Working Healthy

When Occupational Asthma Attacks

Nail technicians, as well as hairstylists, can be susceptible to contracting this frightening but manageable condition. With a little planning and care, onset can sometimes be prevented, slowed, or made more tolerable.

It might be a typical day at work, except that you’ve been battling what you’ve suspected is a bad winter cold. A nagging cough has dogged you for weeks, and recently you’ve had nausea, headaches, dizziness, and clumsiness. You’ve dealt with these problems for a few months now, so it seems like an ordinary day, doesn’t it? But shortly after you start working on your first client’s nails, you start having a tight feeling in your chest. Breathing gets a little harder; your breath gets shorter. Then you start filing. What’s the “strangling” feeling in your throat?

It’s OK, you tell yourself, because it’s Saturday and you’ll have two days off to recuperate. You ignore the fact that come Tuesday, this will start all over again.

You might decide to live with this discomfort because other nail technicians tell you that it’s just a matter of getting used to the vapors, but you never do. Or you might go to your family doctor, who might not see a lot of patients with a work-related illness, and she prescribes an antibiotic, which won’t work. What it will probably take to make you better is a specialist who will get the diagnosis correct: occupational asthma.

Nail technicians with occupational asthma might not display all of the above-mentioned symptoms, or they might come down with others, such as a hoarse voice, fever, or wheezing. Similar to the asthma that typically affects children and young adults, occupational asthma strikes people who otherwise aren’t prone to respiratory or allergy problems.

According to Cecile Rose, M.D., M.P.H., at National Jewish Center for Immunology and Respiratory medicine, occupational asthma is triggered by something in the work environment. It accounts for 2%-15% of all adult-onset asthma. In nail technicians, a tell-tale sign of occupational asthma is the progression of symptoms over the course of the work week.

“The nail technician’s symptoms will worsen over the course of the day, and will become progressively worse day by day, being worst on the last day of her work week. The symptoms will subside over the weekend; she’ll feel best at the end of the weekend. Then it will start again as soon as she goes back to work,” says Robert Eitches, M.D., assistant clinical professional at the University of California at Los Angeles and a board-certified allergist.

Where Does This Come From?

The thing in a nail technician’s environment that causes what’s known as an asthma attack, or asthma episode, is called the trigger. For some asthmatics, exercise, animals, or extremely cold weather are triggers. In the case of an occupational asthmatic, the trigger is typically a chemical or organic substance found only at work. Nail technicians’ occupational asthma is most commonly triggered by acrylic monomer or dust from filing acrylic. Even bakers are known to suffer occupational asthma; bakers’ asthma attacks can be triggered by plain old flour, says Nellie Brown, western regional director of the Chemical Hazard Information Program at Cornell University.

When the agent triggers an asthma attack, the respiratory airway becomes obstructed when muscles constrict, according to Dr. Rose. Then the airway becomes either inflamed and swollen or clogged by excessive mucous production. It is more difficult to breathe when the passageway for air is restricted and the result is a wheezing nail technician if there is excess mucous.

So Now What?

Immediate go to a doctor who specializes in asthma and/or allergies if you exhibit symptoms. If there isn’t a specialist in your area, go to a respiratory specialist instead. The sooner you get treatment, the better your chances of recovering more completely, says Dr. Rose. Dr. Eitches says that most nail technicians with occupational asthma can be successfully treated and return to work, typically within two to three weeks.

“One patient I treated is a nail technician and her occupational asthma was so severe that she went to the emergency room twice for asthma attacks. Now she’s working again and using an inhaled cortisone, and only once in a blue moon does she have to take it,” Dr. Eitches says.

Severe asthma reactions, like anaphylactic shock (an often severe and sometimes fatal systemic reaction in a susceptible person upon exposure to a specific trigger after sensitization, characterized by respiratory symptoms, fainting, and itching), call for serious injectible medication that is usually only dispensed in emergency rooms. But the standard treatment for mild, stable asthmatics is inhaled medications that the patient breathes through an inhaler. These medications are called bronchodilators and they are similar to over the counter inhaled medications like Primatine mist, only better, says Richard Barbers, M.D., associate professor of medicine at USC Asthma and allergy Center. “The over the counter medicines for asthma contain more chemicals that are toxic to your heart than the prescription medications, and they are far less effective,” he says.

Avoiding the triggers is the most effective way to prevent future attacks, says Dr. Barbers. Before you give notice, there are measures you can take to avoid your triggers and keep working. The easiest fixes are in how you handle your products. If you’re triggered by acrylic monomer, dispense it at your station in a pump dispenser rather than a dappen dish. If that isn’t enough, you might think about actually switching your clients to another extension system. A fiberglass system is a gentler option for clients of asthmatic nail technicians because the most aggressive chemical in fiberglass and silk systems is cyanoacrylate (the resin and adhesive), but Brown says it shouldn’t be a problem for asthmatics.

“They’re in more danger of sticking body parts together with a cyanoacrylate than triggering an asthma attack. A triggering agent, like acrylic dust or monomer, can only trigger an attack while it’s curing. Once it has cured, it is inert,” she says.

All the experts we spoke with recommend that nail technicians make sure they have adequate ventilation in their workplace. Brown suggests that a nail technician with occupational asthma be positioned closest to the fresh air outlet of the salon’s ventilation system. “Sometimes merely rearranging the furniture in the salon will accomplish this, provided an adequate ventilation system has been installed,” says Brown.

Not taking care of occupational asthma can be a big deal. It mimics hypersensitivity because both disorders are characterized by headaches, fatigue, and dizziness. They are both incapacitating, but occupational asthma can turn into a serious problem for anyone who has it. Moderate to severe states of asthma can involve attacks either at night or during the day, says Dr. Barbers, and it can send you to the emergency room if it’s bad enough, says Dr. Eitches, who continues to explain that without treatment, occupational asthma will develop to the point where the nail technicians won’t recover between attacks. Every time a nail technician is exposed to the trigger, her attacks will become worse.

Follow-up studies to predict the prognosis of occupational asthma are scarce, according to Dr. Rose. She explains that the data available on occupational asthma show that it is on the rise, but that it because more doctors are making the connection between the asthma and the workplace. But in Dr. Eitches’ experience, asthmatic nail technicians whose illness is occupational can expect a smooth recovery. Flare-ups, however, are bumps in the road that can happen, says Dr. Barbers, and he encourages the nail technicians to seek medical attention if necessary and for the salon owner to be understanding. Quick medical attention means you’ll be back to work more quickly.

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