Work-related asthma
We continue our series on occupational health and safety. In this article we look at work-related asthma.
Mr. AG, a 32 year old employee of a motor manufacturing company, has been attending his family doctor for the last two years with a history of repeated chest pain and cough. The symptoms were initially only every other week, but now they are present almost every day. He now also complains of a wheeze (a whistling sound in his chest).
What is wrong with me doctor?
You have asthma.
What is asthma?
Asthma is a disease of the lungs. It occurs when the airways (windpipes) in our lungs become narrow (“closed up”). This makes your test feel tight, you become short of breath and it is difficult to breathe. The condition is not present all the time, and clears up with medication. If you have a sudden asthma attack and don’t get treated immediately, you could die.
Do you think it is from my work?
It could be. You started with vague symptoms, such as a dry cough, that took a long time to get better and chest pain. And I see from your records that you have had “acute bronchitis” a number of times over the last few years.
In the early stages, you told me that you got better when you were away from work on weekends. Now, you only see improvements when you are away from work during long holidays.
Now you are wheezing (a “whistling” sound from the chest) and you become breathless when you are involved in exercise or strenuous activity.
But when you are on medication for asthma, you get better quickly. What work do you do?
I am a spraypainter at my company. I have been doing this job for about two and a half years. I did not have asthma prior to starting work as a spraypainter. I have been provided with a mask, and I do work in a spraybooth. Could this condition have been caused by my work? My father has asthma, could I have got this from him?
“Occupational asthma” is caused by a specific exposure that is found in the workplace. Sometimes a worker can develop the condition outside the workplace. But exposure to certain things in the workplace, can aggravate this. This is then called work-aggravated asthma . Sometimes it is difficult to determine whether the condition was caused by the workplace or by factors outside the workplace. This is referred to as work-related asthma .
There are two types of asthma caused by the workplace:
(a) asthma that starts after a few weeks or months after starting work with a specific exposure (delayed onset);
(b) asthma that starts immediately after a large accidental exposure to substances such as chlorine gas or sulphur dioxide (“irritant induced”).
Is occupational asthma a common problem?
Yes, it is a major problem in this country.
What sectors are prone to it?
You find most cases in the manufacturing and chemical industries. In Numsa’s sectors, metal manufacturing and motor manufacturing are most prone to it.
What could have caused my asthma in the workplace?
There is a chemical called ” isocyanates “. You find this in spraypaints. It is one of the most important causes of occupational asthma.
What must I do to see if it is from my work?
Ask your employer to give you details of what is in the spraypaints that you use. You will find this in MSDS (Material Safety Data Sheets) on the spray paints. The employer is required to have these available and the worker is entitled to have access to this information in terms of the Hazardous Chemical Substances Regulations.
Handling of hazardous chemical substances
Box 1. Subject to section 10(3) of the Act, every person who manufactures, imports, sells or supplies any hazardous chemical substance for use at work, shall, as far as is reasonably practicable, provide the person receiving such substance, free of charge, with a material safety data sheet in the form of Annexure 1, containing all the information as contemplated in either ISO 11014 or ANSIZ400.1.1993 with regard to-
(a) product and company identification; (b) composition, information on ingredients; (c) hazards identification;(d) first-aid measures;(e) fire-fighting measures; (f) accidental release measures;(g) handling and storage; (h) exposure control/personal protection;(i) physical and chemical properties;(j) stability and reactivity;(k) toxicological information;(l) ecological information;(m) disposal considerations;(n) transport information;(o) regulatory information; and(p) other information;Provided that, where it is not reasonably practicable to provide a material safety data sheet, the manufacturer, importer, seller or supplier shall supply the receiver of any hazardous chemical substance with sufficient information to enable the user to take the necessary measures as regards the protection of health and safety
Box 2. Every employer who uses any hazardous chemical substance at work, shall be in possession of a copy of Annexure 8 or a copy of sufficient information, as contemplated is subregulation (1).
Box 3. Every employer shall make Annexure 8 or sufficient information, as contemplated in subregulation (1), available at the request of any interested or affected person.
[Reg. 9A inserted by GN R930 of 25 June 2003 ]
Will I get compensation?
