Occupational Asthma

Overview

Occupational asthma is a type of asthma that develops as a result of breathing in chemical fumes, gases, dust, or other substances in the workplace. It triggers an allergic or immunological response, leading to symptoms such as chest tightness, wheezing, and shortness of breath. People with allergies or a family history of allergies are more susceptible to developing occupational asthma. Avoidance of occupational triggers is crucial for management, and medications can be used to alleviate symptoms. However, if left undiagnosed and unprotected, occupational asthma can cause permanent changes to the lungs and lead to complications.

Understanding the disease

Symptoms

The symptoms of occupational asthma may include wheezing, coughing, shortness of breath, chest tightness, runny nose, nasal congestion, and eye irritation. These symptoms can vary depending on the substance the individual is exposed to at work and how long and often they are exposed. Symptoms may worsen as the workweek progresses, go away during weekends and vacations, and recur when the individual returns to work. Additionally, occupational asthma may occur both at work and away from work and can start as soon as exposure to an asthma-inducing substance or after a period of regular exposure. If left untreated or undiagnosed, occupational asthma can cause permanent changes to the lungs.

Risk Factors

The risk factors for developing occupational asthma include:

1. Existing allergies or asthma.
2. Family history of allergies or asthma.
3. High-risk occupations, as listed in the provided text.
4. Inhaling lung irritants, such as chlorine, sulfur dioxide, or smoke.
5. Exposure to respiratory irritants, like chlorine gas or sulfur dioxide. It's important to note that even if you have allergies or asthma, you may still be able to perform jobs that expose you to lung irritants without developing symptoms. However, proper management and avoidance of occupational triggers are crucial to prevent the development and worsening of occupational asthma.

Development

Occupational asthma develops when individuals are exposed to certain substances in their workplace, triggering an allergic or immunological response in their airways. These substances can include chemical fumes, gases, dust, or other irritants. Common triggers associated with various high-risk occupations include:

• Adhesive handlers: Exposed to chemicals
• Animal handlers, veterinarians: Exposed to animal proteins
• Bakers, millers, farmers: Exposed to cereal grains
• Carpet-makers: Exposed to vegetable gums
• Hairdressers: Exposed to dyes
• Health care workers: Exposed to latex and chemicals
• Metal workers: Exposed to cobalt, nickel
• Pharmaceutical workers, bakers: Exposed to milk powder, egg powder In some cases, asthma symptoms may not appear immediately after exposure to these substances, but can develop over time with continued exposure. Prolonged exposure to these asthma-causing substances can lead to permanent changes in the lungs and more severe asthma symptoms.

Assessment and Diagnosis

Diagnosis

To diagnose occupational asthma, your health care provider will perform a series of tests to determine if a workplace substance is causing your asthma symptoms and identify the specific substance responsible. The process includes:

1. Lung function tests: Spirometry and peak flow measurement are used to measure lung function and assess airway obstruction.
2. Allergy skin tests: Skin prick tests are used to identify allergies to common allergens such as animal dander, mold, dust mites, and latex.
3. Challenge test: Inhaling an aerosol containing a suspected chemical is used to see if it triggers a reaction and affects lung function.
4. Chest X-ray: A chest X-ray may be used to diagnose other types of work-related lung diseases.
5. Bronchodilator response test: Lung function tests are performed before and after taking a bronchodilator medication to determine if the airways are responsive to the medication.
6. Methacholine challenge: This test is used to identify airway hyperresponsiveness, which is a hallmark of asthma. These tests, along with a thorough evaluation of your work environment and medical history, will help your health care provider make an accurate diagnosis of occupational asthma.

Management and Treatment

Complications

Potential complications of untreated or misdiagnosed occupational asthma include permanent changes to the lungs, reduced quality of life, sick days from work or school, emergency room visits, and hospitalizations for severe asthma attacks. Proper treatment, including avoidance of occupational triggers and medication, can help prevent these complications.

Prevention

occupational asthma can be prevented by controlling exposure to irritating substances and chemicals in the workplace, using less harmful substances, and providing personal protective equipment (PPE) for workers. Other preventive measures include quitting smoking, getting a flu vaccination, avoiding certain medications that may worsen symptoms, and maintaining a healthy weight.

Treatment

Treatments for occupational asthma typically involve controlling exposure to workplace irritants, taking medications to reduce symptoms, and maintaining overall health. Medications may include bronchodilators to open airways, corticosteroids to reduce inflammation, and leukotriene modifiers to decrease inflammation and mucus production. In some cases, an allergy medication called an antihistamine may be prescribed. Additionally, avoiding triggers, quitting smoking, getting a flu vaccination, and losing weight can help manage symptoms and prevent attacks.

Preparing for medical consultation

To prepare for an appointment for occupational asthma, you should:

1. Note any symptoms you're experiencing, including those that may seem unrelated to asthma, and the timing of your symptoms.
2. Make a list of all possible workplace lung irritants and anything that triggers your symptoms. Consider reviewing the material safety data sheet (MSDS) for your work area if available.
3. Write down key personal information, including major stresses, recent life changes, and changes in your job or workplace.
4. Bring a list of all medications, vitamins, or supplements you take.
5. Consider bringing a family member or friend along for support, as they may remember information you missed or forgot.
6. Prepare a list of questions to ask your care provider, such as:
   • Is a workplace irritant a likely cause of my breathing problems or asthma flare-ups?
   • What are other possible causes for my symptoms or condition?
   • What tests do I need? Do these tests require any special preparation?
   • Is my condition likely temporary or chronic?
   • How do I treat occupational asthma? Do I have to quit my job?
   • What are the alternatives to the primary approach you're suggesting?
   • How can I best manage my other health conditions alongside occupational asthma?
   • Are there any restrictions I need to follow?
   • Should I see a specialist?
   • Is there a generic alternative to the medication you're prescribing?
   • Are there brochures or other printed material I can take with me? What websites do you recommend? Preparing for the appointment in advance will help you make the most of your time with your doctor and ensure you address all your concerns.