Occupational asthma

Classification of occupational asthma and the most frequent causal agents
Specialty| Respiratory system

Occupational asthma is new onset asthma or the recurrence of previously quiescent asthma directly caused by exposure to an agent at workplace. It is an occupational lung disease and a type of work-related asthma. Agents that can induce occupational asthma can be grouped into sensitizers and irritants.[1]

Sensitizer-induced occupational asthma is an immunologic form of asthma which occurs due to inhalation of specific substances (i.e., high-molecular-weight proteins from plants and animal origins, or low-molecular-weight agents that include chemicals, metals and wood dusts) and occurs after a latency period of several weeks to years.[1]

Irritant-induced (occupational) asthma is a non-immunologic form of asthma that results from a single or multiple high dose exposure to irritant products. It is usually develops early after exposure; however can also develop insidiously over a few months after a massive exposure to a complex mixture of alkaline dust and combustion products, as shown in the World Trade Center disaster. Unlike those with sensitizer-induced occupational asthma, subjects with irritant-induced occupational asthma do not develop work-related asthma symptoms after re-exposure to low concentrations of the irritant that initiated the symptoms.[2] Reactive airways dysfunction syndrome (RADS) is a severe form of irritant induced asthma where respiratory symptoms usually develop in the minutes or hours after a single accidental inhalation of a high concentration of irritant gas, aerosol, vapor, or smoke.[3]

Another type of work-related asthma is work-exacerbated asthma (WEA) which is asthma worsened by workplace conditions but not caused by it. WEA is present in about a fifth of patients with asthma and a wide variety of conditions at work, including irritant chemicals, dusts, second-hand smoke, common allergens that may be present at work, as well as other "exposures" such as emotional stress, worksite temperature, and physical exertion can exacerbate asthma symptoms in these patients.[4] Both occupational asthma and work-exacerbated asthma can be present in an individual.

A number of diseases have symptoms that mimic occupational asthma, such as asthma due to nonoccupational causes, chronic obstructive pulmonary disease (COPD), irritable larynx syndrome, hyperventilation syndrome, hypersensitivity pneumonitis, and bronchiolitis obliterans.

## Contents

* 1 Signs and symptoms
* 2 Risk factors
* 3 Diagnosis
* 4 Prevention
* 5 Management
* 5.1 Medication
* 6 Epidemiology
* 7 Society and culture
* 7.1 Compensation
* 8 See also
* 9 References
* 10 External links

## Signs and symptoms[edit | edit source]

Like other types of asthma, it is characterized by airway inflammation, reversible airways obstruction, and bronchospasm, but it is caused by something in the workplace environment.[5] Symptoms include shortness of breath, tightness of the chest, coughing, sputum production and wheezing. Some patients may also develop upper airway symptoms such as itchy eyes, tearing, sneezing, nasal congestion and rhinorrhea.[3]

Symptoms may develop over many years as in sensitizer induced asthma or may occur after a single exposure to a high-concentration agent as in case of RADS.

## Risk factors[edit | edit source]

At present, over 400 workplace substances have been identified as having asthmagenic or allergenic properties.[2][6][7] Agents such as flour, diisocyanates, latex, persulfate salts, aldehydes, animals, wood dusts, metals, enzymes usually account for the majority cases, however, the distribution of causal agents may vary widely across geographic areas, depending on the pattern of industrial activities.[2][8] For example, in France the industries most affected are bakeries and cake-shops, automobile industry and hairdressers,[9] whereas in Canada the principal cause is wood dust, followed by isocyanates. Furthermore, the most common cause of occupational asthma in the workplace are isocyanates.[10] Isocyanates are used in the production of motor vehicles and in the application of orthopaedic polyurethane and fibreglass casts.[10]

