Troubled Breathing: New Trends in Respiratory Illness

M. L. Hopkins

The last major U.S. reckoning with widespread respiratory problems was during the COVID global health emergency. In 2020, employers reported 428,700 cases of respiratory illness, 79% of all 544,600 employer-reported illness in that year. That was a nearly 4,000% increase from 2019 when respiratory illness cases (10,000) were just 8% of the total (127,200).1

Many people haven’t been breathing much easier since the pandemic ended, however, due to other rising respiratory challenges, the signs of which can also be seen in the workplace. These include the effects of:

  • Wildfire smoke
  • Pollen and allergies
  • Extreme temperatures

Supporting good respiratory health is an important aspect of wellness and productivity in the workplace. Occupational health consultations, physical exams, and specialized respiratory services can help employers address these environmental factors.

Wildfire smoke

Canada’s 2023 wildfire season is its worst since 1989, and drifting smoke has triggered numerous air quality alerts in wide swaths of the U.S. Midwest, East Coast, and South.2

A rainbow in the smoke is that the first eight months of the 2023 U.S. wildfire season was “significantly below the 10-year average (2013-2022) of 38,494 fires and the average acreage of 4.65 million acres.” As of August 21, 2023, the National Interagency Fire Center reported 36,275 wildfires covering 1.76 million acres.3

Wildfires can cause several ill-health effects, and individuals may present to healthcare professionals with symptoms of headache, eye irritation, coughing, wheezing, chest pain, fatigue, and even palpitations.4

Wildfire smoke exposure can be especially risky for individuals with pre-existing chronic conditions affecting the lungs or heart, such as asthma or congestive heart failure.

In California, a perennial U.S. leader in wildfires, Cal/OSHA offers employers several recommendations:5,6

  • Create a communication plan to inform employees about wildfire smoke health hazards
  • Conduct employee training that includes how to track air quality over time
  • Adopt engineering controls, if feasible, such as reassigning work to indoor locations with filtered air
  • Make changes in work schedules to avoid peak exposures
  • Require employees to use personal protective equipment

In a June 2023 news release, the national Occupational Safety and Health Administration (OSHA) announced a comprehensive website with safety tips and resources to help employers and workers reduce their exposure to smoke during wildfires.7,8

Pollen and allergies

Pollen used to mean the sniffles and red eyes for a month or two in the spring. It was barely a blip in the workplace, except, perhaps, for the sudden appearance of multiple boxes of tissues. That has changed.

“According to the Centers for Disease Control and Prevention, Americans spend over $3 billion on medical costs linked to pollen, with nearly half of those costs coming from prescription medications,” a Yale publication reports. Two changes accredited to warmer global temperatures have occurred: The pollen season now starts 20 days earlier in North America, and pollen concentrations have increased by 21%.9,10

Besides the well-known hay fever symptoms (skin rashes, sneezing, coughing, and runny nose), pollen can also increase risk for employees with asthma, resulting in shortness of breath, chest tightening, wheezing, and trips to the emergency room.11

Employees do miss work due to seasonal allergies. Florence Ida Hsu, MD, an adult allergist/immunologist and assistant professor of clinical medicine at Yale School of Medicine, explains why seasonal allergies are a bigger concern than may be popularly believed. “There is a theory called ‘the unified airway’ in which the nose is connected to the lungs, so if you have a lot of inflammation in the nasal passages and the sinuses, that can then lead to ‘lower respiratory’ symptoms, such as cough, shortness of breath, and wheezing. You’ll find people with allergies getting recurrent sinus infections, and both can lead to respiratory symptoms, asthma, and bronchitis,” says Dr. Hsu.12

Employers need to look beyond just those employees who are obviously exposed to rising pollen levels in their jobs, such as outdoor workers in agriculture, ranching, and construction, advises the U.S. Environmental Protection Agency. Pollen and other allergens can also make their way indoors. In addition, extreme rainfalls and flooding can result in a variety of asthma triggers, including mold and bacteria.13

Extreme temperatures

Extreme heat (and associated use of air conditioning) and extreme cold can impact breathing.

Hot temperatures swell airways, causing coughing, wheezing, and shortness of breath.14,15 Using a dehumidifier to keep humidity moderate helps, but watch out for sudden major shifts in temperature, such as when going from extreme outdoor heat to a frosty air-conditioned office.

