Work-Asthma Domain Experts (WADE) Final Report

Details

• Personal Author:
  Filios, Margaret S. ; Gerald J ; Harber P ; Hines S ; Redlich CA ; Storey, Eileen
• Description:
  Asthma is a common chronic inflammatory disease of the lungs affecting close to 19 million adults 18 years or older in the U.S. Work-related asthma (WRA) is defined as asthma caused or exacerbated by exposures in the workplace. An estimated 17% (median) of new-onset adult asthma cases are caused by workplace exposures and an estimated 21.5% (mean; range 13-58%) have pre-existing or current asthma exacerbated by workplace exposures. WRA can have long-term adverse impacts on individuals, including increased morbidity and adverse socioeconomic impacts. Early diagnosis of WRA and elimination/reduction of exposures can reduce the likelihood of permanent asthma and reduce disability. Recognizing WRA in one worker can lead to better exposure controls for co-workers, a form of primary prevention. Thus primary and secondary prevention are facilitated by recognizing WRA. The relatively short latency and availability of many exposure control methods make WRA an excellent candidate for linking prevention with clinical input. However, unfortunately work-related asthma continues to be under-recognized and under-diagnosed for multiple reasons. In a U.S survey of over 50,000 individuals with asthma, only 14.7% of ever-employed adults with current asthma communicated with a healthcare professional about the relationship of their asthma to work. Clinicians frequently do not inquire about potential occupational exposures and therefore may miss important opportunities for diagnosis and intervention. In addition, further work-up to clarify the diagnosis of asthma and/or evaluate work-relatedness may not be performed and /or the worker may leave the causative workplace. This report provides a suggested approach and rationale for addressing work-related asthma in the primary care setting using Clinical Decision Support (CDS). The primary objective is to improve recognition and management of work-related asthma in primary care settings for working age patients with asthma. The recommendations are meant to prompt and support clinician-patient discussion and further evaluation of possible WRA, rather than provide a specific diagnostic algorithm. The recommendations are based on the major relevant professional organizations' statements and/or guidelines that address WRA, including: the American College of Chest Physicians (ACCP) consensus statement on WRA, the American Thoracic Society (ATS) official statement on work exacerbated asthma, the European Respiratory Society (ERS) taskforce guidelines for the management of work-related asthma, and the British Thoracic Society (BTS) standards of care for occupational asthma, and the related British Occupational Health Research Foundation (BOHRF) evidence reviews. As these guidelines and statements do not adequately address the more limited capabilities for evaluating and managing WRA in many primary care settings, WADE expertise also guided the development of these recommendations. The WADE working group discussed whether agent-specific (e.g. allergens, irritants) recommendations should be made and favored a more general approach. The working group felt that a list of WRA exposure agents/conditions as well as resources targeted to health care providers and patients would facilitate the recognition and management of WRA. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Decision Making Diagnosis Health Personnel Lung Lung Diseases Occupational Exposure Occupational Health Respiratory System Respiratory Tract Diseases Safety Workplace

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• Keywords:
  Algorithms Breathing Bronchial Asthma Clinical Diagnosis Decision Making Diagnostic Techniques Employee Exposure Guidelines Health Care Health Care Personnel Lung Disorders Medical Management Guidelines Occupational Asthma Occupational Exposure Physicians Pulmonary System Disorders Recommendations Respiratory System Disorders Surveillance Thorax Work Environment Work Experience

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• Publisher:
  American Thoracic Society
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Final Contract Report
• Place as Subject:
  Arizona ; Connecticut ; Maryland ; OSHA Region 1 ; OSHA Region 3 ; OSHA Region 9 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DRDS - Division of Respiratory Disease Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-19
• NIOSHTIC Number:
  nn:20052160
• Citation:
  New York, NY: American Thoracic Society (ATS), 2016 Jan; :1-19
• Federal Fiscal Year:
  2016
• Performing Organization:
  American Thoracic Society
• Peer Reviewed:
  False
• Source Full Name:
  Work-asthma domain experts (WADE) final report
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1ff90700c457cd19efd3dbe166c846e270ae1c4748668f3846cd883896a2d55f9b6d98b368f7afb813ae3fe46cebdb645c427610634cf76ce4d19593db0c4427
• Download URL:
  https://stacks.cdc.gov/view/cdc/211749/cdc_211749_DS1.pdf
• File Type:
  [PDF - 453.98 KB ]