Work Related Asthma (WRA)

Work-related asthma (WRA) is an umbrella term for asthma that is caused by a sensitizer (an allergic-type) in the workplace and/or asthma that is made worse in the workplace. It includes the following:

• Occupational asthma: asthma caused by work, includes the following:
  • Sensitizer-induced asthma:
    • Sometimes, the body can develop a sensitization (an allergic-type) reaction when it is exposed continually to a substance. The process is usually not immediate but evolves over a period of time and involves the body's immune system.
    • Sensitizer-induced asthma is asthma that is induced by sensitization to a specific substance found in the workplace.
• Irritant-induced asthma:
  • Irritant-induced asthma refers to asthma that is induced by exposure to an inhaled irritant found in the workplace e.g. chemicals (like chlorine or anhydrous ammonia), smoke, etc.
  • The most decisive form is reactive airways dysfunction syndrome (RADS) which occurs after a single, very high irritant exposure.
• Work-exacerbated Asthma (WEA): pre-existing or concurrent asthma triggered by workplace factors i.e. aeroallergens or irritants.

Management of work related asthma 

For all work-related asthma:

• Control exposure (through elimination, substitution, process modification, respirator use, and engineering control)
• Optimize usual asthma management (education, fast-acting relievers as needed, etc.)

For sensitizer-induced occupational asthma:

• Remove from exposure to the causative agent – as determined by the physician specialist managing asthma

For irritant-induced occupational asthma OR work-exacerbated asthma:

• Reduce exposure; if unsuccessful, change to a workplace with fewer triggers (as determined by the physician specialist managing asthma)

Primary Prevention

• Primary prevention of occupational asthma is about the maintenance of safe working conditions and avoiding exposure to known sensitizers and irritants.

Secondary Prevention

• Secondary prevention of occupational asthma involves screening of workforces at risk. Employees known to be exposed to asthmatic agents should undergo regular health surveillance.

Resources for work related asthma

For more information download the Taking Control of Asthma from our Lung Health Materials.

Pregnancy and Asthma

Many women have concerns about asthma and pregnancy. Studies show that when asthma is under control, there is no greater chance of complications during pregnancy and birth. One-third of women find that their asthma actually improves during pregnancy. Another third find that their symptoms get worse and the remaining one-third see no change in their asthma symptoms.

During pregnancy, you are breathing for two — your baby and you. If asthma is not controlled, the baby’s supply of oxygen can be reduced. A good supply of oxygen is necessary for the healthy growth and development of your baby. If your asthma is not under control during pregnancy, the following unhealthy conditions may occur:

•  Your baby’s birth weight may be lower.
•  Your baby may be born prematurely.

 Most asthma medicines are considered safe for the baby. Poorly controlled asthma is generally a much greater risk to the baby than any possible side effects from asthma medications.

What to do during your pregnancy to protect yourself and your unborn baby

• Avoid contact with your asthma triggers.
• Always avoid smoking or exposure to any tobacco smoke.
• Work with your health care provider to find the lowest dose of asthma medication that keeps your asthma controlled. It is important to continue to use your asthma medicines during pregnancy as prescribed. Discuss all of your concerns about your medications with your health care provider.
•  Ask your health care provider for a written asthma action plan and learn how to use it.
•  When you do have asthma symptoms or a flare-up, follow the steps in your asthma action plan. If your symptoms don’t get better, contact your health care provider, call 911, or have someone take you to the hospital. It is very important to get control of a flare-up as soon as possible.

What you can do during labour

• Speak to your health care provider about the use of anaesthetics during labour and delivery.
• Make sure that the hospital knows about your asthma and has the asthma medication you use on your record.
• Ask your health care provider about what will happen if your symptoms flare-up during labour.

What you can do to protect your newborn baby

• Don’t put the health of your baby at risk by exposing him or her to tobacco smoke at any time (including before birth).
•  Breast-feed your baby when possible.

Travelling with Asthma

Travel can expose you to new asthma triggers. Here are some tips to help you enjoy a worry-free, healthy holiday:

• Find out if there are adequate medical services in the place you want to visit
• Ensure your vaccinations, including flu and pneumonia, are up to date
• Bring enough medication to last longer than the length of time you will be away in case of unforeseen problems
• Leave medications in their original containers that list dose and strength
• Carry your medications with you
• Do not pack medication in your luggage
• Make sure your vaccinations are up to date (pneumonia, influenza, COVID-19 etc.)
• Consider wearing a mask on the plane, in busy airports and indoors where many people gather to protect yourself from germs and viruses

 Find out what kind of triggers you may encounter at your destination:

• Seasonal levels of air pollution or pollens
• Temperature extremes
• Accommodations (use of air conditioning and pet friendly policies)
• Whether smoking is allowed indoors
• Before your holiday, talk with your health care provider even if your asthma is under control. If you don’t have one already, ask for a written asthma action plan for instructions on what to do if you develop problems.
• Even if your symptoms improve while you’re on holiday, do not decrease or stop your medications.
• If you are travelling outside the province or country, make sure that you have enough medical insurance to cover you in case of an emergency.

Conditions that Can Worsen Asthma

Gastroesophageal Reflux Disease (GERD)

GERD is a digestive disorder that affects the sphincter muscle of the esophagus, food tube where food that is swallowed goes to your stomach. People experience GERD when the sphincter does not close all the way, causing some food that is not completely digested and acid to be pushed up into the esophagus.  This is called reflux.  People usually feel burning in their chest referred to as heartburn.
GERD is common in adults with asthma. Treating GERD may or may not improve asthma symptoms.  Speak with your health care provider to find the best treatment for you.

Obesity

Obesity may make asthma medications not as effective and asthma may be more difficult to treat.