Work-related asthma (WRA), encompassing new-onset occupational asthma (OA) and workplace exacerbation of asthma (WEA), is the most common occupationally-induced lung disease in industrial countries; however, few studies have addressed WEA. We investigated workplace exacerbation of asthma symptoms (WEAS) in a low-income, urban, predominantly minority patient population, recruiting working patients with a diagnosis of asthma seen from 2001 to 2002 at Bellevue Hospital. We hypothesized that job categories with high exposure to asthma-aggravating agents would be associated with WEAS. Of 301 subjects, 51% reported WEAS in their current or most recent job; 71% reported WEAS in any job. Compared to those who never held a high-exposure job, those subjects who ever held a high-exposure job were significantly more likely to report WEAS (134 subjects, odds ratio 1.7, 95% CI 1.0--2.9). Odds ratios (OR) of association between WEAS and job-exposure category or specific job classification were estimated by logistic regression using the generalized estimating equation (GEE) method. Job (N = 1,091) was used as the unit of analysis, with multiple jobs per subject; GEE was used to improve estimates of precision. Adjusted ORs are given as (N of jobs, OR, 95% CI). The reference is all job categories identified a priori with low likelihood of exposure to asthma-aggravating agents. High-prevalence, high-exposure jobs (106, 1.7, 0.9--3.3), and janitorial jobs (67, 2.3, 1.3--4.1) were associated with WEAS. Thus workplace exacerbation of asthma symptoms is related to high-exposure jobs, and might be more prevalent in urban minority populations than previously thought.
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