Asthma Management Handbook

Asthma prevention in adults

Recommendations

Advise people who work with airborne sensitisers or irritants that many airborne substances can damage respiratory health and may cause asthma.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available), with particular reference to the following source(s):

  • Heederik et al. 20121
  • Baur et al. 20122

Warn sportspeople, particularly elite athletes, that training while exposed to airborne pollutants or cold, dry air may increase the risk of developing asthma.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available), with particular reference to the following source(s):

  • Anderson and Kippelen, 20083
  • Parsons et al. 20134
  • Sue-Chu et al. 20105
  • Weiler et al. 20106

More information

Effects of pollutants on asthma risk

Exposure to a range of indoor and outdoor airborne pollutants has been associated with increased asthma risk in cross-sectional surveys.

Exposure to the following during early childhood has been associated with increased risk of wheezing or asthma:

  • the use of gas stoves or ovens in homes7
  • living in damp or mouldy environments8, 91011
  • high exposure to traffic pollution.1213

Various indoor and outdoor pollutants have also been associated with increased risk of adult-onset asthma. These include airborne substances used in the home (e.g. cleaning sprays14) and many airborne substances encountered in workplaces.

Close
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.15  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.12

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.1

There is limited evidence that the use of respirators is effective in preventing occupational asthma.1 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.

Close
Aetiology of exercise-induced bronchoconstriction

Both genetics and environment may contribute to exercise-induced bronchoconstriction.6

Exercise-induced bronchoconstriction occurs when a person’s ventilatory rate is high and their airways must heat and humidify a large volume of air in a short time. Dehydration of the airway leads to release of inflammatory mediators within the airway and contraction of airway smooth muscle.6 Dry air is one risk factor.6

Exercise-induced bronchoconstriction in athletes who do not have chronic asthma may have different pathogenesis and presentation than exercise-induced bronchoconstriction in people with asthma.6 Elite athletes often report onset of exercise-induced bronchoconstriction after age 20 years and after many years of high-level training.16

In elite athletes, exercise-induced bronchoconstriction is probably due to chronic injury to airway epithelium associated with long-term frequent prolonged high ventilation rates in the presence of environmental exposure to cold air, dry air, and airborne pollutants such as ozone, particulate matter:

  • The high prevalence of exercise-induced bronchoconstriction in ice-rink athletes has been linked to inhalation of cold dry air in combination with airborne pollutants from fossil-fuelled ice resurfacing machines
  • Exercise-induced bronchoconstriction in skiers and other winter athletes has been linked to injury of airway epithelium due to conditioning large volumes of cold dry air435
  • The high prevalence of asthma and exercise-induced bronchoconstriction reported among competitive swimmers has been associated with exposure to chlorine in indoor swimming pools417, 18
  • The increased prevalence of exercise-induced bronchoconstriction among distance runners, compared with the general population, has been attributed to exposure to high levels of airborne allergens and ozone64
  • Certain airborne viruses inhaled during exercise may also contribute to exercise-induced bronchoconstriction.6
Close

References

  1. 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
  2. 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
  3. Anderson SD, Kippelen P. Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes. J Allergy Clin Immunol. 2008; 122: 225-235. Available from: http://www.jacionline.org/article/S0091-6749(08)00785-9/fulltext
  4. Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013; 187: 1016-27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23634861
  5. Sue-Chu M, Brannan JD, Anderson SD, et al. Airway hyperresponsiveness to methacholine, adenosine5-monophosphate, mannitol, eucapnic voluntary hyperpnoea and field exercise challenge in elite cross country skiers. Brit J Sports Med. 2010; 44: 827-832. Available from: http://bjsm.bmj.com/content/44/11/827.long
  6. Weiler JM, Anderson SD, Randolph C, et al. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol. 2010; 105: S1-47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21167465
  7. Lanphear BP, Aligne CA, Auinger P, et al. Residential exposures associated with asthma in US children. Pediatrics. 2001; 107: 505-511. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11230590
  8. Mendell MJ, Mirer AG, Cheung K, et al. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect. 2011; 119: 748-56. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114807/
  9. Quansah R, Jaakkola MS, Hugg TT, et al. Residential dampness and molds and the risk of developing asthma: a systematic review and meta-analysis. PloS one. 2012; 7: e47526. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492391/
  10. Tischer C, Chen CM, Heinrich J. Association between domestic mould and mould components, and asthma and allergy in children: a systematic review. Eur Respir J. 2011; 38: 812-824. Available from: http://erj.ersjournals.com/content/38/4/812.full
  11. Tischer CG, Hohmann C, Thiering E, et al. Meta-analysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts: an ENRIECO initiative. Allergy. 2011; 66: 1570-9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492391/
  12. Bernstein, D I. Traffic-related pollutants and wheezing in children. J Asthma. 2012; 49: 5-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22211400
  13. Gasana J, Dillikar D, Mendy A, et al. Motor vehicle air pollution and asthma in children: a meta-analysis. Environ Res. 2012; 117: 36-45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22683007
  14. Zock JP, Plana E, Jarvis D, et al. The use of household cleaning sprays and adult asthma: an international longitudinal study. Am J Respir Crit Care Med. 2007; 176: 735-741. Available from: http://ajrccm.atsjournals.org/content/176/8/735.full
  15. 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.
  16. Fitch KD, Sue-Chu M, Anderson SD, et al. Asthma and the elite athlete: Summary of the International Olympic Committee's Consensus Conference, Lausanne, Switzerland, January 22-24, 2008. J Allergy Clin Immunol. 2008; 122: 254-260. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18678340
  17. Bougault V, Boulet LP, Turmel J. Bronchial challenges and respiratory symptoms in elite swimmers and winter sport athletes. Chest. 2010; 138: 31S-37S. Available from: http://journal.publications.chestnet.org/article.aspx?articleid=1086631
  18. Bougault V, Turmel J, St-Laurent J, et al. Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes. Eur Respir J. 2009; 33: 740-746. Available from: http://erj.ersjournals.com/content/33/4/740.long