A comprehensive list of asthmagens to inform health interventions in the Australian workplace

Crewe, Julie; Carey, Renee; Glass, Deborah Catherine; Peters, Susan; Abramson, Michael J.; Benke, Geza; Reid, Alison; Driscoll, Tim; Fritschi, Lin

doi:10.1111/1753-6405.12479

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…A diagnosis of WRA requires the objective diagnosis of asthma with symptoms temporally related to the individual's place of employment (141). Over 250 agents may potentially cause sensitization and possibly occupational asthma (OA), and comprehensive lists are available (Table 1) (112–115). Briefly, the two main classes of sensitizing agents, namely high molecular weight (HMW) and low molecular weight (LMW) agents can cause sensitizer-induced asthma which is usually after a latency period and this may contrast the frequent rapid action of irritant agent exposure.…”

Section: Environmental Exposures Associated With Asthma In Children Amentioning

confidence: 99%

Epidemiology of Asthma in Children and Adults

2019

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Asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and mortality in severe cases. We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while adult asthma is more common in women, and the reversal of this sex difference in prevalence occurs around puberty suggesting sex hormones may play a role in the etiology of asthma. The global epidemic of asthma that has been observed in both children and adults is still continuing, especially in low to middle income countries, although it has subsided in some developed countries. As a heterogeneous disease, distinct asthma phenotypes, and endotypes need to be adequately characterized to develop more accurate and meaningful definitions for use in research and clinical settings. This may be facilitated by new clustering techniques such as latent class analysis, and computational phenotyping methods are being developed to retrieve information from electronic health records using natural language processing (NLP) algorithms to assist in the early diagnosis of asthma. While some important environmental determinants that trigger asthma are well-established, more work is needed to define the role of environmental exposures in the development of asthma in both children and adults. There is increasing evidence that investigation into possible gene-by-environment and environment-by-environment interactions may help to better uncover the determinants of asthma. Therefore, there is an urgent need to further investigate the interrelationship between environmental and genetic determinants to identify high risk groups and key modifiable exposures. For children, asthma may impair airway development and reduce maximally attained lung function, and these lung function deficits may persist into adulthood without additional progressive loss. Adult asthma may accelerate lung function decline and increase the risk of fixed airflow obstruction, with the effect of early onset asthma being greater than late onset asthma. Therefore, in managing asthma, our focus going forward should be firmly on improving not only short-term symptoms, but also the long-term respiratory and other health outcomes.

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Section: Environmental Exposures Associated With Asthma In Children Amentioning

confidence: 99%

Epidemiology of Asthma in Children and Adults

2019

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“…Because OccIDEAS assesses exposures to 27 asthmagen groups (refer to the paper by Crewe et al, 2016 [ 21 ] for the list of asthmagens) and the OAsJEM assesses exposures to 30 agents, some agents were grouped together for the analyses in this study and some were dropped (Table 1 ). This resulted in the assessment of exposure to a total of 19 agents for the AWES-Asthma study and nine agents for the Bhutan healthcare workers study.…”

Section: Methodsmentioning

confidence: 99%

“…It has also been used in breast cancer epidemiological studies to assess exposure to solvents [ 16 ], radiation [ 17 ], engine exhausts [ 18 ], and pesticides [ 19 ]; and for exposure to asbestos for a mesothelioma registry [ 20 ]. OccIDEAS assesses exposure to 27 asthmagen groups, which include a comprehensive list of agents that are known to be asthmagens and are used in occupational settings in Australia [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of agreement in asthmagen exposure assessments between rule-based automatic algorithms and a job exposure matrix in healthcare workers in Australia and Bhutan

