NIOSH Research Rounds

NIOSH Research Rounds is a monthly bulletin of selected research conducted by researchers at NIOSH and NIOSH-funded researchers at other institutions.

Volume 5, Number 3 (September 2019)

Inside NIOSH:
Preventing Work-related Asthma

Work-related asthma can occur when workplace exposure to a hazardous substance triggers symptoms in someone with asthma or causes new asthma to occur in someone who doesn’t already have it. Symptoms range from mild to severe and include coughing, wheezing, chest tightness, and shortness of breath. More than 300 known or suspected substances in the workplace can cause or worsen symptoms of work-related asthma. It is important to identify and avoid these substances to prevent work-related asthma from occurring or getting worse.

At NIOSH, investigators study how to prevent work-related asthma by controlling exposure to hazardous substances. In two recent studies summarized below, NIOSH investigators looked at different issues related to work-related asthma. In the first, they focused on the link between cleaning and disinfecting products and various asthma symptoms among healthcare workers. In the second study, they looked at the presence of chronic obstructive pulmonary disease (COPD) among people with work-related asthma and those with asthma from other causes.

Combinations of Some Cleaning and Disinfecting Agents Increase Asthma Risk

Cleaning and disinfecting agents are recognized as causes of asthma symptoms in healthcare workers. Recent research published in the International Journal of Hygiene and Environmental Health used a technique called cluster analysis to evaluate relationships between exposures to different groups (clusters) of cleaning and disinfecting agents and experiences of different groups (clusters) of asthma symptoms.

Investigators collected self-reports about asthma symptoms and cleaning and disinfecting tasks from 2,030 healthcare workers in New York City. The self-reports also included information such as age, gender, race, education, allergies, and smoking. The investigators then grouped study participants with similar patterns of asthma symptoms into five health clusters: 1) no symptoms, 2) winter cough/phlegm, 3) mild asthma symptoms, 4) undiagnosed/untreated asthma, and 5) asthma attacks/exacerbations. Each health cluster was matched to one of five exposure clusters based on participants’ use of cleaning and disinfecting products. To help visualize this complicated information, investigators created word groupings known as word clouds for each cluster. Results showed that combinations of certain products, such as alcohols, bleach, and strong disinfectants, increased the risk for asthma symptoms. Their findings underscore the need for targeting combinations of products with prevention efforts.

Combined Work-related Asthma and COPD Linked to More Severe Symptoms and Healthcare Use

Up to one fifth of people diagnosed with asthma also have COPD. When asthma and COPD occur together, patients often have more severe symptoms than people with asthma alone. According to research published in the Journal of Asthma, adults with work-related asthma are more likely to also have COPD than those with nonwork-related asthma. Also, those with work-related asthma and COPD have more severe asthma symptoms than in those with nonwork-related asthma alone.

Investigators reviewed 23,137 responses to the 2012–2014 Behavioral Risk Factor Surveillance System Asthma Call-back Survey, representing an estimated 15 million ever-employed adults from 31 states and the District of Columbia. Overall, more than 1 million adults had both work-related asthma and COPD. More than half (51.9%) of adults with work-related asthma had been diagnosed with COPD, compared to a quarter (25.6%) of adults with nonwork-related asthma. Compared to adults with nonwork-related asthma and no COPD, those with work-related asthma and COPD had more severe symptoms and greater healthcare use. These symptoms and healthcare use included asthma attacks, urgent treatment, emergency room visits, overnight hospital stays, activity limitations on 1–13 days or ≥ 14 days, and poorly controlled asthma. More research is needed to understand how to prevent and treat the combination of work-related asthma and COPD.

More information is available:

• Clustering Asthma Symptoms and Cleaning and Disinfecting Activities and Evaluating Their Associations Among Healthcare Workers
• Prevalence of COPD Among Workers with Work-related Asthma
• NIOSH: Work-related Asthma

Unintentional Drug Exposures Highlight Need to Protect First Responders

In two recent incidents, law enforcement officers developed health symptoms after exposure to opioids and other drugs at work that prevented them from performing their duties. These incidents highlight the need for policies and procedures, as well as education and training about exposure prevention, according to a report published in the American Journal of Industrial Medicine.

Media reports of health effects among first responders exposed to opioids on the job have raised health and safety concerns. After officers in two law enforcement agencies experienced health effects related to potential opioid exposure, the agencies requested assistance through the NIOSH Health Hazard Evaluation Program, which provides free workplace evaluations.

The first incident occurred in 2017 when white powder fell onto an officer during a traffic stop in New Hampshire. In the second incident, in 2018, four officers developed symptoms while responding to a call about a possible drug overdose in Virginia. NIOSH investigators interviewed the officers and others, and reviewed medical records, incident reports, laboratory results, and body camera footage if available. They found that both incidents involved several types of drugs: opioids, such as fentanyl, and stimulants, including cocaine and methamphetamine. All five officers reported nonspecific symptoms that required medical attention and temporarily prevented them from working, but the symptoms were not consistent with severe or life-threatening opioid toxicity. Although the routes of exposure were not well characterized, the investigators made recommendations to prevent such incidents:

1. Develop policies to prevent exposure on topics such as on-scene risk assessment, standard safe operating procedures and work practices, personal protective equipment, and decontamination.
2. Provide education and training to officers.

Additional research, including surveillance, is needed to inform future recommendations to protect officers.

More information is available:

• Health Effects from Unintentional Occupational Exposure to Opioids Among Law Enforcement Officers: Two Case Investigations
• NIOSH Opioids in the Workplace
• NIOSH Health Hazard Evaluation Program

Outside NIOSH:
Safety Intervention Less Effective for Low-wage Workers

A safe patient-handling intervention decreased injuries among nurses, but not among lower-wage workers employed as patient care associates, according to a recent study in the American Journal of Public Health.

This NIOSH-funded study at the Harvard T.H. Chan School of Public Health compared self-reports of safe patient-handling practices and hospital injury rates at two large Boston area hospitals from 2012 to 2014. The purpose of the study was to investigate how results at the population level may not show the full picture.

In 2013, nurses and patient care associates at one hospital received the same safe patient-handling intervention while workers at the other hospital did not. The intervention included initial and ongoing training on using new equipment, including slings and special devices, to help move patients safely. Study participants included 482 nurses and 96 patient care associates at the intervention hospital and 915 nurses and 94 patient care associates at the comparison hospital.

After the intervention, lifting and exertion injuries among nurses decreased by about a third, but no decrease in injuries occurred among patient care associates. At the same time, both groups reported similar improvements in their own safe handling of patients. These findings are an example of the “inequality paradox,” which is the tendency of some interventions to unintentionally widen the gap between less and more advantaged workers. As such, the results highlight the importance of accounting for differences among workers when designing and evaluating health and safety interventions.

More information is available:

• Commentary: Tradeoffs Between Equity and Efficiency at the Heart of Population Health Science: A Public Health of Consequence, April 2019
• Harvard T.H. Chan School of Public Health Center for Work, Health & Well-being
• NIOSH Total Worker Health^® Program
• NIOSH Extramural Research and Training Programs: NIOSH Centers of Excellence for Total Worker Health^®