By Brenda L. Mooney
MILWAUKEE— A survey at a VAMC recorded the prevalence of current diagnosed asthma at 17.6% but also found that nearly half of the healthcare workers reported some asthma-like symptoms. [ See Table ]
Researchers from the Respiratory Health Division, National Institute for Occupational Safety and Health in Morgantown, WV, and the Clement J. Zablocki VAMC in Milwaukee noted that rate is considerably higher than asthma prevalence in Wisconsin or nationally.
Other research has found increased risk of respiratory disorders among healthcare workers, according to an article in the International Journal of Hygiene and Environmental Health.1 Earlier findings associated with the research were presented at last year’s American Thoracic Society meeting.2
For the study, the investigators sought to estimate the prevalence of current asthma and asthmalike symptoms and their association with workplace exposures and tasks among employees at one VA medical facility.
To do that, they conducted a survey from a sample of workers at the Milwaukee VAMC, collecting information on respiratory health and work characteristics, including tasks performed, products used and exposures. The questionnaires were collected during 2012-2014. Based on the responses, researchers evaluated associations of asthma and asthmalike symptoms with cleaning and disinfecting tasks and products. Also taken into account were exposure to dampness and molds, as well as construction dust.
“We observed elevated prevalence of current asthma among the VA healthcare workers compared to the U.S. general and working adult populations,” the study authors noted. “Asthma and asthma-like symptoms were significantly associated with mold, dampness, and construction material exposures; cleaning and disinfecting products; and cleaning or disinfecting tasks.”
In the earlier report presented at the ATS conference, study authors explained that the survey instrument included assessments of respiratory health, work characteristics (tasks), employment history and worker exposures. They sought information on prevalence of current physician-diagnosed asthma, based on two criteria: lifetime physician diagnosed asthma and positive response to at least one of the following: “Do you still have asthma?”, “Have you had an attack of asthma at any time in the last 12 months?” or “Are you currently taking any medications for asthma?”
The survey also included self-reports of asthmalike symptoms in the past 12 months, including wheezing, chest tightness, shortness of breath, asthma attack and taking asthma medications.
The conference presentation noted that self-reported current asthma in their survey, 18.2%, was higher than population estimates in Wisconsin, 10.4%, or national estimates, 9%.
Highest Among Nurses
Nurses were determined to have the highest prevalence of asthma—6.1% physician diagnosed and 15.1% self-reported symptoms, followed by health technologists, technicians and healthcare support workers—3.2% physician diagnosed, 6.5% self-reported symptoms—and office and administrative support workers—2.9% physician diagnosed, 4.7% self-reported symptoms.
In addition, asthma prevalence was highest among workers reporting:
- exposure to accidental chemical spills or gas release—32.3% physician diagnosed, 64.5% self-reported symptoms;
- aerosolized medicines used with patients—29.4% physician diagnosed, 56.9% self-reported symptoms, and
- cleaning and disinfectant products used on fixed surfaces—23.3% physician diagnosed, 53.8% self-reported symptoms.
“We found elevated rates of asthma and asthma-like symptoms among study participants compared to a representative sample of adults residing in the state where respondents worked,” the authors explained. “Prevalence of asthma and asthma-like symptoms were highest among nurses, highlighting the need to focus asthma prevention efforts on specific healthcare occupation groups”
The elevated rates of asthma in healthcare workers shouldn’t be that surprising. An article a year ago in the Morbidity & Mortality Weekly Report noted that data from the 2006-2007 adult Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey from 33 states indicated that up to 48% of adult current asthma might be related to work. National Centers for Disease Control and Prevention (CDC) researchers suggested some of that could potentially be prevented, adding that asthma prevalence is higher among adults working in certain industries and occupations.3
Based on the Asthma Call-back Survey results, public health officials estimate that as many as 2.7 million U.S. workers might have asthma caused by or exacerbated by workplace conditions, with healthcare as one of the industries with the highest rates. In fact, the MMWR article used as an example that state-specific prevalence of current asthma was highest among workers in healthcare support occupations in Michigan, at 21.5%.
“Overall, prevalence of current asthma among workers ranged from 5.0% in Mississippi to 10.0% in Michigan, and was highest in the health care and social assistance industry (10.7%) and in health care support occupations (12.4%),” the study authors reported, adding, “Among the five industries with the highest current asthma prevalence, health care and social assistance was identified in 20 of the 21 states, retail trade in 16 states, and education in 14 states. Among the five occupations with the highest current asthma prevalence, office and administrative support was identified in 16 of the 21 states, health care practitioners and technical in 15 states, and sales and related in 13 states.”
