Why awareness and prevention are vital

In 2019, 3,524 people died with asthma in the United States. As many as 21% of those deaths are attributed to exposures at work. Workplace practices have improved but still the highest number of occupational asthma deaths among men, based on a 1999-to-2016 study, occurred in the construction industry. For women, asthma deaths were highest in health care.

Fortunately, asthma-related deaths are preventable. The solution is to monitor, mitigate or eliminate exposures at the worksite. If asthma symptoms arise, removing the employee from the exposure can prevent asthma complications or reduce severity. Occupational health clinicians can provide guidance for awareness and action.

More than 300 substances used in work environments are known or suspected to cause occupational asthma. Asthma symptoms may develop shortly after exposure or over a period of weeks or months – even years. Employees with pre-existing asthma need to be monitored for any signs that the condition is worsening. Occupational health clinicians can monitor healthy employees for the signs and symptoms of new-onset asthma.

How Asthma-Related Exposures Occur in Construction

At virtually any phase of the construction process, asthma-related exposures may occur due to the composition of diverse construction materials and work conditions presenting potential risk. Different types of dust may be present during marking, excavation, concreting and other foundation work, as well as in the masonry and brick work involved in constructing walls. Isocyanates are a concern in many phases of construction, including roofing, siding and sheet metal work, mechanical work, carpentry and flooring, and electrical work. At several junctures, wood dust, asbestos, welding fumes, and chromium are other exposures construction employers should monitor.

Of all of these potential exposures, isocyanates may be the most serious. Isocyanates are a family of highly reactive, low molecular weight chemicals found in foams, fibers, paints and varnishes, and building insulation, among other construction materials. Isocyanates can sensitize construction workers in a way that makes them vulnerable to severe asthma attacks, even when subsequent exposure levels are below exposure limits.

Solvents and resins in paints and paint thinners and glues also are exposures of concern.

How Occupational Medicine Can Help

Interest in respiratory screenings and tests as part of a pre-placement, fit-for-duty or a medical surveillance exam is increasing in many industries. Here’s what to expect from an occupational health expert. First, the clinician will take an accurate health history and use an asthma screening questionnaire to learn more about exposure types and duration.

Pulmonary function testing will be done to assess different aspects of lung performance. Spirometry is comprehensive pulmonary function testing to identify serious respiratory conditions and reversible airway disease. Serial peak flow meter testing at work and away from work for the initial evaluation of occupational asthma is the next step to document if there is work-associated airflow limitation. Both of these tests can be ordered and evaluated at an occupational health clinic.

Construction leaders are encouraged to consult with occupational health experts for guidance on determining possible exposures at the worksite and then to seek information about medical surveillance exams that provide information about changes in lung function over time. There are options for mitigating the health effects of exposures. If possible, substituting construction materials that do not pose an asthma risk is best. Otherwise, limiting access to the exposure (for example, with appropriate personal protective equipment), and removing an employee with asthma symptoms from the exposure are recommended.

Communication May Be the Biggest Challenge

When construction supervisors and construction workers take steps to learn about occupational asthma and potential worksite exposures, they have taken an important first step. Asthma affects about 8% of adults generally, but it has been growing since the 1980s.

Lack of awareness may be a key factor in that growth. Researchers have discovered that only about one-third of employees with occupational asthma had any previous knowledge about work-related exposures and the fact that these exposures can cause new-onset asthma or worsen existing asthma. These researchers also reported that there is an opportunity for employers and employees to work together and enlist an occupational health expert to understand worksite exposures with asthma or other respiratory health effects and to mitigate the health effects to keep health costs down and productivity up.

According to research, primary care physicians are so overburdened and time-constrained, they frequently are unable to talk with their patients about occupational asthma exposures. Conversely, employees may not offer up the information. Only one in seven employees talk to their primary care doctor about possible work-related asthma triggers.

Building a Healthier Future

Work-related asthma can be prevented and, if not that, it can at least be well-controlled. When asthma is not well controlled, studies show that hospitalizations are almost five times more frequent and use of emergency departments nearly twice as high compared to people without asthma—factors that can increase costs significantly. But when asthma is well-controlled, hospitalization and emergency department usage rates were no different than for people without asthma. By working together, occupational health experts, construction leaders and employees can achieve better employee health, less downtime and fewer unpredictable costs—all of which are strongly valued in the construction industry.