Actions for managing occupational asthma

[Mercy Adeniji]

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Actions for managing occupational asthma

The onset of asthma in the workplace can often be traced to specific causes that can be removed. Employers have duty of care responsibilities and no asthmatic employee should suffer in silence or worry about losing their job. Jon Herbert reports.

Around 10% to 25% of adults with asthma are actually suffering from occupational asthma, a type of the ailment caused by exposure to inhaled irritants commonly found in the workplace, such as flour or wood dust, gases, fumes and vapours, according to the John Hopkins Medicine website.

HSE — the public body responsible for overseeing workplace health, safety and welfare in the UK — explains that these substances are called “respiratory sensitisers'” or asthmagens and can cause a change in people's airways, known as the “hypersensitive state”.

HSE also provides a detailed breakdown of UK figures in a report titled Work-related Asthma Statistics, 2023, which can be found here, and offers more information, advice and guidance, here.

Economic cost

Asthma is a serious health problem thousands of people in the UK face every day which can stop sufferers from doing simple tasks such as carrying shopping bags or climbing up the stairs. The financial impact is high. The article Costs of Occupational Asthma in the UK analyses the annual lifetime cost to society measured in millions of pounds, with a newly diagnosed cohort adding more each year. It is supported by the Investing in Breath technical report which estimates that the impact of asthma and chronic obstructive pulmonary disease (COPD) in the UK, plus the interventions to improve diagnosis and better care, are significant costs to the UK economy.

According to the technical report, the UK is one of the worst among developed countries for general asthma deaths in the age range of 5–34 years, ranking 35th out of 37. The UK is also among the top 20 developed countries for deaths and hospital admissions; COPD is responsible for 30,000 deaths annually in England, it adds.

UK improvement

The more positive news is that HSE says UK statistics since 2000 indicate a decrease in the number of occupational asthma cases — those with the highest incidence rates include bakers and vehicle paint sprayers. Hairdressers and healthcare workers can also be at high risk. Full guidance for employers and workers in specific trades is given on the HSE website.

Additional encouragement comes from the fact that not everyone who becomes sensitised goes on to develop asthma. But once lungs become hypersensitive, further exposure to irritating substances, even at quite low levels, may trigger an attack.

Fortunately for those affected, this is often a reversible condition, in as much that symptoms can disappear when the irritants are avoided. However, prolonged exposure can lead to permanent damage, making it important to act early.

Causes

The most commonly cited cause of occupational asthma was isocyanates followed by flour, HSE adds. A wider list includes substances mentioned below.

Allergens: flour dust and additives, latex in healthcare and vapours and particles from hospital surgical procedures. Animal fur, skin and saliva, plus dust from animal enclosures, grain and poultry were the most common cause of occupational asthma among agricultural workers.

Irritants: chemicals in car spray paints, bleach in hairdressing salons, wood dust from machining or sanding, plus fumes, mists and vapours from electronic, engineering or metal work, adhesives, and chlorine in indoor pools.

Symptoms

Occupational asthma symptoms — also known as asthma exacerbations or flare-ups — like those in any other asthma attacks include wheezing, shortness of breath, nasal congestion, eye irritation and chest tightness, which worsen during exposure to irritants at work. They can also be associated with rhinitis (sneezing/runny nose) and conjunctivitis (itchy and inflamed red eyes).

The causes can be allergic or non-allergic and may improve when an employee is not at work. Symptoms sometimes only appear several hours after exposure.

When the disease begins, symptoms can decrease during weekends and holidays but return within 24 hours of any new exposure at work. People with occupational asthma may also find that their symptoms worsen as the working week progresses — on Monday it is not too bad, but deteriorate by Friday.

Further triggers

During occupational asthma’s advanced stages, symptoms can become problematic because of exposure to additional common asthma triggers that include smoke, other kinds of dust and temperature changes. The best practical remedy is the obvious one of avoiding these triggers.

The alternative practical solution can be to change jobs. But measures can be taken in the workplace before this to reduce occupational asthma risks … and any employee fears of losing their jobs.

Warning signs

If an employee develops new asthma symptoms at work, this could either be a case of returning childhood asthma, or signs of new occupational asthma. One complication is that it may take a while for symptoms to show as the person’s immune system becomes sensitive to workplace triggers.

However, once a person becomes sensitive to a substance at work, this can trigger asthma symptoms the next time they come into contact with even just small amounts of that particular substance.

Diagnosing occupational asthma

The advice of lung charity Asthma + Lung UK is that employees who notice symptoms should see their GP to confirm, or rule out, an occupational asthma diagnosis. GPs will want to discuss symptoms. They will also ask about when they occur, the type of work involved and an individual’s medical history. See here for more information.

Before visiting a GP, it is often useful to think through answers to potential questions. These may include: whether systems started as an adult, if childhood symptoms have returned since started working, whether symptoms improve when not at work, do they get worse after work and disrupt sleep, does the employee have a history of allergies and do they smoke, or have rhinitis?

Tests

Depending on the GP’s opinion, confirmatory tests may be needed and could include those mentioned below.

Peak flow: this involves using a peak flow meter, while also keeping a peak flow diary, to show peak flow scores at work and at home — normally four readings a day for circa three weeks.

Blood tests — skin prick tests: these confirm any allergies as opposed to symptoms triggered by irritants.

Challenge tests: these involve breathing in samples of suspected substances to see if they trigger symptoms and are closely monitored at a specialist centre.

There may also be a referral to an occupational asthma specialist.

Treating occupational asthma

The encouraging news is that the symptoms of occupational asthma can sometimes end completely provided they are diagnosed quickly, the cause is identified and the employee is no longer exposed to the trigger. This might be immediate or take a while longer.

However, it is important to remember that the substance which set the symptoms off will always be a trigger and should be avoided, as should similar workplaces.

In some instances, symptoms do not stop completely and can continue for years even after exposure to the trigger has ended. This is likely to be because occupational asthma was not identified soon enough or was more severe.

If consulted early enough, a GP or asthma nurse may prescribe a preventer inhaler to reduce underlying inflammation, plus a reliever inhaler to control symptoms when they do occur.

Employer responsibilities

Under the Health and Safety at Work, etc Act 1974, employers have a duty to minimise any exposure to hazardous substances in the workplace.

In situations where work involves contact with allergens or irritants, risks should be explained to vulnerable employees before they start work and they should have a health check when they start work, including a breathing test.

Affected staff should also have checks every year to ensure they are not developing asthma. If individuals do develop occupational asthma, employers must notify HSE.

Employee concerns

Where employees are worried about losing their job or income, or changing their job role, the advice is to talk to employers, an occupational health doctor or nurse if available, plus a union representative.

Further options might be to replace products or substances triggering asthma with safe alternatives or provide employees with PPE (Personal Protective Equipment) such as masks.

Additional advice for employees who have been told that their asthma has been caused by their job, is to get information quickly about compensation and benefits they may be entitled to. The level of benefit will depend on the severity of disability and may include eligibility for Industrial Injuries Disablement Benefit or Reduced Earnings Allowance. Payments start from the day the claim is made and not the day of diagnosis.

Further information A list of substances that can cause occupational asthma can be seen here. An extensive list of publications is also available here for the baker, vehicle spray painter/motor vehicle repair (MVR), non-MVR sector, solderer, woodworker, healthcare worker, agriculture worker and engineering worker, as well as general HSE guidance.

COSHH

The Control of Substances Hazardous to Health Regulations (COSHH) require employers to prevent or control exposures to hazardous substances to protect employee health. See here. Additionally, the COSHH Approved Code of Practice for Control of Substances that Cause Occupational Asthma can be seen here.

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