The Compensation for Occupational Injuries and Diseases Act (COIDA) compensates workers if they have worked with these types of materials and have developed occupational asthma:
isocyanates
platinum, nickel, cobalt, vanadium or chromium salts
hardening agents, including epoxy resins
acrylic acids or derived acrylates
soldering or welding fumes
substances from animals or insects
fungi or spores
proteolytic enzymes
organic dust
vapours or fumes of formaldehyde, anhydrides, amines or diamines
These compounds are the most common causes of occupational asthma – isocyanates; flour dust (“baker’s asthma); grain dust; glutaraldehyde (used in photographic films); wood dust; latex (natural rubber latex); solder/colophony; laboratory animals; some glues and resins.
There are about 50 workers in my section. Not all of them have asthma. Why is this the case?
Anyone can develop the problem. But some people have a greater chance because they may have more ” risk factors “. The risk factors for occupational asthma are:
A family history of asthma (your father had asthma), eczema (a skin rash) and persistent runny nose
A childhood history of asthma
Cigarette smoking (smoking does NOT cause asthma, but increases the chance of getting the disease)
You say that I have asthma. Is there a test that you can do to establish that I do indeed have asthma?
Yes, I want to do a ” lung function test “. You must blow into a machine. (Mr AG blows) Yes, your results are lower than normal. Now you must breathe in from an asthma “pump” and I will test again after 10 minutes. (Mr. AG breathes from the asthma pump. He blows again after 10 minutes).
Your second test shows an improvement of at least 12-15%. This shows that there is a strong likelihood that you have asthma.
How do you establish that I have “occupational asthma”?
I am satisfied that you have asthma, that your symptoms are related to your work and that they started only after you were exposed to a sensitiser (isocyanates in spraypaints) and that you have a risk factor (family history).
I will test your lungs again after a long weekend, before you go back to work. I will then repeat it after the first shift and also at the end of that working week. It is called ” cross-shift “ lung function testing.
I will also give you a ” peak flow meter “. This is an instrument with a measuring gauge. You must blow into it at least five times a day – on waking up, before commencing work, two hours into the shift (or at tea-time), in the afternoon at work and finally just before going to sleep.
We must record this every day for a full two weeks (including days on which you are off work and on weekends). I will also arrange with your management to have you removed from exposure (preferably given some office work, or put on sick leave) for a further two weeks, and continue this recording. This testing is called ” serial peak flow recordings”.
I will then compare the results between the weeks when you had exposure, with the weeks when you were not exposed.
Two months later when the tests are finished, the doctor notices that Mr. AG’s results are better when he is away from work, further convincing him that this is occupational asthma.
Can you treat me for this condition?
Yes, I will give you a pump (known as an ” inhaler “). This will relieve the immediate symptoms of tight chest and difficulty breathing (” reliever medication “). Because your symptoms occur frequently, I will give you another inhaler. You must use this every day, irrespective of whether your chest is tight or not (the ” preventer medication “).
You might have to take this treatment forever if your symptoms don’t get better when you are taken away from exposure. If you start needing the “reliever medication” more often, then your condition could be deteriorating. You must visit me or another GP immediately.
What is the best thing that I can do for myself?
Get them to move you away from spray painting. If they move you immediately, there is a chance that your lung function will return to normal.
Can I get compensation?
Yes, you do qualify for compensation. For the first two years, you should receive compensation for temporary disability. This will cover any days off due to ill-health and will also cover medical expenses – the medical practitioner submits a claim for their expenses, same with the pharmacy.
Your company must process your loss of wages due to time off work via the company.
At the end of the two years, the commissioner will make a decision on permanent disability. The amount paid out will vary depending on the extent of the disability, calculated on the basis of the lung function test, starting from 10% disability upward.
(Look at Numsa Bulletin No 9 and 10, August 2003 for the details of how this is worked out)
These are many causes of asthma, including exposures at work. You can get more information on asthma at this websitehttp://www.asthma.co.za/asthma.htm
Compiled by Dr. Rajen Naidoo and Amanda Ryan
Centre for Occupational and Environmental Health, Nelson R Mandela School of Medicine.