Occupational and Work-Related Asthma

Overview

Asthma is a disease that affects your airways, making it hard to breathe. When asthma begins or gets worse because of your job, healthcare providers may diagnose work-related asthma. For 15% to 33% of adult-onset asthma, their asthma is work-related.

Work-related asthma has two categories:

  • Occupational asthma starts due to inhaling (breathing in) irritants in the workplace.
  • Work-exacerbated asthma is when existing asthma gets worse from exposure to substances at work.

Who gets occupational asthma?

Anyone who spends a significant time around common irritants can develop occupational asthma. But some careers have a higher risk because of frequent contact. These careers can include:

  • Bakers who may get “baker’s lung” after breathing in flour and grain dust over a long period.
  • Farmers, grain elevator workers or millers.
  • Healthcare workers who breathe in powder from latex gloves or other chemicals.
  • Laboratory workers who deal with animals.
  • Pharmaceutical workers with exposure to airborne particles of drugs.
  • Maintenance or cleaning occupations with exposure to chemicals from cleaning products.
  • People who work with metals, plastics or wood.

Symptoms and Causes

What causes occupational asthma?

People who work around common irritants can develop occupational asthma. More than 300 known substances can cause or worsen asthma. These substances are called irritants or triggers. When you breathe in these irritants, they can cause asthma in one of three different ways:

  • Allergic reaction, when your immune system overreacts to a substance.
  • Irritant reaction, when the substance you inhale irritates your airways.
  • A buildup of chemicals that your body makes naturally, such as histamines or acetylcholine, causing airways to tighten.

Irritants can come in many forms. Some occupational asthma irritants include:

  • Animal dander or hair.
  • Building materials, such as insulation, carpeting and foam.
  • Chemicals, such as glues, coatings, dyes or plastics.
  • Grain dust.
  • Wood dust.

What are occupational asthma symptoms?

Occupational asthma has the same kinds of symptoms as other asthma. Typical symptoms may include:

Signs of occupational asthma tend to get better when you stay away from work for a while. If you notice your symptoms get better when you go on vacation or take a weekend off, they may be happening because of workplace irritants.

Does occupational asthma cause asthma attacks?

Yes, occupational asthma can cause an attack. As you breathe in irritants, airways become inflamed and swollen. During an asthma attack, three things happen:

  • Bronchospasm: Muscles tighten around your airways, making them narrow. Air cannot flow freely through constricted airways.
  • Inflammation: Airway linings swell and don’t let as much air in or out of the lungs.
  • Mucus production: Your body creates thick mucus that clogs airways.

When is an asthma attack an emergency?

If you have a severe asthma attack, you need immediate medical care. The first step is using a rescue inhaler, which provides fast-acting medicines to help you breathe. A rescue inhaler and a maintenance inhaler are not the same. You use maintenance inhalers every day and rescue inhalers only in an emergency.

If your rescue inhaler doesn’t help or you don’t have it with you, go to the nearest emergency department if you have:

  • Bluish lips or fingernails (in lighter-skinned people) or gray or white lips and gums (in darker-skinned people).
  • Feelings of anxiousness or panic.
  • Pressure or pain in the chest.
  • Severe wheezing or coughing that won’t stop.
  • Trouble talking.
  • Very rapid breathing.

Diagnosis and Tests

How do I know if my asthma is occupational?

Signs of occupational asthma tend to get better when you’re away from work. If you notice symptoms getting better on the weekend or vacation, you can talk to your provider. They can refer you to an allergist. These specialists help with asthma.

Symptoms don’t always get better after leaving work. And you may develop occupational asthma even if you use respirators or personal protective equipment. It may take a few weeks away from the trigger to notice any improvement.

How is occupational asthma diagnosed?

An allergy and immunology specialist or pulmonologist can diagnose occupational asthma. This specialist will ask you several questions about your medical history. They will need to know where you have worked and what jobs you had. This information gives your healthcare provider clues about what might be triggering asthma attacks.

Before your appointment, it can be helpful to keep a log of when you have symptoms. Then you and your provider can compare the times you have symptoms to your work schedule. Knowing when you have the worst symptoms will help your provider determine if you have work-related asthma.

You’ll also have a complete physical exam. This exam can rule out other conditions that could be causing your symptoms, such as chronic sinusitis, gastroesophageal reflux disorder (GERD) or obstructive sleep apnea.

It’s important to get care early if you suspect you might have occupational asthma. Continued exposure to irritants could damage your lungs permanently.

What tests do doctors use to find occupational asthma?

