Asthma Management Handbook

Preventing work-related asthma

Recommendations

When educating people with allergies or asthma on self-management, explain the risks of work-related asthma, especially in workplaces where they are exposed to sensitisers or irritants, and advise them what to do if they experience symptoms at work. However, do not routinely advise people with asthma against certain occupations so as to avoid developing work-related asthma.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Warn workers (especially those with a history of asthma or atopy) against potential respiratory hazards in the workplace, and advise them about early symptoms of work-related asthma.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Referral options for investigation of work-related asthma

To identify a specialist with experience investigating work-related asthma, consult the Thoracic Society of Australia and New Zealand or the Australasian Faculty of Occupational and Environmental Medicine.

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Prevention of work-related asthma within the workplace

Work-related asthma is potentially preventable. Preventive measures focus on controlling workers’ exposure to respiratory irritants and sensitisers at the workplace, and must be undertaken by employers.

An Australian report has recommended that employers should minimise exposure to sensitisers and irritants for all workers in high-risk workplaces.1  Actions by employers should be guided by occupational health and safety authorities and specialists with expertise in work-related asthma.

Prevention strategies currently in use include:

  • elimination of the substance from the workplace (e.g. substituting the substance, remote control handling)
  • reducing exposure (e.g safety procedures, training)
  • isolating the substance (e.g. changed work processes, segregation of areas)
  • ventilation
  • wearing personal respirators, protective clothing and masks.

The most effective strategy is to eliminate or minimise exposures at the source or in the environment.23

Avoiding the use of powdered latex gloves (e.g. substituting with low-protein, powder-free natural rubber latex gloves or latex-free gloves) reduces natural rubber latex aeroallergens, natural rubber latex sensitisation and natural rubber latex asthma in healthcare workers.2

There is limited evidence that the use of respirators is effective in preventing occupational asthma.2 Most studies have measured effects of respirators on exposure, not asthma incidence. Limited evidence suggests that the risk of developing asthma among workers using hexahydrophthalic anhydride in epoxy resin manufacture may be reduced by wearing respirators. A combination of information and training, exhaust ventilation, and wearing of respirators while handling of powdered bread improvers may reduce the risk of symptomatic sensitisation to flour and fungal amylase in bakers. Small studies suggest that respirators can reduce exposure to isocyanates among spray painters if they are well designed, fitted and maintained, and workers are trained to use them correctly.

If a face mask is recommended to minimise exposure to a particular sensitiser or irritant, the employer should select the appropriate type, and provide the worker with education and training to use it properly. Personal protection should be part of a comprehensive control program – not the sole strategy for reducing exposure.

If an employee develops work-related asthma, this should be considered as a warning that other workers may be at risk and that control measures at the workplace should be reviewed.

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Advice for patients about work-related asthma

Choice of occupation or workplace

There is insufficient evidence to determine whether people with asthma or allergies should avoid certain jobs to avoid developing work-related asthma.

People with existing asthma or atopy might consider avoiding workplaces where employers cannot prevent exposure to known sensitisers or irritants.4 They should be made aware of risks when considering employment at such workplaces.

Patients with work-exacerbated asthma or irritant-induced occupational asthma

Unless asthma is severe, patients with work-exacerbated asthma or irritant-induced occupational asthma can usually remain in their job if exposure to workplace triggers and respiratory irritants can be minimised (e.g. by changing tasks, improving ventilation or work processes, or use of a face mask and respirator to avoid short-term exposure).5

Patients with sensitiser-induced occupational asthma

For sensitiser-induced occupational asthma, optimal management involves completely avoiding exposure as soon as possible.5 Compared with complete avoidance, reduced exposure to sensitisers is associated with a higher risk of failure to improve, worsening symptoms and nonspecific bronchial hyperresponsiveness.6 Patients should be offered assessment by a specialist in occupational asthma before giving up their job.

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References

  1. Sim M, Abramson MJ, LaMontagne T, et al. Occupational asthma – detection, surveillance and prevention of the disease burden. Final report. Monash University Department of Epidemiology and Preventive Medicine, Melbourne, 2005.
  2. Heederik D, Henneberger PK, Redlich CA. Primary prevention: exposure reduction, skin exposure and respiratory protection. Eur Respir J. 2012; 21: 112-124. Available from: http://err.ersjournals.com/content/21/124/112.full
  3. Baur X, Sigsgaard T, Aasen TB, et al. Guidelines for the management of work-related asthma. Eur Respir J Supplement. 2012; 39: 529-45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22379148
  4. Henneberger PK, Redlich CA, Callahan DB, et al. An official american thoracic society statement: work-exacerbated asthma. Am J Respir Crit Care Med. 2011; 184: 368-78. Available from: http://ajrccm.atsjournals.org/content/184/3/368.long
  5. Hoy RF, Abramson MJ, Sim MR. Work related asthma - diagnosis and management. Aust Fam Physician. 2010; 39: 39-42. Available from: http://www.racgp.org.au/afp/201001/35841
  6. Vandenplas O, Dressel H, Wilken D, et al. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J. 2011; 38: 804-11. Available from: http://erj.ersjournals.com/content/38/4/804.full