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: 1.74). 02/1998; 33(1):1-10. DOI: 10.1002/(SICI)1097-0274(199801)33:13.0.CO;2-2
Source: PubMed


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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    • "Although fewer studies on new onset asthma have been conducted among adults than children, several cohort studies have found that traffic-related local pollutants can contribute to the onset and manifestation of asthma in adults [55,58,59]. Also, a substantial proportion of adult-onset asthma has been attributed to occupational exposures [60-65]. In a population-based, 10-year prospective study of 6,837 adults (aged 20–44 years at study onset) from 13 countries that participated in the European Community Respiratory Health Surveys (ECRHS and ECRHS II) [66], Kogevinas et al. found large geographic variations in population attributable risk (PAR) for adult-onset asthma due to occupational exposures (PAR range 10-25%); significant excess risk for nurses (relative risk [RR] 2.2, 95% CI 1.3-4.0); "
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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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    Full-text · Article · Apr 2006 · International Archives of Occupational and Environmental Health
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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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