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Exploring occupational asthma

In 2003 in Michigan, a manager of a vehicle detailing business sprayed a truck bed liner on the floor and sides of a cargo van. After the manager finished the task, a co-worker saw that he was having trouble breathing. They went to an urgent care facility and the manager was transported to an emergency room, where he died.

A report from the Michigan Fatality Assessment and Control Evaluation Program listed the cause of death as “acute asthmatic reaction due to inhalation of chemicals.” Several factors could have played a role, including confinement of the vapors, which may have increased the worker’s potential exposure to isocyanate – one of the most common chemicals linked to work-related asthma. The worker was not adequately fitted for his respirator, nor was he trained on how to use it. In addition, his employer lacked a hazard communication program.

The report illustrates the dangers of work-related asthma.

About 11 million workers are exposed to at least one agent associated with occupational asthma, according to OSHA. And a report from the Centers for Disease Control and Prevention, published in the Dec. 2 issue of Morbidity and Mortality Weekly Report, concluded that as many as 2.7 million U.S. workers may have asthma caused or aggravated by workplace conditions.

“Asthma in general is on the increase in the United States,” said Vincent Castranova, professor of pharmaceutical sciences at West Virginia University and former chief of the Pathology and Physiology Research Branch in NIOSH’s Health Effects Laboratory Division. “There’s questions about why. One answer is our ability to diagnose it is much better, and the education of physicians to look for it in the occupational setting is much increased.”

What is it?

Asthma is a lung disease in which the airways become inflamed and narrow. Symptoms can include wheezing, coughing, chest tightness and shortness of breath. Exposure to irritants and substances, such as pollen or smoke, can trigger it. People who smoke and those who have a family history of allergies have a higher risk for developing asthma, according to the Milwaukee-based American Academy of Allergy, Asthma and Immunology.

“If an employee’s asthma is not well-controlled, it can have a significant impact on both that person’s productivity at work and overall ability to function well in life, and it can cost the employer substantial amounts of money beyond just functioning at work in terms of trips to the emergency room and hospitalizations,” said Polly Hoppin, research professor and program director of the Environmental Health Program at the Lowell Center for Sustainable Production at the University of Massachusetts-Lowell.

Occupational asthma can occur when a worker is exposed to on-the-job substances such as dust, chemicals or mold, OSHA states. A worker can be exposed through breathing or skin contact.

“What’s been learned over the last decade or so is your sensitization might not have occurred by inhalation – it might have occurred by dermal exposure,” Castranova said. “Latex gloves are the hallmark of that. It could be mainly dermal exposure. You became sensitive to the latex protein through skin exposure, and that affected your immune system. Then a very low exposure in the air could give an asthmatic event.”

Work-related asthma can be broken down into types.

Asthma resulting from sensitization to a substance – such as a chemical or allergen – may develop hours, days, weeks or even years after the first exposure.

Asthma induced by an irritant – also called Reactive Airways Dysfunction Syndrome – is caused by a high-level exposure to a substance. In addition, a workplace exposure can exacerbate preexisting asthma.

The Mayo Clinic notes that more than 300 workplace materials may cause occupational asthma, including animal substances, enzymes and metals.

“In an office setting, there can be chemicals that cause or contribute to asthma in furniture or building materials,” Hoppin said. “There can be particular exposures like flour in the bakery industry, or several hundred chemicals used in manufacturing processes – such as isocyanates or formaldehyde – that can contribute to asthma when workers are exposed. Work environments can have mold or dust, just as homes can.”

Symptoms can begin while on the job or within hours of leaving work, according to OSHA, and may persist even when exposure stops. If not treated, long-term lung damage, disability and death can result.

“If it’s treated early and identified early, typically the prognosis is very good, depending on how much airway obstruction there is,” said Dr. Jonathan Bernstein, an associate professor of internal medicine at the University of Cincinnati who specializes in allergy and asthma.

If it’s treated early and identified early, typically the prognosis is very good, depending on how much airway obstruction there is.




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