Occupational Asthma Reference

Mackie J, Effective health surveillance for occupational asthma in motor vehicle repair, Occup Med (London), 2008;58:551-555,

Keywords: Health surveillance; isocyanates; motor vehicle repair; occupational asthma

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Abstract

Background
Diisocyanates are the commonest reported cause of occupational asthma (OA) in the UK. Health surveillance should play an important part in the early detection of disease and the prevention of long-term morbidity.

Aim
To assess the efficacy of a UK-wide health surveillance programme provided to the motor vehicle repair industry.

Methods
Analysis of respiratory questionnaire and spirometry results during the period 1995–2000 and more detailed assessment of the outcome of cases suggestive of OA between 1998 and 2000.

Results
Approximately 3700 employees underwent health surveillance each year. As a result, a number (27%) required further assessment; information on 92 employees who were referred to their general practitioner (GP) for further assessment was examined. Half of these employees subsequently failed to see their GP and of those referred to a specialist only 63% attended that appointment. Of the 20 employees who did see a specialist, nine (45%) were subsequently diagnosed as having OA due to isocyanates, indicating a mean annual incidence rate of 0.79 per 1000 workers identified by surveillance. A year after identification, five of the diagnosed employees were still working in the same job.

Conclusions
Health surveillance is only one part of a process for identifying OA. In this programme, the high drop out rate of employees in the medical investigation process initiated by surveillance was a significant problem. Recommendations are suggested for the future operation of respiratory health surveillance programmes.



Plain text: Background Diisocyanates are the commonest reported cause of occupational asthma (OA) in the UK. Health surveillance should play an important part in the early detection of disease and the prevention of long-term morbidity. Aim To assess the efficacy of a UK-wide health surveillance programme provided to the motor vehicle repair industry. Methods Analysis of respiratory questionnaire and spirometry results during the period 1995-2000 and more detailed assessment of the outcome of cases suggestive of OA between 1998 and 2000. Results Approximately 3700 employees underwent health surveillance each year. As a result, a number (27%) required further assessment; information on 92 employees who were referred to their general practitioner (GP) for further assessment was examined. Half of these employees subsequently failed to see their GP and of those referred to a specialist only 63% attended that appointment. Of the 20 employees who did see a specialist, nine (45%) were subsequently diagnosed as having OA due to isocyanates, indicating a mean annual incidence rate of 0.79 per 1000 workers identified by surveillance. A year after identification, five of the diagnosed employees were still working in the same job. Conclusions Health surveillance is only one part of a process for identifying OA. In this programme, the high drop out rate of employees in the medical investigation process initiated by surveillance was a significant problem. Recommendations are suggested for the future operation of respiratory health surveillance programmes.

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Associated Questions

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Health Surveillance
burgeps This is a report of surveillance for a large group of motor vehicle repairers exposed to isocyanate containing paints. The company contracted to do the health surveillance provided a questionaaire and spirometry, supervised by nurses, and a paper review of abnormal responses by a qualified occupational physician. If the OP thought that occupational asthma was possible, referral to the workerss GP was made with a request for on-referral to a respiratory specialist. Of 92 referred to a GP only 32 were referred to a specialist and only 20 attended, 9 of whom were diagnosed as occupational asthma. This shows how a surveillance scheme which does not include responsibility for surveilaance failures is unlikely to be effective.

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