From the Massachusetts Nurse Newsletter
March 2006 Edition
Nurses report work-related asthma (WRA) in greater numbers than other groups of workers according to the December 2005 issue of the Occupational Lung Disease Bulletin.*
In Massachusetts, WRA is a reportable occupational health condition. To receive a copy of the form that is used to report WRA, call the MNA’s health and safety division or contact the Occupational Health Surveillance Program at the Massachusetts Department of Public Health at 617.624.5632.
Cases of WRA are sentinel health events that indicate the need for preventive intervention. Massachusetts and three other states track cases of WRA to identify these sentinel health events and describe the industries, occupations and exposures that need attention. For surveillance purposes, a case of work-related asthma is defined as an individual with a physician’s diagnosis of asthma and an association between the symptoms of asthma and work.
WRA includes two main categories:
- Pre-existing asthma aggravated by workplace exposures
- New onset asthma caused by sensitizers or irritants in the workplace
- Occupational asthma
- ReactiveAirways Dysfunction Syndrome (RADS)
RADS is a subset of new onset asthma distinguished by persistent asthma symptoms caused by a one-time high level irritant exposure. Since 1993, physicians in Massachusetts (and since January 2003, all health care providers) have been required by public health regulations to report confirmed and suspected cases of WRA to the Massachusetts Department of Public Health.
SENSOR staff conduct follow-up telephone interviews with those individuals reported to the Occupational Health Surveillance Program (OHSP) to learn more about the cases, and to confirm the association of asthma with work. Information from cases is used to identify suspect asthma-causing agents and inform intervention activities.
Between January 1993 and December 2004 SENSOR received 1048 case reports of work-related asthma (WRA). Interviews were completed with 594 cases (57 percent), of which 578 cases met the criteria for WRA.
Individuals with WRA were predominantly female (62 percent) and white (81 percent); seven percent (n=38) were of Hispanic origin. The vast majority of the cases were new-onset occupational asthma (88 percent, n=506).
RADS accounted for 65 cases (11 percent), and the remaining 441 cases were new onset occupational asthma. Work-aggravated asthma accounted for 61 cases (11 percent). An additional 11 cases met the case definition for work-related asthma, but were not classifiable.
Industry, occupation and exposures
Over half of all the WRA cases were employed in the service sector (n=296, 52 percent), mostly in the health care industry (n=168, 30 percent), followed by educational services.
Manufacturing accounted for one quarter of all cases (n=138, 24 percent) led by chemical manufacturing and miscellaneous manufacturing. Public administration employed another nine percent, followed by the retail and wholesale trade industries. Construction accounted for only 4 percent.
SENSOR staff record up to three exposures per person that trigger his or her asthma. In many of the cases the specific agent of concern was unidentifiable. The most frequently reported exposures included indoor air pollutants; dusts and fibers; cleaning products; mold; and solvents.
Specific agents identified included latex; isocyanates; smoke; and formaldehyde. Among the 65 RADS cases, cleaning products and unspecified chemicals were most frequently reported.
The impact
WRA can have very serious health and financial impacts on working adults. Eighty-eight percent of those with WRA still had breathing problems at the time of the interview and 23 percent reported their symptoms had become “more severe,” since their initial diagnosis. More than half reported one or more emergency room treatments for their asthma symptoms; and nearly one third of the cases reported multiple visits to the emergency department.
A total of 211 cases reported leaving the job that caused their breathing problems, including 19 cases who reported that they were fired because of their breathing problems.
Summary
It is well recognized that only a small proportion of WRA cases are reported to SENSOR and that findings may not be representative of the underlying incidence of WRA in the Massachusetts population. Interview response patterns also influence the findings reported here, which are based on the 57 percent (n=594) of all reported cases who consented to participate in telephone interviews. White-collar workers were more likely to respond than blue-collar workers and women were more likely to respond than men. Thus white collar workers and women are over-represented in the findings.
It is unlikely that the observed decline in reported cases over time reflects a true drop in incidence, but is more likely due to reduced reporting. It has been suggested that this decline may be due, in part, to the time and paperwork required in the face of ever increasing workloads. There has also been increased concern in recent years about patient confidentiality.
Health care providers are reminded that reporting cases of WRA to the Massachusetts DPH is NOT a violation of the Health Insurance Portability and Accountability Act (HIPAA) because Massachusetts regulations require reporting of this condition. HIPAA expressly “authorizes health care providers to disclose protected health information without permission of the individual, to MDPH, the public health authority authorized to receive it.”
*The Occupational Lung Disease Bulletin is published and circulated by the Massachusetts Department of Public Health; the National Institute for Occupational Safety and Health (NIOSH); and the Sentinel Event Notification System for Occupational Risks (SENSOR).
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