Last month, coinciding with the return of thousands of workers to commercial premises after consecutive months of home-working, clinicians at the University Hospitals Birmingham NHS Trust attended the European Respiratory Society (ERS) International Congress[i] to present findings of their new study on the detection of asthma-inducing respiratory sensitisers routinely harboured in office environments.[ii]
Essentially, the research made the experts question: is the general presumption that offices are ‘relatively safe’, for the purposes of not contracting occupational asthma, a myth?
Their investigation concerned 47 office workers, who had been referred the Birmingham Regional Occupational Lung Disease Service (part of the NHS Trust) and were subsequently diagnosed with the condition. Over 80% of cases were confirmed by serial peak flow monitoring (measures exhalation rate), while over 35% of patients presented with lungs that reacted strongly to a methacholine challenge test (exposes sensitive/reactive airways).
Having detected ‘clusters of [occupational asthma] cases in specific offices’, they were able to pinpoint several substances that could trigger irreversible disease, including floor tile adhesive, printer toner, cleaning products, mould circulating in incorrectly installed air conditioning/ventilation shafts, as well as paint, vehicle and workshop fumes emanating from the immediate environment. Senior investigators acknowledged that ‘there will certainly be other [sources of injurious exposure]’ besides those presently identified.
Despite only representing a ‘relatively small study’, this was one of the largest to document occupational asthma cases among office workers because there has been ‘very little’ research into the issue to-date. It is therefore implied that the ‘seemingly innocuous’ guise of an office setting has resulted in occupational causes of asthma previously being ‘overlooked’.
This view is echoed by ERS Advocacy Council Chair, Professor Arzu Yorgancıoğlu, who believes that ‘it is likely that there are more patients out there with undiagnosed office work-related asthma’.
For now, though, it appears that COVID-19 restrictions have had a positive impact on the number of new patient referrals (i.e. a slower rate of occupational asthma diagnosis) and has also seen improvements for existing patients:
‘Working from home has been useful for patients in both establishing their diagnosis and as a form of non-pharmacological treatment’ – NHS Doctor and Lead Investigator, Christopher Huntley.
With health benefits in mind, therefore, researchers recommend that employers allow home working practices to continue, in spite of easing COVID-19 restrictions. Should workers be permitted to return to offices, however, they stress the importance of identifying and removing potential asthmagens. Indeed, by making the necessary adjustments to workplace conditions, affected employees can recover from symptoms, reduce the number of sick days taken and enhance job retention. When companies failed to act on instances of occupational asthma, workers were found to be 100-times more likely to resign.
In summary, the findings to come out of the University Hospitals Birmingham NHS Trust study offer a rebuttal to the general presumption that cases of occupational asthma will predominantly occur in workers that habitually come into contact with chemicals, or dusts containing cotton, flax, or hemp, e.g. metalworkers or those who make paint or build mattresses.
[i] Abstract no: PA1904 “Occupational Asthma in Office Workers: A Cross-Sectional Study”, by Christopher Huntley et al; Presented in session, “Occupational rhinitis and asthma” at 13:15-14:15 CEST on Monday 6 September 2021. <https://k4.ersnet.org/prod/v2/Front/Program/Session?e=262&session=13568> accessed 20 September 2021.
[ii] Denis Campbell, ‘Offices may harbour asthma risks, new research suggests’ (6 September 2021 The Guardian) <https://www.theguardian.com/society/2021/sep/06/offices-may-harbour-asthma-risks-new-research-suggests> accessed 20 September 2021.
‘Asthma can be caused by office work but finding and tackling the cause can keep employees in work’ (6 September 2021 European Respiratory Society) <https://www.ersnet.org/news-and-features/news/asthma-office-finding-cause-keep-employees-in-work/> accessed 20 September 2021.