Towards a Better Understanding of Work-Aggravated Asthma

Details

• Personal Author:
  Boulet LP ; Gérin M ; Kennedy W ; Lemiere C ; Maghni K ; Malo JL
• Description:
  Objectives: The general objective of this research program was to improve the diagnosis of work-exacerbated asthma (WEA) and to assess the medical and economic burden of this disease. The specific objectives were to 1) describe the characteristics of the workers referred yearly for possible work-related asthma (WRA) in two clinics specialized in the field of WRA; 2) compare the clinical, functional and inflammatory characteristics of subjects with WEA occupational asthma (OA), and asthmatic subjects without WRA (non work-related asthma: NWRA) 3) evaluate the risk of developing WEA or OA according to the exposure to specific agents at the workplace; 4) compare the clinical, functional and inflammatory outcome of subjects with WEA, OA and NWRA over two years in order to establish prognostic factors for WEA; 5) assess the economic impact of WEA compared with OA and NWRA in terms of work disability and use of health resources associated with treatment of asthma. Methods: We performed a prospective cohort study of workers with WRA (WEA+OA) and NWRA with a 2-year follow-up. During the first year of the study, we also enrolled workers complaining of work-related respiratory symptoms (WRS) in whom asthma was not confirmed. The diagnosis of OA and WEA was made according to the results of specific inhalation challenges. Occupational hygienists blind to the diagnoses performed an expert assessment of their work exposures. A two-year follow-up of the subjects with WRA and NWRA was conducted. Results: 57.5% (n=69) of the subjects referred for possible WRA during year one showed WRS but did not have any objective criteria of asthma, 44.9% of them reported a physician-diagnosed asthma while 73.9% of them were taking anti-asthma medication. Fifty-three workers with WEA, 68 with OA and 33 with NWRA were enrolled. WEA was associated with more frequent prescriptions of ICS (OR (95%CI) = 3.4(1.2-9.8) p=0.03), a non-eosinophilic phenotype (OR (95%CI): 0.4(0.1-0.97) p=0.04), and a trends towards a higher proportion of smokers (OR (95%CI): 2.5 (0.96- 9.7, p=0.06) than OA. There was no significant difference within subjects with WEA or OA over time in terms of ACQ score, PC20, FEV1. However, % predicted FEV1 remained lower in subjects with WEA (71.5 +/- 21.6) than in subjects with OA (83.4 +/- 17.1). The health care utilization and related costs were similar between OA and WEA, but the healthcare utilization and related costs of WRA were much higher than those of NWRA. WEA was associated with exposure to ammonia, engine exhaust fumes, silica, mineral fibers, aerosol propellants and solvents in contrast with OA. Conclusion: This research program showed that 1) there is a high percentage of misdiagnoses of asthma in workers complaining of WRS; 2) WEA and OA have similar clinical characteristics but a different underlying airway inflammation induced by the workplace; 3) WEA and OA are associated with different type of work exposures. 4) OA and WEA have greater healthcare utilization than NWRA. The cost related to healthcare utilization was similar in subjects with OA and WEA but was much higher than in subjects with NWRA. [Description provided by NIOSH]
• Subjects:
  Asthma Asthma, Occupational Delivery Of Health Care Economics Immune System Occupational Exposure Occupational Health Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Costs Economic Impact Immune Reaction Medical Care Occupational Asthma Occupational Exposure Respiratory Diseases
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-38
• NIOSHTIC Number:
  nn:20059290
• NTIS Accession Number:
  PB2021-100124
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-008391, 2011 Nov; :1-38
• Contact Point Address:
  Catherine Lemiere, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin Ouest Montréal H4J 1C5
• Email:
  catherine.lemiere@umontreal.ca
• Federal Fiscal Year:
  2012
• Performing Organization:
  Hôpital du Sacré-Coeur de Montréal
• Peer Reviewed:
  False
• Start Date:
  20050901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20110831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:99f36705127946e37e084e2b6604dfa0b76760e1d797d04bca246a8e034e21dbd7e18dfd6cb9d3a211eb0a5fd35eb4fbf658dfca7b67a8a0c360b6540975529d
• Download URL:
  https://stacks.cdc.gov/view/cdc/218974/cdc_218974_DS1.pdf
• File Type:
  [PDF - 427.03 KB ]