Occupational Respiratory Disease Surveillance

Work-Related Asthma (WRA)

Worker is is applying adhesive to glass blocks.
Assistant is holding exhaust hose to help
remove toxic fumes.

Massachusetts, Michigan, and New Jersey have maintained WRA surveillance programs since 1988. California has maintained a WRA surveillance program since 1993, and Washington began surveillance for WRA and 2002. New York conducts surveillance for all occupational lung diseases, including WRA, through its long-standing Occupational Lung Disease Registry. Health care professional reports represent the primary ascertainment source in Massachusetts, Michigan, New Jersey, and California. California identifies cases by reviewing data from Doctor’s First Reports (DFR) of Occupational Injury or Illness, a longstanding statewide health care professional reporting system linked to reimbursement for medical services. The primary ascertainment source in New York is hospital discharge data. Washington identifies cases through their state Workers’ Compensation system; employers in Washington are required to obtain State Fund insurance unless they are able to self-insure. Several states use multiple data sources to identify cases including hospital discharge data, emergency room data, workers’ compensation data, as well as Poison Control data in Michigan. State surveillance staff collect demographic, work-history, and medical information for case confirmation, classification, and description through a combination of data sources, review of medical records, and when possible, a follow-up interview with reported cases.

Surveillance Guidelines for State Health Departments

Recommended guidelines for identifying and reporting actual or suspected cases of work-related asthma.

• Reporting Guidelines for WRA
• Surveillance Case Definition for WRA
• WRA Surveillance Categories
• Decision Logic and Case Classification for WRA
• Surveillance Case Classification Criteria for WRA

Asthmagens

AOEC Exposure Codes
External link: http://www.aoec.org/tools.htm
An exposure coding scheme which includes agents classified as "known asthma inducers" and is maintained by the Association of Occupational and Environmental Clinics (AOEC). To facilitate consistency in agent coding across states, putative causes of WRA for each case are coded using this scheme.

Asmapro: A web server for Occupational Asthma
External link: http://www.remcomp.com/asmanet/asmapro/asmawork.htm
An occupational asthma diagnostic tool for providers dealing with asthma in the workplace. Over 70 different occupational asthma cases reside in an html-based relational database, and each case can be retrieved by case id, by the agent (over 400 different agents are listed), or by patient's job (more than 140 different jobs are registered).

Haz-Map®
External link: http://hazmap.nlm.nih.gov/
An occupational toxicology database (of chemicals, jobs, and diseases) designed to link jobs to hazardous job tasks which are linked to occupational diseases and their symptoms.

NIOSHTIC-2

NIOSHTIC-2 is a searchable bibliographic database of occupational safety and health publications, documents, grant reports and journal articles supported in whole or in part by NIOSH.

NIOSHTIC Search Results for Work-Related Asthma
Search Terms: asthma AND CA or MA or MI or NJ or WA or WI or NY And Not animals.

Selected Resources and References Related to Diagnosis/Clinical Evaluation of Work-Related Asthma

The links to external web sites included below are provided for informational purposes only. Citation should not be taken as endorsement by NIOSH of the web site content nor of the sponsoring organization.

American College of Chest Physicians (ACCP) Consensus Statement: Diagnosis and Management of Work-Related Asthma
External link: http://chestjournal.org/cgi/content/abstract/134/3_suppl/1S
The 2008 Consensus Statement was developed by an expert panel and covers issues of assessment, outcome, management, and prevention.

Diagnosing Work-Related Asthma
External link: http://www.lni.wa.gov/Safety/Research/OccHealth/Asthma/default.asp#Resources
An on-line Continuing Medical Education (CME) developed by the Washington State Department of Labor & Industries, Safety & Health Assessment & Research for Prevention (SHARP) Program (2006).

British Occupational Health Research Foundation (BOHRF)
External link: http://www.bohrf.org.uk/content/asthma.html
Includes evidence-based guidelines for the prevention, identification, and management of occupational asthma (2004/2005).

Guidelines for Assessing and Managing Asthma Risk at Work, School, and Recreation
External link: http://www.thoracic.org/sections/publications/statements/pages/eoh/asthma2004.html ATS (2004).
An American Thoracic Society statement, providing health care practitioners, workplace managers, school administrators, and the general public with the issues and guidelines that impact patients with asthma in the workplace, school, and recreation (2004).

Clinical Evaluation, Management, and Prevention of Work-Related Asthma
External link:http: //www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=
10573601&dopt=Abstract
A practical stepwise organization of the diagnostic evaluation of work-related asthma, used by primary care physicians and physicians specializing in occupational diseases and asthma (2000).