Work-related asthma

Work-related asthma is asthma that is caused or made worse by exposures in the workplace. About 16% of new asthma in adults is caused by exposures at work. Asthma is a chronic disease, with symptoms including difficulty breathing, chest tightness, shortness of breath, night coughing, and wheeze.

There are hundreds of substances that are known to cause work-related asthma. Examples of some the most common substances in Washington workplaces include cedar and other wood dusts, isocyanates, epoxies, cleaning materials, flour dust, agricultural hop dust, and more.

Work-related asthma is preventable. Ventilation, respirators and gloves, and workplace controls can be used to prevent this serious illness and to reduce the risk of work disability. If you think you might have work-related asthma, you should talk to your doctor about your symptoms, your work, and the materials you handle. Early diagnosis and treatment can improve your health.

Work-related asthma surveillance

Work-related asthma surveillance is the ongoing, systematic collection and analysis of data for the purpose of public health data sharing and prevention efforts. Launched in 2001, the purpose of our surveillance system is to identify workers at high risk who can benefit from disease prevention activities and public health education.

Workers’ compensation and physician reporting are the data sources used. Health care providers and health care facilities are required to report cases of work-related asthma to the SHARP program under Washington State’s Reportable Conditions Rule. Data is compiled to describe the incidence and prevalence of work-related asthma, identify high-risk occupations and industries, identify useful prevention strategies, and to identify new or emerging asthma-causing agents.

SHARP shares surveillance information with health care providers, public health professionals, employers, employees, trade industry groups, and others. In addition to work-related asthma, SHARP conducts surveillance for other occupational lung diseases, toxic inhalations, and hazardous exposures.

Notifiable Condition Reporting

Submitting case reports

Case reports for the following conditions must be received by SHARP within 1 month of diagnosis. 

Fax the form to: 360 902 5672

or Mail to:

Reportable Conditions
SHARP Program
PO Box 44330
Olympia WA 98504 4330

Reporting 

Under Washington State's Reportable Conditions Rule (WAC 246 101), all health care providers and health care facilities are required to report cases of work-related asthma. As part of a cooperative agreement with the Washington State Department of Health the case reports are to be sent directly to the Safety and Health Assessment and Research for Prevention (SHARP) Program at the Department of Labor and Industries.  Effective January 1, 2023 work-related hypersensitivity pneumonitis and silicosis are also reportable.

Case Definition

All health care providers and health care facilities must report any diagnosed or suspected case of work-related asthma caused or exacerbated by workplace exposures in a worker employed in Washington State.  Beginning January 1, 2023 diagnosed or suspected cases of work-related hypersensitivity pneumonitis and silicosis caused by workplace exposures are similarly reportable in Washington workers.

Workers' compensation insurance

Reporting a case to SHARP under the Reportable Conditions Rule does not relieve the diagnosing physician of their responsibility to inform the patient on their right to file a workers’ compensation claim. Similarly, the filing of a workers’ compensation claim does not relieve the diagnosing physician of the Reportable Conditions Rule.

Privacy and confidentiality

All information obtained from case reports will be used for public health surveillance and prevention purposes only. Specific personal identifiers obtained by SHARP for surveillance purposes will not be shared with any other group within L&I for claims initiation/management or any other purpose without written permission by the case.

Work-related lung disease

Work-related lung diseases are lung diseases that are caused or made worse by the work environment. Breathing in vapors, gas, dust and fumes at work may put you at risk for developing a work-related lung problem. Symptoms of lung disease may include cough, wheeze, or shortness of breath. All workplaces, both industrial and non-industrial, have some chance for people to develop breathing problems.

If you think exposures at your workplace are affecting your breathing, it is important to talk to your health care provider. Tell them about your symptoms, your job, and the kinds of materials you are exposed to at work. Talking to your doctor is important because steps can be taken to prevent disease from developing or to keep it from getting worse.

Work-related lung disease surveillance

Asbestos-related disease: Exposure to asbestos fibers over a prolonged period of time can case non-malignant disease such as asbestosis and pleural plaques as well as malignant disease including lung cancer and malignant mesothelioma. Common materials that may contain asbestos include insulation, fireproofing, asbestos-cement pipe and sheet material, tiles, wallboard, siding and roofing, friction materials on brakes and clutches, and others. Industries and jobs that may involve exposure to asbestos are construction, agriculture, firefighter, HVAC worker, industrial worker, engineer, machine operator, mechanic, and oil, rail and shipyard workers.

Chronic Obstructive Pulmonary Disease (COPD): Breathing in airborne substances at work can cause COPD or make the condition worse in people who already have COPD. Exposure to substances such as cement and other mineral dusts, wood and other organic dusts, diesel exhaust, smoke, isocyanates, cleaning agents, and irritants such as ammonia, chlorine, and sulfur dioxide are all associated with COPD. Both smokers and non-smokers are at risk for work-related COPD.

