Occupational asthma

More than 400 workplace substances have been identified as possible causes of occupational asthma. These substances include:

• Animal substances, such as proteins found in dander, hair, scales, fur, saliva and body wastes.
• Chemicals used to make paints, varnishes, adhesives, laminates and soldering resin. Other examples include chemicals used to make insulation, packaging materials, and foam mattresses and upholstery.
• Enzymes used in detergents and flour conditioners.
• Metals, particularly platinum, chromium and nickel sulfate.
• Plant substances, including proteins found in natural rubber latex, flour, cereals, cotton, flax, hemp, rye, wheat and papain — a digestive enzyme derived from papaya.
• Respiratory irritants, such as chlorine gas, sulfur dioxide and smoke.

Asthma symptoms start when your lungs become irritated (inflamed). Inflammation causes several reactions that restrict the airways and make it difficult to breathe. With occupational asthma, lung inflammation may be triggered by an allergic response to a substance, which usually develops over time. Inhaling fumes from a lung irritant, such as chlorine, can trigger immediate asthma symptoms in the absence of allergy.

The intensity of your exposure increases your risk of developing occupational asthma. In addition, you will have increased risk if:

• You have existing allergies or asthma. Although this can increase your risk, many people who have allergies or asthma do jobs that expose them to lung irritants and never have symptoms.
• Allergies or asthma runs in your family. Your parents may pass down genes that make it more likely for you to develop asthma.
• You work around known asthma triggers. Some substances are known to be lung irritants and asthma triggers.
• You smoke. Smoking increases your risk of developing asthma if you are exposed to certain types of irritants.

High-risk occupations

It's possible to develop occupational asthma in almost any workplace. But your risk is higher if you work in certain occupations. Some of the riskiest jobs and the asthma-producing substances associated with them include the following:

The longer you're exposed to a substance that causes occupational asthma, the worse your symptoms may become — and the longer it will take for them to improve once you end your exposure to the irritant. In some cases, exposure to airborne asthma triggers can cause permanent changes to your lungs.

The best way to prevent occupational asthma is to control exposure to chemicals and other substances that that workers may be sensitive to or that are irritating. Workplaces can implement better control methods to prevent exposures, use less harmful substances and provide personal protective equipment (PPE) for workers.

Medications may help relieve symptoms and control inflammation associated with occupational asthma. But you can do several things on your own to maintain overall health and lessen the possibility of attacks:

• If you smoke, quit. Being smoke-free may help prevent or lessen symptoms of occupational asthma.
• Get a flu vaccination. This can help prevent illness.
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications that may make symptoms worse.
• Lose weight. For people with obesity, losing weight can help improve symptoms and lung function.

If you are in the United States and you have a job in a high-risk profession, your company has legal responsibilities to help protect you from hazardous chemicals. Under guidelines established by the Occupational Safety and Health Administration (OSHA), your employer is required to do the following:

• Inform you if you'll be working with any hazardous chemicals.
• Train you how to safely handle these chemicals.
• Train you how to respond to an emergency, such as a chemical spill.
• Provide protective gear, such as masks and respirators.
• Offer additional training if a new chemical is introduced to your workplace.

Under OSHA guidelines, your employer is required to keep a material safety data sheet (MSDS) for each hazardous chemical used in your workplace. This is a document that must be submitted by the chemical's manufacturer to your employer. You have a legal right to see and copy such documents. If you suspect you're allergic to a certain substance, show the MSDS to your health care provider.

While at work, be alert for unsafe and unhealthy working conditions and report them to your supervisor. If necessary, call OSHA at 800-321-OSHA (800-321-6742) and ask for an on-site inspection. You can do this so that your name won't be revealed to your employer.

Avoiding the workplace substance that causes your symptoms is critical. However, once you become sensitive to a substance, tiny amounts may trigger asthma symptoms, even if you wear a mask or respirator.

The goal of treatment is to prevent symptoms and stop an asthma attack in progress. You may need medications for successful treatment. The same medication guidelines are used to treat both occupational and nonoccupational asthma.

The right medication for you depends on many things. These include your age, symptoms, asthma triggers and what seems to work best to keep your asthma under control.

Long-term control medications

• Inhaled corticosteroids. Inhaled corticosteroids reduce inflammation and have a relatively low risk of side effects.
• Leukotriene modifiers. These medications are alternatives to corticosteroids. Sometimes, they're taken with corticosteroids.
• Long-acting beta agonists (LABAs). LABAs open the airways and reduce inflammation. For asthma, LABAs generally should only be taken in combination with an inhaled corticosteroid.
• Combination inhalers. These medications contain a LABA and a corticosteroid.

Quick-relief, short-term medications

• Short-acting beta agonists. These medications ease symptoms during an asthma attack.
• Oral and intravenous corticosteroids. These relieve airway inflammation for severe asthma. Long-term, they cause serious side effects.

If you find you need to use a quick-relief inhaler more often than recommended, you may need to adjust your long-term control medication.

Also, if your asthma is triggered or worsened by allergies, you may benefit from allergy treatment. Allergy treatments include oral and nasal spray antihistamines and decongestants.

Many people claim alternative remedies reduce asthma symptoms. But in most cases more research is needed to see if they work and if they have possible side effects, especially in people with allergies and asthma. A number of alternative treatments have been tried for asthma, but there's no clear, proven benefit from treatments such as:

• Breathing techniques. These include structured breathing programs such as the Buteyko method, the Papworth method, lung-muscle training and yoga breathing exercises (pranayama). While these techniques may help improve quality of life, they have not proved to improve asthma symptoms.
• Acupuncture. This technique has roots in traditional Chinese medicine. It involves placing very thin needles at strategic points on your body. Acupuncture is safe and generally painless, but evidence for its use in asthma is inconclusive.

You're likely to start by seeing your primary health care provider. Or you may start by seeing a doctor who specializes in asthma (allergist-immunologist or pulmonologist).

Here's some information to help you prepare for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance. You may need to stop taking antihistamines if you're likely to have an allergy skin test.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Note the timing of your asthma symptoms — for example, note if your symptoms are worse at work and get better when you're away from work.
• Make a list of all possible workplace lung irritants and anything else that seems to trigger your symptoms. You may want to take a look at the material safety data sheet (MSDS) for your work area, if there is one. This sheet lists toxic substances and irritants used on your job site. Keep in mind, not all occupational asthma triggers are listed in the MSDS.
• Write down key personal information, including major stresses or recent life changes and changes in your job or workplace.
• Bring a list of all medications, vitamins or supplements you take.
• Bring a family member or friend along, if possible. Someone who accompanies you may remember information you missed or forgot.
• Write down questions to ask your care provider.

For occupational asthma, some basic questions to ask your care provider include:

• 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?
• I have other health conditions. How can I best manage these conditions together?
• Are there restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your care provider is likely to ask you a number of questions, such as:

• When did you first notice your symptoms?
• How severe are your symptoms?
• Do you have breathing problems when you're away from work or only when you're on the job?
• Have your symptoms been continuous, or do they come and go?
• Have you been diagnosed with allergies or asthma?
• Are you exposed to fumes, gases, smoke, irritants, chemicals, or plant or animal substances at work? If so, how often and for how long?
• Do you work in unusual environmental conditions, such as extreme heat, cold or dryness?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do allergies and asthma run in your family?