Research reported in the journal Clinical and Transactional Allergy found that people with chronic respiratory disease (asthma or COPD, chronic obstructive pulmonary disease) can experience a worsening of their symptoms over days if they work in air-conditioned temperatures colder than 75 degrees F or if they are exposed to dramatic changes in temperature when transitioning from the hot outdoors to air conditioning.16

In cold weather, low natural humidity or the use of heaters, which can bring in drier air from outside, can irritate the lungs and constrict airways. This is called bronchospasm, and its effects are seen in shortness of breath, tightness and a burning sensation in the chest, wheezing, or coughing.17

Employers can help protect employees’ respiratory health by maintaining, as much as possible, consistent moderate temperatures and humidity in the workplace. In addition, ventilation systems should be cleaned and indoor air quality checked regularly.18

OSHA does not have indoor air quality standards but does provide guidance through standards for ventilation and for particular air contaminants. Poor indoor air quality may cause employees to experience adverse reactions, such as headaches, fatigue, trouble concentrating, and irritation of the eyes, nose, throat, and lungs, OSHA says.19

OSHA has responded to employers’ most frequently asked questions on its website and is available to provide additional help, if needed.20

Next steps to healthy breathing

When an employee is experiencing acute respiratory distress, call 9-1-1 for emergency help immediately. First responders have specialized training to understand what’s happening. They know how to assess many complex factors, including  ventilation, oxygenation, work of breathing (the amount of energy needed by respiratory muscles to produce enough ventilation and respiration for the body’s metabolic demands), lung function, airway resistance, and air flow.21,22

Employers, however, should give attention to day-to-day environmental conditions to help promote respiratory health.

For respiratory health, turn to Concentra

Concentra helps employers navigate respiratory health challenges through consultations, respirator clearance physical exams, and specialized efforts, such as pulmonary function testing and asthma/allergy questionnaires to evaluate employees’ ability to work in certain environments.

Respiratory health is just one example of Concentra’s many solutions to support employers in improving employee health and their understanding of conditions through a variety of clinical services.


  1. Employer-reported respiratory illnesses increase nearly 4,000 percent in 2020.” U.S. Bureau of Labor Statistics: The Economics Daily. November 5, 2021.
  2. Canada wildfires: what are the causes and when will it end?” Reuters. August 19, 2023. Accessed August 24, 2023.
  3. 2023 North American Wildfires.” Updated August 22, 2023.
  4. Wildfire Smoke.” Centers for Disease Control and Prevention. May 18, 2023. Accessed August 24, 2023.
  5. Facts + Statistics: Wildfires.” Insurance Information Institute. Accessed August 24, 2023.
  6. Protecting Outdoor Workers Exposed to Smoke from Wildfires.” California Department of Industrial Relations. February 2021. Accessed August 24, 2023.
  7. U.S. Department of Labor urgers employers to have a plan to protect outdoor workers from hazards associated with poor air quality.” OSHA National News Release. June 9, 2023.
  8. Wildfires.” OSHA. Accessed August 24, 2023.
  9. “’In every breath we take’: How climate change impacts pollen allergies. Longer growing seasons and more pollen spell misery for millions,” by Samantha Harringon. Yale Climate Connections. April 19, 2023.
  10. Angeregg WRL, Abatzoglou JT, Anderegg LDL, et al. Anthropogenic climate change is worsening North American pollen seasons. Proceedings of the National Academy of Sciences. February 8, 2021.
  11. Harrington. Yale Climate Connections.
  12. Seasonal Allergies Are Back – What You Can Do About It,” by Kathy Katella. Yale Medicine. Updated March 23, 2023. Accessed August 26, 2023.
  13. Climate Change and the Health of Workers.” U.S. Environmental Protection Agency. Updated December 13, 2022. Accessed August 26, 2023.
  14. Why breathing problems can get worse in warm weather – and what to do about it.” Optum. Accessed August 25, 2023.
  15. 5 Tips to Help You Breathe Easier in Hot or Cold Weather.” Cleveland Clinic. March 3, 2021.
  16. D’Amato M, Molino A, Calabrese G, et al. The impact of cold on the respiratory tract and its consequences to respiratory health. Clinical and Translational Allergy. 2018;8:20
  17. Cold Takes Your Breath Aways: How to Breathe Easier in Winter,” by Matya Swift Yasgur. WebMD. November 11, 2022.
  18. Facilities and Fatigue: Guidance for a Safe and Health Office Space,” by Michelle Hopkins. Concentra. June 14, 2021.
  19. Indoor Air Quality.” OSHA. Accessed August 26, 2023.
  20. Indoor Air Quality Frequently Asked Questions.” OSHA. Accessed August 26, 2023.
  21. McEvoy M. How to Assess and Treat Acute Respiratory Distress. Journal of Emergency Medical Services. July 19, 2013.
  22. Dekerlegand RL, Cahalin LP, Perme C. Respiratory Failure | Work of Breathing. Physical Rehabilitation, 2007.