ORIGINAL ARTICLE

The frequency of workplace exacerbation among health maintenance organisation members with asthma

P K Henneberger¹, S J Derk¹, S R Sama², R J Boylstein¹, C D Hoffman¹, P A Preusse³, R A Rosiello³, D K Milton⁴

¹ Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, WV, USA
² Fallon Clinic, Worcester, MA, USA
³ Fallon Clinic Research Department, Worcester, MA, USA
⁴ Department of Work Environment, University of Massachusetts, Lowell, MA, USA

Correspondence to:
Dr P Henneberger
NIOSH/CDC, M/S H2800, 1095 Willowdale Road, Morgantown, WV 26501, USA; pkh0{at}cdc.gov

Objectives: Workplace conditions can potentially contribute to the worsening of asthma, yet it is unclear what percentage of adults with asthma experience workplace exacerbation of symptoms. The objective of this investigation was to determine the prevalence of workplace exacerbation of asthma (WEA).

Methods: Adults with asthma aged 18–44 were enrolled into the baseline survey of a longitudinal study. Members of a health maintenance organisation were considered candidates for participation if they fulfilled membership, diagnostic, and treatment criteria based on automated review of electronic billing, claims, and pharmacy records. Diagnosis and treatment were confirmed by manual review of medical records. A telephone questionnaire was administered. A work related symptom score was assigned to each participant based on responses to questions about work related asthma symptoms, medication use, and symptom triggers. Blinded to participants’ answers to these questions, two researchers independently reviewed the self-reported work histories and assigned exposure ratings. A final exposure score was then calculated. Participants with sufficient evidence for work related symptoms and exposure were classified as having WEA.

Results: Of the 598 participants with complete data, 557 (93%) were working, and 136 (23%) fulfilled the criteria for WEA. Those with WEA were more likely to be male and to report that they had been bothered by asthma symptoms during the past seven days.

Conclusions: Workplace exacerbation of asthma was common in this study population, occurring in over a fifth of these adults with asthma. Physicians should consider that work can contribute to the exacerbation of symptoms when treating adults with asthma.

Abbreviations: FCHP, Fallon Community Health Plan; HMO, health maintenance organisation; HSRB, Human Subjects Review Board; ICD-9, International Classification of Diseases, Ninth Revision; NIOSH, National Institute for Occupational Safety and Health; SENSOR, Sentinel Event Notification System for Occupational Risks; WEA, workplace exacerbation of asthma

Keywords: asthma; occupational diseases; occupational exposure; inhalation exposure; exacerbation

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