Work-related asthma

1. Work-related asthma CHNA 22 April 5, 2013 Stonehill College

2. Housekeeper, Boston 2001

3. Work-Related Asthma Asthma that is caused or made worse by work • Work-aggravated asthma • New-onset asthma • Occupational asthma • Reactive airways dysfunction syndrome (RADS)

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

5. Work-related asthma

6. Health Care Workers—4 states, 1993-1997 • 305 of 1,879 cases = 16% • Leading exposures • Cleaning products 24% • Latex 20% • Glutaraldehyde 9% • Chemicals, NOS 9% • Paints, solvents 7% American Journal of Industrial Medicine 47:265-275 (2005) Pechter et al.

7. Top Categories of Agents Associated with WRA Cases, Educational Services, 1993–2000 Poor indoor air quality or lack of ventilation graffiti remover, floor strippers, bleach, carpet cleaners, disinfectants, and ammonia paint, acetone, asphalt mostly dust, NOS Percent of cases Mineral & inorganic dust Indoor air pollutants Mold Cleaning products Solvents, hydrocarbons Acknowledgement: Jacek Mazurek, MD, MS (NIOSH,DRDS)

8. 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

9. 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

10. Example: isocyanate exposurein packing department

14. Overview of Cuming cluster

15. 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

16. Asthma & Construction Workers

17. Energy saving using foam

19. Awareness to improve diagnosis • Based on SWORD model • Distributed to 1800 providers 2X/year • Secondary distribution • Reporting form • Case stories, surveillance results, literature updates

20. 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)

21. How to Report to MDPH Confidential Fax: (617) 624-5696 Mail: OHSP, MDPH 250 Washington St, 6th Flr Boston, MA 02108 Phone: (617) 624-5632 (617) 624-5624 www.mass.gov/dph/ohsp/

22. Hierarchy of Controls & Toxics Use Reduction

23. What can we do? • Ask about work • Report cases to me • Safer chemicals • Safer conditions • Right to know • Protective gear • PREVENTION

24. Workers: canaries in the coalmine

25. 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/

26. 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

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

28. 3-year average annual rate of hospitalizations due to asthma, by CHNA of residence, 2004-6

30. Asthma effects • 58% limit activities • 22% unable to work at least one day • 24% difficulty sleeping • 14% ED visit • 35% report depression

31. 76% report asthma is not well controlled • 23% very poorly controlled • ED visits, sleep interruptions, unable to do usual activities