The occupations most at risk are: adhesive handlers (e.g. acrylate), animal handlers and veterinarians (animal proteins), bakers and millers (cereal grains), carpet makers (gums), electronics workers (soldering resin), forest workers, carpenters and cabinetmakers (wood dust), hairdressers (e.g. persulfate), health care workers (latex and chemicals such as glutaraldehyde), janitors and cleaning staff (e.g. chloramine-T), pharmaceutical workers (drugs, enzymes), seafood processors, shellac handlers (e.g. amines), solderers and refiners (metals), spray painters, insulation installers, plastics and foam industry workers (e.g. diisocyanates), textile workers (dyes) and users of plastics and epoxy resins (e.g. anhydrides)[11]

The following tables show occupations that are known to be at risk for occupational asthma, the main reference for these is the Canadian Centre for Occupational Health and Safety.[12]

Grains, flours, plants and gums

Occupation[12]

Agent[12]

Bakers, millers

Wheat

Chemists, coffee bean baggers and handlers, gardeners, millers, oil industry workers, farmers

Castor beans

Cigarette factory workers

Tobacco dust

Drug manufacturers, mold makers in sweet factories, printers

Gum acacia

Farmers, grain handlers

Grain dust

Gum manufacturers, sweet makers

Gum tragacanth

Strawberry growers

Strawberry pollen

Tea sifters and packers

Tea dust

Tobacco farmers

Tobacco leaf

Woollen industry workers

Wool

Animals, insects and fungi

Occupation[12]

Agent[12]

Bird fanciers

Avian proteins

Cosmetic manufacturers

Carmine

Entomologists

Moths, butterflies

Feather pluckers

Feathers

Field contact workers

Crickets

Fish bait breeders

Bee moths

Flour mill workers, bakers, farm workers, grain handlers

Grain storage mites, alternaria, aspergillus

Laboratory workers

Locusts, cockroaches, grain weevils, rats, mice, guinea pigs, rabbits

Mushroom cultivators

Mushroom spores

Oyster farmers

Sea pineapples (Hoya)

Pea sorters

Mexican bean weevils

Pigeon breeders

Pigeons

Poultry workers

Chickens

Prawn processors

Prawns

Silkworm sericulturers

Silkworms

Zoological museum curators

Beetles

Chemicals/Materials

Occupation[12]

Agent[12]

Aircraft fitters

Triethyltetramine

Aluminum cable solderers

Aminoethylethanolamine

Aluminum pot room workers

Fluorine

Autobody workers

Acrylates (resins, glues, sealants, adhesives)

Brewery workers

Chloramine-T

Chemical plant workers, pulp mill workers

Chlorine

Dye weighers

Levafix brilliant yellow, drimarene brilliant yellow and blue, cibachrome brilliant scarlet

Electronics workers

Colophony

Epoxy resin manufacturers

Tetrachlorophthalic anhydride

Foundry mold makers

Furan-based resin binder systems

Fur dyers

Para-phenylenediamine

Hairdressers

Persulphate salts

Health care workers

Glutaraldehyde, latex

Laboratory workers, nurses, phenolic resin molders

Formaldehyde

Meat wrappers

Polyvinyl chloride vapour

Paint manufacturers, plastic molders, tool setters

Phthalic anhydride

Paint sprayers

Dimethylethanolamine

Photographic workers, shellac manufacturers

Ethylenediamine

Refrigeration industry workers

CFCs

Solderers

Polyether alcohol, polypropylene glycol

Isocyanates and metals

Occupation[12]

Agent[12]

Boat builders, foam manufacturers, office workers, plastics factory workers, refrigerator manufacturers, TDI manufacturers/users, printers, laminators, tinners, toy makers

TDI

Boiler cleaners, gas turbine cleaners

Vanadium

Car sprayers

Hexamethylene diisocyanate

Cement workers

Potassium dichromate

Chrome platers, chrome polishers

Sodium bichromate, chromic acid, potassium chromate

Nickel platers

Nickel sulphate

Platinum chemists

Chloroplatinic acid

Platinum refiners

Platinum salts

Polyurethane foam manufacturers, printers, laminators

Diphenylmethane diisocyanate

Rubber workers

Naphthalene diisocyanate

Tungsten carbide grinders

Cobalt

Welders

Stainless steel fumes

Drugs and enzymes

Occupation[12]

