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As a lung expert, I am always tracking new research and statistics on asthma, chronic obstructive pulmonary disease (COPD), tuberculosis (TB), and other pulmonary conditions. A recent health news article that tracked professions with the highest asthma rates caught my eye.
The survey data from the Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey suggests that among all U.S. workers, the current asthma rate is about eight percent. Some of the findings in the survey, which offered state-by-state rates, were quite interesting.
We already know from a 2006-2007 BRFSS survey that nearly half of the population here in the U.S. suffering with asthma have work-related exposures that incite the disease, or work-related exacerbations that make asthma symptoms worse or more frequent in nature. Some professions are linked to higher rates of asthma. A more recent survey looked at data from the 2013 BRFSS survey, and specifically at data collected from 21 states. This data reflected information gathered from individuals who were 18 years of age or older, and who were employed at the time of the survey or had been out of work for less than 12 months.
The initial data showed that about 77 percent or nearly 2.7 million U.S. workers might have had asthma either caused by the type of work or environment in which they were working, or had increased symptoms or duration of symptoms due to the work or work environment.Workers in five industries had the highest rates of asthma. Two of those — health care and social assistance work — topped the list and were noted in 20 of the 21 states. Social assistance jobs include individual/family services, community food and housing, vocational rehabilitation, and emergency or other relief work.
The researchers who compiled the data noted that it’s pretty well-known that if you work with cleaning agents, you likely inhale fumes that put you at higher risk of asthma. If you work with a population using aerosolized medications or cleaning agents, that too would put you at a higher risk of developing asthma or having more frequent asthma attacks.
What was interesting is that the researchers also found that individuals who already have a diagnosis of asthma were more likely to be working in those two previously noted professions. Certainly, if you work in health care, it’s also likely that you will be more readily diagnosed with asthma if you have it, which could contribute to the data findings.
Workplace exposures that induce asthma or worsen pre-existing asthma include: irritant chemicals, dusts, exposure to secondhand smoke, other known allergens, stressful work conditions, physical exertion, and even certain temperatures.
If you work in an environment where there is constant exposure to disinfectants, powdered latex gloves, or aerosolized medications, data shows that you have a two-fold increase in risk for new onset asthma.** Some specific state-by-state findings included:**
Twenty states (out of 21) showed that health care/social assistance professionals had the highest rates of asthma or exacerbations
Illinois, Louisiana, Michigan, Mississippi, New York, and Wisconsin had the highest asthma rates in health care and social assistance professionals.
Montana, Washington, and Wyoming had the highest rates of asthma in “accommodation and food services” industries.
It’s important to remember that a study like this “by phone survey” is only as good as the recall of the individual providing the information and the number of participants (individual state participant groups were small). Participation by state varied, and recall can often be subjective. Results can also weigh heavily in favor of educated respondents who know more about their disease or about respiratory diseases, which may explain the high health care representation. Given the nature of asthma, there may have also been many potential respondents who remained out of work for longer than 12 months, and then returned to work.
I can only use the information referenced here to guide my evaluation of a patient. I am typically on alert when I see patients who work in the professions mentioned because I am familiar with the types of exposures and work conditions that heighten risk of asthma or that send the patient to me more frequently with asthma attacks.
It was no surprise to me, for example, that respiratory illness in general, and asthma specifically, was heightened in 9/11 first responders. Many did not wear masks (or the correct respirators) as they toiled for days and weeks at Ground Zero and on “the pile,” in an area that was filled with contaminants. As a pulmonary specialist, it’s important for me to monitor the professions and work environments of my patients, so I am clued into the groups at higher risk for asthma. If I can make recommendations to them before disease appears, I can lower their risk of developing a disease that can be costly and that can also dramatically interfere with their day-to-day quality of life. I do take a detailed occupational history from my asthma patients, so we can figure out how to mitigate disease or symptoms directly linked to their work.
Here are some basic recommendations to help limit risk of developing work-related asthma:
- Know your triggers if you already have asthma
- Replace caustic or concentrated cleaning fluids with heavily diluted bleach or vinegar or some of the newer “green cleaners” when possible
- Use powder-free natural rubber latex
- Ask for better ventilation in areas where fumes concentrate
- Wear an appropriate mask while performing certain activities that involve fume or allergen exposures
- Wash hands frequently and remove clothes as soon as you get home
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.