Occupational Respiratory Disease Surveillance

State-Based Surveillance

Work-Related Asthma (WRA)

Worker is is applying adhesive to glass blocks. Assistant is holding exhaust hose to help remove toxic fumes.

Massachusetts, Michigan, and New Jersey have maintained WRA surveillance programs since 1988, California has maintained a WRA surveillance program since 1993, and New York and Washington began surveillance for WRA in 2001 and 2002, respectively. Physician reports represent the primary ascertainment source in Massachusetts, Michigan, New Jersey, and New York. California identifies cases by reviewing data from Doctor's First Reports (DFR) of Occupation Injury or Illness, a longstanding statewide reporting system linked to reimbursement for medical services. Washington identifies cases through their state Workers' Compensation system; employers in WA are required to obtain State Fund insurance unless they are able to self-insure. Additional data sources utilized to identify cases include hospital discharge and emergency room data, as well as workers' compensation data in California, Massachusetts, Michigan, and New Jersey. State surveillance staff collect demographic, work-history, and medical information for case confirmation, classification, and description through a combination of the data sources, review of medical records, and, when possible, follow-up interview with reported cases.

Surveillance Guidelines for State Health Departments. Recommended guidelines for identifying and reporting actual or suspected cases of work-related asthma. PDF version available 170 KB (3 pages)

Reporting Guidelines for WRA

Surveillance Case Definition for WRA

Surveillance Case Classification Criteria for WRA

Decision Logic and Case Classification for WRA

Asthmagens

AOEC Exposure Codes
External link: http://www.aoec.org/aoeccode.htm
An exposure coding scheme which includes agents classified as "known asthma inducers" and is maintained by the Association of Occupational and Environmental Clinics (AOEC). To facilitate consistency in agent coding across states, putative causes of WRA for each case are coded using this scheme.

Asmapro: A web server for Occupational Asthma
External link: http://www.remcomp.com/asmanet/asmapro/asmawork.htm
An occupational asthma diagnostic tool for medical doctors dealing with asthma in the workplace. Over 70 different occupational asthma cases reside in an html-based relational database, and each case can be retrieved by case id, by the agent (over 350 different agents are listed), or by patient's job (more than 140 different jobs are registered).

Haz-Map®
External link: http://hazmap.nlm.nih.gov/
An occupational toxicology database (of chemicals, jobs, and diseases) designed to link jobs to hazardous job tasks which are linked to occupational diseases and their symptoms.

Articles Resulting From WRA State-Based Programs. A listing of articles published as a result of surveillance efforts in state-based programs.

References Related to Diagnosis/Clinical Evaluation of Work-Related Asthma. A listing of articles presenting guidelines and principles used by health care professionals specializing in the recognition, diagnosis, and prevention or management of work-related asthma.

Articles from Work-Related Asthma Programs

The links to external web sites included below are provided for informational purposes only. Citation should not be taken as endorsement by NIOSH of the web site content nor of the sponsoring organization.

Surveillance of Work-Related Asthma in Selected U.S. States Using Surveillance Guidelines for State Health Departments-California, Massachusetts, Michigan, and New Jersey, 1993-1999 (CDC/NIOSH)
Morbidity and Mortality Weekly Report, June 25, 1999 / 48(SS-3):1-20
PDFonly 493 KB (20 pages)
Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. This report summarizes surveillance data from four states and the results support the inclusion of WRA as a priority condition warranting surveillance at the state level.

Work-related reactive airways dysfunction syndrome cases from surveillance in selected US states (J Occup Environ Med) (abstract)
Describes the epidemiology of work-related cases of reactive airways dysfunction syndrome (RADS) identified in four states in the United States during 1993-1995 as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR) Program.

Cleaning products and work related asthma (J Occup Environ Med) (abstract)
State-based surveillance systems for work-related asthma in California, Massachusetts, Michigan, and New Jersey were used to identify cases of asthma associated with exposure to cleaning products at work.

A descriptive study of work-aggravated asthma (J Occup Environ Med) (abstract)
A better understanding of work-aggravated asthma, as well as work-related new-onset asthma, is needed to aid in prevention efforts.

References Related to Diagnosis/Clinical Evaluation of Work-Related Asthma

The links to external web sites included below are provided for informational purposes only. Citation should not be taken as endorsement by NIOSH of the web site content nor of the sponsoring organization.

Assessment of Asthma in the Workplace
External link: http://www.chestjournal.org/cgi/reprint/108/4/1084
A consensus statement of the American College of Chest Physicians on the approach to assessment and management of asthma in the workplace, intended for pulmonologist, allergists, and specialists in occupational and environmental medicine.

Canadian Thoracic Society Guidelines for Occupational Asthma
External link: http://www.thoracic.org/adobe/canadastate.pdf
PDF only 2270 KB (12 pages)
Provides broad guidelines and principles to help primary care physicians, occupational physicians, allergists, and respirologists with the recognition, diagnosis, and management of patients with occupational asthma.

Clinical Evaluation, Management, and Prevention of Work-Related Asthma
External link:http: //www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=
10573601&dopt=Abstract
A practical stepwise organization of the diagnostic evaluation of work-related asthma, used by primary care physicians and physicians specializing in occupational diseases and asthma.

Guidelines for Assessing and Managing Asthma Risk at Work, School, and Recreation
External link: http://www.thoracic.org/sections/publications/statements/pages/eoh/asthma2004.html ATS (2004).
An American Thoracic Society statement, providing health care practitioners, workplace managers, school administrators, and the general public with the issues and guidelines that impact patients with asthma in the workplace, school, and recreation.

Work-Related Asthma
External link: http://www.aafp.org/afp/20011201/1839.html
Diagnosis, treatment, prevention, and reduction of exposure are all important steps taken by the physician of victims of work-aggravated asthma, occupational asthma, reactive airways dysfunction syndrome, and allergic occupational asthma.