Agent[12]

Ampicillin manufacturers

Phenylglycine acid chloride

Detergent manufacturers

Bacillus subtilis

Enzyme manufacturers

Fungal alpha-amylase

Food technologists, laboratory workers

Papain

Pharmacists

Gentian powder, flaviastase

Pharmaceutical workers

Methyldopa, salbutamol, dichloramine, piperazine dihydrochloride, spiramycin, penicillins, sulphathiazole, sulphonechloramides, chloramine-T, phosdrin, pancreatic extracts

Poultry workers

Amprolium hydrochloride

Process workers, plastic polymer production workers

Trypsin, bromelin

Woods

Occupation[12]

Agent[12]

Carpenters, timber millers, woodworkers

Western red cedar, cedar of Lebanon, iroko, California redwood, ramin, African zebrawood

Sawmill workers, pattern makers

Mansonia, oak, mahogany, abiruana

Wood finishers

Cocabolla

Wood machinists

Kejaat

## Diagnosis[edit | edit source]

To diagnose occupational asthma it is necessary to confirm the symptoms of asthma and establish the causal connection with the work environment. Various diagnostic tests can be used to aid in diagnoses of work related asthma.[1][3][13][14]

A spirometer is a device used to measure timed expired and inspired volumes, and can be used to help diagnose asthma.

Peak expiratory flow rate (PEFR) is a hand held device which measures how fast a person can exhale and is a reliable test for occupational asthma.[15] Serial PEFR can be measured to see if there is a difference in ability to exhale at work compared to that in a controlled environment.

A non-specific bronchial hyperreactivity test can be used to support the diagnose occupational asthma. It involves measuring the forced expiratory volume in 1 second (FEV-1) of the patient before and after exposure to methacholine or mannitol. Presence of airway responsiveness i.e. significant drop in FEV-1 can be seen in patients with occupational asthma.[1]

Specific inhalation challenges test consist of exposing the subjects to the suspected occupational agent in the laboratory and/or at the workplace and assess for asthma symptoms as well as a reduction in FEV1.[3][16]

Other tests such as skin prick test, serum immunologic testing and measurement of sputum eosinophils can also be useful in establishing the diagnosis of occupational asthma.[13]

## Prevention[edit | edit source]

A video on research on preventing asthma in health care

Several forms of preventive measures have been suggested to prevent development of occupational asthma and also detect risk or disease early to allow intervention and improve outcomes.[17] These include: comprehensive programs, education and training, medical examinations, use of medications, reduction of exposures and elimination of exposures.[18]

Asthma symptoms and airway hyperresponsiveness can persist for several years after removal from the offending environment.[13] Thus, early restriction from exposure to the trigger is advisable. Completely stopping exposure is more effective treatment than reducing exposure, but not always feasible.[8]

## Management[edit | edit source]

### Medication[edit | edit source]

Medications used for occupational asthma are similar to those used for other types of asthma such as short-acting beta-agonists like salbutamol or terbutaline, long-acting beta-agonists like salmeterol and formoterol and inhaled corticosteroids. Immunotherapy can also be used in some cases of sensitizer induced occupational asthma.[14]

## Epidemiology[edit | edit source]

Occupational asthma is one of the most common occupational lung disease. Approximately 17% of all adult-onset asthma cases are related to occupational exposures.[19] About one fourth of adults with asthma have work-exacerbated asthma.[4] Patients with work-related asthma are more likely to experience asthma attacks, emergency room visits, and worsening of their asthma symptoms compared with other adult asthma patients.[19]

## Society and culture[edit | edit source]

### Compensation[edit | edit source]

When a person is diagnosed with occupational asthma, it can result in serious socio-economic consequences not only for the workers but also for the employer and the healthcare system because the worker must change positions.[20] The probability of being re-employed is lower for those with occupational asthma compared to those with normal asthma. The employer not only pays compensation to the employee, but will also have to spend a considerable amount of time and energy and funds for hiring and training new personnel.[21][22] In the United States, it was estimated that the direct cost of occupational asthma in 1996 was $1.2 billion and the indirect cost $0.4 billion, for a total cost of $1.6 billion. In most cases, the employer could have saved more money by adhering to safety standards rather than causing employees to become injured. [23]

