Workplace management of respiratory conditions including asthma

Print the entire guide

Overview

Overview

A worker’s respiratory tract can come into contact with about 14,000L of air during a 40-hour working week – and physical activity will increase their breathing rate even more. Therefore, the quality of the air we breathe at work can have major implications for a worker’s respiratory health.

Any part of the respiratory tract, from the nose down to the alveoli (the tiny air sacs in the lungs), can be affected by airborne contaminants. The part of the respiratory tract affected depends on:

Airborne contaminants may be dusts, gases, vapours, or fumes.

Inhalation of airborne contaminants may immediately injure the respiratory tract and cause acute symptoms, such as shortness of breath, cough and chest tightness, and require emergency medical care – or it could lead to prolonged symptoms due to the development of irritant induced lung disease.

The extent of injury will depend on the type and dose of exposure.

Back to top

Types of respiratory disease and causative agents

Types of respiratory disease and causative agents

Table 1: Classification of occupational and exposure associated lung disease

Upper respiratory tract disorders

Disease category

Representative causative agent (Allergen)

Symptoms and further info

Nonspecific irritation

Irritant gases (eg ammonia; chlorine), fumes, dust

Symptoms include cough, nasal irritation and congestion

Rhinitis (allergic and non-allergic)

Pollens, animals, house dust mites, various chemicals

  • Symptoms include sneezing, rhinorrhoea, nasal obstruction and itching of the nose, eyes and palate
  • If due to an allergic mechanism, sneezing occurs immediately, then nasal discharge followed by nasal obstruction over a few hours

Upper airway dysfunction (vocal cord dysfunction, work associated irritable larynx syndrome)

Chemicals with a high water solubility, alkaline and acids gases, dust and mists

  • Dysfunctional behaviour of the larynx is an important and underappreciated cause of recurrent respiratory symptoms
  • It may imitate symptoms suggestive of asthma – or it may also co-exist with asthma
  • Symptoms are due to inappropriate vocal cord movement causing partial airway obstruction, especially when breathing in
  • Typical symptoms are recurrent episodes of difficulty breathing, chest tightness, throat tightness and cough
  • Frequently, episodes have a rapid onset
Airway disorders

Disease category

Representative causative agent (Allergen)

Symptoms and further info

Occupational asthma - Sensitiser induced asthma / Reactive airways dysfunction syndrome

Currently there are over 400 known respiratory sensitising agents (substances that cause an allergic asthmatic response)

Examples include:

  • Some volatile organic compounds such as formaldehyde, aldehydes, rosin fume
  • Isocyanates (chemicals mainly used to make polyurethane products, such as rigid and flexible foams, paint coatings, adhesives and sealants)
  • wood dust (eg western red cedar, redwood, oak etc)
  • flour
  • animals
  • Occupational asthma is the development of new onset asthma (or the recurrence of pre-existing asthma) due to an exposure specific to a workplace
  • Occupational asthma is the most common occupational lung disease in developed countries. Over 90% is sensitiser induced
  • There is a clear association between occupational allergic rhinitis and asthma
  • Asthma affects the lung’s bronchioles (small airways), causing tightening of muscles around the airways (bronchospasm). During the asthma attack, the airway’s lining also becomes swollen / inflamed producing lots of thicker mucus. Symptoms often vary from person to person, but they are most commonly breathlessness, wheezing, chest tightness and continuing cough. If the asthma symptoms are worse during the working week (and improve on weekends or when away from work), then the worker may be experiencing occupational asthma
  • Occupational asthma is generally characterised by a period of latency between first exposure to the substance and development of asthma symptoms, which may vary from a few weeks to several years

Occupational asthma - Irritant induced asthma

Examples include:

  • Irritant dusts and gases
  • smoke
  • Irritant induced asthma is a common condition that is influenced by environmental exposures – including at the workplace
  • Irritant induced asthma affects and symptoms are the same as for sensitiser induced asthma
  • There is no latency period between exposure and development of symptoms – can happen within minutes to hours of the exposure

Reactive airways dysfunction syndrome (RADS)

