Risk and incidence of asthma attributable to occupational exposure among HMO members

Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
American Journal of Industrial Medicine (Impact Factor: 1.59). 02/1998; 33(1):1-10. DOI: 10.1002/(SICI)1097-0274(199801)33:13.0.CO;2-2
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ABSTRACT Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12-32%) of cases giving an incidence of 71/100,000 (95% CI 43-111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest 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.

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Available from: Donald K Milton, Feb 04, 2014
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    • "The contribution of occupational exposure to the prevalence of asthma is unknown. Estimates of the incidence of occupational asthma from surveillance of occupational physicians' reports and workers' compensation data are lower than expected from community-based cross-sectional studies, and some authors suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported (Milton et al. 1998; Smith and Patton 1999). Previous studies reported that underdiagnosed asthma was frequent in young subjects (Peat et al. 1994; Nish and Schweitz 1992). "
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    ABSTRACT: The prevalence of diagnosed asthma and wheezing in young subjects is increasing; among environmental risk factors, occupational exposure can play a relevant role. The purpose of the study was to evaluate the effects of occupational exposure to a large variety of irritants and/or sensitizers on the incidence of respiratory symptoms and pulmonary function impairment in a group of young apprentices during the first year of work exposure, and to determine the prevalence of asthma-like symptoms and the role of different risk factors (gender, smoking habit, atopy and occupational exposure) in this young population. We studied 448 young apprentices at the first pre-employment evaluation with a standardized questionnaire, spirometry and skin prick tests; in 244 of them clinical and functional evaluation was repeated after 1 year exposure to respiratory irritants or sensitizers. At the first examination, males had higher prevalence of attacks of shortness of breath with wheeze, diagnosis of asthma, smoking habit and atopy than females. At the second examination there was no significant increase in the prevalence of respiratory symptoms. However, incident cases for cough, phlegm, wheezing, shortness of breath with wheeze (SOBWHZ) and asthma were all higher than remittent cases. Incidence of respiratory symptoms was associated with atopy and smoking habit. Respiratory symptoms slightly increase over 1 year occupational exposure to sensitizers or irritants. The loss at the follow-up of subjects with higher smoking habit suggests a small "health worker effect" and could underestimate the effect of occupational exposure in apprentices.
    International Archives of Occupational and Environmental Health 04/2006; 79(3):237-43. DOI:10.1007/s00420-005-0040-0
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    • "Our occupation-based JEM is consistent with this methodology. There are, however, more sophisticated JEM approaches that use survey responses to modify the risk assignment, either on a probabilistic basis or based on structured or open-ended descriptions of job duties that may be even more targeted for lung disease [Milton et al., 1998,Le Moual et al., 2000,Kennedy et al., 2000,Zock et al., 2004]. In a variant of this approach, the responses from referents within a study can be used to establish the JEM applied to cases, avoiding potential reporting bias linked to disease [Flodin et al., 1996]. "
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    ABSTRACT: Occupational exposure assessment often relies upon subject report. We examined the characteristics of self-reported exposure in respondents' longest held job to vapors, gas, dust, or fumes (VGDF) compared to other measures of exposure risk. We analyzed data from 1,876 respondents from a national US population-based telephone survey designed to estimate the association between occupational factors and chronic disease of the airways. We tested a single VGDF item against responses to a 16-item battery assessing specific inhalation exposures and against a job exposure matrix (JEM). We analyzed all of these measures for their association with adult-onset asthma after excluding subjects with COPD or asthma with onset before age 18. VDGF (single item) was reported by 744 (40%) subjects; any of the 16 exposures by 899 (48%); and an intermediate or high exposure likelihood job by JEM was assigned to 682 (36%). The sensitivity of the VGDF item measured against the 16-item battery was 69%; the specificity was 88%; (classification agreement kappa=0.58); against the JEM classification the sensitivity was 64% and specificity 74% (kappa=0.37). The relative odds (OR) for adult-onset asthma associated with various measures of exposure were: VGDF, 1.7 (95% Confidence Interval [CI] 1.0-2.8; P=0.04); any of the 16 exposures, 1.6 (95% CI 1.0-2.7; P=0.06), and intermediate or high by JEM, 1.2 (0.7-2.1; P>0.50). A single VGDF survey item appears to delineate exposure risk at least as well as a multiple-item battery assessing such exposures; it has modest agreement with a JEM-based exposure categorization.
    American Journal of Industrial Medicine 08/2005; 48(2):110-7. DOI:10.1002/ajim.20187
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    • "In this study we further analyzed these data to determine associations between general occupational titles with work-related asthma and work-related wheezing in the adult U.S. population and to estimate the proportion of cases of work-related asthma and work-related wheezing attributable to occupations. The PAR estimates were 26% for workrelated asthma and 27% for work-related wheezing, which are within the range of those reported in earlier populationbased studies from North America [Milton et al., 1998; Johnson et al., 2000; Arif et al., 2002], but higher than those described in studies from other industrialized countries [Fishwick et al., 1997; Kogevinas et al., 1999]. "
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    ABSTRACT: Background National estimates of occupational asthma (OA) in the United States are sparse.Methods Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988–1994, we analyzed associations between occupation and work-related asthma and work-related wheezing among U.S. workers.ResultsThis study identified several occupations that were at risk of developing work-related asthma and/or wheezing, with cleaners and equipment cleaners showing the highest risks. Other major occupations identified were farm and agriculture; entertainment; protective services; construction; mechanics and repairers; textile; fabricators and assemblers; other transportation and material moving occupations; freight, stock, and material movers; and motor vehicle operators. The population attributable risks for work-related asthma and work-related wheezing were 26% and 27%, respectively.Conclusions This study adds evidence to the literature that identifies work-related asthma as an important public health problem. Several occupations are targeted for additional evaluation and study. Of particular interest are cleaners, which are being increasingly reported as a risk group for asthma. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace. Am. J. Ind. Med. 44:368–376, 2003. © 2003 Wiley-Liss, Inc.
    American Journal of Industrial Medicine 10/2003; 44(4):368 - 376. DOI:10.1002/ajim.10291
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