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Questions About Asthma?

American College of Occupational and Environmental Medicine (ACOEM) 847-818-1800 x383, www.acoem.org, or e-mail dcaplick@acoem.org

Occupational Safety and Health Administration (OSHA) - US Department of Labor www.osha.gov/oshinfo/priorities/asthma.html

National Asthma Education and Prevention Program (NAEPP) 301-496-4326

National Heart, Lung, and Blood Institute (NHLBI) www.nhlbi.nih.gov/nhlbi.htm

Environmental Protection Agency (EPA) 800-490-9198

Indoor Air Quality Clearinghouse/EPA 800-438-4318

National Institute for Occupational Safety and Health (NIOSH) 800-356-4674, or cdc.gov/niosh/homepage.html

Recognizing the significance of respiratory problems at work, The American College of Occupational & Environmental Medicine (ACOEM) has selected Asthma in the Workplace for their 1999 Labor Day Checklist. The Labor Day Checklist is an annual ACOEM program that highlights a specific health problem to educate employers and workers about occupational and environmental issues in the workplace. The list highlights action areas to combat asthma in three categories: workplace, environment and lifestyle. Thirty helpful tips are summarized for employers and employees to use to eliminate or reduce asthma-related problems.

On the Rise

"In the world of occupational disease, asthma is the single most common respiratory disorder in developed countries," says Dr. Robert J. McCunney, ACOEM President and director, Environmental Medical Services at MIT. "In fact, the prevalence of asthma has been increasing worldwide for reasons yet unclear. Environmental particulates, chemicals and well known antigens such as pollen, dusts and animal materials have all been held accountable. However, we can prevent and control asthma with proper diagnosis, treatment and attention to prevention."

The Centers for Disease Control (CDC) reports that from 1980 to 1994, the number of people diagnosed with asthma increased by about 75%. This number includes all races, sexes and age groups. It is also estimated that up to 28% of adult asthma cases may be attributable to exposure in work settings; the yearly costs of occupational asthma could reach $400 million (as reported by The National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health). NORA also reports that airway disease, which includes asthma, is the fourth leading cause of death, and the CDC reports that asthma is the ninth leading cause of hospitalization.

Attacks & Symptoms

An asthma attack in the workplace occurs when the airways become inflamed in reaction to irritants and other substances that workers may inhale. Environmental "triggers," substances that cause the airways to overreact, result in constriction of airways. The symptoms of asthma include wheezing, a tight feeling in the chest, coughing and shortness of breath. One of the hallmarks of occupational asthma is a cough, particularly after leaving work or at night. In many cases, the respiratory symptoms are not always recognized as a warning sign until the worker experiences a severe reaction to a substance in the work area.

Types of Asthma

While asthma is not usually caused by work, it can affect a person’s ability to work. People who suffer from allergies may have antibodies to certain materials, such as platinum and latex, that contribute to the narrowing of their airways. When an allergen enters their air passages, it binds to these antibodies, which initiates a sequence of events resulting in bronchial constriction, the hallmark of an asthma attack. This form of occupational asthma may begin after a period of exposure to an environmental substance. "Typically allergic sensitization occurs during a latency period of one to three years," notes Dr. Jane Barlow, Medical Director, Family Health Center, El Rio, Texas, who developed the 1999 ACOEM Checklist.

Another form of occupational asthma, which has no latency period, is irritant-induced asthma, which is also called reactive airways dysfunction syndrome (RADS). With this type, asthma symptoms and cough begin within 24 hours after a single high-level toxic exposure to a respiratory irritant.

In the workplace reactions can be caused by a number of asthma triggers, including biologic agents (such as latex), drugs (such as penicillin), or chemicals (such as isocyanates used to make plastics). Early detection and proper diagnosis can help prevent the development of permanent asthma. When a worker develops asthma symptoms due to his work environment, the disease can often be reversed when the employee changes jobs, is relocated to a new area within the organization, or makes accommodations to remove exposures from the present job.

Finally, though many asthma cases are not caused by workplace exposures, controlling certain exposures can avoid triggering exacerbations. Persons with asthma may be more sensitive to low levels of irritants such as formaldehyde or second hand smoke; they may even be affected by working in cold environments.

Dr. Barlow suggests that every asthma patient should discuss work factors with his or her physician. Where needed, changes may be made at work to significantly improve the asthma. Occupational medicine physicians have special training to evaluate asthma as to whether it is caused or aggravated by work. If a person has asthma that is adversely affected by work, he or she may be eligible for workers’ compensation benefits. "Workers with asthma also are protected by the ADA if they can still perform their essential job duties," says Dr. McCunney.

Is Workplace Asthma Preventable?

Looking at the workplace specifically, much asthma is preventable. Through education, sharing of knowledge and use of the 1999 Labor Day Checklist, physicians, employers and employees can work together to reduce the incidence and severity of asthma in the workplace. v

Excerpts from: Workplace Asthma-Nothing to Sneeze About, August, 1999, ACOEM, reproduced by permission.

For a free copy of the 1999 Labor Day Checklist, send a stamped, self-addressed, business size envelope to: Labor Day Checklist, ACOEM, 1114 N. Arlington Heights Rd, Arlington Heights, IL 60004-4770. You may also browse to www.acoem.org, or get a fax-on-demand at 800-226-3626.

Editors Note: We hope you will share this useful and practical information in your safety, prevention and educational efforts with your client companies and patients.