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Work related asthma
  1. G M Liss,
  2. S M Tarlo
  1. Gage Occupational and Environmental Health Unit, University of Toronto, Canada
  1. Correspondence to:
 Dr G Liss, Gage Occupational and Environmental Health Unit, 655 Bay Street, 14th Floor, Toronto, Ontario M5G 2K4, Canada;

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Difficulties in assessing relationships from population based surveys

Occupational asthma (OA) is the most frequently reported work related respiratory disease in Canada1,2 and other countries such as the United Kingdom,3 and a diagnosis of OA is associated with the potential for serious complications related to both health, such as excess hospitalisations,4 and economic consequences.5,6 In the United Kingdom, occupational lung disease surveillance data based on physician reports from the SWORD and SHIELD reporting schemes3,7 provide a valuable extensive picture of implicated industries. In the USA, the Sentinel Event Notification System for Occupational Risks (SENSOR) is also a source for physician reports of possible cases of OA asthma,8 but only from a limited number of states, without national estimates or reporting system. Thus, the report by Arif and colleagues9 in this issue helps in part to address this gap from a different perspective, based on a general population data source.

The authors analysed data from the Third National Health and Nutrition Examination Survey, 1988–1994 (NHANES III) to estimate the prevalence of participants reporting two outcomes, defined as work related asthma and work related wheezing, as well as which industries are at higher risk and could be targeted for future intervention.

They observed important proportions of asthma and wheezing that appeared to be attributable to work (based on the definitions utilised), with estimates of population attributable risk of 36.5% and 28.5%, respectively. To put these estimates in perspective, the authors noted that a recent analysis of previous studies by Blanc and Toren,10 regarding how much adult asthma might be attributable to occupational factors, including new onset and reactivation of preexisting asthma, found a range for attributable risk of 2–33% (median 9%). Among the 12 studies considered to be of higher quality, …

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