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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4 Recommendations
4 Recommendations
Pages 132-149
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From page 132... ...
Strategic Goal 1: Prevent and reduce work-related airway diseases Work-Related Airway Diseases The RDRP has divided work-related airway diseases into two main categories, work-related asthma (WRA) and fixed obstructive airway disease.
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From page 133... ...
Recommendation: Previous RDRP work on diisocyanates directly addressed the most common low-molecular-weight sensitizing cause of asthma in the developed world and led to important knowledge that has been transferred to prevent disease. The committee recommends that the RDRP assess how its research on diisocyanates and asthma can be extended to other low-molecular-weight sensitizers that cause occupational asthma, especially in terms of mechanisms of disease.
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From page 134... ...
Strategic Goal 2: Prevent and Reduce Work-Related Interstitial Lung Diseases Continue and expand efforts to prevent coal workers' pneumoconiosis (CWP) , silicosis, fiber-induced interstitial lung disease, and chronic beryllium disease.
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From page 135... ...
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 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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From page 136... ...
The RDRP should consider 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 NIOSH should continue to play a leading role in informing and guiding national and international efforts to address potential occupational hazards and risks associated with the use of manufactured nanomaterials.
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From page 137... ...
For example, the RDRP should assess how NIOSH-supported research and medical surveillance of World Trade Center disaster emergency responders and recovery workers may or may not be relevant to WRA, work-related fixed obstructive airway disease, interstitial lung disease, and possibly malignancies. The RDRP has made important contributions to the emergency response to recent disasters, including the World Trade Center and anthrax terror attacks, and hurricanes Katrina and Rita.
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From page 138... ...
As noted for WRA, the likely contribution of occupational exposures to the burden of chronic obstructive pulmonary disease (COPD) is high, and thus work in pursuit of the four fixed obstructive airway disease subgoals potentially can have a great impact on improved occupational safety and health among the U.S.
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From page 139... ...
and technical assistance program was key to identifying both diacetyl and nylon flock as agents that can cause respiratory disease, the RDRP should explore ways to systematically mine data from HHEs that share a common exposure and outcome focus. Strategic Goal 2: Prevent and reduce work-related interstitial lung diseases Much of the RDRP research on interstitial lung diseases is focused on preventing well-known pneumoconioses -- coal workers' pneumoconiosis (CWP)
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From page 140... ...
, with additional focus on the adequacy of exposure assessment and compliance deter mination. The evaluation committee also recommends that the RDRP continue to conduct research to further support MSHA's adoption of the NIOSH recom mended exposure limit of 1.0 mg/m3 as the actual permissible exposure limit for coal mine dust.
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From page 141... ...
Extending research to other, work-related granulomatous lung diseases is also encouraged. Strategic Goal 3: Prevent and reduce work-related infectious respiratory diseases The evidence package presented five intermediate goals, or subgoals, for the infectious disease component of the NIOSH RDRP.
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From page 142... ...
Recommendation: The RDRP histoplasmosis research activity appears to be of historical interest, and the evidence package states that no new RDRP research is planned. In the absence of an operational definition of "awareness" and the docu mented lack of adequate resources for specific surveillance activities, it is unclear how the RDRP can achieve this subgoal.
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From page 143... ...
The impact of the respiratory malignancies program has been strong with regard to the three specific carcinogenic exposures in the workplace listed above -- hexavalent chromium, silica, and diesel exhaust -- and no specific recommendations are given with respect to these subgoals. In fact, the comprehensive approach to addressing specific carcinogens such as these may serve as a model for developing future initiatives on occupational respiratory malignancies.
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From page 144... ...
Continued surveillance for asbestos-related risks should receive addi tional attention. Strategic Goal 5: Prevent respiratory and other diseases potentially resulting frOm occupational exposures to nanomaterials The growing recognition of the usefulness of nanomaterials in various indus trial applications has created an urgent need to study the potential health effects of exposures to nanoparticles and methods to control exposures to nanoparticles during manufacturing processes.
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From page 145... ...
In Chapter 3, the committee briefly discusses continuing and emerging issues related to surveillance activities, exposure assessment, respirator policy, emergency response, and RDRP resource allocation. The committee provides further discussion and recommendations related to these issues here.
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From page 146... ...
The United States is practically alone among highly developed countries with regard to its lack of comprehensive surveillance of occupational dis eases. 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.
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From page 147... ...
Thus, the evidence package refers frequently to exposure assessment activities as services provided to the RDRP research activities rather than as an integral component of the research questions. The RDRP does not present these exposure assessment activities as part of an explicit or comprehensive focus on exposure assessment methods.
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From page 148... ...
For example, the RDRP should assess how NIOSH supported research and medical surveillance of World Trade Center disaster emer gency responders and recovery workers may or may not be relevant to WRA, work-related fixed obstructive airway disease, interstitial lung disease, and possibly malignancies. RDRP Resource Allocation The RDRP was created during the recent NORA2 reorganization of NIOSH.
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From page 149... ...
• Outreach to the pulmonary research community: The RDRP has played an important role in the past to focus and catalyze research efforts on important occupational exposures and work-related lung diseases by hosting or cosponsoring conferences and workshops. The evaluation committee strongly recommends continued support of such activities to stimulate extramural investigators to target priority issues identified by the RDRP strategic-planning process.
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