Asthma Deaths Driven by Workplace Exposure

The Centers for Disease Control and Prevention (CDC) reported that up to 21% of asthma-related deaths in the US are due to occupational exposures — many of which could be avoided.

Principle investigator Jacek Mazurek, MD, PhD, Respiratory Health Division, National Institute for Occupational Safety and Health, CDC and colleagues analyzed reports of asthma-related mortality and the details of occupations of persons in the US aged 15 to 64 years from the period between 1999 and 2016.

There were 33,307 asthma-related deaths in that period, with 3,396 in 2015 alone. The investigators deemed that 11% to 21% occurred from occupational exposures, and characterized them as potentially preventable.

"Work-related asthma is a preventable condition that includes asthma caused by exposures in the workplace and concurrent asthma worsened by exposures in the work place," Mazurek told MD Magazine. "It has been estimated that 7% to 51% of asthma in adults is attributable to occupational exposure. In addition to adverse socioeconomic outcomes, work-related asthma has been associated with disability and mortality."

Mazurek and colleagues accessed the National Vital Statistics System's multiple cause-of-death data to establish asthma-related deaths and calculated death rates by sex, race, ethnicity for each year of the study period using the 2000 US Census standard population. Industry and occupation data were available from 26 states for the years 1999, 2003, 2004, and 2007 through 2012.

By industry, the highest number of deaths occurred among males in the construction industry (184; 12.2%) and among females in the health care industry (279; 14%). By occupation, the highest number of asthma deaths occurred among male construction trades workers (149; 10.7%); and among female office and administrative support workers (186; 9.3%).

"The elevated asthma mortality among workers in certain industries and occupations underscores the importance of early diagnosis, identifying and preventing or reducing potential workplace exposures, and optimal asthma management of asthma cases," Mazurek said.

The investigators offered examples of successful measures which have been implemented in the workplace, such as the replacement of powdered latex gloves with powder-free natural rubber latex or non-latex gloves to reduce latex allergen exposure.

They also noted that ongoing exposures to numerous agents can trigger asthma exacerbation, such as cleaners, disinfectants, antibiotics among health care workers; and welding fumes and isocyanates in paints among construction workers.

The investigators emphasize that early identification and elimination of exposures is the preferred means of primary prevention to reduce asthma related to occupational exposures, but acknowledge that reduction of exposure might be a more attainable goal when elimination is not possible.

In addition to encouraging industry to reduce exposure hazards for persons with asthma, Mazurek told MD Magazine that there is an opportunity for healthcare providers to intervene more effectively.

"A thorough occupational history is critical for establishing a work-related asthma diagnosis and implementing prevention," Mazurek said. "Inadequate screening of workers for occupational exposures by health providers and lack of recognition of associations between workplace exposures and asthma symptoms remain the main reasons for under-recognition and under-diagnosis of work-related asthma."

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