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Work-Related Asthma

There is an obvious concern with a decreased quality of life when a someone is exposed to asthma triggers while at work. This article on occupational asthma was first published in AARC Times, the American Association for Respiratory Care’s monthly magazine.

Editor

We don’t often equate our occupation as being a health hazard, but in some cases it may be. There are a number of occupations that can aggravate the allergic and asthmatic condition. Interestingly, occupational asthma is one of the most common forms of occupational lung disease throughout the world. Nine to 15% of adults with asthma have been able to identify their own work environment to the onset of the disease.1 The aggravating factors of the disease can then lead to a work-related flare-up of asthma. It is estimated that 18% of adults with asthma, 25% of working adults with asthma, and 45% of all work-related cases are worsened by the work environment. Triggers—such as extreme temperatures, exercise, stress, odors, and general irritants like dust—commonly bring about these responses.2

Occupational asthma is more common in industrialized countries. In fact, in developing countries the incidence is 2 per 100,000 compared to developed countries, where the incidence is 18 per 100,000.3 The common environment where there is an increased risk is one where workers are exposed to dust, fumes, aerosols, and irritating chemicals.

In the fields
There are occupational risks to farmers who are exposed to organic dust particles. In the United States the most common is grain dust and is more likely to occur during the harvest season. It is prudent for farmers exposed to this trigger to take necessary precautions to reduce their exposure. On the other hand, some studies are showing that there are farm families whose children may actually experience a lower prevalence of sensitization and allergic rhinitis.4 We are starting to see additional studies that are showing similar results.

In the kitchens
Bakers face a risk of asthma aggravation and rhinitis due to exposure to alpha-amylase, wheat, rye, and soy flour. As the baker mixes the bread, dust clouds form from sieving and throwing the flour, and it becomes airborne and inhaled by the baker. This phenomenon has been noted specifically in Sweden, where the incidence of asthma is more than twice that for bakers than for non-bakers. This has resulted in many of them changing occupations.5 For the baker, there may also be ways to remediate the risk in their workplace, which could include respiratory protective equipment and dust extraction.

In salons
Another occupation that is more related to an industrialized nation is hairdressers. This is an occupation that exposes the professional to allergenic and irritative chemicals. There is an increased prevalence of respiratory symptoms in this group as a result of exposure to these irritants, many of which include eye-related symptoms often associated with rhinitis, productive cough, and dyspnea.6 A phone survey of hairdressers done by Leino and fellow researchers also noted an atopic component to this exposure. This survey found that dermatitis, occupational rhinitis, and asthma were prevalent with exposed hairdressers. If the hairdresser had been diagnosed with atopic disease, their risk of occupational skin exposure was increased three-fold.

In hospitals
Health care workers are not exempt from risk either. A recently published study noted that 6% of health care workers report new onset of asthma after entering their occupation.7 Respiratory therapists are among the highest in number who have an elevated risk of respiratory symptoms as a result of work-related exposures. In a Canadian study, when compared to physiotherapists, respiratory therapists had twice the number of nocturnal symptoms, wheeze, asthma attacks, and asthma being diagnosed after entering the profession. Asthma is associated with hospital-based medical instrument cleaning, general cleaning, use of powered latex gloves, and use of aerosolized medications.8

Always be on alert
There is an obvious concern with a decreased quality of life when a worker is exposed to asthma triggers on the job. The effect of work-related flare-ups, once identified, should lead management to consider other duties that the susceptible worker can undertake that has less impact on their pulmonary status. That just makes good sense. At the same time, there needs to be a move toward earlier recognition, diagnosis, and management of these conditions. Workers may not always be aware that there could be a cause and effect related to asthma and rhinitis while on the job. This is an area that you may want to explore with your respiratory therapist in the course of learning more about asthma.

References

1. Mapp CE, Miotto D, Boschetto P. Occupational asthma. Med Lav 2006; 97(2):404-409.
2. Henneberger PK. Work-exacerbated asthma. Curr Opin Allergy Clin Immunol 2007; 7(2):146-151.
3. Jeebhay MF, Quirce S . Occupational asthma in the developing and industrialized world: a review. Int J Tuberc Lung Dis 2007; 11(2):122-133.
4. Schulze A, van Strien RT, Praml G, et al. Characterization of asthma among adults with and without childhood farm contact. Eur Respir J, (Epub ahead of print on Feb. 14, 2007).
5. Brisman SJ, Jarvholm BG. Occurrence of self-reported asthma among Swedish bakers. Scand J Work Environ Health 1995; 21(6):487-493.
6. Leino T, Tammilehto L, Luukkonen R, Nordman H. Self reported respiratory symptoms and diseases among hairdressers. Occup Environ Med 1997; 54(6):452-455.
7. Mirabelli MC, Zock JP, Plana E, et al. Occupational risk factors for asthma among nurses and related health care professionals in an international study. Occup Environ Med, (Epub ahead of print on March 1, 2007).
8. Delclos GL, Gimeno D, Arif AA, et al. Occupational risk factors and asthma among heath care professionals. Am J Respir Crit Care Med 2007; 175(7):667-675.

About the Author
Tom Kallstrom, MS, RRT, AE-C, FAARC, a respiratory therapist, is associate executive director/chief operating officer of the American Association for Respiratory Care. For many years he has served as a member of the National Asthma Education and Prevention Program Coordinating Committee.