Work-Related Asthma

What is work-related asthma?

Asthma is considered to be “Work-related” when someone’s asthma symptoms worsen because of exposures to allergens or irritants at work. It is estimated that 15% of people with asthma experience worsening symptoms at work or work-related asthma (WRA).

Occupational asthma

If exposures at work have caused the development of newly diagnosed asthma, it is referred to as Occupational Asthma (OA). Approximately 17% of all adult-onset asthma cases are related to occupational exposures. The median prevalence of work-exacerbated or work-related asthma is 22%, but some studies have suggested that this could be as high as 58%. (NIOSH 2018).

In general, the term work-related asthma is used to cover both asthma that is caused by work and asthma that gets worse at work.

Why work-related asthma is important

Work-related asthma can:

• reduce productivity
• lower quality of life
• increase costs to employees and their families, to businesses and taxpayers

It is important to protect yourself from exposures to allergens and irritants because continued exposures can worsen asthma. Sometimes workers are forced to change their job in order to avoid asthma attacks. In the worst cases, asthma can cause death.

Workers in certain occupations are more likely than others to experience worsening asthma. Among the 11 million adults who had asthma in 2011-2016, 9.9% reported having an asthma-related emergency department (ED) visit. However, that figure rises to 17.4% for workers in personal care and service occupations such as nail technicians and hair stylists.

Asthma attacks must be taken seriously. In 2015 there were a total of 3,396 asthma deaths reported among adults in the United States.  According to the US Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR), an estimated 11%-21% of those asthma deaths can be attributed or related to exposures at work.

How can work-related asthma be prevented?

There are over 250 substances found in various workplaces that have been linked to asthma. It is often difficult to completely avoid all substances that have been linked to asthma.

The best plan of action is to create a safe and healthy work environment to minimize exposure to allergens and/or irritants in the workplace.  It is important that everyone in the workplace, including workers and employers, takes steps to maintain an asthma-friendly workplace.

One approach to maintaining an asthma-friendly workplace is through the use of the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health Program. The Total Worker Health (TWH) Program integrates workplace safety and health with activities that advance the overall wellbeing of workers. The TWH provides a list of actions to be taken to deal with allergens or irritants in the workplace that could make someone’s asthma worse or cause an asthma attack:

1. Eliminate work conditions that threaten human safety, health and wellbeing
2. Substitute health enhancing policies, programs, and practices
3. Redesign the work environment for safety, health and well-being
4. Educate for safety and health
5. Encourage personal change 
6. Some larger workplaces may have industrial hygienists, occupational health nurses and even occupational physicians on staff to help ensure worker safety. These professionals can be a resource to help workers and employers address the control of irritants and allergens found in the workplace.

Treatment

Unless work-related asthma is diagnosed and managed early, it is likely to continue and can get worse. Work with your health care provider if you suspect you might have work-related asthma. Early detection and treatment can improve the quality of life and progression or development of the disease. Health care providers should ask their asthma patients about possible work-related exposures. Additional information can be found in the National Heart, Lung and Blood Institute Guidelines for the Diagnosis and Management of Asthma.

What Minnesota is doing

MDH's Asthma Program continues to collaborate with internal and external partner groups to improve education, prevention, and intervention methods around work-related asthma. Visit the Minnesota Board of Cosmetology to learn more about safety practices for cosmetologists.

Learn more

For workers

• Asthma and agriculture. (2012). Farm and Ranch eXtension in Safety and Health (FReSH) Community of Practice. FReSH is a collaborative community of practice between universities, industry, and government to provider user-friendly information for the general rural population, agricultural producers, and agricultural safety and health professionals.
• Work-Related Asthma Fact Sheet (PDF) November 2018 
  This fact sheet provides basic information and resources available to Minnesota workers to investigate hazards in the workplace. 
• Do You Have Work-Related Asthma? A Guide for YOU and YOUR DOCTOR This federal Occupational Safety and Health Administration (OSHA) fact sheet reviews key questions that you and your doctor should explore if you think that you may have work-related asthma. It lists common jobs and products associated with isocyanate exposure, a common chemical linked to asthma.
• How Lung Friendly is Your Workplace? 
  The American Lung Association has information on basic steps that can be taken to create a lung-friendly workplace by addressing potential triggers of asthma found in the workplace.  
• The California Department of Public Health’s  Work-Related Asthma Prevention Program (WRAPP) helps identify exposures that put workers at risk for work-related asthma. Their Work-related Asthma: What you should know fact sheet lists common jobs with typical chemical exposures that can cause or make asthma worse. They also have fact sheets on fragrances in the workplace, cleaning and disinfectants, and other difficult to find resources. Some of their fact sheets are available in Spanish, Chinese, Korean, Tagalog, and Vietnamese.
• The Canadian Centre for Occupational Health and Safety (CCOHS) has basic information on work-related asthma. It discusses irritants and allergens potentially found in various occupations.
   

For health professionals

• OSHA’s Occupational Asthma website The federal Occupational Safety and Health Administration (OSHA) has information on standards and hazard recognition as it relates to factors in the workplace associated with occupational asthma. There is good information on possible solutions to preventing the development and/or worsening of asthma in the workplace. 
• NIOSH resource for healthcare professionals The National Institute for Occupational Safety and Health (NIOSH) has many resources for healthcare professionals on work-related asthma. Besides current information on the epidemiology, psychophysiology, diagnosis, prevention and treatment of work-related asthma, their website includes information on various exposures that can cause or worsen asthma. The “Prevention of Work-Related Asthma” section has a searchable database to help health care professionals find information on types of agents associated with asthma and interventions that can be taken.
• AOEC Exposure code lookup The Association of Occupational and Environmental Clinics (AOEC) has a helpful exposure code lookup as well as a video library, including information on aging workers and their health and safety needs.

For employers

• NIOSH Work-Related Asthma The National Institute for Occupational Safety and Health (NIOSH) has information on how work-related asthma exposures are identified and prevented.
• The Minnesota Technical Assistance Program (Mn Tap), an outreach program at the University of Minnesota, has engineers on staff and sponsors projects that provide assistance with efforts to reduce the use of toxic chemicals.