Table 5.

Respiratory epidemiology and disease and occupational health surveillance knowledge gaps and research priorities

Major Area	Knowledge Gaps and Research Priorities
Epidemiology studies of isocyanate exposed workers	Access to cohorts of isocyanate exposed workers in different work settings, and workplace exposure assessment, to determine: Risk of isocyanate asthma and other health effects in different work settings. Exposure risk factors (skin, airborne, peak exposures, co-exposures). Host risk factors (other diseases, acquired, genetic). Biomarkers of exposure and early disease (banked blood from representative-exposed cohorts for biomarkers and epidemiology studies).
Clinical spectrum and diagnosis of isocyanate asthma, other health effects	Better characterization of isocyanate health effects and overlap syndromes: asthma, rhinitis, HP, chronic obstructive pulmonary disease, dermatitis. Develop better diagnostic tests, including accurate tests for isocyanate sensitization, and determine the optimal role of available clinical tests, such as the clinical history, isocyanate specific antibody testing, spirometry and peak flow recordings, and nonspecific and specific inhalation challenge testing.
Surveillance of isocyanate exposed workers	Evaluate different medical surveillance approaches, including questionnaires (specific questions), spirometry and potential changes over time, and biomarkers in order to optimize the frequency and content of surveillance. Evaluate the effectiveness of preventive interventions such as workplace controls, product changes, PPE (respirators, gloves, clothing) to reduce exposures (isocyanates and co-exposures) and disease. Evaluate the cost-effectiveness of different surveillance and management approaches. Evaluate obstacles to surveillance – disincentives and incentives Improve clinicians’ and workers’ awareness of isocyanate health effects, the varied clinical presentations, and preventive actions.