The article noted that each of the industries and occupations discussed in the MMWR report is associated with a specific set of existing and emerging workplace exposures, including irritant chemicals, dusts, secondhand smoke, allergens, emotional stress, temperature and physical exertion—all of which are linked to work-exacerbated asthma.
“For example, it is well recognized that workers in the health care and social assistance industry who are exposed to cleaning and disinfection products, powdered latex gloves, and aerosolized medications have a twofold increased likelihood of new-onset asthma,” the authors wrote.
Public health officials recommended that physicians get a detailed occupational history among adults with asthma, because this is critical for making a work-related asthma diagnosis and recommending optimal treatment and management.
They also urged reduction or elimination of workplace exposures, such as substitution of hazardous products with nonhazardous products or improved ventilation or removal of the worker from the environment, might be necessary for management of asthma symptoms related to work. An example provided is reducing exposure to latex allergens by replacing powdered latex gloves with powder-free natural rubber latex or nonlatex gloves to considerably reduce work-related asthma in the healthcare industry
- Kurth L, Virji MA, Storey E, Framberg S, Kallio C, Fink J, Laney AS. Current asthma and asthma-like symptoms among workers at a Veterans Administration Medical Center. Int J Hyg Environ Health. 2017 Nov;220(8):1325-1332. doi: 10.1016/j.ijheh.2017.09.001. Epub 2017 Sep 5. PubMed PMID: 28923472.
- Laney AS, Kurth LM, Virji MA, Storey E, Framberg S, Kallio C, Fink J. Asthma and Asthma-Like Symptoms Among Veterans’ Administration Healthcare Workers. Poster session presented at the American Thoracic Society (ATS) 2016 International Conference, May 13-18, 2016. San Francisco, CA.
- Dodd KE, Mazurek JM. Asthma Among Employed Adults, by Industry and Occupation — 21 States, 2013. MMWR Morb Mortal Wkly Rep 2016;65:1325–1331. DOI: http://dx.doi.org/10.15585/mmwr.mm6547a1.
Prevalence of current asthma* among adults employed in the 12 months preceding the interview,† ranked by industry and occupation categories — Behavioral Risk Factor Surveillance System (BRFSS), 21 states, 2013
|Industry||%§ (95% CI)||Occupation||%§ (95% CI)|
|Health care and social assistance||10.7 (9.6–11.8)||Health care support||12.4 (9.7–15.2)|
|Education||9.1 (7.8–10.3)||Community and social services||12.2 (7.9–16.6)|
|Arts, entertainment, and recreation||9.0 (5.1–13.0)||Personal care and service||12.1 (9.3–14.9)|
|Information||8.7 (6.3–11.1)||Arts, design, entertainment, sports, and media||11.7 (8.5–14.8)|
|Retail trade||8.7 (7.3–10.2)||Office and administrative support||10.2 (8.7–11.7)|
|Finance and insurance||8.4 (6.4–10.3)||Health care practitioners and technical||9.2 (7.9–10.5)|
|Other services (except public administration)||8.3 (6.6–9.9)||Legal||9.2 (5.9–12.5)|
|Professional, scientific, and technical services||7.6 (6.1–9.1)||Food preparation and serving||8.3 (6.5–10.2)|
|Accommodation and food services||7.4 (6.0–8.7)||Education, training, and library||8.2 (6.8–9.5)|
|Transportation and warehouse||7.1 (4.8–9.3)||Sales and related||7.6 (6.5–8.8)|
|Public administration||7.0 (5.8–8.2)||Life, physical, and social science||7.5 (4.6–10.4)|
|Real estate, rental, and leasing||6.9 (4.4–9.4)||Business and financial operations||7.2 (5.6–8.9)|
|Administrative and support, waste management, and remediation||6.4 (4.4–8.3)||Building and grounds cleaning and maintenance||7.1 (5.4–8.9)|
|Manufacturing||6.1 (5.1–7.2)||Management||6.9 (5.7–8.0)|
|Mining, oil and gas||6.0 (3.6–8.3)||Transportation and material moving||6.7 (4.7–8.7)|
|Construction||5.9 (4.5–7.2)||Computer and mathematical||6.7 (4.9–8.6)|
|Wholesale trade||5.8 (3.4–8.3)||Protective service||6.6 (4.1–9.2)|
|Agriculture, forestry, fishing and hunting||4.2 (2.0–6.4)||Production||5.7 (4.1–7.3)|
|Utilities||—¶||Installation, maintenance, and repair||5.7 (3.9–7.5)|
|Management of companies and enterprises||—||Construction and extraction||4.6 (3.4–5.8)|
|Armed forces||—||Architecture and engineering||4.1 (2.8–5.4)|
|Farming, fishing, and forestry||2.6 (1.1–4.1)|
|Military active duty||—|