Respiratory Diseases Research at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health (2008) / Chapter Skim
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Pages 1-14
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These activities focus on airway diseases such as asthma and chronic obstructive pulmonary disease (COPD) , interstitial lung diseases such as silicosis and asbestosis, respiratory infectious diseases including tuberculosis and avian influenza and severe acute respiratory syndrome (SARS)
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These recommendations include an emphasis on the need to expand surveillance activities to detect exposure to those agents responsible for disease and to detect outbreaks of known diseases and identify new respiratory diseases affecting workers. The committee also recommends continued support of research on the development and improvement of methods to detect respiratory effects earlier and more accurately, continued research on the molecular mechanisms driving the pathogenesis of workplace respiratory dis eases, the characterization of those agents (or attributes of those agents)
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Current work-related respiratory diseases and disorders that NIOSH is studying consist of a broad spectrum of a dverse health effects including airway diseases such as asthma and COPD, interstitial lung diseases such as silicosis and asbestosis, respiratory infectious diseases such as tuberculosis and avian influenza and SARS, and respiratory cancers. These health effects can arise in a wide range of occupational settings and range from mild, reversible conditions to progressive fatal disorders and can be linked to shortterm or long-term exposures.
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Five goals, intended to support the RDRP mission statement provided above, were provided: • Prevent and reduce work-related airway diseases. • Prevent and reduce work-related interstitial lung diseases.
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1 = Research in the research program is an ad hoc collection of projects, is not integrated into a program, and is not likely to improve workplace safety or health. Assessment of Relevance and Impact Chapter 2 of this report describes in detail the NIOSH activities, outputs, and outcomes relating to each of the RDRP's strategic goals and their subgoals; an assessment of the relevance and assessment of the impacts of those activities and outcomes follows that description.
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This reflects the judgment of the committee that the activities related to most of the subgoals are in the highest-priority subject areas and highly relevant to improvements in work place protection and that the RDRP is engaged in transfer activities at a significant level. This is particularly true for activities related to interstitial lung diseases as well as many parts of the activities related to airways and infectious diseases and malig nancies.
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These activities include the development and improvement of methods (e.g., spirometry, r adiography, and novel biomarkers) to detect respiratory effects earlier and more accurately, continued research on the molecular mechanisms driving the pathogenesis of workplace-related respiratory diseases, characterization of those agents (or attributes of those agents)
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, silicosis, fiber-induced interstitial lung disease, and chronic beryllium disease. The a ctivities related to interstitial lung diseases form a critical core of the RDRP and The second phase of the National Occupational Research Agenda (NORA)
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The committee recommends that the effectiveness of digital radiography in CWP surveillance should be an important continuing research priority, which will extend to all interstitial lung diseases. Strategic Goal 3: Prevent and Reduce Work Related Infectious Respiratory Diseases 3.
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The RDRP should con sider developing long-term follow-up of workers exposed to asbestos and should consider enhancing surveillance for asbestos-related risks. Strategic Goal 5: Prevent Respiratory and Other Diseases Potentially Resulting from Occupational Exposures to Nanomaterials 5.
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The effectiveness of past NIOSH surveillance activities for coal-dust-related diseases, both CWP and COPD, highlight the importance of improved surveillance for other occupational respiratory disorders. NIOSH should engage in development and evaluation of surveillance methods as a high priority for occupational respiratory disease surveillance, including methods to systematically review and analyze the findings of reports through the health hazard evaluation and technical assistance program and other data collection approaches.
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However, much more can be learned about exposure response relationships and ultimately about protecting emergency responders by conducting longitudinal cohort studies relating to catastrophic events. Information from emergency responses to toxicant exposures should be applicable to models of irritant-induced asthma, fixed airway obstruction, interstitial lung disease, and possibly even malignancies.
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Strategic Goal 3: Prevent and Reduce Work-Related Infectious Respiratory Diseases 3. Continue to support efforts to protect workers from occupational exposures and to define mechanisms that make workers susceptible to respiratory infections.
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For example, the RDRP should assess how NIOSH-supported research and medical surveil lance of World Trade Center disaster emergency responders and recovery workers may or may not be relevant to work-related asthma, work-related fixed obstructive airway disease, interstitial lung diseases, and possibly malignancies. RDRP Resource Allocation 9.
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