Chemicals at work taking their breath away: work-related asthma

Researchers with CDC's National Institute for Occupational (NIOSH) report that nearly 16 percent of current asthma cases in US adults are work-related. The reported findings are based on data from the Behaviorial Risk Factor Surveillance System (BRFSS) Adult Asthma Call-back Survey (ACBS) and reported this month in Morbitity and Mortality Weekly Report (MMWR). The survey respondents, made up of adults from 22 states, answered "yes" to the question:

"Have you ever been told by a doctor or other health professional that your asthma was caused by, or your symptoms made worse by, any job you ever had?"

The proportion of every-employed adults who answered "yes" was highest in Missouri (23.1%) and Wisconsin (21.1%) and lowest in Hawaii (9%) and New Mexico (13.5%).  The authors note the likelihood that the data understates the problem, writing:

"clinicians documented occupational exposure in only 7% of adult-onset cases indicating that work-related asthma is underdiagnosed in the US; thus results are likely underestimates of the true proportion" of the disease.

This may also explain the wide difference between States in reported work-related asthma cases.

On the heels of these findings is the report on a cluster of asthma cases from workers employed at a manufacturing facility in Massachusetts. The company makes syntactic foam which is used in large floatation equipment for the offshore oil and gas industry (e.g., this New Jersey company.)

The Massachusetts Department of Health learned of the cases through a unique program which requires healthcare providers and laboratories in Massachusetts to report certain occupational injuries (e.g., amputations) and illnesses (e.g., asthma.) From 2008 through 2012, six different physicians reported to the Massachusetts Occupational Health Surveillance Program a total of nine case of work-related asthma among employees at the plant.

The MMWR article describes the cases, which began with a 53 year-old worker who was a non-smoker and had no history of respiratory disease. He worked as an electrician and traveled throughout the facility repairing and maintaining equipment. His physician initially treated him for bronchitis and his symptoms would improve when he was off-work. After suffering several years with chronic breathing problems, he quit his job to work elsewhere.

The cluster investigation is summarized in this week's MMWR and elaborated on in a NIOSH Health Hazard Evaluation (HHE). The HHE describes the toxic soup of chemical hazards he and the other workers at the plant were exposed to:

"polystyrene beads, epoxy resins (e.g., bisphenol A, epichlorohydrin, bisphenol A diglycidyl ether), amines (e.g., triethylenetetramine), reactive diluents, carbon fibers, milled fibers, glass microspheres, polyester resin adhesives, anhydrides (e.g., methyltetrahydrophthalic anhydride) and catalysts."

The facility (which is not named in the MMWR or the HHE) had been subject to OSHA inspections in 2007 and 2009. Among other things, the company was cited for an inadequate respiratory protection program. An EPA emergency response team also visited the facility in 2009 following the report of two employees being hospitalized because of chemical exposure.

In early 2012, the NIOSH investigators interviewed workers from the plant. The investigators write:

"Many [workers] felt that skin irritation and breathing problems were common among employees; some felt health problems were to be accepted as part of the job, as good jobs were difficult to find."

Despite being cited previously by OSHA for the same problem, the NIOSH investigators found many deficiencies in the company's respiratory protection program. Page after page of the report told me that this workplace was ripe for causing asthma and other injuries.

About half of the 165 workers at the plant identified as Black and another 10 percent as Hispanic. Sixty-nine percent were born outside the US.

At the conclusion of NIOSH's HHE, the agency provided about two dozen recommendations to the company to improve working conditions and cases of work-related asthma. Some of them involved equipment enhancements and substitutions of safer chemicals. Others involved a program to monitor employees' respiratory health to identify early cases of occupational asthma and refer workers to a healthcare provider with expertise in occupational lung disease. The company is not compelled, however, to implement any of the recommendations. The HHE notes that the company took a few of those steps, but I'm not convinced they've done enough to stop taking away their workers' breath.

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