A breath of fresh air: Occupational asthma and the workplace

occupational asthma

How employers can reduce the risks and impacts of asthma at work

Breathing difficulties have a long history in industry and, contrary to popular belief, are not confined to the past. In fact, there has been an increase in work-related asthma, including occupational asthma, in recent years.

Asthma is a serious condition that affects 5.4 million people in the UK.

There are links to several factors such as family history and childhood illness. But asthma can also be caused or worsened by environmental conditions, including those in the workplace.

According to the British Lung Foundation, employers have a responsibility to create safe working environments that prevent or minimise the risk of workers developing lung conditions such as asthma – it is part of their statutory duty of care for employee health.

Risks of occupational asthma in the workplace

Asthma causes inflammation of the airways. A major symptom of asthma is shortness of breath. This stops sufferers from performing simple, everyday tasks like walking upstairs or carrying a small load.

Asthma can cause symptoms like wheezing, coughing and tightness of the chest, dizziness, fainting and more. In the worst cases, asthma can be fatal.

Asthma in the workplace is caused by breathing in airborne substances. It can be a worsening of an existing condition or a new reaction to an allergen and can manifest in different ways.

Employers must be aware of both to protect their staff and minimise the risks.

Work-related asthma

Work-related asthma has a broad definition and can be hard to diagnose. This is because there may be a time lag of several hours between a worker inhaling the trigger substance in the workplace and suffering the onset of an asthma attack. As a result, the onset of symptoms may not occur until the employee is at home.

Sometimes, the only way to identify a relationship between exposure at work and asthma is to ask workers to track their asthma symptoms over time. Then observing whether they improve on days away from work such as weekends or holidays.

The Society of Occupational Medicine defines work-related asthma in two types:

  • Work aggravated asthma – caused when a patient has a history of asthma, and the condition is exacerbated by substances at work including general dust, or even cold or dry air.
  • Occupational asthma – caused when a worker inhales a hazardous substance in the workplace.

Triggers of occupational asthma

“Occupational asthma may account for 9-15% of adult-onset asthma. It is reported to be the most common industrial lung disease in the developed world.”

National Institute for Health and Care Excellence

Occupational asthma develops when a worker experiences an allergic reaction to environmental conditions. For example, reactions can be triggered by inhaling wood dust in a sawmill or flour in the air at a bakery.

Substances like these are known as respiratory sensitisers, or asthmagens, and can cause employees’ airways to become hypersensitised. Around 90% of occupational asthma is sensitiser induced.

Reactions can also occur when employers are exposed to high levels of an irritant – either on one occasion, or over several occasions. Irritants can include gases such as ammonia or chlorine.

Businesses need to be aware of all possible triggers for asthma in their workplace in order to protect the health of their staff.

They should also take on board that a worker who has been diagnosed with occupational asthma will need to avoid the trigger substance completely to avoid the condition worsening.

How high are the risks of occupational asthma?

Although not everyone who becomes exposed or sensitised will develop asthma, it is important for employers to understand that even low-level exposure following hypersensitisation could trigger an asthma attack.

“Occupational asthma is a serious condition which can cause workers to be severely disabled; unable to continue in the normal jobs and sometimes having to be retired on the grounds of ill health.”

Society of Occupational Medicine

Around a third of employees with occupational asthma leave the workforce after diagnosis which takes valuable knowledge and experience away from the business.

However, occupational asthma is an entirely preventable disease. Employers can help to protect their staff from developing it by minimising and managing risks through a range of strategies.

Employer responsibilities around asthma in the workplace

Workers most affected tend to be in sectors such as bakeries, vehicle paint spraying, woodwork, healthcare, agriculture and engineering. However, there are many other industries where workers are at risk.

A full list of substances that can cause occupational asthma is provided by the Health and Safety Executive.

There are a number of key responsibilities to be aware of where there is deemed any relevant risk relating to asthma, exposure to potential triggers, or risks to lung health:

  • Employers have a legal responsibility to minimise exposure to hazardous substances in the workplace. If employees are required to work with hazardous allergens or respiratory irritants, the risks should be communicated before an employee starts work.
  • A health check, including breathing test, should be carried out at the start of employment.
  • Employers should thereafter provide annual health checks to ensure the employee is not developing asthma. Regular monitoring ensures the best outcome for a worker. This can detect the onset of occupational asthma before symptoms become apparent.
  • The Health and Safety Executive must be informed if an employee develops occupational asthma. It is reportable within 10 days, under their RIDDOR regulations as an industrial disease. The worker will also need to avoid any further exposure to the trigger substance to prevent the condition from worsening. This may require a workplace adjustment to their role or working conditions.

Asthma at work and the law

Several laws cover asthma in the workplace, whether it is occupational or work related. Employers need to be aware of their legal position, and protect the health and welfare of their employees. They can do this by controlling and minimising use of hazardous substances and providing protective equipment.

The Society of Occupational Medicine provides a detailed list of the laws and regulations pertaining to asthma in the workplace, for employers.

How employers can reduce occupational asthma risks for workers

There are plenty of measures that employers can take to protect staff from developing occupational asthma. For example:

  • providing well-ventilated workspaces
  • installing suitable extraction mechanisms
  • testing extraction mechanisms regularly, at least every 14 months
  • enclosing processes to limit dust and vapours
  • replacing hazardous substances with less hazardous materials or chemicals where possible
  • providing staff with Respiratory Protective Equipment (RPE)
  • training staff on fit, removal and replacement of RPE to ensure effective protection

The British Occupational Hygiene Society reports that in a 2021 survey, 27% of workers said that their employer does not give training for use of control measures for airborne substances. A fifth reported that ventilation systems were tested less that every 14 months. This is below the minimum testing frequency in the UK.

Employers need to be proactive in their responsibilities to protect staff. By training them in how to protect themselves, they fulfil their legal duty of care.

Many industries requiring employees to work with airborne substances that could cause or exacerbate asthma. Refer to the HSE for industry-specific guidance on how to protect workers in your business.

How can employers take action on Asthma?

Work-related asthma can be prevented when employers use good multidisciplinary occupational health services and are proactive in preventing risks.  

Businesses can – and should – take a range of steps to protect their staff. You can improve worker protection from occupational asthma with the following actions:

  • Get involved in Asthma Awareness Day each May, to raise awareness throughout your team and encourage best practice for safe use of hazardous substances.
  • Minimise exposure to hazardous substances through a hierarchical control programme of elimination, replacement, enclosure, ventilation, and respiratory protective equipment.
  • Create robust risk assessments wherever work processes cause airborne substances. Risk assessments should be tracked and reviewed regularly to evaluate the effectiveness of safety measures as work practices evolve. Systems such as Empactis can make this process efficient, clear, and manageable.
  • Provide correct RPE (Respiratory Protective Equipment) and train staff in fitting, removal, and replacement.
  • Carry out health surveillance for workers who come into contact with respiratory sensitisers or irritants. Specially designed employee health management systems such as Empactis can help with proactive monitoring.

Useful Links

  • A guide for employers from the Society of Occupational Medicine provides information on prevention, employee health surveillance and what to do if a worker is diagnosed with occupational asthma.
  • Guidance on higher- and lower-level surveillance and record-keeping recommendations can be found at COSHH G402.

Conducting, tracking, and monitoring employee health risk assessments and then the ongoing surveillance of employee health are challenges for which the Empactis Employee Health Management System was designed. Find out more about Empactis Health Manager.