Risk and incidence of asthma attributable to occupational exposures among HMO members.
SENSOR Occup Lung Dis Bull 1998 Jul; :1-2
In this issue of the Occupational Lung Disease Bulletin, we include a summary of a recent study of work-related asthma among members of a Massachusetts HMO. In this study the authors define "asthma attributable to occupational exposures" to include new onset of asthma induced by exposure to irritants as well as sensitizers, and new onset of clinically significant symptoms in people with quiescent asthma who have been free of a need for significant asthma medications for a year. In a recent editorial, Wagner and Wegman, point out that this broad concept of work-related asthma has important implications for prevention. "While sensitizer-induced asthma is the best known cause of occupational asthma, prevention of occupational asthma should not be limited to considerations of initial sensitization alone. Rather, it is essential to see the much larger goal of preventing all acute and chronic asthma-related conditions in all workers potentially at risk." This broad definition of "asthma attributable to occupational exposures" is consistent with the guidelines for reporting work-related asthma in Massachusetts. The guidelines specify reporting of all individuals with a physician's diagnosis of asthma who have symptoms related to work. These include not only individuals with new onset asthma caused by workplace exposures but individuals with pre-existing asthma exacerbated by exposures at work. We appreciate your efforts in reporting these cases to the Department. Milton et al point out the benefits of early diagnosis and treatment for the individual affected. Reporting cases to the surveillance system can benefit the population at large as it helps provide the information necessary to target primary prevention efforts. Estimates of the annual incidence of occupational asthma have ranged from 0.9 to 15 cases per 100,000 adults based on surveillance data. Findings from a recent study of a community-based HMO population suggest that the incidence may be much higher and that physicians often fail to ask the questions necessary to assess whether asthma may be work-related. Milton et al. conducted a study of 79,204 HMO members between the ages 15 and 55 at risk of asthma, following them for a three month period. Computerized files, medical records and telephone interviews were used to identify and characterize asthma cases. Evidence for work causation was determined from work-related symptoms and work histories which were evaluated independently by two industrial hygienists who rated potential exposures to sensitizers and irritants. The authors conclude that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported and accounts for a sizable proportion of adult-onset asthma. Given that approximately 20% of adult onset asthma cases may be work-related, failure to diagnose these cases and bill workers' compensation implies a significant loss of revenue to the HMO. More importantly, prompt diagnosis is essential because early cessation of exposure and early anti-inflammatory treatment may improve the prognosis of occupational asthma.
Occupational-diseases; Occupational-health; Lung-disease; Work-environment; Occupational-exposure; Respiratory-system-disorders; Pulmonary-system-disorders; Bronchial-asthma; Employee-exposure; Occupational-respiratory-disease; Health-care; Surveillance-programs; Lung-irritants; Medical-services; Airway-resistance; Medical-services; Risk-analysis; Risk-factors; Information-processing; Information-systems; Occupational-exposure
Massachusetts Department of Public Health, Occupational Health Surveillance Program, 250 Washington Street, 6th Floor, Boston, MA 02108
SENSOR Occupational Lung Disease Bulletin
Massachusetts State Department of Public Health