Surveillance of work-related asthma including the emergence of a cannabis-associated case series in Washington State

Abstract

Objective: We conducted surveillance for work-related asthma (WRA) in Washington State to identify the industry sectors and asthma exposures most commonly affecting injured workers and in need of prevention activities.Methods: Using workers' compensation data as the primary data source, valid cases were classified as work-aggravated asthma (WAA) or new onset asthma that includes occupational asthma (OA) and reactive airways dysfunction syndrome (RADS). The source of exposure that caused the worker's asthma, their industry and occupation were determined.Results: There were 784 valid work-related asthma cases identified for the period 2009 -2016, WAA (n=529) was most common followed by occupational asthma (n=127) and RADS (n=12). The Health Care and Social Assistance industry had the highest number of cases (n=170) with 82% classified as WAA. The highest overall proportions of new onset asthma are occurring in Agriculture, Forestry, Fishing and Hunting (33% of work related asthma cases), Manufacturing (31%) and Construction (30%). The leading substances associated with new onset asthma across all industries include hop plant dust, wood and cedar dust, mineral and inorganic dust, mold, and cleaning materials. We describe ten cases of cannabis-associated asthma including seven from workers in the legalized cannabis industry, four of whom had OA. Conclusion:State-based work-related asthma surveillance is critical in identifying the workers and exposures associated with this occupational disease, including the detection of a case-series in the cannabis industry.

Fatal Occupational Asthma in Cannabis Production — Massachusetts, 2022

“…Enhanced surveillance for work-related asthma in the state of Washington identified seven asthma cases among employees in indoor cannabis production facilities ( 5 ). Three employees with work-exacerbated asthma discontinued cannabis employment; one with occupational asthma was symptomatic in two different cannabis facilities separated by a 2-year asymptomatic period while unexposed.…”

Recent developments in occupational asthma

“…In France, the personal service activities (10.6%), the food industry (10.2%) and the healthcare activities (7.6%) accounted for the work activities with the highest prevalence of WRA [6 ▪ ]. In the United States, Reeb-Whitaker et al [8 ▪ ] used Washington State Workers’ Compensation data to examine cases of WRA from 2009 to 2016. Sixteen percent of identified cases were classified as OA.…”

“…In the UK, most cases of OA have been shown to be related to exposure to flour dust or isocyanates [1 ▪▪ ] whereas in France the most common causal agents of OA were flour (10%), quaternary ammonium compounds (5.3%), isocyanates (5.1%), and cleaning products (4.8%) [6 ▪ ]. In contrast, in the USA's state of Washington, the most frequent agents associated with new onset asthma were hop plan dust, wood & cedar dust, mineral & inorganic dust, mold, and cleaning materials [8 ▪ ].…”

“…Since cannabis has now been legalized in some countries, it would be expected to observe more cases related to this industry. Reeb-Whitaker et al [8 ▪ ] documented WRA cases among workers of various cannabis-related industries in Washington State. Six cannabis-associated WEA cases and four cannabis-associated OA cases were identified for the period 2002–2019.…”

The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry

“…Published case reports of cannabis-associated asthma include a bird breeder with occupational exposure to C. sativa seed and a series of 10 cases published from the Washington Worker Compensation Claim Database from 2002 to 2019, four of which were classified as new onset occupational asthma. 54,58 A recent fatality in a cannabis cultivation worker who was exposed to ground cannabis dust while preparing prefilled joints was attributed to occupational asthma per an Occupational Safety and Health Administration (OSHA) investigation. 59 The prevalence of asthma among cannabis employees is still uncertain.…”