Silicosis: Inhaling too much silica over a long period of time can cause silicosis. Silica is a crystal-like mineral found in sand, rock and quartz. A partial list of materials that contain silica include natural stone, engineered stone, concrete, graphite, mineral products, polishing compounds, paints, pavement, filter aids and slag. Jobs where silica exposure may occur include construction labor, heavy machine operator, abrasive blasting, engineered stone fabrication, mining, stone work, and many others.

Valley fever (Coccidioidomycosis): Valley fever is caused by inhaling airborne spores of the fungus Coccidioides spp. The fungus is found in the soil of south-central Washington State as well as the southwestern Unites States and parts of Mexico, Central and South America. The spores can become airborne when soil is disturbed, and are carried by the wind with dust particles. Jobs where workers have a high risk for acquiring Valley fever are outdoor jobs where soil is disturbed such as construction, agriculture, landscaping, wildland firefighting, land clearing, mining, and earth sciences. Symptoms may not be present or can be mild flu-like and can progress to a chronic condition with fever and cough.

Prevention Resources Publications

Technical Reports

Washington State’s occupational respiratory disease surveillance system, 2017 – 2022: Surveillance methods and evaluation

Washington State’s occupational respiratory disease surveillance system, 2016-2017: Surveillance methods and a preliminary evaluation. Describes disease incidence, high-risk industries and exposures associated with work-related asthma, silicosis, asbestos-related disease, and Valley fever.

Work-Related Asthma in Washington State, 2009-2013

Journal Publications

Sack C, Reeb-Whitaker C, Todorov D, and Darby P (2023). Toxic inhalation of sodium metabisulphite by-products from a shipping container. Occupational Medicine. DOI:10.1093/occmed/kqad009 | Research Finding

Reeb-Whitaker C, Lasee C and Bonauto D (2021).  Surveillance of work-related asthma including the emergence of a cannabis-associated case series in Washington State.  Journal of Asthma.  DOI: 10.1080/02770903.2021.1955379 | Research Finding

Rose C, Heinzerling A, Patel K, Sack C, Wolff J, Zell-Baran L, Weissman D, Hall E, Sooriash R, McCarthy R, Bojes H, Korotzer B, Flattery J, Weinberg J, Potocko J, Jones K, Reeb-Whitaker C, Reul N, LaSee C, Materna B, Raghu G, Harrison R (2019).  Severe silicosis in engineered stone fabrication workers - California, Colorado, Texas and Washington, 2017 - 2019.  MMWR Morbidity Mortality Weekly Report DOI: http://dx.doi.org/10.15585/mmwr.mm6838a1 | Research Finding

LaSee CR and Reeb-Whitaker C (2019). Work-related asthma in Washington State: Time trends, industry rates, and workers' compensation costs, 2002-2016. Journal of Asthma DOI: 10.1080/02770903.2019.1571084 | Research Finding

Reeb-Whitaker C and Schoonover TS (2016). Isocyanate exposure below analytical detection when a paint brush or roller are used to apply moisture-cure polyurethane paint. Annals of Occupational Hygiene DOI: 10.1093/annhyg/mew003 |  Research Finding

Anderson NJ, Fan ZJ, Reeb-Whitaker C, Bonauto D, and Rauser E. (2014). Distribution of asthma by occupation: Washington State Behavioral Risk Factor Surveillance System Data, 2006-2009. Journal of Asthma DOI: 10.3109/02770903.2014.939282 |  Research Finding

Reeb-Whitaker C, and Bonauto DK (2014). Respiratory disease associated with occupational inhalation to hop (Humulus lupulus) during harvest and processing. Annals Allergy Asthma Immunology DOI:10.1016/j.anai.2014.07.029 |  Research Finding

Reeb-Whitaker C, Anderson NJ, and Bonauto DK (2013). Prevention Guidance for Isocyanate-Induced Asthma Using Occupational Surveillance Data. Journal of Occupational & Environmental Hygiene DOI:10.1080/15459624.2013.818236 |  Research Finding

Reeb-Whitaker CK, Whittaker SG, and Ceballos DM et. al. (2012) Airborne isocyanate exposures in the collision repair industry and a comparison to occupational exposure limits. Journal of Occupational and Environmental Hygiene DOI: 10.1080/15459624.2012.672871 | Research Finding

Anderson NJ, Reeb-Whitaker CK, Bonauto DK, and Rauser E (2011). Work-related asthma in Washington State. Journal of Asthma DOI:10.3109/02770903.2011.604881 |  Research Finding

Curwick CC, Bonauto DK, and Adams DA (2006). Use of objective testing in the diagnosis of work-related asthma by physician specialty. Annals of Allergy, Asthma and Immunology DOI: 10.1016/S1081-1206(10)60948-9.