Primary Prevention of Asthma—the Role of Occupational Asthma in Pushing the Agenda

BACKGROUND: Asthma affects 18.7 million adults in the US, contributing to poor quality of life, disability, and medical costs.  In Massachusetts, 10.3% of adults have current asthma.  Work-related asthma (WRA) contributes significantly to this burden. Nearly 50% of adults report that work caused or worsened their asthma; sentinel surveillance systems in five states continue to uncover WRA in specific industries and occupations, as well as the use of asthmagens—agents that can initiate asthma. Asthma is often seen as genetic in origin and manageable.  This approach misses opportunities to prevent the disease.  Even when chemicals lead to clusters of WRA (e.g. latex allergy and isocyanate asthma deaths), the lessons are not necessarily applied to different settings:  environmental, consumer and public health.

METHODS: The Strategic Plan for Asthma in Massachusetts, 2009-14 set a goal of developing a roadmap for understanding asthma causes and the role of primary prevention.  The lead partner was the Lowell Center for Sustainable Production. With guidance from a multi-stakeholder planning committee, they convened an innovative 2-day symposium (April 2013) that brought together researchers, clinicians, advocates and state and federal agency representatives, including the Massachusetts Department of Public Health, to focus on primary prevention. The WRA Surveillance and Prevention project participated, articulating how chemicals can initiate asthma, and how these lessons can be applied in workplaces and other settings.  The symposium began with researchers summarizing the weight of the evidence on the contribution of a range of risk factors to the development of asthma. These included indoor environmental allergens, obesity and nutritional factors, psychosocial stress, chemicals, tobacco and air pollution.   Roundtables were later challenged to make recommendations for addressing risk factors identified as “ready for action.” The symposium methods, products, and subsequent organizing are promoting collaboration between academia, clinical care and public health that can reduce the burden of asthma in Massachusetts and nation.

 

RESULTS: The April symposium concluded that workplace chemicals were ready for action, and highlighted healthcare and education as locations where workers share exposures with patients, visitors and children.  The next five-year strategic plan for asthma, 2015-2020 incorporates toxics use reduction and workplace issues into a broader public health framework.

CONCLUSIONS: Efforts to focus on primary prevention of asthma benefit from active participation of occupational health experts.  WRA programs benefit from collaboration with leaders in other fields to ensure consideration of social issues that impact asthma control. The collaborations engendered by these efforts expand the capacity for action.