Two recent studies by the National Institute for Occupational Safety and Health (NIOSH) are shedding light on how to prevent work-related asthma by controlling exposure to hazardous substances. Work-related asthma can occur when workplace exposure to a hazardous substance triggers symptoms in someone with asthma or causes new asthma to occur in someone who doesn’t already have it. Symptoms range from mild to severe and include coughing, wheezing, chest tightness, and shortness of breath. More than 300 known or suspected substances in the workplace can cause or worsen symptoms of work-related asthma. It is important to identify and avoid these substances to prevent work-related asthma from occurring or getting worse.

In the first study, NIOSH investigators focused on the link between cleaning and disinfecting products and various asthma symptoms among healthcare workers. In the second, they looked at the presence of chronic obstructive pulmonary disease (COPD) among people with work-related asthma and those with asthma from other causes.

Combinations of some cleaning and disinfecting agents increase asthma risk

Cleaning and disinfecting agents are recognized as causes of asthma symptoms in healthcare workers. Recent research published in the International Journal of Hygiene and Environmental Healthexternal icon used a technique called cluster analysis to evaluate relationships between exposures to different groups (clusters) of cleaning and disinfecting agents and experiences of different groups (clusters) of asthma symptoms.

Investigators collected self-reports about asthma symptoms and cleaning and disinfecting tasks from 2,030 healthcare workers in New York City. The self-reports also included information such as age, gender, race, education, allergies, and smoking. The investigators then grouped study participants with similar patterns of asthma symptoms into five health clusters: 1) no symptoms, 2) winter cough/phlegm, 3) mild asthma symptoms, 4) undiagnosed/untreated asthma, and 5) asthma attacks/exacerbations. Each health cluster was matched to one of five exposure clusters based on participants’ use of cleaning and disinfecting products. To help visualize this complicated information, investigators created word groupings known as word clouds for each cluster. Results showed that combinations of certain products, such as alcohols, bleach, and strong disinfectants, increased the risk for asthma symptoms. Their findings underscore the need for targeting combinations of products with prevention efforts.

Combined work-related asthma and COPD linked to more severe symptoms and healthcare use

Up to one fifth of people diagnosed with asthma also have COPD. When asthma and COPD occur together, patients often have more severe symptoms than people with asthma alone. According to research published in the Journal of Asthmaexternal icon, adults with work-related asthma are more likely to also have COPD than those with nonwork-related asthma. Also, those with work-related asthma and COPD have more severe asthma symptoms than in those with nonwork-related asthma alone.

Investigators reviewed 23,137 responses to the 2012–2014 Behavioral Risk Factor Surveillance System Asthma Call-back Survey, representing an estimated 15 million ever-employed adults from 31 states and the District of Columbia. Overall, more than 1 million adults had both work-related asthma and COPD. More than half (51.9%) of adults with work-related asthma had been diagnosed with COPD, compared to a quarter (25.6%) of adults with nonwork-related asthma. Compared to adults with nonwork-related asthma and no COPD, those with work-related asthma and COPD had more severe symptoms and greater healthcare use. These symptoms and healthcare use included asthma attacks, urgent treatment, emergency room visits, overnight hospital stays, activity limitations on 1–13 days or ≥ 14 days, and poorly controlled asthma. More research is needed to understand how to prevent and treat the combination of work-related asthma and COPD.

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