implement and monitor a model screening and surveillance program for work-related asthma (WRA) in the isocyanate industry, an evaluation of the effectiveness of recommendations made in response to health hazard evaluations (HHEs), and continued development of better approaches to facilitate the use of ambulatory spirometry for assessing WRA. With regard to work-related chronic obstructive pulmonary disease (COPD), the RDRP will continue to evaluate the relation between COPD prevalence and occupation and pursue aggressive surveillance of work-related bronchiolitis obliterans. Much of this goal is a direct extension of material presented in the evidence package. The focus on mold allergen stems from the NIOSH-RDRP response to the high frequency of HHE requests triggered by asthma and asthma-like symptoms.

Committee Comments

Exposure and disease surveillance are critical to the objective of detecting and reducing work-related airway diseases as well as other major program goals of the RDRP. WRA is a difficult condition to identify and the RDRP should explore ways to identify new agents, outbreaks, or “hot spots” of WRA caused by known agents and trends in WRA. Furthermore, many WRA agents are present in small businesses that current surveillance methods do not identify or track effectively. Expanding the SENSOR program to include additional geographic areas and, thus, an even broader occupational mix would provide the much needed opportunity to track trends and to highlight possible geographic variation. One strength of the SENSOR program is that it does have elements that go beyond a purely passive (that is wholly voluntary) scheme.1 Active elements, such as mandatory physician reporting, warrant additional follow-up from the RDRP to evaluate their possible extrapolation to other geographic areas and other respiratory diseases. Without SENSOR data, the appropriate targeting of limited resources for exposure and medical monitoring and interventions to prevent and control disease is difficult, if not impossible. NIOSH should develop strategies to work with state health departments to develop methods for WRA surveillance.

The requirement for improved surveillance in work-related COPD parallels the need with WRA. RDRP efforts to seek new methods for conducting work-related COPD surveillance are of great importance. Furthermore, the RDRP should

1

The California SENSOR program, in particular, has utilized legally required physician reporting of occupational disease (the Doctor’s First Report system) for case finding. In addition, a NIOSH-led effort exploited the multiple routes of SENSOR case detection in the Michigan program to carry out a formal “capture-recapture” analysis of case incidence, once again highlighting that this scheme transcends the strict definition of a passive surveillance program (Henneberger et al, 1999). Also in Michigan, NIOSH participated in a similar surveillance related to silicosis (Rosenman et al 2003).



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