Work-related asthma (WRA) is asthma that is caused or triggered by conditions or substances in the workplace, and is a significant public health problem. It includes new onset asthma, or asthma that newly develops from workplace exposures, as well as pre-existing asthma that is exacerbated by conditions of the workplace.
It is estimated that between 137,000 and 315,000 adults in California have work-related asthma. Surveillance data show that among people with WRA, 62 percent were either unable to perform their usual work or had to perform modified work, and 34 percent left their job either against their will or voluntarily due to their asthma. Over 60 percent had been to the emergency department for their WRA an average of four times since their breathing problems at work began. It is known that current surveillance efforts underestimate the extent of WRA.
Although WRA is very often unrecognized and therefore not always diagnosed or reported, it is preventable. The most important treatment for WRA is to identify the conditions in the workplace that trigger asthma and control or eliminate them. Many of the most common substances associated with WRA are exposures shared by workers and the general public in common environments such as schools, hospitals, and government buildings.
Accomplishment of the WRA objectives will improve data collection, surveillance, evaluation, and use. Prevention strategies would be promoted and implemented. Collaboration with and eduction of health care providers, employers, workers, communities, and regulatory agencies are also recommended.
- 4D.1. Improve data collection, surveillance, and evaluation of data on WRA, and ensure data are used for prevention.
4D.1.1. Maintain statewide surveillance for WRA (Figure 17. Current Work Related Asthma Surveillance Data Sources).
4D.1.2. Identify ways to increase reporting of WRA by health care providers as required.*
4D.1.3. Expand surveillance to include new data sources by evaluating, validating, and when appropriate adding new data sources. Characterize populations of workers that are not in the current surveillance system.
4D.1.4. Utilize surveillance data to focus prevention efforts by identifying high-risk industries, occupations, worksites, and exposures.
4D.1.5. Increase access and usefulness of WRA surveillance data by preparing and disseminating annual reports on current incidence, prevalence and trends. Post work-related asthma surveillance data on the web.
* Doctor's First Report of Occupational Injury or Illness: Labor code 6409(a).
Figure 17. Current Work-Related Asthma Surveillance Data Sources
Doctor's First Reports of Occupational Injury or Illness (DFR) have been collected and entered into the system since 1993. As of January 2007, over 3,700 reports of WRA are in the system. DFRs must be completed by all care providers when an injury or illness is suspected to be work-related.
Hospital discharge data are currently being evaluated and included in the system if confirmed, beginning with 2003 data.
Data from the Worker's Compensation Information System are also currently being evaluated for possible inclusion in the system.
All cases identified through any data source receive follow-up in the form of an attempted telephone interview, and in some cases review of medical records.
- 4D.2. Develop and implement strategies to prevent WRA.
4D.2.1. Implement work site evaluations and exposure assessments with selected employers to identify potential asthma-causing conditions in the workplace. Evaluate and promote effective interventions for WRA in targeted industries.
4D.2.2. Promote the use of controls in the workplace to reduce or eliminate exposures, including the substitution of sensitizers and asthma triggering substances with safer alternatives, the implementation of engineering and admininistrative controls, and as a last resort, appropriate use of personal protective equipment.
4D.2.3. Promote the inclusion of asthma prevention and medical surveillance in workplace Illness and Injury Prevention Programs (IIPPs).*
4D.2.4. Encourage prevention in specific industries by demonstrating its benefits to employers. Develop corporate social responsibility guidelines on WRA for use in the private sector.
4D.2.5. Work with Cal/OSHA to consider the potential of regulated chemicals to cause asthma or respiratory sensitization when setting standards. Train Cal/OSHA staff on how to include respiratory sensitization in their worksite assessments and make recommendations to prevent it.
4D.2.6. Implement collaborative prevention efforts in the community and the wrorkplace by identifying public spaces that are also workplaces (e.g., hospitals, schools, public transportation, government buildings, parks, and recreational lands) and developing strategies that address occupational and environmental exposures.
4D.2.7. Support lcoal law enforcement to improve compliance with the workplace smoking ban.†
4D.2.8. Support efforts to reduce asthma irritants (e.g., perfumes, scented cleaning agents, chemical food scents, etc.) in the workplace through targeted information to employers and employee groups.
* Cal/OSHA requirements for Injury and Illness Prevention Programs: T8 CCR Sections 3203, 1509 of the General Industry Safety Orders www.dir.ca.gov/dosh/dosh_publications/iipp.html.
† Secondhand smoke bans: California State Labor Code 6404.5; Government Code 7596-7598, 19994.30, and 19994.33.
- 4D.3. Increase awareness and knowledge about WRA and its prevention among health care providers, employers, workers and communities.
4D.3.1. Identify existing education opportunities targeted to health care providers and assess whether and how to incorporate information on WRA. Materials and trainings could include: asthmagenic exposures in the workplace, guidelines and tools for evaluation and diagnosis of WRA, reporting requirements for workplace illness, and resources for WRA, among others. Explore incorporating WRA into existing medical school curricula.4D.3.2. Conduct outreach and education directed at workers in high-risk industries, occupations, worksites, and exposures as identified through surveillance data.4D.3.3. Encourage the utilization of existing resources (e.g., employee health clinics) in the workplace for outreach and education to workers regarding WRA.4D.3.4. Develop and distribute linguistically and culturally appropriate educational materials on WRA for workers, including workers reported to the WRA surveillance system.4D.3.5. Collaborate with unions, work centers, and other labor oriented sites to distribute materials and conduct training about WRA to workers. Provide information on asthma and asthma risk factors to the sel-employed work force such as house cleaners and day laborers.4D.3.6. Develop and disseminate information to identified employers on known asthma triggers/causes and their prevention. Utilize existing outreach channels such as trade organization newsletters and publications to publicize information about WRA, interventions, and to collaborate on trainings for employers.4D.3.7. Collaborate with groups working in the community on asthma prevention and disparities to include WRA in their efforts (agencies, coalitions, health centers, schools, and non-governmental organizations).