Occupational asthma: Supplement

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Questions and Answers:

1. How can a person be sure that their asthma symptoms are caused by exposure to something at work? Are there specific tests?

There are three types of work-related asthma. The first type is related to an allergy to something in the workplace. In that case, patients note that the asthma clears up whenever they’re not at work or they’re on vacation. The second type is where there is pre-existing asthma; irritants at the work site will constantly aggravate the existing asthma, so that they always have a lot of minor attacks at work because there may be several things that bother them. The third type is irritant-induced asthma or reactive airways dysfunction syndrome (RADS), reactive airways dysfunction syndrome, which is due to a high level of exposure. In these cases, patients become immediately ill and require medical care, and they would have asthma subsequent to that.

The most common are the first two types. Testing for these would require seeing a specialist, who may do a variety of tests involving specific challenges. For instance, a doctor might do what is called a natural challenge, in which a peak flow meter is used to measure asthma attacks. A peak flow meter is routinely used by family doctors to monitor asthma. By blowing into a cylinder, the meter shows high or low numbers which represent a reliable, objective measurement of the severity of asthma. This device can easily be used at home or in the workplace. Patients can take measurements themselves using a peak flow meter for about two weeks at home, and then go back to work and do the same, to document for the physician if there are differences: this way you can tell if they are really having more asthma at work than at home. By keeping a diary of peak flow measurements, patterns can emerge: asthma may be better or worse at certain times of the day, which may also help in tracking irritants that may be exacerbating the asthma.

2. Are asthma symptoms very different in asthma with latency and asthma without latency?

Basically, asthma is asthma; symptoms are the same whether it is with or without latency. Only the initiation of attacks will be different. Asthma with latency, which is the allergy-related asthma, requires a long exposure of several months or years during which time a person develops an allergy or sensitivity to a chemical in the workplace. This is the type that gets better when the patient is away from work, on the weekends or on vacation. The other type of asthma, without latency, is the high-dose, sudden-onset asthma, which can be put down to a single exposure at one moment in time.

3. Can you explain briefly why you don’t have to be allergic to a substance to have an asthma attack?

Asthma without latency is due to an irritant. The irritant is of such high magnitude that it actually produces injury to the airways of the lung, similar to a respiratory infection or the type of injury induced by an allergic response that causes inflammation of the lungs. This inflammation persists for reasons that aren’t clear, but it is due to this persistent inflammation that they suffer from asthma.

4. Why is taking appropriate asthma medication to keep you on the job site not a good idea?

If you have the type of asthma that is irritant-induced (RADS) or if it is aggravated by some substances at work like cigarette smoke or welding fumes, medication in many cases will allow you to tolerate these exposures and be able to work. In contrast, if you are allergic to something specific, every time you’re exposed to it, your asthma worsens, and continues to increase in severity. There have been a few reports of allergic-type asthma or asthma with latency where the exposure has led to the death of a person. Once you are allergic or sensitized, it is recommended that you have no further exposure to the substance, because it can produce significant worsening and may have serious consequences. In these cases we recommend the person not return to work if the exposure can’t be avoided. This is in contrast to the irritant-type asthma, where the aggravation, even if it is acute and precipitates attacks, doesn’t severely injure the airways. Generally, this type of asthma is not specific to the workplace. In these people, medication seems to improve response to irritants and they can usually stay on the job.

For asthmatics in general, avoiding irritants is probably a good idea, as is getting appropriate medication.