EDITORIAL
INT J TUBERC LUNG DIS 19(4):372 Q 2015 The Union http://dx.doi.org/10.5588/ijtld.15.0129
Occupational asthma in developing countries requires further research A SYSTEMIC REVIEW of international studies has estimated that the population burden of asthma attributable to occupational exposures is substantial, at between 15% and 20%.1 This estimate is, however, primarily based on, and is therefore applicable to, industrialised countries, which have well-developed sources of occupational health data such as occupational asthma surveillance programs and large insurance schemes. Apart from South Africa, relatively little is known about the burden of asthma from workplace exposures in developing countries.2 The incidence of occupational asthma tends to be highest in the manufacturing sector, which globally accounts for one in six jobs. Historically, in terms of global trade, developing countries were solely suppliers of minerals and agricultural commodities; now, however, significantly more manufacturing takes place in developing countries. World manufactured exports from industrialising economies have increased from 13.9% in 1997 to 29.6% in 2011.3 This change is not uniform among countries defined as ‘developing’, however, as China has clearly shown the greatest increase in manufacturing. The growth of manufacturing is vital to the growth of the economies of developing nations, and leads to increased employment opportunities for the population. However, as employment in manufacturing increases, so too does the risk of occupational asthma. Concerns about health and safety standards in the manufacturing sector in many developing countries are well documented. Unfortunately, in countries where livelihoods depend on the need to work, workers are likely to be more accepting of poor workplace conditions. Other major industrial concerns, apart from respiratory exposures, are also present, such as excessive work hours and the use of child labor. Lawin and colleagues in this issue of the Journal report on the effect of exposure to polyvinyl chloride (PVC) dust on 42 workers in a PVC pipe manufacturing plant in West Africa.4 The researchers note a significant reduction in peak expiratory flow over the working week, and that dyspnea is more prevalent in PVC dust exposed workers compared with a control group. Although the outcomes assessed are not the standard measures for diagnosing occupational asthma, the results do suggest an adverse effect of PVC
dust exposure. In critiquing studies of occupational asthma from developing countries it should be recognized that limitations in diagnostic capacity are likely to be present. As employment in manufacturing rises in developing countries, occupational asthma research needs to be an area of priority to mitigate the burden of asthma caused by work. Improved characterization of occupational asthma in these countries will allow the identification of high-risk industries, at-risk workers, and support advocacy to improve working conditions. Occupational asthma is a preventable form of asthma. In developing countries, prevention of asthma is even more important, especially as access to drugs to optimally manage asthma may be limited due to prohibitive costs.5 Collaboration between international experts in occupational lung disease and researchers in developing countries should be strongly supported as a means to help progress optimal research in this field. RYAN HOY, MBBS, FRACP Department of Epidemiology and Preventive Medicine Monash University, Melbourne Victoria, Australia e-mail: [email protected] Conflicts of interest: none declared.
References 1 Toren K, Blanc P D. Asthma caused by occupational exposures is common — a systematic analysis of estimates of the populationattributable fraction. BMC Pulm Med 2009; 9: 7. 2 Jeebhay M F, Quirce S. Occupational asthma in the developing and industrialised world: a review. Int J Tuberc Lung Dis. 2007; 11: 122–133. 3 United Nations Industrial Development Organization. Industrial Development Report 2013. Sustaining employment growth: the role of manufacturing and structural change. Vienna, Austria: UNIDO, 2013. 4 Lawin H, Ayelo P, Hinson V, Kagima J, Fayomi B. Change over time in peak expiratory flow among workers exposed to polyvinyl chloride dust. Int J Tuberc Lung Dis 2015; 19: 448– 491. 5 A¨ıt-Khaled N, Auregan G, Bencharif N, et al. Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries. Int J Tuberc Lung Dis 2000; 4: 268–271.
INT J TUBERC LUNG DIS 19(4):372 Q 2015 The Union http://dx.doi.org/10.5588/ijtld.15.0129
Occupational asthma in developing countries requires further research A SYSTEMIC REVIEW of international studies has estimated that the population burden of asthma attributable to occupational exposures is substantial, at between 15% and 20%.1 This estimate is, however, primarily based on, and is therefore applicable to, industrialised countries, which have well-developed sources of occupational health data such as occupational asthma surveillance programs and large insurance schemes. Apart from South Africa, relatively little is known about the burden of asthma from workplace exposures in developing countries.2 The incidence of occupational asthma tends to be highest in the manufacturing sector, which globally accounts for one in six jobs. Historically, in terms of global trade, developing countries were solely suppliers of minerals and agricultural commodities; now, however, significantly more manufacturing takes place in developing countries. World manufactured exports from industrialising economies have increased from 13.9% in 1997 to 29.6% in 2011.3 This change is not uniform among countries defined as ‘developing’, however, as China has clearly shown the greatest increase in manufacturing. The growth of manufacturing is vital to the growth of the economies of developing nations, and leads to increased employment opportunities for the population. However, as employment in manufacturing increases, so too does the risk of occupational asthma. Concerns about health and safety standards in the manufacturing sector in many developing countries are well documented. Unfortunately, in countries where livelihoods depend on the need to work, workers are likely to be more accepting of poor workplace conditions. Other major industrial concerns, apart from respiratory exposures, are also present, such as excessive work hours and the use of child labor. Lawin and colleagues in this issue of the Journal report on the effect of exposure to polyvinyl chloride (PVC) dust on 42 workers in a PVC pipe manufacturing plant in West Africa.4 The researchers note a significant reduction in peak expiratory flow over the working week, and that dyspnea is more prevalent in PVC dust exposed workers compared with a control group. Although the outcomes assessed are not the standard measures for diagnosing occupational asthma, the results do suggest an adverse effect of PVC
dust exposure. In critiquing studies of occupational asthma from developing countries it should be recognized that limitations in diagnostic capacity are likely to be present. As employment in manufacturing rises in developing countries, occupational asthma research needs to be an area of priority to mitigate the burden of asthma caused by work. Improved characterization of occupational asthma in these countries will allow the identification of high-risk industries, at-risk workers, and support advocacy to improve working conditions. Occupational asthma is a preventable form of asthma. In developing countries, prevention of asthma is even more important, especially as access to drugs to optimally manage asthma may be limited due to prohibitive costs.5 Collaboration between international experts in occupational lung disease and researchers in developing countries should be strongly supported as a means to help progress optimal research in this field. RYAN HOY, MBBS, FRACP Department of Epidemiology and Preventive Medicine Monash University, Melbourne Victoria, Australia e-mail: [email protected] Conflicts of interest: none declared.
References 1 Toren K, Blanc P D. Asthma caused by occupational exposures is common — a systematic analysis of estimates of the populationattributable fraction. BMC Pulm Med 2009; 9: 7. 2 Jeebhay M F, Quirce S. Occupational asthma in the developing and industrialised world: a review. Int J Tuberc Lung Dis. 2007; 11: 122–133. 3 United Nations Industrial Development Organization. Industrial Development Report 2013. Sustaining employment growth: the role of manufacturing and structural change. Vienna, Austria: UNIDO, 2013. 4 Lawin H, Ayelo P, Hinson V, Kagima J, Fayomi B. Change over time in peak expiratory flow among workers exposed to polyvinyl chloride dust. Int J Tuberc Lung Dis 2015; 19: 448– 491. 5 A¨ıt-Khaled N, Auregan G, Bencharif N, et al. Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries. Int J Tuberc Lung Dis 2000; 4: 268–271.
