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Premium member Presentation Transcript Breathing Easy: Topics in Respiratory Health of Farmworkers : Breathing Easy: Topics in Respiratory Health of Farmworkers Pamela Rao, PhD Farmworker Justice 1126 16th St NW, Suite 270 Washington, DC 20036 202-293-5420 www.farmworkerjustice.org Presentation Outline : Farmworker Justice, WMSF 2009 2 Presentation Outline Occupational Respiratory Health Respiratory Health and Agriculture Pesticides Asthma Avian Flu Recommendations for Providers Occupational Respiratory Health : Farmworker Justice, WMSF 2009 3 Occupational Respiratory Health The National Institute for Occupational Safety and Health (NIOSH) estimates that work-related respiratory disease and malignancies comprise about 70% of all occupationally-related deaths. Respiratory health issues are especially difficult to characterize because a given illness can have multiple etiologies, while a given exposure can have multiple health endpoints. Respiratory Health and Agriculture (1) : Farmworker Justice, WMSF 2009 4 Respiratory Health and Agriculture (1) Farmworkers are exposed regularly to a wide variety of substances: pesticides: insecticides, herbicides, fumigants other agricultural chemicals: fertilizers, plant growth regulators crops and related allergens: pollens, pests, microorganisms land: organic and inorganic dusts The likelihood that an individual worker has been exposed to only a single identifiable agent is small. Measuring exposure is also challenging, which makes dose-response relationships difficult to assess. Exposure limits have not been set for most relevant agents. Respiratory Health and Agriculture (2) : Farmworker Justice, WMSF 2009 5 Respiratory Health and Agriculture (2) Agricultural respiratory disease often goes untreated and unreported, especially by small operations not regulated by OSHA, making it nearly impossible to determine the true extent of the problem. Many agricultural exposures are manageable and/or avoidable, so respiratory diseases among farmworkers are largely preventable. Pesticides (1) : Farmworker Justice, WMSF 2009 6 Pesticides (1) The various means of exposure to pesticides beyond working directly with them, e.g., residue and drift, create hazardous working conditions for all agricultural workers regardless of individual activity. Inhalation is an extremely efficient way to introduce organic compounds into the bloodstream. Many pesticides cause irritation to the respiratory tract (mechanism of action is via the respiratory system). If an individual becomes sensitized to a chemical, minimal exposure can cause serious adverse effects. A 1998-99 study in California [Das et al 2001] found: Route of exposure in 24.2% of pesticide illness cases was inhalation. 23.7% of farmworkers experiencing pesticide-related illness reported respiratory system illness. Pesticides (2) : Farmworker Justice, WMSF 2009 7 Pesticides (2) Relevant findings from the Agricultural Health Study: Evidence of a strong association of wheeze with exposure to several organophosphates. Increased prevalence of chronic bronchitis for individuals who have experienced a high pesticide exposure event. Association of farmer’s lung with high pesticide exposure events and use of organochlorines and carbamates, as well as the insecticides DDT, lindane, and aldicarb . Chronic bronchitis among the women in the study was associated with five pesticides, including paraquat, DDT, cyanazine, dichlorvos, and methyl bromide. Atopic asthma among the women was highly associated with having both grown up on a farm and applied pesticides at any time. Asthma (1) : Farmworker Justice, WMSF 2009 8 Asthma (1) Occupational asthma results from causes and conditions encountered only in an occupational environment. Work-aggravated asthma refers to pre-existing asthma exacerbated by workplace exposures. Asthma is an important issue in agriculture because so many substances found on farms are known contributors to either occupational asthma or work-aggravated asthma. Pre-existing asthma is likely to be exacerbated by exposure to dust and other substances in the agricultural workplace. Asthma (2) : Farmworker Justice, WMSF 2009 9 Asthma (2) Data from the National Health and Nutrition Examination Survey (NHANES) of work-related asthma and work-related wheezing indicate an increased risk of both in farm- and agriculture-related occupations. A study of asthma among elderly Hispanic and non-Hispanic whites in Texas found a significant positive association between current asthma and a history of having done farm-related work (Arif et al 2005). Prenatal and early childhood