Feb. 10, 2000 The butcher, the baker, and the candlestick-maker have more in common than a romp in the tub. People in these and a much wider variety of occupations than often suspected are at risk of developing respiratory injury or disease in the work place, says a University of Rochester physician in an article in the Feb. 10 issue of the New England Journal of Medicine.
"It used to be that mainly coal miners or people who worked with asbestos were the ones who came to doctors with lung disease from the work place," says author William Beckett, M.D., professor of environmental medicine. "But today, conventional work places like hospitals or construction sites are just as likely to cause respiratory disease. There's been a tremendous amount of new information pouring out in recent years; doctors may see such patients and not realize the cause."
Respiratory problems caused by the work place can range from a stuffy nose, sinusitis or laryngitis, all the way to allergies, asthma, emphysema and lung cancer. The butcher (fumes from plastic wrap), the baker (mites and fungi hitching a ride on grain dust), and the candlestick-maker (fumes) mark just a few of the occupations that can cause respiratory distress. More common culprits include latex gloves, dust kicked up during construction, and everyday cleaning solutions.
While employees in certain occupations know the risks, others don't. The latter group often includes construction workers, says Beckett. Just as coal miners are at risk of developing respiratory diseases from dust, so are construction workers who break down rocks and move earth as part of highway or building construction.
In hospital or pharmaceutical laboratories, employees have higher rates of asthma because of the latex gloves they wear. A physician at the University of Toronto Medical Center has found that it's the cornstarch powder, added to make the gloves easier to pull on and off, that causes the problem by carrying latex particles into the nose and lungs. Powder-free gloves there have helped reduce asthma among workers. "It's often a very simple technological fix that solves these problems," Beckett says.
Asthma can also be a problem for roofers. As part of the sealing process, roofers now use polyurethane foam, which can provoke asthma. The same material in paints is the reason why auto-body shops are home to the largest number of work-place-induced asthma cases in the United States, Canada and United Kingdom, according to Beckett. He says that most shop operators know the risks and have installed special ventilation systems and wear respirators.
In addition to such patients, Beckett says that nearly every pulmonary physician in the North, where asbestos was once used widely to insulate houses and pipes, has patients who are now developing asbestos-related lung diseases. These patients make up the best-known group of people who have permanent lung injury from their work. Such workers are at much higher risk of developing lung cancer or fibrosis, where the lungs become hard and aren't able to absorb oxygen efficiently.
Other lines of work that put workers at higher risk of respiratory disease include:
. Farm work. Farmers are susceptible to "silo filler's disease," caused by freshly stored hay that gives off a gas that can be dangerous. Agriculture workers are also prone to developing allergies to molds that grow in hay bales.
. The seafood industry. Crabs and other crustaceans can cause asthma.
. The food industry. Mites and fungi often piggyback onto food dust and can infiltrate the lungs, causing allergies and asthma.
. Hospitals. The chemicals used to sterilize instruments can sometimes cause allergies.
. Janitorial services. Custodians can be exposed to dangerous gases if they mix bleach with common detergents.
. Manufacturing. Cleaning products, paints and other chemicals can cause allergies and asthma.
. Tool Fabrication. The grinding releases particles of elements such as cobalt that can cause respiratory disease in tool-makers.
Beckett says doctors should consider the work place as a possible cause for any unexplained lung ailment in a working adult, and they should check if symptoms ease after work or during weekends or vacations. Even so, oftentimes a person's illness has nothing to do with the work place, even though circumstances might make a doctor suspect a link. One patient Beckett saw had developed a serious lung ailment caused by molds that often grow in the type of metal-working fluids she was exposed to in her job at a manufacturing plant. A little bit of detective work located the real source of the problem: fiberglass insulation in her basement that had become home to a large colony of mold.
"What's important to realize is that most work sites are very safe and very healthy. But if a patient is having a respiratory problem, the physician should consider the patient's work place when looking for the cause of illness," says Beckett, whose work is supported by the National Institute of Environmental Health Sciences.
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