IAQ and Occupational Asthma
As a first step in looking at indoor air quality, employers would be well advised to examine NIOSH's eight-point plan for improving IAQ.
- By Andrew Sibley
- Apr 01, 2012
We may not like going to work, but we expect the buildings in which we work to provide a safe and healthy environment. That's not always the case, however. Some buildings, particularly older buildings dating back 20 years or more, can suffer from Sick Building Syndrome (SBS), which has been officially recognized as a health issue by the World Health Organization.
It causes a variety of illnesses and conditions that range from eye, nose, and throat irritation to headaches, dry cough, dry or itchy skin, dizziness, nausea, difficulty in concentrating, fatigue, and sensitivity to odors, according to the Environmental Protection Agency.
SBS is a hidden epidemic with a very real human cost because we can't avoid going to work, and Americans spend more than 90 percent of their time indoors. So prevalent is the problem that EPA estimates SBS costs businesses some $60 billion annually. While SBS can have a number of causes -- from poor lighting to badly maintained air conditioning -- the main causative factor is the quality of indoor air. In fact, WHO estimates 30 percent of buildings in the United States may experience indoor air quality problems.
That adds up to a heavy burden of illness, with one specific manifestation being the incidence of occupational asthma. Overall, asthma affects 25 million people in the United States, and approximately 13 million people have reported having an asthma attack in the past year.1 The number of people diagnosed with asthma in the United States grew by 4.3 million from 2001 to 2009. Asthma was linked to 3,447 deaths (about nine per day) in 2007, and U.S. asthma costs grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6 percent increase.
Occupational Asthma Statistics
In the workplace, an estimated 11 million workers in a wide range of occupations are exposed to at least one of the numerous agents known to be associated with occupational asthma. Occupational factors are associated with up to 15 percent of disabling asthma cases in the United States.2
Indeed, occupational asthma is the most common work-related lung disease in developed countries. It is caused by occupational exposure to airborne substances known as asthmagens. More than 200 respiratory sensitizers already have been classified, and others are being identified all the time. It's the reason why health and safety regulations relating to indoor air quality have become increasingly stringent across the developed and developing world, with sufferers of occupational asthma having greater access to legal redress and financial compensation from their employers. For today's employers, it's about recognizing and dealing with the problem because many jurisdictions now make it unlawful in codes of employment to discriminate against asthmatics.
The Air Pollution and Respiratory Health Branch of the National Center for Environmental Health at the Centers for Disease Control and Prevention leads the fight against environmentally related respiratory illnesses, including asthma, and it studies indoor and outdoor air pollution. CDC's asthma program focuses on three main activities: collecting and analyzing data, implementing scientifically proven interventions to reduce the burden of asthma, and establishing partnerships to develop, implement, and evaluate local asthma control programs.
OSHA's general duty clause also may come into play because it requires covered employers to provide workers with a safe workplace that does not have any known hazards causing or are likely to cause death or serious injury. OSHA does have standards about ventilation and on some of the air contaminants that can be involved in IAQ problems. Employers should be reasonably aware of the possible sources of poor air quality and should have the resources necessary to recognize and control workplace hazards. It is also their responsibility to inform employees of the immediate dangers that are present. In addition, specific state and local regulations may apply.
"The quality of indoor air inside offices, schools, and other workplaces is important not only for workers' comfort but also for their health," according to OSHA. "Poor indoor air quality (IAQ) has been tied to symptoms like headaches, fatigue, trouble concentrating, and irritation of the eyes, nose, throat and lungs. Also, some specific diseases have been linked to specific air contaminants or indoor environments, like asthma.... Many factors affect IAQ. These factors include poor ventilation (lack of outside air), problems controlling temperature, high or low humidity, recent remodeling, and other activities in or near a building that can affect the fresh air coming into the building. Sometimes, specific contaminants like dust from construction or renovation, mold, cleaning supplies, pesticides, or other airborne chemicals (including small amounts of chemicals released as a gas over time) may cause poor IAQ."
Poor IAQ largely can be avoided by adopting appropriate preventative and control strategies and by making an early identification of individuals in the workplace who suffer from pre-existing asthma or potentially may suffer from occupational asthma.
As a first step in looking at indoor air quality, employers would be well advised to examine NIOSH's eight-point plan for improving IAQ – from designating an IAQ manager and an IAQ profile of their premises to developing, implementing and monitoring its effectiveness.3
Prevention and control starts with a workplace assessment to identify potential asthmagens and, thereafter, an exchange of views among the employer, employees, and workplace health and safety professionals on appropriate strategies to minimize or eliminate exposure -– such as by installing a better ventilation system or placing dangerous chemicals in a fume cupboard. At its simplest, apart from an absolute ban on indoor smoking, dust, chemicals, perfumes and air fresheners are the most likely to cause problems, and these can be easily addressed.
However, in instances where a significant risk is identified, continued health surveillance might also be required. This would involve spirometry testing to detect early indications of disease and provide appropriate medical advice to individual employees.
Early detection is important in occupational asthma. Because people spend so much time at work -- one estimate suggests a person in a full-time office job will spend up to 1,800 hours a year at his or her place of work -- that they will have had extensive exposure to their trigger by the time their symptoms become apparent and a diagnosis of asthma is made. But while it's impossible to protect all employees from all possible asthmagens, the growing importance of work-related asthma with its associated duty of care from employers means that the role of health and safety professionals continues to change -- not only in monitoring indoor air quality, but also in providing the best possible overall environment for staff.
That environment starts from the floor because, among others, the German asthma foundation (DAAB) has for some time advised that the harmful effects of particulate matter can be greatly reduced if carpeting is chosen over hard flooring options, because carpet can safely trap and immobilize particulates. At the end of last year, The Netherlands Organisation for Applied Scientific Research (TNO) finalized an exploratory study into the relationship between particulate matter in indoor air and the presence of soft or hard flooring. One of the findings of the study was that textile floor coverings absorb more particulates from the air than their hard equivalents. This is due to the larger micro-surface of soft flooring and its better contact between the surface and the air. As a result, the presence of a textile floor covering can limit the concentration of airborne particulate matter indoors. It might seem an unusual weapon in the battle for better air quality but, while modern specialist carpeting might not be a complete solution to indoor air quality and occupational asthma, it can help considerably.
Information from NIOSH about indoor air quality can be found at http://www.cdc.gov/niosh/topics/indoorenv/. Information from OSHA can be found at http://www.osha.gov/SLTC/indoorairquality/building_ops.html.
1. Environmental Protection Agency
2. U.S. Department of Labor
4. Independent tests were carried out by GUI, the German test institute, and based on AirMaster® performance against standard PVC hard flooring and standard structured loop pile carpet. GUI specializes in assessing air quality, dampness, and dust particle count.
This article originally appeared in the April 2012 issue of Occupational Health & Safety.