Your Work and Your Health

Asthma


 


Occupational asthma - the employers' perspective


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Frequently Asked Questions

What is occupational asthma?

Occupational asthma is a condition where there is a breathing problem or chest tightness caused by substances that you might come across at work. The condition can take weeks, months or even years to develop, depending on the person and the substance.

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As an employer, why should I be concerned about occupational asthma?

It is thought that approximately 10% of adult onset asthma is attributable to occupational exposures. Occupational asthma cases are entirely preventable through the implementation of effective primary prevention strategies in the workplace. All workplaces should have adequate control and monitoring processes to allow them to recognise potential dangers in the working environment.

Occupational asthma is the most frequently reported occupational respiratory disease in Great Britain. Around 1200 new cases are reported to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) register each year. In fact, the diagnosis of occupational asthma is often missed and so the true figures may be a great deal higher than this. For example, a general practitioner with 2000 patients would have around 200 adult asthma patients, of which 2-10 could be due to occupational asthma. A diagnosis of occupational asthma carries with it not only physical implications but also financial, psychological, social and legislative issues.

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How do you know that it is work related?

Occupational asthma is caused by workers breathing in substances at work that produce a hypersensitive state in the airways - the small tubes that carry air in and out of the lungs - and trigger a subsequent response in them.

Not everyone who becomes sensitised goes on to get the clinical disease but once the lungs become hypersensitive further exposure to the substance, even at quite low levels, may provoke an attack.

A respiratory sensitiser is a substance which, when breathed in, can cause an allergic response in the airways of the lungs. Occupational asthma from sensitisation is usually the result of numerous exposures to a sensitiser, over a period of time. Symptoms do not usually appear after the first exposure to the sensitiser. The time taken for symptoms to appear varies greatly - from weeks to years.

Once sensitisation has occurred, subsequent exposure to the same sensitiser, even to very small amounts, will produce symptoms. Continued exposure to the same sensitiser can result in increasingly severe symptoms and possibly permanent asthma. Exposure to another trigger, such as cigarette smoke, may also produce symptoms.

Work-related asthma

Work-related asthma is broader and includes substances in the workplace that irritate the airways of individuals with pre-existing (eg childhood asthma). Respiratory irritants may provoke attacks in those with occupational asthma or pre-existing asthma of non-occupational origin. Examples include chlorine, general dust and even cold air. In this case, the individual does not become sensitised to that specific agent, but the attack is still work-related.

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Why can't I ignore this problem?

There are several reasons why you should manage the risk of occupational asthma including the damaging effects on the individual, these include:
  • Ill health;
  • Incapacity to work;
  • Failure to recognise occupational asthma early enough may lead to permanent asthma, even after the worker leaves the industry.

The costs of the organisation, which include:

  • Reduced efficiency, productivity and profitability
  • Unsafe work environment
  • Increased absenteeism, sick leave

Your legal obligations:

  • According to the Health and Safety at Work Etc. Act, 1974 and the Management of Health and Safety at Work Regulations 1999 you have an obligation to ensure the health and safety of each of your workers at work. This means you must take steps to eliminate, or at least minimise, exposures to substances that may cause occupational asthma.

  • The main causes of occupational asthma are set out in Section C of HSE's Asthmagen Compendium, also look for the risk phrase R42 'may cause sensitisation by inhalation' on labels or safety data sheets.

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What signs should I be looking for amongst my employees?

Symptoms of asthma whatever the cause, include attacks of wheezing, coughing chest tightness or shortness of breath. The symptoms can develop right after exposure, but sometimes symptoms appear several hours after exposure, possibly at night, and so any link with workplace activities may not be obvious, but may occur during the day also.

Symptoms may also vary across the working shift or week, usually worsening towards the end of the week with symptoms improving over a few days off work, on weekends or holidays. Other associated conditions are rhinitis (sneezing/runny nose) and/or conjunctivitis (itchy and inflamed red eyes).If occupational asthma is identified early enough and appropriate action is taken, there is a good chance that the symptoms will decrease and in many cases disappear

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What can I do to help?

Managing the risk of occupational asthma involves addressing various issues, including:
  • Consultation
  • Information and training
  • Self reporting
  • Risk management
  • Workplace monitoring
  • Health surveillance
  • First aid

Consultation

Consultation in the workplace involves sharing of information and exchange of views between employers, workers, workplace health and safety officers and workplace health and safety representatives. Sometimes consultation can involve specialist advice in the form of an occupational or respiratory physician.

The responsibility for health and safety decisions for the workplace rests with you and the consultation process should also cover issues relating to risk management and information and training.

Information and Training

Workers should be informed about hazards that cause (or make worse) occupational asthma and the typical symptoms. You need to tell workers which sensitisers and irritants are being used in the workplace. The Material Safety Data sheets for any sensitisers or irritants should also be made available to workers.

If a worker may be exposed to a hazardous substance, you should prepare a risk assessment, provide induction and ongoing training about the nature of these hazardous substances and the controls for their use.

Self- reporting

A procedure for self-reporting symptoms would be useful, workers should report symptoms of occupational asthma to their supervisor, occupational health nurse or workplace health and safety officer as soon as they become aware of them . It is important to make workers feel comfortable about approaching the above people if they suspect they have developed symptoms of occupational asthma. If there are opportunities to re-train in other sections of the workplace this may encourage workers to report symptoms when they occur.

