Occupational asthma in the U.S. workplace
June 14, 2011
Modern evidence suggests we cannot separate our working lives from the working environment. We respond instinctively to our surroundings at a human level and if those surroundings fail to meet our basic needs, we can be made sick by them. It even has a name: Sick Building Syndrome (SBS).
The World Health Organisation (WHO) officially recognised it as a health issue more than 20 years ago.
It’s a complex problem responsible for a variety of conditions from respiratory infection to fatigue, causing illness, absenteeism, staff turnover and low morale. It’s a hidden epidemic caught from the fabric of the buildings within which we live or work.
So significant is the problem of SBS that it’s estimated that, in some countries, up to 30% of all offices, hotels, institutions and industrial premises suffer from it – particularly those buildings that date back thirty years or more.
There are of course many causes for SBS, from inadequate lighting to poor air conditioning. However, one of the main causes of SBS is the quality of indoor air, and one manifestation of that is occupational asthma, which makes up around 15% of all adult-onset asthma cases in the developed world.
Putting that in context, occupational asthma is the most common work-related lung disease in developed countries and is caused by occupational exposure to airborne substances known as asthmagens. More than 200 respiratory sensitizers have already been classified and others are being identified all the time.
Asthma incidence on the increaseAcross the world, the incidence of asthma is on the increase as more people adopt western lifestyles and become exposed to greater numbers of asthmagens. Internationally, there are an estimated 300 million asthma sufferers and, according to the World Health Organisation, some 250,000 people died from asthma worldwide in 2005 alone.
The Global Initiative for Asthma (GINA) was launched in 1993 in collaboration with the US National Heart, Lung, and Blood Institute, the National Institutes of Health, USA, and the World Health Organisation. Its report, The Global Burden of Asthma, highlights the prevalence of asthma symptoms and diagnosed asthma in Canada and the United States that are among the highest in the world for both children and adults. It is estimated that there are 35.5 million sufferers, with a mean prevalence of 11.2%.
That prevalence of diagnosed asthma and asthma symptoms has increased markedly over recent decades. For example, in the United States the prevalence of diagnosed asthma and asthma symptoms in children and adolescents has been reported to have increased by 25-75% per decade during the period since 1960.
The most important risk factors for developing asthma are a combination of genetic predisposition and environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways - everything from pollen and dust mites to animal dander and adhesives. Miniscule dust particles settle in the lungs, and the smallest particles can end up in the bloodstream – with potentially serious consequences.
It’s the reason why health and safety regulations relating to indoor air quality have become increasingly stringent across the developed and developing world, with sufferers of occupational asthma having greater access to legal redress and financial compensation from their employers. For today’s employers, it’s about recognizing and dealing with the problem because many jurisdictions now make it unlawful in codes of employment to discriminate against asthmatics.
Control strategiesHowever, damage to individual employees could be greatly reduced and costs for employers largely avoided by adopting appropriate preventative and control strategies, and by the early identification of individuals within the workplace suffering from pre-existing asthma or potentially suffering from occupational asthma.
Prevention and control starts with a workplace assessment to identify potential asthmagens and, thereafter, an exchange of views between the employer, employees and workplace health and safety professionals on appropriate strategies to minimize or eliminate exposure – for example, installing a better ventilation system or placing dangerous chemicals in a fume cupboard. At its simplest, apart from an absolute ban on indoor smoking, dust, chemicals, perfumes and air fresheners are the most likely to cause problems – and those can be easily addressed.
Some employers now have guidelines to ensure their own offices are safe for asthma sufferers – for example, asking staff not to wear perfume or aftershave at work, to use unscented soaps, deodorants and hair products and not to smoke immediately before coming into the office. Those guidelines also require non-volatile cleaning products and unscented air fresheners to be used.
However, in those instances where a significant risk is identified, continued health surveillance might also be required, involving a programme of spirometry [lung function] testing, to detect early indications of disease and provide appropriate medical advice to individual employees.
Early detection is important in occupational asthma, because people spend so much time at work – one estimate suggests that a person in a full-time office job will spend up to 1,800 hours a year in their office – that they will have had extensive exposure to their trigger by the time their symptoms become apparent and a diagnosis of asthma is made.
Put starkly, the more time you spend exposed to your asthmagen, the more likely you are to have permanent lung inflammation and airway hypersensitivity. That’s why it’s important for employees to raise issues of indoor air quality or, more pertinently about occupational asthma, at the earliest opportunity. For existing sufferers from asthma, it’s equally important that their employer and colleagues know about their condition, what triggers it, and what to do if they have an asthma attack.
But while it’s impossible to protect all employees from all possible asthmagens, the growing importance of work-related asthma with its associated duty of care from employers, means that the role of health and safety professionals continues to change – not only in monitoring indoor air quality but in providing the best possible overall environment for staff.
That environment starts from the floor because, among others, the German asthma foundation (DAAB) has for some time advised that the harmful effects of particulate matter can be greatly reduced if carpeting is chosen over hard flooring options.
It might seem an unusual weapon in the battle for better air quality, but it’s been extremely well received internationally by health and safety and personnel professionals who not only recognise the regulatory responsibilities on maintaining good indoor air quality, but the potential legal and other penalties if they don’t.
What’s on the floor might not be a complete solution to occupational asthma, but it can help considerably.