Link between asthma and occupational exposure
Asthma is attributable to occupational exposure far more commonly than previously reported and accounts for a sizable proportion of adult-onset asthma, according to research from the Harvard School of Public Health in Boston.1
The researchers conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 who were at risk for asthma. Overall, the annual incidence of clinically significant, new-onset asthma was 1.3 per 1,000 workers, increasing to 3.7 per 1,000 workers when including the reactivation of previously quiescent asthma.
Of that number, 21% met the criteria for attrib uting asthma onset to occupational exposure. That means the incidence of occupationally related asthma was 71 per 100,000 workers. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure.
Physicians may not be asking about work-related symptoms often enough, according to the researchers. In this study, the doctors documented physicians' questions about work-related symptoms in only 15% of the charts. They recorded suggestive symptoms in three cases, but they did not obtain occupational medicine consultations, diagnose occupational asthma, report the case to the state surveillance system, or bill workers' compensation for those cases.
In at least one case, the asthma clearly was occupational because it involved a carpenter with heavy exposure to red cedar dust, a known cause of occupational asthma. The researchers advise physicians to be more suspicious of work-related factors when diagnosing adult-onset asthma.
Reference
1. Milton DK, Solomon GM, Rosiello RA. Risk and incidence of asthma attributable to occupational exposure among HMO members. Am J Ind Med 1997; 33:1-10.
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