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Preventing occupational asthma

Preventing occupational asthma. what makes an occupational disease ripe for prevention? what is the role of the academic/clinical community? what influences business?. Paul Cullinan - Pepys 2, Toronto. Factors influencing the prevention of occupational asthma. favourable. +/-.

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Preventing occupational asthma

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  1. Preventing occupational asthma • what makes an occupational disease ripe for prevention? • what is the role of the academic/clinical community? • what influences business? Paul Cullinan - Pepys 2, Toronto

  2. Factors influencing the prevention of occupational asthma favourable +/- unfavourable

  3. Approaches to the prevention of occupational asthma • elimination • substitution • ‘molecular design’ • pre-employment eugenics • exposure control • surveillance • (delivery)

  4. Studies of primary prevention Y N ?

  5. Studies of primary prevention: the effects of enhanced surveillance Tarlo and Liss

  6. Incidence in studies of prevention Y N

  7. Incidence and occupational asthma unusually sensitive risk risk 0 6 12 18 24 30 36m exposure time from first exposure (employment) • individual immunity ---- herd immunity • who is ‘at risk’? • group risk dependent on exposure and turnover • in a state of steady exposure risk depends on turnover

  8. Interpreting prevention studies

  9. Exposure limits in occupational asthma • something to aim at (NCO, subtilisins, bakery dust, amylase…….. • but: • very large # of agents • capturing relevant exposures is technically difficult • thresholds? • measuring biological allergens is technically difficult • SME’s don’t understand them • ‘of limited value in exposure control’ • have they ever ‘worked’? • in-house limits

  10. Secondary prevention: how good is routine surveillance? supermarket bakeries 2975 166 1556 80 370 30 1049 56

  11. Incentives towards prevention • Sticks: • the costs of a case… • regulation • reputation • Carrots: • insurance premiums • tax breaks • what motivates industry? • SME vs the large corporation • (where is OA located?) • occupational lung diseases in history

  12. Barriers to prevention: a chief medical officer’s view Paul, Thank you so much for the meeting yesterday. It was very interesting although I’m not sure it will change our practice. X’s parting shot to me was that he didn’t see why we should investigate anyone for OA as the insurance companies would do it anyway and we might as well just dismiss employees with bakers’ asthma as it would probably be cheaper in the long run. We must admire the human race – etiquette demands it of us (Mark Twain)

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