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OCCUPATIONAL ASTHMA Recently, I was asked to evaluate a worker’s compensation claim regarding respiratory complaints that occurred in the work place. The individual worked in a food milling company and was exposed to flour dust. After 20 years on the job, she noted that she began to experience shortness of breath and wheezing while at work. This had never happened before and she had never been diagnosed with asthma. After an extensive investigation, it was determined that she was suffering from occupational asthma. The number of workers in the United States affected by this condition is unknown, but this is a real disease entity. Let’s look more closely at this respiratory illness. What is occupational asthma? Asthma is a respiratory illness whereby the airways become irritated and over reactive after being exposed to an irritant. In this case, the irritant is found in the work place and research has shown that up to 250 substances can cause this condition. Once there has been exposure, the small airways in the lungs become irritated and the smooth muscles begin to tighten. The tissue begins to swell and there is increased mucous production. This tightening of the airway leads to chest pressure and difficulty breathing. As the condition progresses, it becomes more difficult to breath. This is the same process that occurs with regular asthma, but this condition occurs only in the work place when exposed to a variety of irritants. These irritants can include chemicals, animal dander, plant substances, metals, specific respiratory irritants and enzymes. Specifically, some of these substances include flour dust, animal proteins, glues, wood dust, seafood, metals, and latex. A great deal of focus has been placed on latex, especially in the hospital environment with both patients and providers. What are the symptoms? Just like regular asthma, a person may experience chest tightness, coughing, wheezing, shortness of breath, difficulty exercising, a runny nose, burning eyes, and a stuffed-up nose. The disease process may occur after a brief exposure to the irritants or after prolonged exposure. As I noted with my case, it took nearly 20 years before the individual was afflicted. A worker may notice these symptoms while in the work place. They may worsen by the end of the day. Each day of the week may become progressively worse. After the weekend or vacation, the worker may feel remarkably better. Thus, the history of the symptoms and an accurate journal may help in making the diagnosis. How is this evaluated? Symptoms of asthma must be evaluated, as this is a serious health condition. Your health care provider will assess the history and risk factors, including smoking. Initially, a chest x-ray will be taken to assess lung anatomy. Further testing my include breathing tests called spirometry to evaluate lung volumes. A chemical challenge test may be ordered to see if asthma can be induced. This is done in a very controlled environment with little risk. A worker may then have to carry a peak-flow meter to determine their airflow in the work place throughout the day. Allergy testing may be ordered. Finally, an industrial hygienist may assess the environment of the work place taking air quality samples. Once all of this information has been gathered and comprehensively assessed, a proper diagnosis can be made. What is the treatment? The best treatment is to avoid the irritants in the work place. This may involve a change in position or complete job change. This may be all that is necessary. With more severe cases, standard asthma medications may be prescribed. These may include short-term and long-term bronchodilator medications like albuterol. Inhaled anti-inflammatory steroids may be prescribed. Prevention of the disease is best and most employers are aware of the risks of their industry. A worker must be informed of working with hazardous chemicals and how to safely use them. Information about these chemicals must be present in the work place, as mandated by law. Protective respiratory gear must be provided and should be worn during exposures. Workers should take care of themselves by avoiding unnecessary exposure. Physical fitness and exercise has been shown to improve response to illness. If you are affected by occupational asthma, you will learn how to cope with the symptoms while enjoying a productive career. |
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