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B Stakeholder Responses Online Survey On February 28, 2007, the Committee to Review the NIOSH Respiratory Dis- eases Research Program sent out an invitation to stakeholders asking them to fill out an online questionnaire. A total of 25 people were sent an e-mail and/or letter. The letter and responses are given below (Box B-1). RESPONSES TO ONLINE QUESTIONNAIRE Question 1: Are you familiar with NIOSH activities and products related to occu­ pational respiratory disease? Respondent 1: Yes. Respondent 2: Yes. Respondent 3: Somewhat familiar, particularly regarding occupational infec- tious respiratory diseases. Respondent 4: Yes, I know NIOSH approves respirators, dust masks, etc. 217

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218 R e s p i r ato ry D i s e a s e s R e s e a r c h at NIOSH Box B-1 Letter with Questionnaire Hello, The National Academies has been contracted by the National Institute of Occupational Science and Health (NIOSH) to conduct a review of its occupational respiratory disease activities. As a part of this review the committee would like to give stakeholders an opportunity to comment on NIOSH’s occupational respiratory disease activities and related products. The information that we receive from you will greatly help us in our review. Your responses are received anonymously, but the answers that are given will be made a part of public record. We ask that you please take a moment to comment by clicking on the link below. If you have any questions, please feel free to give myself or the staff officer on this study (K. John Holmes at 202-334-2045) a call or e-mail message. We would appreciate receiving responses by March 20th, but can accept responses up to May 1st. We appreciate your time in helping us with our task. Best regards, Jordan Crago Question 2: What kind of experiences have you had working with the agency or its products? Respondent 1: I am familiar with NIOSH’s support of state-based surveillance activities for respiratory disease. Respondent 2: Good except there could be more interaction between intramural staff and state surveillance programs with cooperative agreements to better target and use limited resources. Now only one person from NIOSH respiratory works with the states and other intramural people, and states do not coordinate activity even when they may be working on same specific respiratory issues Respondent 3: As a CDC employee dealing with infection control matters for health care personnel, I have had to become somewhat familiar with respira- tory protection for this occupational group. I have served on an informal CDC

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A pp e n d i x B 219 working group that included staff from NIOSH as well as others in CDC not at NIOSH. We discussed some research needs in the area of respiratory pro- tection for health care personnel. This evolved into a group that organized a stakeholders’ meeting in late 2005 to open discussion on a possible research agenda addressing respiratory protection for airborne infectious agents. Respondent 4: I use to be an MSHA inspector and participated in some SCSR studies at Bruceton, PA and Morgantown, WV. Since returning to industry I have helped arrange a NIOSH visit to one of our mines. Question 3: In what capacity have you interacted with NIOSH? Respondent 1: I lead a state-based surveillance program. NIOSH supports our program with funding through a competitive grant process. Respondent 2: Recipient of funds and reviewer of intramural and extramural activity. Respondent 3: As a CDC colleague interested in similar issues. Respondent 4: As an MSHA inspector (lab rat duties) and as a safety director for a coal company. Question 4: Please comment on the relevance and impact of NIOSH’s work over the past 10 years in any of the following areas: a. Development, implementation, and evaluation of effective respiratory dis- ease safety and health programs; b. Evaluation of respiratory disease safety and health devices; c. Development and use of engineering controls to reduce respiratory disease health hazards; d. Improved understanding of occupational respiratory disease hazards and disorders through surveillance and investigation for risk factors. Respondent 1: NIOSH has supported several states in the development of a surveillance programs for occupational asthma. Generally, these programs are able to identify new occupational asthmagens and identify some risk factors for OA. These programs are too restrictive and fail to include other occupa-

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220 R e s p i r ato ry D i s e a s e s R e s e a r c h at NIOSH tional respiratory diseases, i.e., pneumoconiosis, or upper airway disorders. There is ­ ineffective dissemination of information about new exposures and occupational respiratory disorders on a state level, i.e., diacetyl and ­brochiolitis obliterans. Failing the development of effective state partners in both the r ­ espiratory and other occupational diseases, there is little effective occupational public health at the state level. Respondent 2: Identification of new occupational respiratory conditions has been major accomplishment. Work in surveillance is better than other NIOSH divisions with the periodic release of work-related lung disease surveillance report but more could be done particularly in coordination with the states. Development of respiratory controls have been excellent. Respondent 3: NIOSH plays an important role in certification of respiratory protection equipment (RPE). In addition, they have conducted studies to a ­ ssess the methods for evaluating the “fit” of RPE. Their strength is with agents for which there are known RELs, the difficulty is applying these principles to i ­ nfectious agents from which RELs are not known nor for which measure- ment techniques currently exist. NIOSH staff have conducted studies on RPE “fit” that have had relevance to discussion of the need for annual fit testing of N95 respirators. They have conducted or sponsored studies to develop a more modern panel of subjects for fit testing of RPE. Respondent 4: I know they’ve worked on mine rescue breathing apparatus s ­ tudies and SCSR studies. I see their approval labels on the respirators we provide for our miners. That’s about it. Question 5: What do you see as and the major challenges and research needs over the past 10 years in occupational respiratory disease? Respondent 1: 1) Identification of occupational respiratory disease clusters and subsequent investigation; 2) indoor air quality and mold exposures; and 3) the poor understanding of occupational respiratory by primary care and general physicians. Respondent 2: To stay relevant by addressing major respiratory burdens and not just focusing on the less prevalent respiratory conditions unique to the work place.

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A pp e n d i x B 221 Respondent 3: 1) Developing methods for detection and quantification of air- borne infectious agents to be able to set exposure limits. 2) Development of standards for “fit” of RPE to which manufacturers should adhere. It is vital to develop RPE that have inherently good “fit” and for which fit testing may not be necessary. 3) Developing techniques to be able to determine if infectious agents are truly airborne, i.e., spread through droplet nuclei. Respondent 4: I think the largest challenge was Congress doing away with the Bureau of Mines and only providing a small amount of funding to NIOSH to replace what was lost. I think more research needs to be done on respirable dust levels around continuous miners using flooded bed dust scrubbers. Question 6: What do you see as significant emerging research needs in occupational respiratory disease? Respondent 1: 1) Identification of new exposures for occupational asthma and respiratory disease, 2) effective delivery of quality medical care for occupational respiratory diseases (occupational health services research), and 3) effective education and controls for respiratory protection in emergency and disaster response. Respondent 2: Continuing to determine the attributable risk for major respira- tory diseases such as asthma, COPD, and lung cancer, and determining specific interventions and controls to reduce the incidence, morbidity, and mortality of these major respiratory conditions Respondent 3: No answer Respondent 4: I think more long-term studies using chest x-rays and pulmonary function tests need to be done to determine what today’s miners and industrial w ­ orkers are being exposed to. It will tell us how effective our current methods are. Question 7: Do you have any other comments to offer about NIOSH research related to identification and control of occupational respiratory diseases? Respondent 1: Get more state partners to improve surveillance and prevention programs!! Make the states work together and in partnership with the federal government.

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222 R e s p i r ato ry D i s e a s e s R e s e a r c h at NIOSH Respondent 2: NIOSH has been precluded from using certain modalities such as specific antigen challenge testing which has hampered their research in the area of occupational asthma. Respondent 3: NIOSH needs to continue to work collaboratively with other areas of CDC interested in these matters. Respondent 4: No.