Asthma

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• Public health importance of work-related asthma.
• Purpose and operation of the surveillance system.
• System components.
• Asthma resources developed by the SHARP program.
• Links to other work-related asthma information.

Public health importance of work-related asthma

Workplace exposures are responsible for the development of an estimated 10 - 20% of all new onset adult asthma cases. Asthma has become the most prevalent work-related lung disease in the United States. Work-related asthma is a serious and sometimes fatal disease.

Workplace exposures to fumes, gases, vapors or dusts may aggravate asthma in a worker with preexisting asthma or may cause asthma for the first time in a previously healthy worker. Currently there are more than 350 substances used in the workplace that are known to cause asthma, including wood dusts, isocyanates, epoxies and certain adhesives.

From 1995 to 2002, the Washington State workers' compensation claims rate for work-related asthma increased by 63%, from 7.9 claims per 100,000 full-time equivalents (FTE) to 12.9 claims per 100,000 FTEs. In July 2000, the public health importance of occupational asthma in the State of Washington was recognized when the State Board of Health made asthma a reportable condition.

Work-related asthma is preventable. Engineering controls, personal protective equipment, and employer/employee education are all potential strategies that can be used to prevent this serious illness. Early identification of disease and appropriate clinical management may prevent significant work disability.

For more information about work-related asthma as a reportable condition in Washington State, visit SHARP's Reporting Work‑related Asthma Cases page.

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Purpose and operation of the surveillance system

Purpose

The purpose of this system is to identify patterns and trends that can be used to reduce, through prevention, the occupational risks associated with work‑related asthma.

Objectives

• Describe the incidence and prevalence of work‑related asthma.
• Identify high risk occupations and industries.
• Identify useful preventive strategies.
• Generate hypotheses about causative agents and factors.

Planned uses

• Identifying clusters of work-related asthma.
• Analyzing risks by occupation and industry.
• Tracking trends in incidence and prevalence.
• Sharing information with health care providers, public health professionals, and labor and industry stakeholders.

Surveillance case definition

Any Washington worker who has been diagnosed with asthma caused or exacerbated by workplace exposures.

Legal authority

On July 12, 2000 the Washington State Board of Health adopted revisions to the Washington Administrative Code Chapter 246 Section 101 (WAC 246‑101) making occupational asthma a reportable condition (www.doh.wa.gov) for health care providers and health care facilities.

Organizational location

The surveillance system is located within the Safety and Health Assessment and Research for Prevention (SHARP) program of the Washington State Department of Labor and Industries.

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System components

Population under surveillance

Workers employed within the State of Washington.

Time period of data collection

Data collection under the revised reporting rule began in September 2000.

Collection and reporting sources

Cases are received from two sources:

• The workers' compensation database.
• Reporting physicians.

First, workers' compensation claims with the word 'asthma' in the text of the report of accident form are identified. Certain information, including the employer, industry and occupation codes, and claim cost data are extracted from the workers' compensation database and imported into a Microsoft Access database. An analyst views the report of accident form and other records associated with the claim to verify that it was indeed filed for work related asthma.

Second, physicians report cases directly to the SHARP Program using a confidential case reporting form. Cases are interviewed by phone to gather additional data, including information on workplace exposures and medical history.

Data management

The surveillance system is maintained as a Microsoft Access database. This relational database management system has the tools to add, delete and update records; to perform automated edit checks during data entry; to identify duplicate records; and to perform the queries needed to maintain the database, identify clusters and create a variety of reports and graphs. Case reports from providers and case interviews are entered manually. The process of extracting data from claims in the workers' compensation database is automated and occurs monthly.

Data analysis and dissemination

Case data are analyzed periodically for clusters by industry and occupation. Dissemination of educational information is a routine part of case follow-up. Each case is sent educational materials prior to a telephone interview.

Patient privacy, data confidentiality, and system security

All records containing or accompanied by patient identifying information are confidential. These records are used solely for surveillance and prevention purposes. All hard copies of case information are kept in locked cabinets. Access to the surveillance database is protected by its own password system. Passwords are issued only to authorized SHARP personnel. Additionally, physical access to the building and access to individual computers are controlled as part of the security systems of the Department of Labor and Industries.

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Asthma resources developed by the SHARP program

Information for physicians Learn more about Diagnosing Work-Related Asthma (277 KB PDF / 1 min) and receive one free hour of Continuing Medical Education (CME) credit by completing the Post Activity Evaluation (57 KB doc).

Publications

Work-related asthma reports and educational materials are available from SHARP's Publications page.

Surveillance tools

These materials may be downloaded to your system and modified for your use. Please reference the source.

Letters for physicians and patients

• Thank you letter mailed to physicians reporting asthma cases:
• Thank you letter (26 KB MS Word).
• Thank you letter (5 KB PDF).
• Letter mailed to workers with asthma identified through the workers' compensation system:
• Asthma identified through workers' compensation system (21 KB MS Word).
• Asthma identified through workers' compensation system (5 KB PDF).
• Letter mailed to workers with asthma identified from a provider report:
• Asthma identified through provider report (21 KB MS Word).
• Asthma identified through provider report (5 KB PDF).

Patient interview form

• Phone Interview Cover Form (Patient Demographics/Instructions to Interviewer/Verbal Consent Language):
• Phone Interview Cover Form (29 KB MS Word).
• Phone Interview Cover Form (16 KB PDF).
• Phone Interview Form:
• Phone Interview Form (74 KB MS Word).
• Phone Interview Form (16 KB PDF).

Questions and answers on SHARP's asthma program

• English version
• Questions & answers (22 KB MS Word).
• Questions & answers (13 KB PDF).
• Spanish version
• Questions & answers (26 KB MS Word).
• Questions & answers (13 KB PDF).

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Links to other work-related asthma information

External hyperlinks are provided as a public service by the SHARP Program. Neither L&I nor SHARP are responsible for the reliability or accuracy of the information found on other web sites (Privacy and Security Policy).

• Coding Scheme for Exposures (www.aoec.org)
  The Association of Occupational and Environmental Clinics (AOEC).
• Occupational Health Surveillance and Evaluation Program (www.dhs.ca.gov)
  California Department of Health Services.
• Connecticut Department of Public Health's Asthma Program (www.dph.state.ct.us).
• SENSOR Occupational Lung Disease Bulletin (www.state.ma.us)
  Massachusetts Department of Public Health.
• Occupational and Environmental Medicine Program (www.oem.msu.edu)
  Michigan State University.
• Occupational Disease Surveillance: Occupational Asthma (www.cdc.gov)
  Morbidity and Mortality Weekly Report. MMWR. February 23, 1990, 39(7):119-123.
• Surveillance for Occupational Asthma - Michigan and New Jersey, 1988-1992 (www.cdc.gov)
  Morbidity and Mortality Weekly Report. MMWR. June 10, 1994, 44(SS-1):9-17.
• Surveillance for Work-Related Asthma in Selected U.S. States Using Surveillance Guidelines for State Health Departments - California, Massachusetts, Michigan, and New Jersey, 1993-1995 (www.cdc.gov)
  Morbidity and Mortality Weekly Report. MMWR. June 25, 1999. 48(SS-3):1-20.
• Occupational Lung Disease Registry (www.health.state.ny.us)
  New York State Department of Health.
• Asthma and Allergies (www.cdc.gov)
  National Institute for Occupational Safety and Health.
• Work-Related Lung Disease Surveillance Report, 2002 (www.cdc.gov)
  National Institute for Occupational Safety and Health.
• Work Related Asthma (www.doh.wa.gov)
  Washington State Department of Health - The Health of Washington State, 2002.

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