Occupational asthma does not necessarily depend on allergies
Occupational asthma is not always related to allergic reactions. Allergenic substances in the workplace that stimulate the sensory nerves at the back of the throat cause asthma complications. In this way, some of the motivational reactions caused by the work environment are clarified. In addition, many asthmatic reactions related to the workplace are not yet known, and are in the early stages of research.
The risk of asthma is higher in allergic people
People with allergies are more prone to occupational asthma. People who are not allergic can also develop occupational asthma, but the severity of symptoms seems to occur after long periods of exposure to the irritant in the workplace.
Delayed asthma attack
Asthma attack caused by work environment is slightly different from asthma attack in other conditions. Symptoms may occur within minutes of exposure to the workplace, and often in such situations, the use of an inhaled bronchodilator is beneficial. However, for a late asthmatic reaction (between four and six hours), the effect of inhaled bronchodilators is not very noticeable. Delayed reactions may be caused by inflammation of the respiratory tracts, not the contraction of the muscles of these tracts. Inhaled bronchodilators and theophylline do not improve these late reactions, but steroid use is effective in these conditions. Steroids are unable to eliminate wheezing that occurs immediately after exposure to workplace irritants. But it should be known that cromolyn sodium (Intal) resolves immediate reactions and late reactions caused by proximity to allergens or stimulants in the work environment.
It is very important to write a career and environmental record
There is no exact test that can definitely justify the cause of an asthma attack as a result of proximity to irritants or allergens in the environment. Therefore, it is important to collect all the information that can help the doctor in correct diagnosis. For example, it has been reported that the inhalation of barley flour brought to the workplace by the wind from the mill has caused asthma symptoms, which are not related to allergens in the workplace. Therefore, the possibility of proximity to industrial stimulants near home or workplace should be considered. Also, in case of proximity to other allergenic materials, such as materials used in gardening, photography, and painting, the doctor should be informed, because it is possible that these occupations may cause asthma symptoms. Symptoms of occupational asthma can be limited to coughing. Other symptoms often associated with occupational asthma may resemble other allergy symptoms such as red and itchy eyes (conjunctivitis), sore throat, or runny nose.
There are no exact tests on propellants
Sometimes, a skin or blood test (RAST test) is helpful, but often there is no specific test to detect allergens or triggers. Only a few known occupational allergens are available for testing.
Breath test
The result of a respiratory test (spirometry) of a person suffering from occupational asthma may be normal, like other types of asthma. Usually, if a spirometry test is performed during an asthma attack, lung function deficiency is seen. If the patient’s breathing test improves after using inhaled bronchodilator, it indicates that the patient has asthma. If the symptoms are due to delayed reactions of asthma, usually the ameliorating effect of bronchodilators is insignificant; In such a situation, a short course of steroids is prescribed to improve the symptoms, and the breathing test is performed again in another day. If the contact with the irritant in the workplace lasts for a long time (for example, several years), it is possible that the airways become blocked. Diagnosing occupational asthma in the early stages is very important, because the doctor can give appropriate recommendations to the patient by periodically performing breathing tests.
Testing respiratory tracts with stimulants in the work environment
One of the ways to find the stimulating substance is to inhale that substance and perform a breathing test after a few hours, which is called a “bronchial stimulation test”. Of course, this experiment is not without risks; Because it can cause a severe decrease in the activity of the respiratory tracts of some patients. Therefore, this test should be performed under the supervision of a specialist, who has the necessary facilities to deal with any possible danger.
Breathing test (spirometry) is usually lower than normal in cigra addicts.
Smoking addiction makes the diagnosis of occupational asthma difficult, because the breath test of smokers is often abnormal. For example, bronchial tests are often lower than normal in smokers. Obviously, the symptoms of occupational asthma are worsened by smoking.
Jobs that can cause asthma
Signs that may appear in industrial centers as well as in stores are:
(a) Symptoms that may occur in meat packing areas due to the gas emitted from the decomposition of plastic chloride polymer (PVC) (during meat packing, the plastic is cut using high heat and its head (b) symptoms caused by inhaling flour in bakeries and confectioneries that are not properly ventilated; d) Symptoms caused by contact with the chemical toluene diisocyanate (TDI).
Identifying the stimulant and how to avoid it
The treatment of occupational asthma, like other cases of the disease, is to avoid contact with the irritant. Compliance with this issue is difficult and expensive for industrial societies. However, employers should warn workers with asthma about the risk of exposure to these substances. Once a hazard from a chemical or other substance has been identified, the employer must take measures to prevent the hazard—for example, control openings that allow the release of the irritant. No substitute for complete ventilation has yet been developed, nor is any means known to keep exposure to propellants to an acceptable level. Face masks can also be useful, but they are not comfortable to wear and often cause problems in vision and breathing.
Changing jobs is not easy
A worker with occupational asthma may not be able to change jobs easily. Because in addition to economic issues and problems, his work experience may not be applicable in other factories. Efforts should be made to use deliberate methods in these cases so that the worker can change his job. When this is not possible, the doctor must prescribe preventive drugs to help the patient deal with stimulants. If the patient remains in the same workshop, all the doctor’s orders should be followed carefully, and breathing tests should be performed regularly.
Selected asthma medications
All asthma medications should be considered in the treatment of occupational asthma. Cromolyn sodium (Intal) is the best medicine for some patients; Because it prevents immediate reactions as well as late reactions to occupational stimulants, and it is steroid-free. But this drug alone may not be enough to control asthma symptoms. Drugs that can be substituted for cromolyn include: (a) theophylline – which, if used continuously to keep the airways open, can control immediate asthmatic reactions to occupational irritants; But it is ineffective in late reactions. (b) Inhaled bronchodilators – if used before entering the workplace, it is possible to control immediate reactions, but it does not control late symptoms. (c) inhaled or oral steroid drugs – can prevent late reactions of asthma. But it does not prevent the immediate reactions of asthma. The combination of theophylline or an inhaled bronchodilator with steroids is considered to control immediate and late reactions, usually as a replacement for or in addition to cromolyn. As mentioned, oral steroids are a last resort, and should be reserved for when theophylline and epinephrine-like bronchodilators are ineffective.
If there is a risk of remaining shortness of breath, the best way is to change the work environment.
Continuing to work in a place that clearly causes symptoms of asthma, even with precautions taken for prevention, poses a very great risk; In such a situation, asthma may eventually lead to permanent narrowing of the airways. Therefore, a person suffering from occupational asthma should be aware of all the risks caused by his work environment. According to the latest researches, the most suitable solution is to change the work environment
