CDC incorporated RDRP recommendations on environmental controls into guidance on TB prevention for the healthcare and correctional/detention settings.
- RDRP influenced guidance from the American Institute of Architects and the American Society of Heating, Refrigerating, and Air-conditioning Engineers.
- RDRP influenced standards used by the Joint Commission on Accreditation of Healthcare Organizations and by OSHA.
- The overall number of TB cases in U.S. declined by 46% between 1992 and 2004.
- The incidence of active TB among healthcare workers declined from 5.6 to 4.6 per 100,000 between 1994 and 1998.
- Limited data for assessing occupationally-related TB, especially asymptomatic TB infection, for most worker groups/settings.
- CDC and HHS rapidly adopted and posted preventive recommendations in the immediate aftermath of the “anthrax attacks,” RDRP made a significant contribution to this effort.
- USPS facilities were decontaminated following recommendations which RDRP helped to develop. RDRP contributed to development and implementation of ventilation filtration systems and biological detection systems.
- While it is impossible to be certain, it is likely that the death toll from the “anthrax attacks” would have been more than five had comprehensive preventive guidance not been developed.
- Though not measurable, preventive guidance is also intended to contribute to safer workplaces in the event of future biological attacks.
SARS, Avian and Pandemic Influenza
- OSHA and others used CDC guidance, in part developed by RDRP, in developing prevention recommendations.
- Avian influenza guidelines implemented by poultry producers.
- WHO revised recommendations to include use of designated disposable respirators that provide protection equivalent to NIOSH-certified N-95 respirators.
- Only 8 people in the U.S. contracted SARS.
- The impact of preventive interventions on reducing morbidity and mortality from intermittent, low-frequency epidemics is difficult to quantify.
Occupational Exposures and Susceptibility to Respiratory Infections
- Based in part on RDRP findings, EPA produced a “Health Assessment Document for Diesel Engine Exhaust.”
- NTP plans to use an RDRP designed welding fume generator system for chronic exposure studies.
- Findings of research on increased susceptibility to lung infection may lead to improved protections for workers
- RDRP recommendations have been adopted as guidance by OSHA, the Center to Protect Workers’ Rights, various State Health Departments and company occupational safety and health programs.
- Occupational outbreaks of histoplasmosis are now infrequent and RDRP established prevention recommendations remain relevant.
Occupational Etiology of Lung Cancer
- IARC cited RDRP data in the classification of beryllium as a Group 1 carcinogen.
- OSHA cited RDRP data in the promulgation of a cadmium PEL (40μg/m3).
- OSHA cited RDRP data in the promulgation of a chromium PEL (5μg/m3) 2006-2008. The chromium PEL was made applicable to Construction sector through availability of RDRP’s field portable instrument. The USAF has adopted use of this instrument for monitoring aircraft restoration activities. Reduced levels of Cr6+ exposure can be expected to reduce cancer risk.
- In 1997 IARC cited RDRP data in the designation of crystalline silica as a Group 1 human carcinogen. More than ten percent of the 400 references cited were authored by RDRP staff. IARC influence can be expected to help reduce silica exposures and number of lung cancer deaths.
- MSHA cited RDRP data in the promulgation of a final rule (2001) for control of diesel engine exhaust. A commercial size-selective sampler for diesel particulate matter, which resulted from an RDRP-industry collaboration, is now commercially available from SKC. Reducing levels of exposure to diesel emissions can reasonably be expected to reduce cancer risk.
- Detection of a reduction in occupational cancer resulting from reduction in exposure to occupational carcinogens will only be possible after decades based on long latency.
- As a result of the production of RDRP nanotechnology products the U.S. was able to provide strong leadership and vision during the formation of the International Standards Organization Technical Committee on Nanotechnologies established (2005). This resulted in the U.S. Chairing the Working Group on Safety and Health Standards.
- Nanotechnology is new and occupational disease has not yet been attributed to manufactured nanomaterial exposures; use of manufactured nanomaterials is projected to grow; lab-based RDRP nanoparticle studies suggest they have been correctly identified as potential occupational health hazards.5
- Knowledge, attitudes, and practices related to mold exposure among residents and remediation workers in post-hurricane New Orleans.
Archives of Environmental & Occupational Health. 61:101-108, 2006.
- Occupational Respiratory Disease Surveillance
- The Work-Related Lung Disease Surveillance Report, 2002
DHHS (NIOSH) Publication No. 2003-111
- Enhanced preventive program at a beryllium oxide ceramics facility reduces beryllium sensitization among new workers.
Occup Environ Med. 64:134-140, 2007.
- Am. J. Physiol. [LC/MP] 289: 698-708, 2005.
- National Institute for Occupational Safety and Health (NIOSH)
- Centers for Disease Control and Prevention
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