Irritant gases, corrosive mists or solvent vapours

  • RADS is the clearest example of irritant induced occupational asthma
  • Recurrent lower levels of irritant exposure may also lead to the development of irritant induced occupational asthma
  • Often occurs as part of an industrial accident or spillage
  • Symptoms include temporary breathlessness and a wheeze similar to asthma that usually occur within 24 hours of a single exposure
  • Usually, symptoms will gradually improve as the airways heal, but occasionally, workers can be left with permanent symptoms

Work exacerbated asthma

Irritants (eg cotton dust), fumes, exertion, cold air, emotion

  • Refers to worsening of pre-existing asthma due to workplace factors (eg inhalation of airborne substances, physical exertion or exposure to cold air)
  • Occurs in an estimated 22% of adults with asthma

Chronic bronchitis / chronic obstructive pulmonary disease (COPD)

Irritants, mineral dust, coal, welding fumes, organic dusts, grain and flour dusts

  • Often, there may be a period of latency (inactivity) between the actual exposure and the development of the disease, which can vary from years to decades
  • Chronic respiratory diseases (eg COPD, pulmonary fibrosis and bronchiectasis) are likely to damage the respiratory tract defence mechanisms, causing the worker to be more susceptible to the effects of adverse exposures

Byssinosis

Inhalation of cotton dust, or dusts from other vegetable fibres (such as flax, hemp and sisal)

  • This disease is a form of reactive airways disease characterised by bronchoconstriction
  • Byssinosis manifests with asthmatic like symptoms, tightness in the chest along with wheezing and coughing

Bronchiolitis

Noxious chemicals such as oxides of nitrogen, Diacetyl (‘popcorn worker’s lung’)

  • This disease is an inflammation of the lung’s bronchioles
  • Diacetyl is a chemical used to produce artificial butter flavouring and is found in many products. Inhalation may cause bronchiolitis obliterans (extensive scarring that blocks the airways)
  • First symptoms resemble a common cold (runny nose, mild cough, nasal stuffiness) that may last 1-2 days
  • Then followed by increased breathing problems, eg increased breathing rate; poor appetite; wheezing; and fever)

Acute inhalation injuries

Disease category

Representative causative agent (Allergen)

Symptoms and further info

Toxic pneumonitis

Inhalation of metal fumes, or toxic gases and vapours

  • Toxic pneumonitis is acute inflammation of the lungs
  • The two types of pulmonary agents:
    • Central: are water soluble and injure the upper airways (ammonia gas, hydrogen chloride)
    • Peripheral: are less water soluble and penetrate into the deeper lung areas (ozone, phosgene, oxides of nitrogen). This can give rise to pulmonary oedema (excess fluid in the lungs) which can be delayed and fatal

Metal fume fever

Metal oxides, oxides (zinc, magnesium, silver, gold, beryllium, cadmium, cobalt, copper, etc

  • Signs and symptoms are nonspecific but are generally flu-like and include fever, chills, nausea, headache, fatigue, muscle aches, joint pains, lack of appetite, shortness of breath, pneumonia, chest pain, and cough
  • A sweet or metallic taste in the mouth may also be reported along with a dry or irritated throat which may lead to hoarseness
  • Symptoms of a more severe metal toxicity may include a burning sensation in the body, shock, no urine output, collapse, convulsions, shortness of breath, yellow eyes or yellow skin, rash, vomiting and watery or bloody diarrhea, all of which require prompt medical attention

Smoke inhalation

Combustible products (carbon monoxide, oxides of nitrogen, formaldehyde, hydrogen cyanide, etc)

Smoke particulate containing absorbed irritants and carcinogenic polycyclic aromatic hydrocarbons (PAHs)

  • Severe smoke inhalation can prove fatal as the gases of combustion can lead to chemical asphyxiation (particularly cyanide and carbon monoxide)
  • Also, the particulate matter breathed in can mechanically obstruct the lung’s small airways, leading to asphyxiation
  • Severe irritation of the lung can lead to pulmonary oedema
Malignancies

Disease category

Representative causative agent (Allergen)

Symptoms and further info

Sino-Nasal Cancer

Wood dust

Often, there may be a period of latency (inactivity) between the actual exposure and the development of disease, which might take decades. However, the inhalation of radioactive materials can induce sino-nasal and lung cancer reasonably rapidly.

