OCCUPATIONAL ASTHMA
By Evelyn I. Bain, M Ed, RN, COHN-S, Associate Director, Occupational Safety and Health Specialist

What do nurses, other health care professionals, computer manufacturing technicians, dental workers, bakers and sawmill operators have in common? Besides being people, usually hard working in their chosen fields, these workers and many others have occupational exposures to substances that cause hyperactive airway disease, or occupational asthma.

In recent years, asthma appears to be on the rise. School nurses and athletic coaches report more children than ever using inhalers. Nurses note that they and/or their co-workers carry and use inhalers (bronco-dilators and steroids) before, during, and after work.

Managed care programs identify asthma as a leading cause of hospital emergency room visits, medical expenditures and lost time from work. These programs emphasize patient education as a strategy to prevent escalation of symptoms and better control of the disease. Little is said about prevention, identification of causative agents and avoidance of those irritants .

Preventing exposure to toxic substances is a major focus of occupational safety programs. Hazardous materials in the work environment, those causing respiratory irritation as well as other health problems, can be controlled following occupational principles of elimination of the offending agent, substitution to less hazardous products, engineering controls to contain the offending agent, administrative controls that limit time and personnel exposed or personal protective equipment to filter or modify the exposure.

Products that are designed for patient care may have the potential for causing adverse health effects in the health care worker if they are inhaled during application. Whenever compounds can be inhaled as dusts, vapors, fumes or mists, there is potential for airway irritation. In the health care work environment, substances that are known to cause respiratory irritation and/or occupational asthma include formaldehyde, gluteraldehyde, antibiotics, antineoplastic agents and many other pharmaceuticals, pesticides, environmental cleaning chemicals, disinfectants and sterilizing agents. Airborne latex proteins, being carried by cornstarch powder and dust, are major airborne contaminant causing asthmatic reactions.

To identify agents that are causing respiratory irritation and asthmatic attacks, nurses need to look closely at the relationship of symptoms to tasks that they perform or situations that are occurring at work. This is done by keeping a diary that notes when symptoms occur and what you may be doing or what is happening around you. This recordkeeping need not be complex and is critical to identify causation. The tasks that you may be performing include donning or removing powdered latex gloves, administering aerosolized medications, unloading sterilized equipment, or spraying and wiping down surfaces. The activities that may be going on around you include other workers donning and removing powdered latex gloves, housekeeping tasks that use scented products or floor buffing that raises chemical particulates, air conditioning equipment that activates and releases dusts, molds and other particulates. When keeping records it is also important to note the times that you feel well and are without symptoms as this often correlates with the absence of the above noted exposures.

In addition to keeping your own records, it is important that you report your symptoms to the person/department responsible for handling work-related illnesses in your facility. When reporting, you should be sure that a written report is on record. There are various methods of written reporting in occupational health facilities. One may be a daily in-house log of persons reporting to the facility, another is a First Report of Injury form which is equal to the OSHA 101 report and still another is the OSHA 200 Log. The type of report that is kept depends on the severity of the illness or injury on the day it is reported or the course that it takes over time. There are federal and state regulations relating to illness reporting. The immediate concern for the worker is that a written report is kept and that you have a copy of that report or a note that is was filed. Enter the date and the information you gave the occupational health person in your own diary.

Except in the case of acute respiratory distress, when emergency care is required, treatment for respiratory irritation or occupational asthma may be with a personal or an occupational health care provider. You may need to assist your health care provider to identify the substances that are irritating you. Information should be available in your workplace that will help you to do this. Materials Safety Data Sheets, required by OSHA Standard 1910.1200 Hazard Communication, provide information on the health effects of workplace chemicals. These should be available in each work area. To determine health effects, nurses need to look at the section on the MSDS entitled “Health Effects”. A problem arises in health care as products that are considered curative may not be identified as hazardous to workers. In this case information can be obtained from manufacturers, FDA or CDC (no easy feat!!) but it can be done.

Nurses should consider the inhalation of any substance used in patient care to be suspect and work with the local committees and management to insure that measures are instituted to provide for their protection. This is where the processes of elimination, substitution, engineering and administrative controls and personal protective equipment are applied. An example of elimination of a toxic product would be removal of powdered latex gloves and substitution of a non-latex non-powdered glove. An example of an engineering control is the hood that is placed over the patient’s bed to contain the drugs used in inhalation therapy or the exhaust ventilation used in the operating room to trap exhaled anesthetic gases. This same equipment would protect nurses providing post anesthesia care. An example of administrative control is the requirement of containment of construction projects to prohibit inhalation of dust and building materials such as fibers, glues, paints and other chemicals. (Epidemics of respiratory irritation have been known to follow construction projects where the materials are free to float through work spaces and air conditioning ducts). Personal protective equipment is the HEPA filter mask used when caring for a patient with active TB. While not all substances are related to respiratory irritation and asthma, infections, dermatitis, neurological and cardiac symptoms may occur from exposure to toxic substances and can have equally serious immediate and long term effects. The same occupational safety and health principles of worker protection apply.

If you have questions or have solved a problem of exposure to respiratory irritants in your worksetting, please call Evelyn Bain, M Ed, RN, COHN-S, Associate Director and Occupational Safety and Health Specialist at 781.830.5776 or email eviebain@mnarn.org