Asthma often ignored in workplace as workers avoid revealing illness
Productivity decreases as many workers don’t know what’s wrong
Asthma in the workplace has been overlooked in recent years, even though occupational health professionals can play a key role in combating it, according to leaders familiar with the problem. Up to 28% of adult asthma cases may be attributable to exposure in work settings, according to the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati.
"We can prevent and control asthma with proper diagnosis, treatment, and attention to prevention," says Robert McCunney, MD, MPH, director of environmental medicine at the Massachusetts Institute of Technology in Boston and president of the American College of Occupational and Environmental Medicine (ACOEM) in Arlington Heights, IL. "The prevalence of asthma has been increasing worldwide for reasons as yet unclear. Environmental particulates, chemicals, and well-known antigens such as pollens, dusts, and animal materials have all been held accountable."
An asthma attack occurs when the airways to the lungs become inflamed in reaction to irritants and other substances that the worker might inhale. More than 17 million Americans suffer from respiratory diseases, including asthma, McCunney says. Airway disease, including asthma, is the fourth leading cause of death, according to the National Occupational Research Agenda of NIOSH. (Federal safety officials are warning about another workplace exposure that can cause respiratory problems. See story, p. 123.)
Symptoms can be deceiving
Hundreds of materials in the workplace can cause asthma, says Philip Harber, MD, director of occupational and environmental medicine at the University of California-Los Angeles. Harber specializes in lung diseases. The illness can be difficult to detect if the occupational health professional is not on the alert for it, he says.
"Sometimes the worker will only have a slight cough or any one of the other symptoms that occur while he or she is exposed to a particular substance at work," Harber says. "The symptoms can 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, he says. A cough after work could be caused by several things, so it is common for everyone — the worker, the employer, and the occupational health professional — to overlook it until there is a much more serious reaction, usually one that can be traced to a particular substance in the workplace. The asthma itself usually is not caused by workplace exposure, but an attack often is triggered by an exposure, he says.
People who suffer from allergies can have antibodies to certain materials encountered in the workplace, such as platinum and latex, and that can contribute to the narrowing of their airways. When an allergen enters their air passages, it binds to these antibodies and that initiates a sequence of events resulting in bronchial constriction.
Another form of occupational asthma is irritant-induced asthma, also called reactive airways dysfunction syndrome. This type of asthma manifests with cough and other symptoms within 24 hours of a single high-level toxic exposure to a respiratory irritant. Harber recounts one patient who worked in building maintenance and was called to repair an exercise bike at a health club. As he bent over the bike, the man suddenly felt tightness in his chest and began gasping for air. He panicked as he fought for breath, not knowing what was happening.
It turned out that the man was reacting to the inhalation of chlorine gas leaking from a nearby pool. Though he recovered from the incident, his exposure led to permanent asthma. Repeated exposure to an irritant, or one large exposure as in that man’s case, can cause a worker to develop asthma that will leave him or her always susceptible to more attacks. Early detection and abatement of such exposures can prevent that susceptibility, Harber says.
Detecting the workers’ existing asthma and detecting possible irritants are key components of an occupational asthma program, McCunney says. The presence of workers with known asthma also makes it even more important to control exposure to some workplace irritants. Even low levels of some substances such as formaldehyde and secondhand smoke can trigger an asthma attack in sensitive individuals, he says. Simple exertion or exposure to cold weather also can trigger attacks.
McCunney notes that workers with asthma are protected by the Americans with Disabilities Act. The disease also can sharply reduce a worker’s productivity, so he says everyone benefits by effectively detecting and treating the problem.
Employers, employees in the dark sometimes
An occupational health nurse who treats difficult asthma cases says the disease often is a mystery to both the employer and the suffering employee. Jill Steiner, RN, occupational health nurse at North Valley Hospital in Whitefish, MT, says she sees occupational asthma as an often overlooked and misunderstood problem.
"People just don’t take asthma seriously," she says. "They think it’s treatable, then you’re fine and it’s no big deal. They don’t see it as a very dangerous, life-threatening disease."
Even if the worker has asthma and is suffering from attacks, he or she may make no connection between the symptoms and asthma. Or even if the worker is fully aware that he has asthma, he may make no connection between the asthma attacks and exposures to irritants in the workplace.
"They often have no idea what exposure sets off the attack, so we have to sit down and play detective with them," she says. "I’ll ask what they were doing when the attack started, or what kind of activities they were involved with over the past week. Sometimes we’ll hit on some sort of exposure that turns out to be the particular irritant for them."
Steiner is treating several workers in her community who suffer from occupational asthma. They all work in the area’s lumber industry, and she has found that some of them have very specific triggers for asthma. One worker, for instance, is sensitive only to dust from spruce trees.
Respirators can be a solution
Even when the problem is accurately diagnosed, preventing attacks can be difficult. Steiner says job modification often is a good idea, and sometimes respirators are an effective way to avoid exposure to the workplace irritant. But because asthma often is seen as a minor problem, employers are unlikely to push for the respirator use, and employees often are lax about wearing them.
Steiner says the occupational health nurse needs to be diligent about personally checking for workplace exposures and to urge the worker to comply with corrective measures. Educating employers and employees about the seriousness of asthma is the most important part of the occupational health provider’s intervention, she says.
"Employees often are reluctant to tell you about their asthma because they see this as a weakness and don’t want to admit to it," Steiner says. "They will suffer silently until the occupational health nurse is physically there at the worksite and can see the suffering. When you ask about the coughing and wheezing and point out the dust or other exposure, they’re sometimes willing to talk to you then."
Source
The American College of Occupational and Environmental Medicine (ACOEM) offers a free checklist for controlling asthma in the workplace. Send a stamped, self-addressed envelope to:
• Labor Day Checklist, ACOEM, 1114 N. Arlington Heights Road, Arlington Heights, IL 60004-4770.
For more information on treating asthma, contact:
• Jill Steiner, Occupational Health Department, North Valley Hospital, 6575 Highway 93 S., Whitefish, MT 59937. Telephone: (406) 863-353. E-mail: [email protected].
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