Objectives for health monitoring and surveillance.

A properly designed respiratory disease monitoring and surveillance program for the effects of cotton dust uses tools similar to those used clinically but provides a different focus--the potential for disease prevention in individuals and the control of excess exposures in groups. Both surveillance and monitoring require the use of standard instruments (questionnaires and pulmonary function equipment) with careful attention to equipment calibration and standard methods for administering tests. Monitoring focuses on the individual to identify early evidence of disease and to detect those subjects who are susceptible even under usually well controlled exposure circumstances. Surveillance is successful when designed to collect information at regular intervals (based on type and level of exposure and previously measured response) and the results are interpreted according to reasonably rigorous criteria. A major additional component is the examination of surveillance results according to groups based on job, exposure, work tenure, and other risk factors (e.g., smoking).