Asthma is a common lung disease that makes breathing difficult. When the cause of the asthma is directly linked to workplace exposure it is called occupational asthma. For example, people who work in flour mills, teachers who perform baking demonstrations regularly, and school cooks are at risk of developing what is known as baker’s asthma.
A Canadian journal, Bakers Journal, profiled a bakery owner, Scott Dion, back in 2007, in a column, A Career to Die For. The profile detailed how this bakery owner suffered from serious asthma that was directly by his bakery environment. The exposures in the baking area of his establishment included wheat, rye, barley, and soy flours (and the dust created from these grain flours), yeast, eggs, sesame seeds, nuts, molds, flax seed, dust mites, enzyme additives (amylase, cellulose), and other allergens. Back in 1998, a study identified baker’s asthma as one of the most frequent occupational respiratory disorders.
As in traditional asthma diagnosis, people suffering from baker’s asthma experience coughing, shortness of breath, wheezing, and chest tightness during an attack. What’s interesting is that the individual with baker’s asthma may not initially connect the workplace exposures to the condition. It is often telling that on days off and during vacations, their asthma literally disappears or at least improves.
When an individual presents to the doctor with suspected bake’s asthma, it’s important to identify the allergen or multiple allergens causing the asthma. This will involve a detailed work history which should include all the possible allergen exposures, blood tests, X-rays, a pulmonary function test and allergy skin tests. Prior studies have shown that general questionnaires may not be accurate, so a personalized and detailed discussion of the environment and symptoms is more likely to detect baker’s asthma. Of course, one of the cornerstones of asthma treatment is reducing or eliminating the allergens involved in causing the asthma attacks. The employer and employee can play a role in this effort. The employer can:
- Try to eliminate or minimize the use of the substance or substances that seem to be instigating the attacks.
- If elimination is not possible, then substitution may allow the use of ingredients that produce less dust or are less harmful (dust-reduced flour for example).
- If substitution is not possible, then you can employ measures that lower dust levels. Enclosing machines that produce the most dust, so there is a barrier, and installing local exhaust ventilation, can help.
- Provide protective equipment like face masks and offer proper usage instructions that can help to limit exposures.
- Establish working and cleaning measures that help to limit exposures. Wet-scrubbing surfaces so that dust is not spread during the cleaning process and using vacuums to capture dust can help.
- Follow the guidelines set by the Occupational Health & Safety Act, which includes information on safe levels of dust, and taking air sample measurements to make sure you are meeting dust level standards can also help.
- Make sure your employees are familiar with signs and symptoms of asthma so they can seek early interventions if they do develop baker’s asthma.
- Baking employees can also work carefully to limit dust in the general vicinity. That means avoiding sweeping as a means to clean or clear dust from the floor or counters and not throwing bags of flour onto a surface, which can cause large dust clouds. Place empty bags of flour carefully in garbage receptacles to limit dust clouds. When mixing flour with water, start the mixers slowly until all the dry flour has been wetted down.
If employers follow these recommendations, then the burden really rests on employees to make the effort to follow these strategies and guidelines. One of the biggest problems in the workplace is an employee who develops symptoms and doesn’t seek help, for fear of losing his job. Early diagnosis and treatment, and then implementing avoidance strategies, are keys to managing baker’s asthma.
If you do develop a cough, difficulty breathing, chest tightness, or other respiratory complaints while working in a bakery you should see your doctor. Make sure to share your “symptom history,” including details like the environment where you work, when the symptoms started, and moments when symptoms get worse or disappear.
Eli Hendel, M.D. is a board-certified Internist and pulmonary specialist with board certification in Sleep Medicine. He is an Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations. His areas of expertise in private practice include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases.