WNYLaborToday.com Editor’s Note: The Center for Occupational & Environmental Medicine (COEM), located at Buffalo’s Erie County Medical Center (ECMC), is available to Workers both Union and non, providing care to those who are injured, impaired or who develop an illness as a result of workplace factors – which may include exposure issues, physical injuries, or any other job hazard.  The COEM is also a New York State Department of Health-funded Clinic for the diagnosis and treatment of occupational injuries and illnesses for Workers living in the five counties of Western New York.  The COEM also offers services for any Worker with other job-related medical needs, such as physicals required for employment or licensure - and they assist with completion of paper work for Worker Compensation Claims. With state-of-the-art diagnostic equipment and a highly-skilled and caring Staff, the COEM’s Health Care Services meet U.S. Occupational Safety & Health Administration (OSHA), U.S. Environmental Protection Agency (EPA) and Department of Health Safety Standards.  The COEM takes a different approach to the treatment of injured Workers through prevention, early diagnosis and treatment.  Opened in 2015, the COEM was developed with great support from Western New York Labor Unions and their Leadership.  The COEM, which is open Monday through Friday - 9 a.m. through 5 p.m., can be reached at 716-898-5858.

The author of this article is Nellie Brown (pictured below), who serves as the Director of the Workplace Health and Safety Program, a Statewide Program of the Worker Institute at Cornell University’s School of Industrial and Labor Relations.  Nellie provides Industrial Hygiene Services for the COEM.

Occupational Asthma is asthma due to work exposures.  It can be caused by a specific workplace agent with a specific immune system response – the agent is called a sensitizer. 

It has been recommended that whenever an adult experiences new-onset asthma, Occupational Asthma should be suspected.

The respiratory symptoms of Occupational Asthma include wheezing, shortness of breath, chest tightness, cough, and sputum production.

While these are similar to asthma that is not work-related, these symptoms occur due to a work-related exposure.

So, how much exposure to a sensitizer is needed for a person to experience asthma symptoms?

This can vary a great deal, both as to the amount of allergen needing to be inhaled to trigger the asthmatic attack or the amount of time the person has been doing the job with that exposure.

For some sensitizers and Workers, the symptoms may occur quickly upon the person’s first exposures to the sensitizer.

I’ve known of two workplaces using isocyanates to make polyurethane foam where Workers became exposed on their first few days of doing the job.

For some exposures, symptoms may not appear until after a latency period – this time period could range from weeks to years after the first exposure.

For example, 30 years’ exposure to flour may be needed for a Baker to develop asthma.  While the symptoms occur due to exposure at the job, symptoms may appear at the beginning of the work shift, toward its end or even in the evening after working hours.

Typically, on days away from work, a person will improve or have no symptoms at all.

It is important to note that shiftwork disrupts circadian rhythm and, among its many adverse effects, may also affect asthma symptoms and/or the performance of asthma medications.

What kinds of potential allergens could a person encounter at work?

Workplace exposure could include airborne gases, vapors, aerosols, fumes, dusts, or fibers.  Sensitizers could include chemicals that are very small (low-molecular-weight) or large (high-molecular-weight), as well as chemicals produced by living organisms or pieces of organisms. Below are some examples of allergens with their typical occupations (Please note that this is not an exhaustive list.)

Unfortunately, even several years after removal from exposure, approximately 70% of people with Occupational Asthma can still experience asthma symptoms.

So, the best approach is to be diagnosed early, before the asthma becomes severe, and to identify the allergen and reduce/stop the exposure.

How could exposure to a workplace sensitizer be reduced or stopped?

Depending upon how the allergen is used or exposure occurs, reducing or stopping a workplace exposure could include: Using an alternative chemical to the allergen; Changing from a dry to a wet process for dust control; Using local exhaust ventilation to reduce exposure; Enclosing the work process to capture the allergen; Using measures to decrease the likelihood of a chemical leak or its impact using respiratory protection; and Placement in a different job, away from the allergen.

Also remember that under the Americans with Disabilities Act (ADA), a Worker can request that the employer accommodate his/her Occupational Asthma. 

The above examples for reducing or eliminating occupational exposure could be used for reasonable accommodation.

Under the ADA, an employer may require that an individual not pose a “direct threat” to the health or safety of himself/herself or others.

However, this must be a “significant risk of substantial harm” - employers cannot deny an employment opportunity merely because of a slightly-increased risk. 

Assessing “direct threat” must be strictly based on valid medical analyses and/or other objective evidence and must apply to all Employees (and job applicants).

But, a different standard of risk may be considered in those cases where risk to the public or other Workers is present, as opposed to a risk limited to the Worker.

Each person must be evaluated as an individual - different people experience asthma with differing responses as to how quickly or severely they are affected, as well as what an asthmatic reaction at work would entail.

For example, is the person a Clerical Worker near good medical facilities, or a Police Officer, Firefighter or Airline Pilot during the performance of his/her professional duties?

A medical evaluation needs to be specific, rather than a general statement such as the individual “may not be exposed to gases, mists, or fumes.”

If a direct threat exists, the employer must first try to eliminate or reduce the risk to an acceptable level with reasonable accommodation.

But, if an effective accommodation to a direct threat cannot be found, the employer may discharge an Employee (or may refuse to hire a job applicant).

What if a Worker has asthma that is not caused by a workplace sensitizer?

Sometimes a workplace exposure, such as an irritant, can trigger an episode of asthma for an Employee with non-Occupational Asthma.

Also, there are symptoms that mimic asthma, such as irritable larynx syndrome.

So, even non-work-related asthma can affect the ability to work.