Review

Wheezy on weekdays?

Asthma at work: causes, effects and what to do about them
Rory O’Neill
TUC/Sheffield Occupational Health Project, 1995, £6.00

Possibly because of asthma’s increasing prevalence and the efforts made on behalf of sufferers by the National Asthma Campaign, asthma is often in the news. But the focus tends to be on the association of asthma with air pollution and what should be done about high levels of traffic, or the costs of asthma to the NHS in terms of medication, doctor consultations and hospital admissions. There is very little public awareness of occupational asthma and yet a 1992 survey showed one in five cases of asthma in a study population of a 9,000-patient Sheffield general practice were attributed to occupational factors. According to the Royal College of General Practitioners, ‘occupational factors are important in about 5 per cent of cases of asthma beginning in adults’.

This book is a goldmine of information, interlaced with case histories of individuals with occupational asthma and supported by a glossary of technical and medical terms. It contains information to suit a wide readership, from those with occupational asthma who want to know about possible compensation and how to obtain it, through to health promoters who need to know about possible sources of occupational asthma and how to prevent it.

After an introduction, the book’s second section covers, in considerable depth, occupational asthma by type; allergic occupational asthma and sensitisation; non-allergic occupational asthma such as irritant asthma and reactive airways dysfunction syndrome; and non-occupational asthma exacerbated by exposure to irritants in a work situation. Medical tests used to identify occupational asthma are described and include breathing tests (peak flow, lung function), challenge tests, serological tests (skin prick tests, blood tests), and genetic screening. The contribution each of these can make to diagnosis is also discussed and the section concludes with brief descriptions of other types of lung problems.

The book’s greatest strength is the material provided in sections three and four. These deal with the practical aspects of having occupational asthma and cover not only costs to health but also the financial and psychological costs of lost income, unemployment, and blighted careers. They outline a person’s rights with respect to employment and compensation. Details are provided on how to make a compensation claim and the reasons for possible lack of success or reduction in compensation payout. Other sources of financial aid for sick or disabled workers, social security benefits such as industrial injuries disablement benefit, and how to apply, are covered. For the material in these sections alone, the book should be in every town library.

Other sections focus on public health issues. In section five, the main provisions of the Control of Substances Hazardous to Health Regulations and Chemical (Hazard Information and Packaging and Supply) Regulations are listed, with advice on how to comply. Risk assessment, the process of identifying and quantifying the effects of any hazards which exist in the workplace, is discussed along with the process of developing preventive or protective measures. Section six discusses air pollution in general and section eight provides information on prevalence, relative risk of occupational asthma according to type of work, and current systems for monitoring incidence.

A take-up campaign in Sheffield in the early 1990s to encourage and help residents with occupational asthma to claim DSS industrial injuries and other benefits was highly successful. The lessons learned from this campaign could be of benefit to others working in health promotion, in its broadest sense, who might be considering such action.