Box 4-1

Summary of Recommendations

Strategic Goal 1: Prevent and Reduce Work-Related Airway Diseases

Improve detection of work-related asthma, work-related fixed obstructive airway disease, and relevant exposures. The evaluation committee is concerned that the new, second National Occupational Research Agenda industrial-sector-based priority-setting approach may lead to a decreased emphasis on needed disease-focused research related to airway diseases. The RDRP should systematically evaluate whether work-related asthma (WRA) activities are being compromised under the new approach. Because the contribution of occupational exposures to the burden of adult asthma is high, work in pursuit of the four WRA subgoals (preventing and reducing rubber-latex asthma and allergy among health care workers, preventing and reducing work-related asthma in the isocyanate-production industry, preventing and reducing work-related asthma related to nonindustrial indoor environmental quality, and improving detection of work-related asthma and relevant exposures, described in more detail in Chapter 4), can have a potentially large impact on improved occupational safety and health among the U.S. workforce. In terms of chronic obstructive pulmonary disease (COPD), understanding the contribution of occupational exposures is difficult. To understand this issue, the evaluation committee strongly recommends that, for planning preventive strategies, the RDRP continue to support population-based studies of associations between occupational exposures and COPD to better define groups of workers at greatest risk. In the flavoring industry, the RDRP response to the identification of diacetyl-induced bronchiolitis obliterans has led to surveillance efforts in multiple locations in an effort to detect and prevent disease. The evaluation committee agrees that continued surveillance, prevention of exposures, and mechanistic research to better understand this disease should continue to be a high priority for the RDRP.

Strategic Goal 2: Prevent and Reduce Work-Related Interstitial Lung Diseases

Continue and expand efforts to prevent coal workers’ pneumoconiosis (CWP), silicosis, fiber-induced interstitial lung disease, and chronic beryllium disease. The activities related to interstitial lung diseases form a critical core of the RDRP and have provided well-documented improvements in occupational health. It is important that the RDRP continue to expand its activities in these areas so it can build on its earlier successes while responding to new challenges. In particular, the committee recommends giving high priority to research into the increasing incidence of CWP, “hot spots” of rapidly progressive CWP, and the possible role of concentration and duration of exposure, coal rank, and silica level in the rapidly progressive cases of CWP. Other important areas of research recommended by the evaluation committee are experimental studies of silica-induced cytotoxicity and fibrogenesis and the development of control technologies, including silica substitutes, particle surface coatings, and dust reduction measures. In addition, fibers that are asbestiform, such as vermiculite, or

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