Work-related asthma

CHNA 22

April 5, 2013

Stonehill College

Housekeeper, Boston 2001

Work-Related Asthma Asthma that is caused or made worse by work

1. Work-aggravated asthma

2. New-onset asthmaa. Occupational asthma

b. Reactive airways

dysfunction syndrome (RADS)

Industries among MA WRA, 1995-2008, n=596

Industry # of WRA reports

% of WRA reports

% of MA workforce

Services 310 52% 42%

Health care 171 29% 10%

Education 79 13% 9%

Manufact 138 23% 14%

Public Admin 54 9% 4%

Trade 44 7% 19%

Construction 21 4% 6%

Other 29 5% 14%

Work-related asthma

Courtesy of Regent Medical®

Health Care Workers—4 states, Health Care Workers—4 states, 1993-19971993-1997

• 305 of 1,879 cases = 16%305 of 1,879 cases = 16%• Leading exposuresLeading exposures

• Cleaning products 24%Cleaning products 24%• Latex 20%Latex 20%• Glutaraldehyde 9%Glutaraldehyde 9%• Chemicals, NOS 9%Chemicals, NOS 9%• Paints, solvents 7%Paints, solvents 7%

American Journal of Industrial Medicine 47:265-275 (2005) Pechter et al.

Top Categories of Agents Associated with WRA Cases, Educational Services, 1993–2000

0

5

10

15

20

25

30

Cleaning products

Solvents, hydrocarbons

MoldIndoor air pollutants

Mineral & inorganic

dust

graffiti remover, floor strippers, bleach, carpet cleaners, disinfectants, and ammonia

Perc

ent o

f cas

es

Poor indoor air quality or lack of ventilation

mostly dust, NOS paint, acetone, asphalt

Acknowledgement: Jacek Mazurek, MD, MS (NIOSH,DRDS)

Is WRA different from asthma?

Research based on BRFSS telephone survey in MA

Compare WRA to asthma-not related to work– 4.8 times more likely to have an asthma attack

– 4.7 times more likely to go to the ED

– 2.5 times more likely to visit the doctor for worsening asthma

– Other indices of asthma control and health care use elevated, but not significant

Breton et al, OEM, 2006

40.2

33.1 31.3

25.4

13.910.9 10.09.00.0

10.0

20.0

30.0

40.0

50.0

60.0

Lifetime Current

Perc

ent (

%)

Asthma Caused/Aggrevated by Any JobAsthma Caused/Aggrevated by Previous JobAsthma Caused/Aggrevated by Current JobTold To or By HCP that Asthma w as Related to Work

Figure 3.1: Proportion of Massachusetts Adults with Lifetime or Current Asthma Reporting That Their Asthma Was Associated with Work, 2006-2007

Massachusetts Adults with Lifetime or Current Asthma

Example: isocyanate exposurein packing department

Overview of Cuming clusterAST1210 5/08 MR - 4 Dr. L, CHC No details

AST1211 5/08 MR – 4 Dr. B Age 22, solvents urethane?

AST1230 6/09 MR - 1 Dr. L, CHC Fiberglass?

AST1243 12/09 Interview - 1 Dr. N, occ doc

Clinic closed

AST1244 1/10 Interview - 4 Dr. N, occ doc

AST1245/ WAST030

1/10 Interview - 4 Dr. N, occ doc

Multiple ED visit reports

AST1246 1/10 Interview - 4 Dr. Q

AST1247 12/09 MR - 9 Dr. C Lawyer made connection

AST1276 7/12 MR - 9 Dr. M

Individual workplaces:Referrals to OSHA

• Referrals to OSHA (~24)– Auto body shop

(isocyanates)– Cutting cement (hex

chrome)– Polyurethane packing

(isocyanates)– Welding– Hazard evaluation,

ventilation, HazCom

Asthma & Construction Workers

Energy saving using foam

Awareness to improve diagnosis

• Based on SWORD model

• Distributed to 1800 providers 2X/year– Secondary distribution

• Reporting form• Case stories,

surveillance results, literature updates

Sentinel Event Notification System for Occupational Risks?

(SENSOR)• Active state-based surveillance for ‘sentinel’

work-related conditions

• Focus on prevention-oriented workplace intervention

• Funded by CDC National Institute for Occupational Safety and Health (NIOSH)

How to Report to MDPH

Confidential Fax:Confidential Fax: (617) 624-5696 (617) 624-5696

Mail:Mail: OHSP, MDPH OHSP, MDPH

250 Washington St, 6250 Washington St, 6thth Flr Flr

Boston, MA 02108Boston, MA 02108

Phone:Phone: (617) 624-5632 (617) 624-5632

(617) 624-5624(617) 624-5624

www.mass.gov/dph/ohsp/www.mass.gov/dph/ohsp/

Hierarchy of Controls & Toxics Use Reduction

1 Source 2 Path 3 PersonSubstitution Local exhaust

ventilationPPE

Engineering and Maintenance

Housekeeping Administrative controls

Enclosure

What can we do?• Ask about work

• Report cases to me

• Safer chemicals

• Safer conditions

• Right to know

• Protective gear

• PREVENTION

Workers: canaries in the coalmine

Elise Pechter MPH, CIH

Industrial Hygienist/Intervention Coordinator

Occupational Health Surveillance Program

250 Washington Street

Boston, MA 02108

617 624-5681

Occupational.Asthma@state.ma.us

www.mass.gov/dph/ohsp/

Asthma in Massachusetts Adults

Over 9% of MA adults have asthma Higher than US Went up 16% from 2000—2007 496,700 adults with asthma*

*Estimate from 2007 BRFSS, in

Burden of Asthma in Massachusetts

http://www.mass.gov/Eeohhs2/docs/dph/com_health/asthma/burden_in_mass.pdf

Who has asthma?• Women—prevalence still rising• Increased among 25-34 and 65+• Higher among lower income adults• Smoking—risk factor

3-year average annual rate of hospitalizations due to asthma, by CHNA of residence, 2004-6

Asthma effects

• 58% limit activities

• 22% unable to work at least one day

• 24% difficulty sleeping

• 14% ED visit

• 35% report depression

76% report asthma is not well controlled 23% very poorly controlled

ED visits, sleep interruptions, unable to do usual activities