For Immediate Release
Contact
Debra Bethard-Caplick
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Workplace Asthma -- Nothing to Sneeze About
Chicago, August 9 1999 -- An easy 10-minute maintenance call for Jack to repair an exercise bike at an upscale health club foreshadowed an event that would permanently change his occupation and health.
As Jack bent over the bike's crank mechanism, he suddenly felt tightness in his chest. Panicked and gasping for air, he staggered, wheezing and coughing. Fortunately, a health club member saw Jack's difficulty and quickly called the paramedics.
Jack didn't know at the time that he was reacting to a high concentration of chlorine from a pipe break in a nearby pool. His exposure ultimately led to permanent asthma. Jack is one of more than 17 million Americans who suffer from respiratory diseases, including asthma.
Recognizing the significance of respiratory problems at work, the American College of Occupational and Environmental Medicine (ACOEM) selected asthma in the workplace for its 1999 Labor Day CheckList. 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.
"In the world of occupational disease, asthma is the single most common respiratory disorder in developed countries," says Dr. Robert J. McCunney, ACOEM president. "However, we can prevent and control asthma with proper diagnosis, treatment and attention to prevention," according to Dr. McCunney, director, Environmental Medical Service, Massachusetts Institute of Technology, Cambridge.
"In fact, 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."
What is asthma? Asthma is a disease that affects the airways delivering air to the lungs. It causes periodic reversible attacks of wheezing and shortness of breath. 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.
Airway disease, including asthma, is the fourth leading cause of death, according to the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health. NORA reports as many as 28 percent of adult asthma cases may be attributable to exposure in work settings. There are hundreds of materials in the workplace that may cause asthma, according to Dr. Philip Harber, director, Occupational and Environmental Medicine, University of California, Los Angeles.
NORA also estimates yearly costs of occupational asthma reach $400 million. The Morbidity and Monthly Weekly Report, issued by the Centers for Disease Control and Prevention (CDC), cites asthma as the nation's ninth leading cause of hospitalization. The CDC reports that from 1980 to 1994, the number of people diagnosed with asthma increased about 75%. This number includes all races, sexes and age groups.
Conversely, the Environmental Protection Agency reports that air pollutants have not been increasing, and the outdoor air quality is better than a decade ago. However, asthma is still increasing in some groups. There is a concern that "indoor air pollution" is an important cause of asthma. For example, inner city children exposed to dust mites and cockroach allergens have more pediatrician and hospital emergency visits for asthma.
What are the symptoms? 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.
"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," reports Dr. Harber, an occupational and environmental physician specializing in lung diseases.
In many cases of occupational asthma, respiratory symptoms are not always recognized as a warning sign until the worker experiences a severe reaction to a substance in the work area.
Dr. Harber determined Jack's exposure to chlorine gas caused long term consequences. "When my patient's chronic coughing and wheezing symptoms persisted for two and one-half years, I was confident of my medical diagnosis of permanent asthma," reports Dr. Harber. "The patient is responding to asthma treatment."
Nancy, an emergency room nurse at a large, Midwestern hospital recalls, "One morning, as I was finishing my night shift, I assisted four physicians in stabilizing a toddler who was involved in a head-on collision. After the boy was hurried to the operating room, I noticed that my heart was pounding and I had difficulty breathing. I immediately shook it off as a reaction to the trauma of the day."
But, as Nancy removed her gloves and mask, she realized she was wheezing just like many of her asthma patients. Nancy didn't know at the time that she was allergic to the latex from the surgical gloves she was wearing.
With the increased number of health care workers wearing protective gloves to avoid transmitting infectious diseases, latex allergies have become a major problem for the health care industry.
Types of Asthma? According to Dr. Harber, asthma is not usually caused by work, but can still 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, Del Rio, Texas, who developed the 1999 ACOEM CheckList.
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). Dr. Harber notes that proper early diagnosis of this type of asthma 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 accommodations are made to remove exposures from the present job.
After it was determined that Jack needed to avoid situations that might trigger an asthma reaction, he took a new position with a delivery service in the health industry. Nancy received vocational training and is now employed as a case manager at equivalent pay within the hospital.
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 Jack's situation, a brief exposure to chlorine gas was the irritant that caused permanent damage to his airways.
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 her or his 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 Americans with Disabilities Act 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. "By expanding our knowledge through research and sharing it through education, we will be able to create strategies to control the problem," reports Dr. Harber. "Employers and employees can work together to reduce asthma in the workplace and achieve an optimum healthy work environment."
ACOEM, an international medical society of 7,000 occupational and environmental physicians, provides leadership to promote optimal health and safety of workers, workplaces and environments by educating health professionals and the public; stimulating research; enhancing quality of practice; guiding public policy; and advancing the field of occupational and environmental medicine.
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 Road., Arlington Heights, IL 60004-4770; visit the ACOEM web site, http//:www.acoem.org; or use ACOEM's fax-on-demand service, (800) 226-3626.
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