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 1.Work-aggravated asthma 2.New-onset asthma a.Occupational asthma b.Reactive airways dysfunction syndrome (RADS)

4. Industries among MA WRA, 1995- 2008, n=596 Industry # of WRA reports % of WRA reports % of MA workforce Services 31052% 42% Health care 17129% 10% Education 7913% 9% Manufact 13823% 14% Public Admin 549% 4% Trade 447% 19% Construction 214% 6% Other 295% 14%

5. Work-related asthma

6. Health Care Workers—4 states, 1993-1997 305 of 1,879 cases = 16% 305 of 1,879 cases = 16% Leading exposures Leading 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.

7. Top Categories of Agents Associated with WRA Cases, Educational Services, 1993–2000 Cleaning products Solvents, hydrocarbons MoldIndoor air pollutants Mineral & inorganic dust graffiti remover, floor strippers, bleach, carpet cleaners, disinfectants, and ammonia Percent of cases Poor indoor air quality or lack of ventilation mostly dust, NOS paint, acetone, asphalt 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 exposure in packing department

14. Overview of Cuming cluster AST12105/08MR - 4Dr. L, CHC No details AST12115/08MR – 4Dr. B Age 22, solvents urethane? AST12306/09MR - 1Dr. L, CHC Fiberglass? AST124312/09Interview - 1Dr. N, occ doc Clinic closed AST12441/10Interview - 4Dr. N, occ doc AST1245/ WAST030 1/10Interview - 4Dr. N, occ doc Multiple ED visit reports AST12461/10Interview - 4Dr. Q AST124712/09MR - 9Dr. C Lawyer made connection AST12767/12MR - 9Dr. M

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, 6 th Flr 250 Washington St, 6 th Flr Boston, MA 02108 Boston, MA 02108 Phone: (617) 624-5632 (617) 624-5624 www.mass.gov/dph/ohsp/

22. Hierarchy of Controls & Toxics Use Reduction 1 Source2 Path3 Person SubstitutionLocal exhaust ventilation PPE Engineering and Maintenance HousekeepingAdministrative controls Enclosure

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