work-related asthma chna 22 april 5, 2013 stonehill college
TRANSCRIPT
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
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