Risk management

In order to manage the risks from occupational asthma it is important to identify the hazards, to assess the risks that may result because of these hazards, and to decide on control measures to prevent or minimise the level of risk.

It is important to identify the hazards by being aware of some of the common sensitisers and irritants that may cause occupational asthma and to be aware of the occupations most at risk. Determine which activities at the workplace might cause exposure to sensitisers and irritants especially occasional tasks such as maintenance.

In order to assess the risks above it is important to determine who is likely to be exposed (considering maintenance staff) and the level of exposure to workers including route, duration and frequency of exposure. It may be necessary to carry out workplace monitoring and health surveillance.

Workplace monitoring

Workplace monitoring is carried out to determine the possible level of exposure to a hazardous substance and is required when the irritant or sensitiser at the workplace is a hazardous substance and The Control of Substances Hazardous to Health (COSHH) Regulations apply. It is also recommended where a risk assessment indicates that a worker is exposed to a sensitiser or irritant at the workplace.

Health surveillance

Health surveillance is usually carried out to find out if a workers health is being affected by substances to which they are exposed and is requirement of the Workplace Health and Safety regulation 1997. It is recommended where a risk assessment indicates that a worker is exposed to a respiratory sensitiser or irritant at the workplace that yearly spirometry (breathing test) and questionnaires are carried out on all workers.

Health surveillance may detect occupational asthma at an early stage, where intervention options are likely to be most successful. If health surveillance indicates that a worker has become sensitised it is recommended that the worker be removed from the environment and referred to an occupational or respiratory physician.

It is important to remember:

  • That affected workers who continue to be exposed to sensitisers can develop severe asthma that may persist for years after leaving work.

  • Medical therapy to allow a worker to better tolerate workplace exposure is NOT an acceptable means of controlling the risk.

First aid

Workers who have existing asthma should be advised to bring their personal asthma reliever medication (ventolin, bricanyl) to work. The workplace should have first aid equipment and facilities readily available for use and this should include a spacer (volumatic) for emergency use with a worker's personal reliever. Workers should also have access to trained first aid personnel.

First aid services for persons suffering asthma symptoms or an asthma attack at the workplace should follow the emergency asthma care leaflet provided. This leaflet will advise you how to use your inhaler correctly. You may wish to copy this and enlarge it. This can then be placed in a visible location in the workplace. Every worker suffering from asthma should carry their own inhaler that has been prescribed by their own GP.

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I am a small business employer so what can I do about this problem?

It is easier for large companies to employ human resource management and occupational health professionals to help them develop good practice for managing occupational asthma. In contrast the small business employer is often left alone without the resources to easily solve the problem. Under these circumstances the problem is often ignored.

However, practical solutions such as changing the work pattern, work demand and work environment can be carried out to suit your own business without financial cost. Advice about making these changes can often be provided by local business advisors or by joining small business clubs where you can learn from the experience of others. Occupational health provision can be purchased on a sessional basis from a local provider, or purchased on a yearly basis.

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Where can I go to get help and advice?


HSE has leaflets and books to explain the above-mentioned factors with relevant information and guidelines. They are:

  • A Manager's Guide (HSG 218), HSE Books 2001.
  • The Employment Rights Act 1996, HMSO 1996 ISBN 0 10 541896 X.
  • Protection from Harassment Act 1997, TSO 1997 ISBN 0 10 544097 3.
  • The Working time Regulations 1998, TSO 1998 ISBN 0 11 079410 9.
  • Disability Discrimination Act 1995, HMSO 1996 ISBN 0 10 545095 2.
  • Health and Safety at Work Etc. Act 1974, HMSO 1974 ISBN 0 10 543774 3.
  • Management of Health and Safety at Work Regulations 1999. Approved code of Practice and guidance L2, HSE Books 2000 ISBN 0 7176 2488 9.
  • 5 steps to risk assessment INDG163(rev1) HSE Books 1998. Single copies free, also available in priced packs, ISBN 0 7176 1565 0.
  • Revitalising Health and Safety: Strategy Statement. Available from: The Department of the Environment, Transport and the Regions, Free Literature Service, PO Box 236, Wetherby, West Wetherby, West Yorkshire, LS23 7NB Tel: 0870 1226236.
  • Securing Health together: A Long-term occupational health strategy for England, Scotland, and Wales MISC225 HSE Books 2000.

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I do not have the resources to be able to release staff for training during working hours. Is there an alternative?

If time is a problem and neither you or your employee can be released during working hours then you may wish to consider registering with Learn Direct (http:www.learndirect-business.co.uk) who deliver a range of training services (through the internet or at Business Training Centres located near you (Learn Direct, Free phone: 08000 150 750). Some of these courses are provided at low cost through subsidies from the Learning & Skills Council (http://www.isc.gov.uk). This training can be completed at a time that is most convenient to you with minimal impact upon your business costs and efficiency.

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As an employer am I expected to report work related illness?

Under the 'Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995' (RIDDOR) managers should be aware that it is compulsory for employers to report cases of listed occupational diseases. Workers may be concerned about the consequences of reporting such incidents should an investigation occur. However, it is compulsory for an employer to report these incidents under RIDDOR 1995 regulations.

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