Lung Cancer

Asbestos, radon, silica dust

Mesothelioma

Asbestos

Further respiratory injuries and illness

Disease category

Representative causative agent (Allergen)

Symptoms and further info

Hypersensitivity pnueumonitis

Bacteria, fungi, animal and plant proteins

  • This is a complex syndrome caused by an immunological reaction to an inhaled agent. Can be acute of chronic
  • Acute symptoms may mimic an infective process, and include fevers, chills, malaise, cough and shortness of breath. Symptoms generally subside within hours or a few days of removal from the exposure
  • Chronic symptoms may include features of pulmonary fibrosis such as difficult or uncomfortable breathing
  • Some industries and exposure associated with hypersensitivity pneumonitis include:
    • farming (‘farmer’s lung’, ‘mushroom worker’s lung’)
    • bird or poultry handling (‘bird breeder/fancier’s lung’)
    • water-related contamination (‘humidifier lung’)
    • grain processing (wheat weevil disease)
    • plastics industry workers
    • textile workers

Infectious disorders

Bacteria (eg legionella), pneumonia, tuberculosis, viruses

More information can be obtained from NSW Health and Dept of Primary industries.

Pneumoconiosis

Asbestos, silica, coal

Often, there may be a period of latency (inactivity) between the actual exposure and the development of disease, which might take decades. There are very rare cases where pneumoconiosis can be relatively rapid and take a year or less.

Non-specific building related illness (‘Sick building syndrome’)

  • Some volatile organic compounds from new paint, office furniture and cleaning products
  • Formaldehyde, aldehydes
  • Mould spores, bacteria
  • Fungal endotoxin
  • Inadequate air circulation

The main identifying observation is an increased incidence of workers reporting symptoms such as headache, eye, nose, throat irritation, fatigue, dizziness and nausea.

Adapted from RACGP website article, “Respiratory problems”; Occupational and environmental exposures; Volume 41, No.11, November 2012 Pages 856-860 (initially adapted from Fishman AP, editor. Fishman’s Pulmonary Diseases and Disorders. 4th edn. New York: McGraw Hill, 2008)

Back to top

Managing respiratory conditions in the workplace

Managing respiratory conditions in the workplace

Failure to correctly manage workplace respiratory hazards may put workers at risk of exposure to these preventable occupational diseases. It can also lead to an at-risk worker suffering ongoing respiratory difficulties, the need for higher doses of medication and a substantial, possibly irreversible, decline in lung function and associated disability.

It is important that there is communication between the PCBU, worker, treating physician and health and safety representative (where applicable) to ensure respiratory hazards and conditions, whether pre-existing or otherwise, are effectively managed.

Where necessary, consult with building managers and other relevant parties – it’s more likely that suitable, long term solutions to the problem can be found when everyone works together.

In complex situations, PCBUs should establish a clearer picture of the issue by obtaining the services of an appropriately qualified person (such as an occupational hygienist with skills in air quality) and then appropriate control measures can be developed in consultation with the affected workers. In these situations, the workplace conditions may need to be monitored and recorded as part of the workplace risk management program.

Identify hazards

Effective control and management of respiratory conditions, including asthma, starts with recognising potential sources.

Identify workplace activities that may put someone at risk of exposure. Talk (consult) with all of your workers about anything that could result in them being exposed to a respiratory illness. Analyse workplace incident reports. Check audits of the workplace layout and work practices. There may be a need for a competent person such as an occupational hygienist to assist in the identification process.

Consider who is at risk. Do you have any workers with pre-existing respiratory conditions?

Assess risks

To assess the risks of exposure to a respiratory illness, take into account:

Control risks

To control the risks, follow the hierarchy of controls as much as possible. Use higher level controls first. Only use administrative controls and PPE to supplement the higher controls you’ve implemented. A combination of controls can be used.