exposure to pesticides is being investigated as a contributing factor in the increasing prevalence of childhood asthma worldwide. Avian Influenza (1) : Farmworker Justice, WMSF 2009 10 Avian Influenza (1) Poultry workers in the US may be family members of farmworkers living in agricultural areas, or may be farmworkers themselves, doing poultry work between harvests. Poultry workers are on the front line of risk because they typically get covered by bird litter or dust in the course of the day, and workplace hygiene is often poor. Workers could become infected through contact with bird droppings or contaminated surfaces. Workers who come home covered by bird litter or dust could easily spread the infection to their family members. Human-to-human transmission may have occurred in a small number of cases. Avian Influenza (2) : Farmworker Justice, WMSF 2009 11 Avian Influenza (2) Signs and symptoms in infected people are similar to those of human flu: fever, cough, sore throat, eye infections, muscle aches, pneumonia, acute respiratory distress and other severe and life-threatening complications. If an individual is infected by both the avian flu and a human flu virus at the same time, the viruses could swap genes, creating a virus capable of spreading easily from person-to-person. If such a mutation occurs, a worldwide human pandemic would rapidly ensue. Vaccinations against human flu would reduce the likelihood of such a mutation. Recommendations for Providers : Farmworker Justice, WMSF 2009 12 Recommendations for Providers Health care providers should familiarize themselves with the agricultural activities that occur in their region in order to identify possible agents and be alert for relevant respiratory symptoms. Smoking should be discouraged since it increases risk of reduced lung function. Patients who work with poultry should be educated on the importance of wearing a respirator or NIOSH-certified dust mask (not a hardware store dust mask). Patients who apply pesticides should be reminded to follow the label instructions regarding use of respirators and other personal protective equipment. Workers should be vaccinated against human flu, especially if they work with poultry or live with poultry workers, to reduce the risk of simultaneous infection with avian flu. For more information: : Farmworker Justice, WMSF 2009 13 For more information: Schenker MB, et al.: Respiratory health hazards in agriculture. American Journal of Respiratory and Critical Care Medicine 158(5):S1-S76, 1998. Includes a comprehensive and more technical review of occupational respiratory disease in agriculture, as well as an extensive list of references. Beyond Pesticides: Asthma, Pesticides, and Children: What you should know to protect your family. Washington, DC: Author. www.beyondpesticides.org/children/asthma/asthma%20brochure%20high%20res.pdf (accessed 1/15/09). Pesticide Action Network North America: Secondhand Pesticides: Airborne Pesticide Drift in California. San Francisco, CA: Californians for Pesticide Reform. www.panna.org/files/secondhandDriftAvail.dv.html (accessed 1/15/09). Farmworker Justice Health and Safety Resources: http://www.fwjustice.org/Health&Safety. Includes resources on pesticides and avian flu. National Environmental Education Foundation. Health and Environment Publications (webpage). Includes links for documents on pediatric environmental screening and environmental health practice and education guidelines for medical and nursing professionals. http://www.neefusa.org/health/pubs/index.htm (accessed 1/15/09). References Cited : Farmworker Justice, WMSF 2009 14 References Cited Arif AA, et al.: A population-based study of asthma, quality of life, and occupation among elderly Hispanic and non-Hispanic whites: a cross-sectional investigation. BMC Public Health 5:97-109, 2005 Das R, et al.: Pesticide-related Illness among Migrant Farm Workers in the United States. International Journal of Occupational and Environmental Health 7(4):303-312, 2001. Agricultural Health Study publications: http://aghealth.nci.nih.gov/publications.html Acknowledgements : Farmworker Justice, WMSF 2009 15 Acknowledgements This publication is a joint project of Farmworker Justice and Migrant Clinicians Network, supported by the Health Resources and Services Administration’s Bureau of Primary Health Care. The contents of this publication are solely the responsibility of Farmworker Justice and Migrant Clinicians Network and do not necessarily reflect the official views of the Bureau of Primary Health Care or the Health Resources and Services Administration. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.