However, this can entail severe socio-economic consequences for the worker as well as the employer due to loss of job, unemployment, compensation issues, medical expenditures, and hiring and re-training of new personnel.[20]

## See also[edit | edit source]

* Chronic obstructive pulmonary disease (COPD)
* Specific inhalation challenge
* Occupational safety and health
* National Institute of Occupational Safety and Health (NIOSH)
* Labor rights

## References[edit | edit source]

1. ↑ 1.0 1.1 1.2 1.3 Tarlo, Susan M.; Balmes, John; Balkissoon, Ronald; Beach, Jeremy; Beckett, William; Bernstein, David; Blanc, Paul D.; Brooks, Stuart M.; Cowl, Clayton T. (September 2008). "Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement". Chest. 134 (3 Suppl): 1S–41S. doi:10.1378/chest.08-0201. ISSN 0012-3692. PMID 18779187.
2. ↑ 2.0 2.1 2.2 Murray & Nadel's Textbook of Respiratory Medicine. Elsevier. 2016. pp. 1295–1306. ISBN 9781455733835.
3. ↑ 3.0 3.1 3.2 3.3 Tarlo, Susan M.; Lemiere, Catherine (2014-02-13). "Occupational asthma". The New England Journal of Medicine. 370 (7): 640–649. doi:10.1056/NEJMra1301758. ISSN 1533-4406. PMID 24521110.
4. ↑ 4.0 4.1 Henneberger, Paul K.; Redlich, Carrie A.; Callahan, David B.; Harber, Philip; Lemière, Catherine; Martin, James; Tarlo, Susan M.; Vandenplas, Olivier; Torén, Kjell (2011-08-01). "An official american thoracic society statement: work-exacerbated asthma". American Journal of Respiratory and Critical Care Medicine. 184 (3): 368–378. doi:10.1164/rccm.812011ST. ISSN 1535-4970. PMID 21804122.
5. ↑ "Asthma & Allergies". NIOSH. April 3, 2012. Archived from the original on March 16, 2011. Retrieved July 26, 2023.
6. ↑ "(T78) Occupational Asthma : Table of agents, products and substances which can cause asthma". Archived from the original on 2022-12-19. Retrieved 2023-07-26.
7. ↑ Baur, Xaver; Bakehe, Prudence (May 2014). "Allergens causing occupational asthma: an evidence-based evaluation of the literature". International Archives of Occupational and Environmental Health. 87 (4): 339–363. doi:10.1007/s00420-013-0866-9. ISSN 1432-1246. PMID 23595938. S2CID 38640302.
8. ↑ 8.0 8.1 de Groene, Gerda J.; Pal, Teake M.; Beach, Jeremy; Tarlo, Susan M.; Spreeuwers, Dick; Frings-Dresen, Monique Hw; Mattioli, Stefano; Verbeek, Jos H. (2011). "Workplace interventions for treatment of occupational asthma". The Cochrane Database of Systematic Reviews (5): CD006308. doi:10.1002/14651858.CD006308.pub3. ISSN 1469-493X. PMID 21563151.
9. ↑ Ameille J, Pauli G, Calastreng-Crinquand A, et al. (February 2003). "Reported incidence of occupational asthma in France, 1996–99: the ONAP programme". Occup Environ Med. 60 (2): 136–41. doi:10.1136/oem.60.2.136. PMC 1740458. PMID 12554842.
10. ↑ 10.0 10.1 Chan-Yeung, Moira; Malo, Jean-Luc (1995). "Occupational Asthma". New England Journal of Medicine. 333 (2): 107–112. doi:10.1056/NEJM199507133330207. ISSN 0028-4793. PMID 7777015.
11. ↑ "Occupational asthma". Mayo Clinic. 23 May 2009. Archived from the original on 23 November 2012. Retrieved 26 July 2023.
12. ↑ 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 12.11 12.12 "OSH Answers Asthma, Work-related". Canadian Centre for Occupational Health and Safety. December 16, 2013. Archived from the original on April 27, 2009. Retrieved July 26, 2023.
