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a Department of
Occupational and Environmental Medicine, National Heart and Lung
Institute, Imperial College of Science, Technology and Medicine,
Dovehouse Street, London SW3 6LY, UK, b Department of Preventive
Medicine, School of Medicine, Vanderbilt University, Nashville, TN
37232-2637, USA
Correspondence to: Dr J C McDonald c.mcdonald{at}ic.ac.uk
Accepted 25 July 2000
OBJECTIVES
To examine
trends in estimated population based incidence of occupational
asthma by age, sex, occupation, geographical region, and causal agents
based on 9 years of the Surveillance of Work Related and Occupational
Respiratory Disease (SWORD) data.
METHODSIn January
1989 the SWORD scheme for the surveillance of occupational respiratory
disease was established in the United Kingdom to make good the lack of
epidemiological information on the incidence of these diseases in the
United Kingdom. Between 80% and 90% of chest and occupational
physicians report voluntarily all new cases they see, on a monthly or
random sampling basis. During the 9 years 1989-97, an estimated
25 674 new cases of occupational respiratory disease, including 7387 of occupational asthma, were reported. Suspected causal agents were
classified into 44 categories and estimated annual incidences of asthma
were calculated with denominators from the labour force survey.
RESULTSOverall, a
third of the suspected causes of asthma were organic, a third chemical,
6% metallic, and the rest miscellaneous, or in 8%, unknown. There was
evidence of an increase since 1989 in cases due to latex, and possibly
glutaraldehyde, and an apparent drop since 1991 in the proportion of
cases attributed to isocyanates. Incidences were higher in men than
women and the disparity was especially marked in the population aged 45 years or more in which rates for men were at least twice those for
women. Average annual rates per million workers for 1992-7 ranged from
7 (95% confidence interval (95% CI) 5 to 9) for the lowest risk group
of professional, clerical, and service workers to 1464 (95% CI 968 to
2173) for coach and other spray painters. Except for laboratory
technicians, all other occupations with rates over 100 were concerned
with manufacturing and processing that used chemicals, metals, and organic materials. Incidences were two to three times higher in the
north and midlands than in East Anglia and the south. The introduction
of a sampling scheme in 1992 doubled estimates of reported incidence of
occupational asthma, but there was little evidence of other temporal changes.
CONCLUSIONSThe SWORD
scheme has produced consistent estimates of the causes and incidence of
occupational asthma as seen by chest and occupational physicians. It
has allowed the epidemiology of occupational asthma in the population
to be studied and high risk occupations to be identified. There is
certainly more occupational asthma in the population than that which
reaches specialists in occupational and chest medicine; therefore the
incidence rates presented here are underestimates, but by how much
remains unknown.
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