Following Hurricane Sandy, which hit New York City and New Jersey in October 2012, industrial hygienists from the Mount Sinai and Belleview/New York University occupational medicine clinics conducted monitoring for diesel exhaust and silica in lower Manhattan and Rockaway Peninsula. Average daytime elemental carbon levels at three stations in lower Manhattan on December 4, 2012, ranged from 9 to18 μg/m(3). Sub-micron particle counts at various times on the same day were over 200,000 particles per cubic centimeter on many streets in lower Manhattan. In Rockaway Peninsula on December 12, 2012, all average daytime elemental carbon levels were below a detection limit of approximately 7 μg/m(3). The average daytime crystalline silica dust concentration was below detection at two sites on Rockaway Peninsula, and was 0.015 mg/m(3) quartz where sand was being replaced on the beach. The daily average levels of elemental carbon and airborne particulates that we measured are in the range of levels that have been found to cause respiratory effects in sensitive subpopulations like asthmatic patients after 2 hr of exposure. Control of exposure to diesel exhaust must be considered following natural disasters where diesel-powered equipment is used in cleanup and recovery. Although peak silica exposures were not likely captured in this study, but were reported by a government agency to have exceeded recommended guidelines for at least one cleanup worker, we recommend further study of silica exposures when debris removal operations or traffic create visible levels of suspended dust from soil or sand.

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Occupational asthma (OA) and work-exacerbated asthma (WEA), collectively known as work-related asthma (WRA), have been recognized as the most prevalent work-related lung diseases in the industrialized world. OA is asthma caused by workplace conditions, and is subdivided into sensitizer-induced (allergic) OA and irritant-induced (nonallergic) OA. WEA is asthma that is made worse, but was not initially caused, by workplace conditions. Although WRA is rarely fatal, patients with WRA frequently experience excessive time lost from work, workplace-specific severe disability, loss of income, job loss, and related psychosocial and financial problems. More than 400 workplace environmental agents have been reported to cause WRA, and are classified by molecular weight and allergenic and irritant properties. Diagnosis of WRA requires confirmation of a diagnosis of asthma plus evidence that the asthma was caused or worsened by workplace conditions. Accuracy of diagnosis is important because either overdiagnosis or missed diagnosis of WRA can be problematic for the patient. Self-reported clinical symptoms alone have only fair sensitivity and specificity for OA. If possible, diagnostic assessment should also include objective evidence with functional and immunologic testing. Treatment and prevention of onset or worsening of WRA can be highly effective and typically include both optimal medical management (generally the same as for non-WRA) and, importantly, avoidance of sensitizer or irritant exposures that caused or exacerbate the asthma. In most cases of OA, prognosis is better with cessation rather than reduction of exposure, and this may require substantial changes in the workplace environment or change of job or even profession.