Published ahead of print on December 21, 2006, doi:10.1164/rccm.200609-1331OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200609-1331OC
Occupational Risk Factors and Asthma among Health Care Professionals1 The University of Texas School of Public Health, Houston, Texas; 2 Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain; 3 International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, United Kingdom; 4 Division of Health Services Research, Department of Family and Community Medicine, Texas Tech University Health Science Center, Lubbock, Texas; 5 Municipal Institute of Medical Research (IMIM-IMAS), Barcelona, Spain; and 6 Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Correspondence and requests for reprints should be addressed to George L. Delclos, M.D., M.P.H., The University of Texas–Houston School of Public Health, 1200 Herman Pressler Street, Suite RAS W1018, Houston, TX 77030. E-mail: george.delclos{at}uth.tmc.edu Rationale: Recent U.S. data suggest an increased risk of work-related asthma among health care workers, yet only a few specific determinants have been elucidated. Objectives: To evaluate associations of asthma prevalence with occupational exposures in a cross-sectional survey of health care professionals. Methods: A detailed questionnaire was mailed to a random sample (n = 5,600) of all Texas physicians, nurses, respiratory therapists, and occupational therapists with active licenses in 2003. Information on asthma symptoms and nonoccupational asthma risk factors obtained from the questionnaire was linked to occupational exposures derived through an industry-specific job-exposure matrix. Measurements: There were two a priori defined outcomes: (1) physician-diagnosed asthma with onset after entry into health care ("reported asthma") and (2) "bronchial hyperresponsiveness–related symptoms," defined through an 8-item symptom-based predictor. Main Results: Overall response rate was 66%. The final study population consisted of 862 physicians, 941 nurses, 968 occupational therapists, and 879 respiratory therapists (n = 3,650). Reported asthma was associated with medical instrument cleaning (odds ratio [OR], 2.22; 95% confidence interval [CI], 1.34–3.67), general cleaning (OR, 2.02; 95% CI, 1.20–3.40), use of powdered latex gloves between 1992 and 2000 (OR, 2.17; 95% CI, 1.27–3.73), and administration of aerosolized medications (OR, 1.72; 95% CI, 1.05–2.83). The risk associated with latex glove use was not apparent after 2000. Bronchial hyperresponsiveness–related symptoms were associated with general cleaning (OR, 1.63; 95% CI, 1.21–2.19), aerosolized medication administration (OR, 1.40; 95% CI, 1.06–1.84), use of adhesives on patients (OR, 1.65; 95% CI, 1.22–2.24), and exposure to a chemical spill (OR, 2.02; 95% CI, 1.28–3.21). Conclusions: The contribution of occupational exposures to asthma in health care professionals is not trivial, meriting both implementation of appropriate controls and further study.
Key Words: work-related asthma • health care workers
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