Work-related Asthma

Prevention and Treatment

The two most important components for managing work-related asthma are avoidance of environmental triggers and medically controlling clinical symptoms.

Allergen/Irritant Avoidance

• Reduce occupational and environmental exposures to allergens, irritants, and physical conditions known to worsen asthma symptoms.
• If relevant, initiate a smoking cessation program. Smoking has been associated with difficulty maintaining adequate asthma control.
• Consider referral to a pulmonary, allergy, or occupational medicine specialist for further testing and identification of work-related exposures.

Work Modification or Restrictions

• Exposure cessation is the optimal approach, but exposure reduction through the use of workplace controls may be benefit some workers with work-related asthma.
• For some employees, an individualized management plan (such as assigning an affected employee to a different work location or site away from the exposures or triggers) is required, depending upon medical findings and response to allergen and irritant reduction.
• A short medical removal period can assist with diagnosing patients with suspected work-related asthma. During this period away from work, improvements in peak expiratory flow support an occupational etiology.

Medication

The 2007 National Asthma Education and Prevention Program (NAEPP) Expert Panel Report provides a stepwise approach to pharmacologic therapy. Immunizations such as pneumococcal and annual influenza vaccines are recommended.

Surveillance

Work-related asthma surveillance includes monitoring employees over time at either the worksite or in a clinical setting. Depending on the types of exposures present, some employers might choose to establish a medical surveillance program for their workers. This can be as simple as periodically completing a questionnaire with follow-up testing as needed. In other settings, additional testing such as evaluating for sensitization with allergy skin tests has been used.

Medical surveillance allows early identification of work-related asthma cases. Early identification of work-related asthma cases leads to improved treatment response and reduced hospitalizations. If the patient’s employer does not have an established medical surveillance program, consult with an occupational medicine physician to discuss monitoring options for the patient.

Workplace Assessment

• Contact employee health or an industrial hygiene specialist to conduct workplace assessments for potential allergens, irritants, and harmful physical conditions.
• Communicate with employers and representatives from workers’ compensation regarding relevant sensitizers. The patient and employer need to be informed that continued exposure to the sensitizer could lead to deterioration of asthmatic symptoms.
• Discuss NIOSH’s Health Hazard Evaluation (HHE) Program with patients. This program offers free and confidential assistance with identification of worksite asthma triggers.
• If you do not have access to the worksite, reviewing copies of the Safety Data Sheets (SDS) can help identify potential work-related asthma triggers. The employer should be able to provide copies of the SDS.
• The Association of Occupational and Environmental Clinics has a tool to help healthcare providers determine if substances are known asthmagens.