Eliminate the hazard

Isolate the hazard

To reduce the number of people exposed:

Substitute the hazard

Engineering controls

Administrative controls

Administrative controls and personal protective equipment should be part of a comprehensive control program – not the sole strategy for reducing exposure to respiratory hazards.

Administrative controls don’t remove the hazards - they limit or prevent people's exposure to them, and can include:

Personal protective equipment (PPE)

Back to top

Work health assessments

Work health assessments

Work health assessments determine existing conditions, capabilities or other factors that could pre-dispose a person to possible ill-health by matching their physical and mental capabilities to the requirements of a specified task/s.

Everyone – the worker, PCBU and treating doctor – is a key participant in this process and has an important role to play in achieving a successful outcome from the health assessment.

Work health assessments can be carried out:

There is no ‘one size fits all’ approach – work health assessments should involve specific tests and screening required for the identified respiratory hazards at the PCBUs workplace, such as spirometry and lung function tests.

SafeWork NSW recommends that, as far as is reasonably practicable, work health respiratory assessments are done by an occupational physician. Referral to a physician will assist with further investigations, establishing a diagnosis and developing a workplace respiratory management plan if required.

The physician should obtain information from the PCBU about the workplace, such as identified hazards; required tasks; length of shifts; current controls in place; etc. It is highly recommended the physician visits the workplace to obtain direct and visual information for their assessment. If the worker is asthmatic the physician should also review the worker’s inhaler technique and adherence – and, if poor, advise how to correct and/or improve it.

When the results of the worker’s health assessment is known, it is vital that the worker, their PCBU and physician / treating doctor work closely together to develop a workplace asthma management plan for the worker that includes strategies to reduce exposure to workplace triggers and irritants.

SafeWork NSW acknowledges that in many areas of NSW, it can be difficult to access to such specialists in a timely manner. The Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Faculty of Occupational and Environmental Medicine (AFOEM) can provide assistance in locating specialists.

Back to top

Workplace respiratory management plans

Workplace respiratory management plans

Workplace respiratory management plans, including workplace asthma management plans should document specific advice for both the worker and PCBU about how to effectively manage the respiratory condition at the workplace, and should include:

The PCBU should frequently talk with the worker about their respiratory condition to ensure the plan is effective. These discussions may be required more frequently for workers undertaking new tasks; working in new areas; or during changing weather conditions (outdoor workers).

A copy of the worker’s workplace respiratory management plan should be provided to the Safety Officer, first aid officer and Health and Safety Representatives (where applicable).

Back to top

Workplace emergency respiratory management kits

Workplace emergency respiratory management kits

Workplace asthma emergency kits help to manage asthma flare-ups in the workplace.

They should be located throughout the workplace in high-risk areas. They can also be located in a ‘bum-bag’ worn by first aiders, to be more mobile and easily accessed in an emergency.

The contents of these kits should be as recommended by Asthma Australia and should include:

Ensure there is an effective system in place to regularly check that the contents of each kit is in-date, undamaged and ready for use.

Back to top

What at-risk workers can do

What at-risk workers can do

Don't ignore symptoms or delay seeking help - prompt action is required.

Back to top

What other workers can do

What other workers can do

Back to top

Further information

Further information

NSW Health

Website: http://www.health.nsw.gov.au/Pages/default.aspx

Phone:  (02) 9392 9000

Australian Institute of Occupational Hygienists

Website: https://www.aioh.org.au

Phone:  (03) 9338 1635

Thoracic Society of Australia and New Zealand (TSANZ)

Website: https://www.thoracic.org.au

Phone: (02) 9222 6200

Australasian Faculty of Occupational and Environmental Medicine (AFOEM)

Website: https://www.racp.edu.au

Phone: (02) 9256 5444

Asthma Australia (includes NSW Asthma Foundation)

Website: https://www.asthmaaustralia.org.au/nsw/home

Phone: 1800 ASTHMA (1800 278 462)

Dept of Primary industries

Website: http://www.dpi.nsw.gov.au

Phone: (02) 6391 3100

Back to top

Back to top