et al. 2022

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Background: Assessment of occupational exposures is an integral component of population-based studies investigating the epidemiology of occupational diseases. However, all the available methods for exposure assessment have been developed, tested and used in high-income countries. Except for a few studies examining pesticide exposures, there is limited research on whether these methods are appropriate for assessing exposure in LMICs. The aim of this study is to compare a task-specific algorithm-based method (OccIDEAS) to a job-specific matrix method (OAsJEM) in the assessment of asthmagen exposures among healthcare workers in a high-income country and a low- and middle- income country (LMIC) to determine an appropriate assessment method for use in LMICs for future research. Methods: Data were obtained from a national cross-sectional survey of occupational asthmagens exposure in Australia and a cross-sectional survey of occupational chemical exposure among Bhutanese healthcare workers. Exposure was assessed using OccIDEAS and the OAsJEM. Prevalence of exposure to asthmagens and inter-rater agreement were calculated. Results: In Australia, the prevalence was higher for a majority of agents when assessed by OccIDEAS than by the OAsJEM (13 versus 3). OccIDEAS identified exposures to a greater number of agents (16 versus 7). The agreement as indicated by κ (Cohen’s Kappa coefficient) for six of the seven agents assessed was poor to fair (0.02 to 0.37). In Bhutan, the prevalence of exposure assessed by OccIDEAS was higher for four of the seven agents and κ was poor for all the four agents assessed (-0.06 to 0.13). The OAsJEM overestimated exposures to high-level disinfectants by assigning exposures to all participants from 10 (Bhutan) and 12 (Australia) ISCO-88 codes; whereas OccIDEAS assigned exposures to varying proportions of participants from these ISCO-codes. Conclusion: There was poor to fair agreement in the assessment of asthmagen exposure in healthcare workers between the two methods. The OAsJEM overestimated the prevalence of certain exposures. As compared to the OAsJEM, OccIDEAS appeared to be more appropriate for evaluating cross-country exposures to asthmagens in healthcare workers due to its inherent quality of assessing task-based determinants and its versatility in being adaptable for use in different countries with different exposure circumstances.

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“…Occupational asthmagens were grouped into 27 categories (Crewe et al, 2016). Exposure was assessed within OccIDEAS based on the subject's job title and tasks and answers to the job modules as described previously (Fritschi et al, 2016).…”

Section: Exposure Assessment By Occideasmentioning

confidence: 99%

“…About 10-16% of asthma may be caused by occupational exposure to agents which cause asthma de novo or exacerbate existing asthma (Johnson et al, 2006;Torén and Blanc, 2009;Ghosh et al, 2013). There are many hundreds of occupational asthmagens which makes the task of assessing exposure to such a great number of exposures in community-based studies very challenging (Crewe et al, 2016). Previous studies have examined specific exposures in particular jobs, for example flour exposure in bakers (Baatjies et al, 2010), have looked at occupational exposures among people with asthma via physician interview (McDonald et al, 2005), have assessed exposure using a job exposure matrix in which all people in a particular job are assigned the same exposures (Le Moual et al, 2014) or have asked participants to self assess their exposure to various asthmagen groups (LeVan et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Inter-rater Agreement Between Exposure Assessment Using Automatic Algorithms and Using Experts

Florath

Glass

Rhazi

et al. 2018

Annals of Work Exposures and Health

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Objectives: To estimate the inter-rater agreement between exposure assessment to asthmagens in current jobs by algorithms based on task-based questionnaires (OccIDEAS) and by experts. Methods: Participants in a cross-sectional national survey of exposure to asthmagens (AWES-Asthma) were randomly split into two subcohorts of equal size. Subcohort 1 was used to determine the most common asthmagen groups and occupational groups. From subcohort 2, a random sample of 200 participants was drawn and current occupational exposure (yes/no) was assessed in these by OccIDEAS and by two experts independently and then as a consensus. Inter-rater agreement was estimated using Cohen's Kappa coefficient. The null hypothesis was set at 0.4, because both the experts and the automatic algorithm assessed the exposure using the same task-based questionnaires and therefore an agreement better than by chance would be expected. Results:The Kappa coefficients for the agreement between the experts and the algorithm-based assessments ranged from 0.37 to 1, while the agreement between the two experts ranged from 0.29 to 0.94, depending on the agent being assessed. After discussion by both experts the Kappa coefficients for the consensus decision and OccIDEAS were significantly larger than 0.4 for 7 of the 10 asthmagen groups, while overall the inter-rater agreement was greater than by chance (P < 0.0001). Conclusions:The web-based application OccIDEAS is an appropriate tool for automated assessment of current exposure to asthmagens (yes/no), and requires less time-consuming work by highly-qualified research personnel than the traditional expert-based method. Further, it can learn and reuse expert determinations in future studies.

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A comprehensive list of asthmagens to inform health interventions in the Australian workplace

Cited by 12 publications

References 15 publications

Epidemiology of Asthma in Children and Adults

Epidemiology of Asthma in Children and Adults

Comparison of agreement in asthmagen exposure assessments between rule-based automatic algorithms and a job exposure matrix in healthcare workers in Australia and Bhutan

Inter-rater Agreement Between Exposure Assessment Using Automatic Algorithms and Using Experts

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