13. ↑ 13.0 13.1 13.2 Baur, X.; Sigsgaard, T.; Aasen, T. B.; Burge, P. S.; Heederik, D.; Henneberger, P.; Maestrelli, P.; Rooyackers, J.; Schlünssen, V. (2012-03-01). "Guidelines for the management of work-related asthma". European Respiratory Journal. 39 (3): 529–545. doi:10.1183/09031936.00096111. ISSN 0903-1936. PMID 22379148.
14. ↑ 14.0 14.1 "Occupational/Work-Related Asthma Medical Treatment Guideline" (PDF). Archived (PDF) from the original on 2020-01-25. Retrieved 2023-07-26.
15. ↑ Moscato, G.; Godnic-Cvar, J.; Maestrelli, P.; Malo, J. L.; Burge, P. S.; Coifman, R. (September 1995). "Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma. Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology. American Academy of Allergy and Clinical Immunology. European Respiratory Society. American College of Allergy, Asthma and Immunology". The European Respiratory Journal. 8 (9): 1605–1610. doi:10.1183/09031936.95.08091605. ISSN 0903-1936. PMID 8575590.
16. ↑ Vandenplas, Olivier; Suojalehto, Hille; Aasen, Tor B.; Baur, Xaver; Burge, P. Sherwood; de Blay, Frederic; Fishwick, David; Hoyle, Jennifer; Maestrelli, Piero (June 2014). "Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement". The European Respiratory Journal. 43 (6): 1573–1587. doi:10.1183/09031936.00180313. ISSN 1399-3003. PMID 24603815.
17. ↑ Tarlo, Susan M.; Liss, Gary M. (July 2010). "Prevention of occupational asthma". Current Allergy and Asthma Reports. 10 (4): 278–286. doi:10.1007/s11882-010-0118-y. ISSN 1534-6315. PMID 20424999. S2CID 20166471.
18. ↑ "NIOSH: Prevention of Work-related Asthma". 2018-11-23. Archived from the original on 2019-06-14. Retrieved 2023-07-26.
19. ↑ 19.0 19.1 "NIOSH: Work-related asthma". 2019-01-03. Archived from the original on 2023-02-02. Retrieved 2023-07-26.
20. ↑ 20.0 20.1 Cowl, Clayton T. (2011). "Occupational Asthma". Chest. 139 (3): 674–681. doi:10.1378/chest.10-0079. PMID 21362654.
21. ↑ "Occuptational Asthma". MedlinePlus Medical Encyclopedia. Archived from the original on 2023-05-15. Retrieved 2023-07-26.
22. ↑ Dewitte JD, Chan-Yeung M, Malo JL (May 1994). "Medicolegal and compensation aspects of occupational asthma". Eur. Respir. J. 7 (5): 969–80. doi:10.1183/09031936.94.07050969. PMID 8050556. S2CID 41120422. Archived from the original on 2023-07-27. Retrieved 2023-07-26.
23. ↑ Leigh JP, Romano PS, Schenker MB, Kreiss K (January 2002). "Costs of occupational COPD and asthma". Chest. 121 (1): 264–72. CiteSeerX 10.1.1.455.4942. doi:10.1378/chest.121.1.264. PMID 11796461. Archived from the original on 2023-07-27. Retrieved 2023-07-26.

## External links[edit | edit source]

Classification|

* ICD-10: J45.909
* ICD-9-CM: 493.90
* MeSH: D059366

|

External resources|

* MedlinePlus: 000110

* NIOSH: Prevention of Occupational Asthma Archived 2022-05-25 at the Wayback Machine
* Occupational asthma and work aggravated asthma (UK) Archived 2015-06-24 at the Wayback Machine
* https://www.cdc.gov/niosh/topics/asthma/default.html Archived 2023-06-09 at the Wayback Machine

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