Flour: first responsible

Whether you are a baker, hairdresser or nurse, you are at risk of occupational asthma. This possibility must be evoked in the face of any asthma in order to prevent the disease from perpetuating itself and to implement protective measures quickly.

A delayed appearance

Responsible for 5 to 10% of all asthma, occupational asthma is the most frequent occupational respiratory disease in industrialized countries *. There would thus be between 1,250 and 5,000 new cases each year in the United States.

A difficult reclassification

More than 300 substances that can trigger seizures have been identified. Contrary to what one might think, it is the biological agents that are most often involved. According to the National Observatory of occupational asthma, they are responsible for 48.6% of the cases, in front of the chemical agents involved in 42.8% of the cases and the metals of 2%.
The benefits of recognition

However, six occupations alone are responsible for more than half of cases in the United States

Developing prevention

Asthma is most often an allergic mechanism and appears only after several months or years in the same position. The possibility of a professional origin must therefore always be mentioned. It is very likely if the seizures are punctuated by the periods of work: the respiratory state improves during the weekends and the holidays. However, this rhythm usually fades rapidly over time.

Asthma can also occur within 24 hours after exposure, often accidental, to large amounts of irritating substances (chlorine, acids, isocyanates ...). It is accompanied by a dry cough. These asthma have an irritant mechanism and must be reported in a work accident. They do not show any particular sensitivity to the substance that triggered the crisis. Unlike allergic asthma, a new exposure to low concentrations of this substance does not cause any disturbances.

The diagnosis of occupational asthma requires an investigation by the occupational physician to search for all products handled. Some samples are taken from the atmosphere. The assessment is supplemented by respiratory functional tests and cutaneous and blood immunological tests for allergen sensitization. In difficult cases, challenge tests with suspected allergens can be performed. These tests are only performed in the hospital because they can trigger a serious crisis.

Treatment first requires the removal of any contact with the allergen responsible for the seizures. This may seem simple, but actually comes up against many difficulties.

First identifying the allergen involved is sometimes very complex. Then, despite the eviction of the allergen, in one case in two of the symptoms persist even if the respiratory state improves. The risk of chronic progression is higher the longer the person has been in contact with the substance after the onset of asthma. This underlines the importance of a very early investigation into the causes of asthma.

Finally, it is not always possible to remove the responsible allergen in the workplace. The person is then forced to consider a professional reclassification, sometimes difficult. A study was conducted in 1997 to clarify the fate of these people with occupational asthma. Almost half (44%) had lost their job and, after three years, 25% were still unemployed.

Recognition of asthma as an occupational disease allows some compensation for injury. To be recognized, asthma must correspond to the description given in one of the occupational disease tables, which specify the substances involved.

If the substance responsible for asthma is not included in these tables, a request for recognition may nevertheless be made to the National Committee on Occupational Diseases. Recognition offers several advantages

These provisions do not apply to self-employed persons who must take out voluntary insurance to be covered.

The employee can apply to be recognized as a handicapped worker with Cotorep, which enables him to be one of the 6% of handicapped workers that each company should in principle include in its workforce. It can also request vocational guidance for training.

These measures are of course only a last resort and many people with occupational asthma will not find a job. It is therefore very important to develop prevention

Occupational physicians have a key role to play in developing this prevention, but also to identify occupational asthma, many of which are probably not diagnosed.

* The tables of occupational diseases can be consulted on the INRS website.

(10%), Hairdressers (8%), Painters (8%), Woodworkers (5%), Cleaners (5%).

In the case of partial permanent disability (PPI), payment of a capital (if PPI