An allergy and immunology specialist uses specific tests to find out how well your lungs work. These tests show the healthcare provider how irritants affect your lungs. The tests might include:

  • Blood tests, which measure antibodies to specific allergens.
  • Peak flow meter, which measures how fast air comes out of your lungs when you exhale.
  • Skin tests, which check for allergies to specific substances.
  • Spirometry, a lung-function test that measures how well air flows through your lungs.

Management and Treatment

How do doctors treat occupational asthma?

If your healthcare provider diagnoses you with occupational asthma, you can manage it. Your provider may recommend medications to control or prevent symptoms. Depending on the type of medicine, you may breathe in the drugs or take them by mouth. A metered-dose inhaler, nebulizer or other inhaler delivers some medication when you breathe it.

What can my workplace do to help?

You and your employer can find ways for you to avoid irritants. These changes may include reassignment to another location. The National Institute for Occupational Safety and Health recommends:

  • Safety policies: All businesses whose workers handle common irritants should develop policies to protect employees.
  • Proper ventilation: Employers should install appropriate ventilation to remove irritants and circulate fresh air.
  • Substitutions for hazardous materials: If possible, companies should find lower-risk alternatives.
  • Training: Workplace training covering prevention techniques, policies and reporting problems can protect employees.

Is there a cure for occupational asthma?

Just like “regular” asthma, there is no cure for occupational asthma. But you can control it by avoiding triggers and using medicines correctly. Both actions can cut down the number and severity of attacks.

Prevention

How can I reduce my risk of developing occupational asthma?

The most important thing you can do to avoid developing occupational asthma is to avoid breathing in common irritants. Respirators and personal protective equipment can help. But even with protection, it’s important to have proper ventilation when working with irritants.

If protection doesn’t help, you may need to talk with your employer about a new assignment where you don’t have to be around irritants. In severe cases, you may need to change jobs to protect your health.

Outlook / Prognosis

What is the outlook for someone with occupational asthma?

With treatment, many people live productive lives with occupational asthma. The most challenging part of work-related asthma can be reducing your exposure to irritants. Medication can help, but if you have constant exposure to triggers, you may continue to experience symptoms.

If you reduce or eliminate your exposure to irritants, you are more likely to be able to live symptom-free. Talk to your healthcare provider to learn what triggers your asthma and find ways to control it.

Living With

Does occupational asthma mean someone needs to find a new job?

You may not need to find a new job if you and your employer can find ways to reduce your exposure. Working with your employer and your healthcare provider can help you stay safe.

Are there protections for employees?

A federal agency, the Occupational Safety and Health Administration (OSHA), sets occupational asthma prevention guidelines. All employers must follow these guidelines that limit workers’ exposure to asthma-causing substances. If you believe your employer isn’t following these guidelines, you can contact OSHA for help.

Your job may require you to use some potential irritants. If you do, you and your employer should find a way to work safely.

When should I see a doctor about occupational asthma?

If you notice any asthma symptoms when you’re at work, you should talk to your healthcare provider. They can help you determine the cause and find ways to help you prevent it.

Your provider can suggest how to discuss a diagnosis with your employer. They will offer ways to prevent further exposure and damage from occupational asthma.

A note from Cleveland Clinic

Occupational asthma can be life-threatening. Even if it's only an occasional nuisance, it’s troubling when your job makes you unwell. However, with the right tools and protection, you can control occupational asthma. Talk with your healthcare provider if you notice asthma symptoms when you are at work, and ask your employer about an asthma surveillance program to protect your health.

Last reviewed by a Cleveland Clinic medical professional on 05/18/2021.

References

  • American College of Allergy, Asthma and Immunology. Occupational Asthma. (https://acaai.org/asthma/types-asthma/occupational-asthma) Accessed 5/28/2021.
  • Centers for Disease Control and Prevention. Work-Related Asthma. (https://www.cdc.gov/niosh/topics/asthma/employers.html) Accessed 5/28/2021.
  • Lau A, Tarlo SM. Update on the Management of Occupational Asthma and Work-Exacerbated Asthma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340795/) Allergy, Asthma & Immunology Research. 2019;11(2):188-200. Accessed 5/28/2021.
  • Obase Y, Shimoda T, Mitsuta K, et al. Two patients with occupational asthma who returned to work with dust respirators. (https://oem.bmj.com/content/oemed/57/1/62.full.pdf) Occupational and Environmental Medicine. 2000;57:62-64. Accessed 5/28/2021.
  • Occupational Health and Safety Administration. Occupational Asthma. (https://www.osha.gov/occupational-asthma) Accessed 5/28/2021.

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