Occupational Asthma in the U.S. Workplace

Aug. 1, 2011
Occupational asthma is an issue in some workplaces, but there are things employers can do to improve indoor air quality.

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. One such environmental illness even has a name: sick building syndrome (SBS).

The World Health Organisation (WHO) officially recognised SBS as a health issue over 20 years ago. It’s a complex problem responsible for a variety of conditions from respiratory infection to fatigue, and is responsible for causing illness, absenteeism, staff turnover and low morale. It’s a hidden epidemic created by the buildings in which we live or work.

So significant is the problem of SBS that it’s estimated that, in some countries, up to 30 percent of all offices, hotels, institutions and industrial premises suffer from it – particularly those buildings that date back 30 years or more.

There are of course many causes for SBS, from inadequate lighting to poor air conditioning and ventilation. 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 percent 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. Over 200 respiratory sensitizers already have been classified and others are being identified all the time.

Across 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 WHO, some 250,000 people died from asthma worldwide in 2005 alone.

A Global Initiative

The Global Initiative for Asthma (GINA) was launched in 1993 in collaboration with the U.S. National Heart, Lung and Blood Institute, the National Institutes of Health and WHO. Its report, “The Global Burden of Asthma,” highlights the prevalence of asthma symptoms and diagnosed asthma in Canada and the United States, which 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 percent.

That prevalence of diagnosed asthma and asthma symptoms markedly has increased 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 percent 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. These substances can be 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.

However, damage to individual employees greatly could be 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, followed by a discussion 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. Indoor smoking, dust, chemicals, perfumes and air fresheners are the most likely to cause problems, and those easily can be 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 also might be required, involving a program 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, and that they will have had extensive exposure to their trigger by the time their symptoms become apparent and a diagnosis of asthma is made.

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 asthma sufferers, it equally is important that employers and colleagues know about their condition, what triggers it and what to do if they have an asthma attack.

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.

Carpet types have been developed that are more effective in capturing and retaining fine dust than hard flooring or even standard carpeting. It works by reducing the incidence of potentially harmful allergy-producing particles by trapping and immobilising them. What’s on the floor might not be a complete solution to occupational asthma, but it can help considerably.

About the Author: Andrew Sibley is with Desso, one of the world’s leading carpet manufacturers.

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