Key points

• Asthma is a disease that affects your lungs.
• Work-related asthma is triggered or develops from exposures at work.
• Workplace irritants, allergens, and physical conditions are triggers.
• Work-related asthma symptoms are the same as non-work related asthma.

Overview

Work-related asthma is asthma triggered by exposures at work. Asthma affects the lungs and causes the airways to become narrow and inflamed. To control it, avoid triggers that cause asthma symptoms and take prescribed medicine.

Many triggers can be in the workplace. Over 300 known substances in the workplace can cause or worsen asthma. Avoiding triggers can prevent asthma from getting worse.

Worsening asthma or new onset asthma in a worker should raise questions about workplace causes. Asthma symptoms can develop shortly after exposure. However, they can also develop months or years after repeated exposures to harmful substances.

Asthma is now the most common chronic disorder in childhood. In the U.S., nearly 24 million people have asthma. Asthma often occurs early in life, but it can also occur for the first time in adulthood. Some patients can also "outgrow" asthma at first, but then develop symptoms again later in life.

What is asthma?

Asthma is an inflammatory disease of the lung. It can occur along the entire airway from the nose to the lung. Once the airway becomes swollen and inflamed, it becomes narrower, and less air gets through to the lung tissue. The exact cause of asthma is not known. Researchers think some genetic and environmental factors interact to cause asthma, usually before the age of 5.

What are the symptoms of asthma?

Wheezing, coughing, chest tightness, and trouble breathing. During an asthma attack, the muscles around the airways tighten up, more mucus is produced, and asthma symptoms become worse.

Are allergies related to asthma?

Yes. Asthma can be triggered by substances in the environment called allergens. Some indoor allergens come from dust mites, cockroaches, dogs, cats, rodents, molds, and fungi. Outdoor allergens include pollen from many trees, weeds, and grass. Even food allergies can cause asthma symptoms.

What about air pollution outside?

Outdoor pollution plays a major role, as does cigarette smoke. Children exposed to pollution are more likely to develop asthma. Asthma patients are more likely to have their asthma flare up when they are exposed to pollution. This is why asthma patients should not exercise outdoors during high-pollution days, for example when there is a code-orange ozone day.

How is asthma treated?

Treatment plans can include taking prescribed medicine and avoiding your asthma triggers. You can breathe in some medicines and take other medicines as a pill. Asthma medicines come in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. Long-term control medicines help you have fewer and milder attacks, but they don't help during an asthma attack.

Indoor Allergens & Asthma

What steps can you take to reduce indoor allergens and prevent asthma attacks?

• Vacuum carpets and upholstered furniture every week.
• Reduce humidity to under 50% and check for leaks/water damage to reduce mold.
• Eliminate pest infestations to reduce cockroach or mouse allergen exposure.
• Use HEPA air filtration devices to reduce airborne allergens. Change HVAC filters at least once every quarter, or more frequently if your home has a lot of dust.
• Wash sheets and blankets in hot water every week.
• Put mattresses, pillows, and box springs in allergen-proof covers.
• Limit dog and cat exposure in the home.

There are two main categories of work-related asthma: occupational asthma and work-exacerbated asthma (sometimes known as work-aggravated asthma). Occupational asthma describes asthma caused by worksite exposures. Work-exacerbated asthma describes existing asthma that worsens because of worksite exposures to irritants, allergens, or physical conditions. Work-related asthma that is not identified and managed early can get worse. Work-related asthma reduces productivity and quality of life.

Work-related asthma is associated with exposure to worksite triggers (irritants, allergens, and physical conditions). Examples of asthma triggers are:

• Animal dander, insects, and dust mites
• Chlorine-based cleaning products
• Cigarette smoke
• Materials from cockroaches
• Cold air
• Dust from wood, grain, flour, or green coffee beans
• Gases such as ozone

Other possible triggers include:

• Irritant chemicals
• Metal dust
• Physical exertion
• Pollen and plants
• Strong fumes
• Vapors from chemicals (e.g., ammonia, isocyanates, and solvents)
• Wood smoke

Symptoms of work-related asthma are the same as symptoms for non-work-related asthma. They include:

• Wheezing
• Coughing
• Chest tightness
• Shortness of breath

Asthma symptoms can come and go, and some workers might not have all of the symptoms. Workers can get work-related asthma even when using personal protective equipment such as respirators or face masks. Sometimes breathing problems start at work and continue after leaving work when exposure has stopped.

Symptoms for work-related asthma tend to get better on weekends, vacations, or other times when away from work. However, in some cases, symptoms do not improve until extended time away from exposures or triggers.

