Asthma is a chronic respiratory condition that is characterised by inflammation and narrowing of the airways, leading to symptoms such as shortness of breath, wheezing, coughing and tightness of the chest. Asthma affects both males as well as females but there are gender differences that have been noted and studied.
In an interview with HT Lifestyle, Dr Vikram Vora, Medical Director, Indian Subcontinent at International SOS, revealed, “There is a significant body of scientific literature that states that there is a higher incidence of asthma in males in early life and in females post-puberty. This is thought to have multi-factorial causality –from female sex hormones that inhibit mucous clearance to differences in relative growth of lung tissue and airways between genders. Apart from age, obesity, allergies and other associated environmental exposures also contribute to an increase in adult asthma. I have seen a growing impact on people with asthma at the workplace, as they get exposed to triggers that precipitate sudden attacks or worsen symptoms.”
Bringing his expertise to the same, Dr Lancelot Pinto, Consultant Pulmonologist and Epidemiologist at PD Hinduja Hospital and Medical Research Centre in Mumbai, explained, “Indoor air quality plays an important role in the health of individuals. The “sick building syndrome” defined a few decades ago described a constellation of symptoms (including those involving the upper and lower respiratory tract) that individuals experienced when they spent a prolonged time in a building, very often a workspace. Individuals with asthma have a low threshold for reacting to pollutants (both organic and inorganic), temperature and humidity fluctuations, all of which are heightened in stressful situations.”
He elaboarted, “Air quality tends to be one of the most important determinants of asthma control. Improving air quality in closed spaces would involve architectural changes, heating, ventilation, and air conditioning (HVAC) optimization. Architectural changes are difficult and modifying existing architecture to improve ventilation could be expensive. In a tropical country like India, opening up windows and letting air circulate is easier to do than in colder climates. Fans can be added to help lower temperatures, improve ambient comfort, and help air circulate. There would be challenges to managing this in the monsoons, and one would have to think of novel and tailored solutions to prevent discomfort due to humidity. When it is not possible to turn off air-conditioning, one should try and have air exchanges as frequently as possible rather than recirculate air (even though this may be less energy-efficient). Improving air filtration by mechanical, electronic, ultraviolet-C in air ducts, or HEPA filters can be used, but these tend to be expensive. The most inexpensive way of improving ventilation is possibly a combination of opening up windows and installing strong exhaust fans, the combination of which will lead to constant air circulation.”
Cautioning that fungi or mould growing on damp walls is also a common trigger for asthma and these need to be attended to, Dr Lancelot Pinto warned, “In addition, strong smells such as burning incense sticks, the use of “air fresheners”/strong cleaning solutions/pesticides can all trigger asthma, and essential services (such as cleaning) should be performed over the weekend. Viral infections are a common trigger for asthma attacks, and encouraging sick individuals to work from home, or mask up during meetings could help. Carpets should be avoided, as they harbour dust mites, dirt and dust, all of which can worsen asthma control. In the event that an individual has an asthma attack at work, a written action plan could be shared with a work colleague, along with the listing of the caregiver’s details and a plan to move the person to the nearest healthcare facility are all useful to prevent panic, and help the individual deal with the asthma attack.”
What triggers asthma at the workplace?
According to Dr Vikram Vora, common triggers at the workplace can include pollen, dust and mites, fungi, animal hair and polluted air. He said, “Many asthmatics have specific triggering factors like fumes from aromatic chemicals, detergents and other cleaning products, etc. Depending upon the occupation, long-term exposure to these triggers can cause an asthma attack or worsen pre-existing respiratory illnesses and even lead to new ones. Eg: construction workers exposed to silica dust, textile workers exposed to fabric dust, factory workers exposed to aromatic chemicals, policemen exposed to vehicle exhaust smoke etc. Hence, the first step is for individuals to identify what triggers their bouts of asthma. Understanding these can help in avoiding exposure and minimise the risk of an acute episode.”
He added, “The occupational “hierarchy of controls” - namely elimination, substitution, engineering controls, administrative controls and personal protective equipment – can be extremely useful in management. Organizations today are becoming increasingly sensitive to employee health and well-being needs. Therefore, engaging with one’s employer to discuss one’s condition and triggers can help in arriving at a consensus on any required changes like elimination of the offending triggers, substitution of chemicals, removal of vulnerable individuals from sites of trigger exposure etc. All asthmatic employees should be provided PPEs, which in the case of asthma would be respirator masks like the N95.”
Managing asthma incidents at the workplace
In addition to understanding, identifying and eliminating triggers as far as possible, it is essential for affected employees to practice good asthma management. Dr Vikram Vora suggested, “Wearing a face mask during commuting in cities with low air quality, carrying the necessary medications (including inhalers, if prescribed by a doctor), requesting for and taking several breaks in case symptoms begin to develop are all good practices. With no clear and uniform regulatory guidelines for protecting asthmatics at work, International SOS has developed a framework for managing asthma and other health conditions at workplaces that encompasses assessment, action and monitoring. With over 90% of the country’s total population being exposed to air pollution, it is important for organizations to take steps for the surveillance of asthma at workplaces.”
He recommended, “Periodic but regular health risk assessments of factories, workshops, offices etc. can quantify the risk of workplace asthma. In addition, a workplace health and wellbeing clinic, staffed by qualified doctors and/or nurses, with the availability of necessary medical equipment (like nebulizers) can help manage acute cases in an emergency and prevent complications. The same clinic can also monitor the status of asthma sufferers over a period of time and help in identifying any change in triggering factors. Although asthma may currently appear to be a challenge of a few, the growing air pollution and repeated attacks by a multitude of micro-organisms (that are weakening the human immune system and its response), will ensure that this challenge continues to compound and will lead to a decrease in overall employee wellbeing. In addition, the devastating effect on employee productivity (up to 50% decrease as seen in a recent Indian study) and increase in absenteeism, will only contribute further to organizational non-resilience. In one way or another, asthma will affect us all.”