Breathing difficulties

incidence of occupational asthma could be cut at a stroke if only employers
would substitute asthma-causing substances for safer alternatives. The TUC’s
recent report highlights this and other issues that occupational health staff
need to consider, by Jacqueline Paige

Nowadays people wouldn’t dream of building a new house and putting an
asbestos roof on it – the dangers have been too well documented. Yet when it
comes to asthma-causing substances, where knowledge of their detrimental effect
has developed very rapidly, some people still face daily exposure – despite the
availability of substitutes that could, in some cases, cut incidences of asthma
at a stroke.

This abrogation of duty on the part of some employers, and other recent
developments in the area of occupational asthma – the withdrawal of Cidex, an
approved code of practice – are issues that occupational health professionals
need to be aware of. Many of them are highlighted in a recent report by the TUC
entitled No substitute for asthma.

Occupational asthma is the most frequently diagnosed respiratory disease in
Great Britain according to the Health and Safety Executive. The regulatory body
estimates that each year 1,500 to 3,000 people in Britain develop the

The TUC puts the figure at around 7,000 cases a year – which is more in line
with recent Canadian research suggesting that one-third of all cases of
adult-onset asthma are caused by workplace exposures.


Yet, incidences of occupational asthma could be cut at a stroke in some
instances. Take the case of latex, a substance that has only recently been
understood to cause occupational asthma.

"By abolishing the import or sale of powdered latex or high protein
gloves, exposure to the latex that causes occupational asthma would be
effectively eliminated," the TUC report says.

Unfortunately, some hospital trusts are still using latex, when safer
alternative low-allergen and vinyl gloves are available. Powdered latex gloves,
the main problem, are still available in the NHS supplies catalogue. Some years
ago, the Audit Commission found that hospital trusts could cut their glove
budgets by £25,000 a year by switching from low-allergen gloves to cheaper

But "such savings could be swiftly dwarfed by one single compensation
claim," the TUC report notes.


Many nurses have also had careers blighted by Cidex, a commonly used
disinfectant in the NHS. From 1 May, the product is being taken off the UK
market by the manufacturers, Johnson and Johnson, following safety concerns.
Hospital staff reported suffering skin problems and asthma following exposure
to the substance. Cidex is one of the brand names for glutaraldehyde and is the
most commonly used disinfectant in endoscopy departments.

There are a number of substitutes for glutaraldehyde being used in the NHS.
However, there is debate over their relative safety and efficiency. The only
one that does not present a risk is Sterilox, the trade name for super-oxidised

Other substances

The HSE has put together a ‘hit list’ of the top eight asthma-causing
substances. As well as latex and glutaraldehyde, other substances making an
appearance are glues and resins, wood dust, isocyanates, solder/colophony,
flour/grain, and laboratory animals.

Isocyanates are used in spray paints and are "some of the most potent
asthmagens known and account for many new and successful industrial
claims," the TUC report states. Outside the motor vehicle sector, in
shipbuilding for instance, epoxy paints may be substituted, although some
companies still specify isocyanates for quality reasons. There are now
developments away from isocyanate-based paints.

Interestingly, when British Airways changed the logos on their planes in the
1980s, a great number of cases of occupational asthma resulted because they
used isocyanate paints. Lessons were learned, and when they resprayed avoiding
this type of paint, no cases of asthma were reported.

Some substances have no obvious substitute, for example flour and grain
dust, wood dust, resins and glues. In such cases, exposure levels should be
reduced by the use of ventilated spray booths, or some other enclosed unit.

Finally, the HSE has announced steps to cut occupational asthma by 30 per
cent over the next nine years. It has also agreed an approved Code of Practice
to be published this year to bring home to employers that the law requires them
to control the substances that cause occupational asthma.

Case studies

Compensation for latex allergy

Forty-year-old Pip Wheatcroft had worked as a radiographer at
Good Hope Hospital, Sutton Coldfield, for 17 years, specialising in nuclear
medicine. In February 2002 she was awarded a six-figure sum for loss of
earnings having developed an extreme allergic reaction to latex.

She first developed the allergy to powdered latex gloves in
1996. And although she and others in the nuclear medicine department switched
to using the safer alternative vinyl gloves, latex was still being used
throughout the hospital and in the rest of the department.

Pip continued to receive low-level exposure to latex and was
referred for allergy testing when it was confirmed that she had developed a
severe allergy. What exacerbated her condition though was the hospital
management’s decision in May 1998 to lay a new flooring in her department that
contained latex.

An immunologist concluded that this caused Ms Wheatcroft to
become highly sensitised to latex and she was diagnosed with occupational
asthma in August 1998. During a severe asthma attack, she is in danger of
suffering from anaphylactic shock, a potentially fatal reaction that causes the
patient’s airways to close. Ms Wheatcroft was suspended from her job because
the hospital could not ensure she would not be at risk from latex exposure.

"I wasn’t just risking a rash, I was risking my
life," said Ms Wheatcroft. "I was told the best thing for me to do
would be to take early retirement on grounds of ill-health. It was only when I
tried to sort out my pension and compensation for loss of earnings that
problems began to arise."

For almost three years Pip, with the help of her union, the
Society of Radiographers, fought two cases – one for compensation for loss of
earnings, and one against the NHS Pensions Agency. It finally resulted in the
record out-of-court settlement to compensate for loss of earnings. A few days
later the NHS Pensions Agency agreed to pay a 75 per cent pension.

Ms Wheatcroft now works as a gardener and is studying for an
advanced certificate in horticulture.

Glutaraldehyde allergy

Fostina Brobbey worked as a theatre nurse for 25 years,
originally at Ancoats Hospital and then, from March 1994, at North Manchester
General Hospital. Her work brought her into contact with Cidex, a chemical used
in many hospitals up and down the country to sterilise equipment such as
endoscopes. Cidex contains glutaraldehyde, and it is well known that it can
irritate the skin, eyes, throat and lungs.

In 1995, she was diagnosed with occupational asthma and was
forced to retire in September 1996 due to ill health.

With the help of her union, Unison, Mrs Brobbey made a claim
against North Manchester NHS Trust and was awarded £157,000, one of the largest
sums ever paid out for asthma, including damages for pain and suffering, past
and future loss of earnings, loss of pension and loss of congenial employment.

"Nursing was the only job I’ve ever done and I really
loved it," said Mrs Brobbey. "If I could go back to the job tomorrow
I would, but I couldn’t keep working because of the asthma. It has been a real
strain going through the court case and the stress has made my symptoms worse.
I still wake up coughing at night, unable to breathe."

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