Your doctor can diagnose work-related asthma. Tell your doctor about work exposures and possible triggers including your job, tasks, and materials you use.

Also consider recording when and where your symptoms occur to help determine any patterns. Your doctor will ask questions about your symptoms and will conduct a physical examination. The doctor might also order one or more tests, such as:

• Breathing tests (e.g., peak flow readings, spirometry, methacholine challenge)
• Allergy tests such as skin or blood tests

If your doctor is concerned about a condition other than asthma, he/she might order other tests such as x-rays or other imaging tests.

The most important step of managing asthma is stopping or reducing exposure to triggers causing symptoms. Work with your doctor to develop a personal asthma control plan. Medical professionals often treat asthma with two general types of medicine:

• Quick-relief rescue inhalers (e.g., albuterol, levalbuterol) to open the airways. People use these medicines to treat asthma attacks or flare-ups. Quick relief medications are often used in combination with long-term control medicines such inhaled corticosteroids.
• Long-term control medicines to reduce inflammation in the airways. People use these medicines to help keep asthma symptoms from occurring. When these medicines are working well, quick relief medicine is not used as much.

What to know

Minimizing exposure to work-related asthma triggers can help employees to be healthier. The following guidelines can help employers and employees develop and maintain a worksite safe from asthma triggers.

Employer

The hierarchy of controls is a multi-faceted approach to eliminate or reduce workplace hazards. This approach includes the following:

• Eliminate hazardous processes or materials from work tasks.
• Substitute by using less hazardous processes or materials.
• Install engineering controls. Examples include isolating or enclosing processes or installing local exhaust ventilation.
• Implement administrative controls such as work practices, policies, and worker training.
• Personal protective equipment (PPE) such as respiratory protection.

PPE should not be the sole method for protecting workers. Eliminate, substitute, and use effective engineering and administrative controls together with PPE.

Medical surveillance

Some employers might want to consider establishing a medical surveillance plan to monitor workers for asthma. Medical surveillance plans can help identify workers with asthma at earlier stages of disease. This can eliminate workers from exposure and prevent disease progression. Surveillance can be as simple as periodically completing a questionnaire. Plans should also include:

• Periodic screening of workers for symptoms of asthma
• Follow up medical testing when appropriate

Additional testing, such as evaluating for sensitization with allergy skin tests, has also been used.

If there is not an established medical surveillance program, consider consulting with an occupational physician to discuss monitoring options.

Employees

Employees should pay attention to their work environment, especially those with breathing problems. Follow the steps below if you feel you have work-related asthma symptoms.

• Identify and avoid exposures to asthma triggers.
• Participate in your employer's asthma surveillance plan, if available.
• Report new or worsening breathing problems to your doctor and the designated person at your workplace.
• Report if personal protective equipment or engineering controls malfunction to your supervisor or designated person.
• If you have asthma, take your medications as prescribed and regularly see your doctor.
• Get a flu shot every year and stay up to date with COVID-19 vaccines.
• If you smoke, talk to your doctor or employer about resources to help you quit smoking.

Key points

• Asthma is a disease that affects your lungs.
• It is one of the most common long-term diseases of children, but adults can have asthma, too.
• Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning.

Symptoms

Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs.

An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body's airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways.

You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following your doctor's advice.

Diagnosis

It can be hard to tell if someone has asthma, especially in children under age 5. A doctor can help you find out if you have asthma.

During a checkup, a doctor may ask if you cough a lot, especially at night. He or she may also ask whether your breathing problems are worse after physical activity or at certain times of year. The doctor may ask about chest tightness, wheezing, and colds lasting more than 10 days. He or she may ask whether anyone in your family has or has had asthma, allergies, or other breathing problems. The doctor may ask about your home and whether you have missed school or work or have trouble doing certain things.

The doctor may also do a breathing test, called spirometry, to find out how well your lungs are working. Spirometry tests how much air you breathe out after taking a very deep breath before and after you use asthma medicine.

Symptom management

Take your medicine exactly as your doctor tells you and stay away from things that can trigger an attack to control your asthma.

Everyone with asthma does not take the same medicine.

You can breathe in some medicines and take other medicines as a pill. Asthma medicines can be used in several ways -- as reliever therapy or as controller therapy. If you need to use your reliever medicine more and more, visit your doctor to see if you need a different medicine. Controller medicines help you have fewer and milder asthma attacks.

Asthma medicines can have side effects. Most side effects are mild and soon go away. Ask your doctor about the side effects of your medicines.