Primary prevention
Occupational asthma (OA) is addressed in specific US Occupational Safety and Health Administration (OSHA) standards (personal protective equipment, toxic, and hazardous substances) for general industry. OSHA: occupational asthma - standards Opens in new window
The UK Health and Safety Executive provides guidance on the prevention of asthma in the workplace. Health and Safety Executive: occupational asthma and rhinitis Opens in new window
Workplace surveillance to reduce OA incidence includes improved worker education, hazard identification, and engineering controls.[36][52][53] A combination of primary and secondary preventive measures to reduce exposures relevant to asthma have been associated with reduced incidence of OA.[14][54]
Primary prevention of sensitizer-induced OA[36][52][55][56][57]
Exposure to sensitizers is prevented by:
Use of nonsensitizers such as synthetic or low-protein, powder-free latex gloves in health care
Use of robotics and isolated areas of potential airborne exposures such as in polyurethane foam manufacture (diisocyanates)
Use of air-supply respirators such as for spray painting (diisocyanates/amines)
Other occupational hygiene measures to reduce exposure
Prevention of irritant-induced OA[36][55]
Occupational hygiene measures should be in place to provide adequate ventilation in work areas where potential respiratory irritants are used.
Workers should have workplace training as to safe handling of chemicals to reduce risks of spills and mixing of incompatible chemicals.
Appropriate respiratory protective devices should be provided to those with potential for exposure to respiratory irritants, with education and fit testing, and ensuring that the devices are used when appropriate.
Worker education should include the appropriate measures to take in the event of an accident/fire in the workplace, to minimize irritant respiratory exposures.
Secondary prevention
Early detection of sensitizer-induced OA necessitates educating workers to seek attention for new nasal or asthma symptoms and, as appropriate, a workplace medical surveillance program. Medical screening aims to detect disease in a person at an early stage, often before symptoms, while medical surveillance assesses the health status of a population for the purpose of disease prevention. CDC: about work-related asthma Opens in new window
Medical surveillance may be initiated for workers considered to be at risk of developing sensitizer-induced OA due to their work exposure.[103][104] This may be initiated by a government-mandated program or may be initiated by an employer. A program may include a respiratory questionnaire, skin testing or serum testing for specific immunoglobulin E (IgE) antibodies for a work sensitizer (though the allergens available for this are limited), and spirometry, both before placement and at intervals during employment.[22][105] Details of timing and frequency may vary depending on risks.
Preplacement screening is advised rather than pre-employment screening, which may violate the potential worker’s rights. Positive findings on preplacement screening may lead to alternative placement. Positive findings during employment that may indicate OA should lead to early referral for detailed investigations.
A combination of primary and secondary preventive measures to reduce exposures relevant to asthma have been associated with reduced incidence of OA.[14][54]
Tertiary prevention aims to minimize morbidity through early removal of the patient from further exposure to a relevant work sensitizer after diagnosis (for sensitizer-induced OA), avoidance of significant respiratory irritant exposures, and optimal environmental and pharmacologic management of asthma.
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