Winter’s chilling effect on asthma in the workplace

Lawrence Buirse

Early in the pandemic, there were concerns that a respiratory virus like SARS-CoV-2 would increase a person’s chances of contracting COVID-19; however, research now reveals that this is not necessarily the case.1 But long before there was a COVID-19 pandemic, asthmatics were dealing with a nemesis that has been proven to make life miserable — a threat that emerges each year like clockwork. It’s the winter season.

Winter is considered the worst season for asthma sufferers. According to data from the Centers for Disease Control and Prevention (CDC), 7.8 percent of the U.S. population has asthma.2 This respiratory condition is marked by inflammation, or swelling, in the bronchi — the tubes that carry air from the windpipe to the lungs. Because of this inflammation, breathing in and out is not always so simple. And winter’s cold, dry air can cause the upper airways to go into spasm and contract — a condition called bronchospasm. It’s the contracting of these airways that restricts air delivery to the lungs and causes some of the more common symptoms of asthma, such as:

  • Shortness of breath
  • Wheezing
  • Coughing
  • Chest tightness

Asthma can disrupt a person’s lifestyle. For example, an asthmatic may elect not to engage in certain physical activities (e.g., high-intensity exercises) or outdoor functions to avoid triggers and prevent flare-ups. Other complications caused by asthma can include sleep problems, daytime fatigue, and even anxiety or depression.3

Asthma in the workplace

Avoiding triggers starts by knowing what causes an asthma attack, episode, or flare-up. Common asthma triggers include smoke, mold, pet dander, and outdoor air pollution (e.g., gases). Even in the workplace, it’s not uncommon for someone to develop asthma or exhibit asthma-related symptoms due to exposure to physical conditions (e.g., extreme cold/heat), dust, chemical irritants, or other triggers — a condition known as occupational asthma.

Occupational asthma is the most prevalent lung disease related to work — yet often underrecognized. An employee who exhibits new or worsening asthma-like symptoms at work typically falls into one of two categories:

  • Occupational asthma: An asthma case caused by specific agents in the workplace.
  • Work-exacerbated asthma: An asthma case involving an employee with pre-existing asthma whose symptoms worsen while in the work environment.

Since the winter season may bring asthma-like symptoms more to the forefront, it’s in employers’ best interest to learn more about occupational exposures that trigger work-related asthma and workforce health services that help to prevent or detect the condition.

Occupational spirometry testing

Occupational spirometry testing is a pulmonary function test commonly used to assess lung function. Along with evaluating respiratory health, employers can use this test to screen employees’ ability to safely perform certain tasks at work. Employers can also leverage spirometry testing to help set workplace health and safety protocols. Pulmonary function tests are recommended for both diagnostic purposes and ongoing occupational asthma and allergy surveillance.

Why conduct spirometry testing?

Roughly 15 percent of adult asthma cases derive from occupational exposures.4 Undiagnosed and untreated asthma can lead to serious respiratory issues. Occupational spirometry testing is an essential first step to the diagnosis of asthma. Uncovering and mitigating the risks attributed to occupational or work-exacerbated asthma can be accomplished through the results of the examination and testing.

Because some asthma symptoms resemble symptoms for other respiratory diseases, it’s not uncommon for an individual with asthma to be misdiagnosed and improperly treated. Conversely, someone could be misdiagnosed with asthma when it’s something else. Testing employees who work with occupational asthmagens (i.e., substances found in the workplace that can cause or trigger asthma) can help employers reduce future, work-related medical claims. There are several direct and indirect costs an employer must consider when employees are not tested for asthma or misdiagnosed.

“Indirect costs include decreased worker productivity when asthma is uncontrolled, lost workdays, workers’ compensation expenses, and disability costs,” explains Deepa Rajakrishnan, MD, director of medical operations at Concentra®. “The direct costs include medications, [medical] office visits, emergency department visits, and hospitalizations.”

Medical surveillance for occupational asthma, which includes a medical evaluation and spirometry testing, can provide the level of care needed to prevent asthma attacks, episodes, or flare-ups at work. But more importantly, it can help to preserve the health of a workforce and avoid the one unmeasurable cost: the death of an employee. Occupational exposures are believed to be responsible for up to 21 percent of asthma-related U.S. deaths.5

Occupations to consider for spirometry testing

Several occupations leave employees susceptible to developing asthma, including:

  • Construction laborers
  • Forest workers
  • Factory workers
  • Welders
  • Electricians

Many occupations that require employees to meet physical performance requirements (e.g., first responders) also happen to be jobs that place employees at higher risk of exposure to occupational allergens and weather conditions that can cause the onset of asthma or trigger a flare-up.

COVID-19 and occupational spirometry testing

Until medical experts could collect more data on COVID-19 and gain a better sense of how the virus spread, they recommended the postponement of preventive health screenings believed to increase the risk of exposure. On March 16, 2020, the American College of Occupational and Environmental Medicine (ACOEM) recommended suspending spirometry testing (unless it was determined to be clinically essential) due to the risk of transmitting COVID-19 in asymptomatic carriers during the procedure.6

To better understand the risks associated with spirometry testing, one must understand what happens during a spirometry test. First, a clip is placed on a person’s nose, while a plastic mouthpiece is connected to the spirometer. The person tightly places the lips around the mouthpiece and takes in a big, deep breath. Then, the person blows out as hard and fast as possible. Finally, this step may be repeated for the best possible results.7 This forceful exertion of air can cause the transmission of air droplets — droplets that could originate from an asymptomatic carrier of COVID-19.

But the health climate has changed since the March 2020 recommendation on spirometry testing. Most medical facilities that administer spirometry testing have implemented infection prevention and control (IPC) precautions to mitigate the spread of infection. For example, Concentra medical centers use bacterial viral filters for lung function tests to prevent cross-infection, and clinic staff wears full PPE while performing the tests. Improved infection control standards, wider access to COVID-19 vaccines, and increased return-to-work activity were influential in ACOEM’s decision to update its recommendations on occupational spirometry and fit testing.

Preventing occupational asthma

There are workplace measures that can be taken to reduce exposures or triggers for someone with work-exacerbated asthma. These employees will still have a diagnosis of asthma, but the exacerbations can be resolved or controlled.

“Occupational asthma is an airway dysfunction that can be treated and resolved with proper management,” says Dr. Rajakrishnan. “When the substances that caused asthma are avoided, symptoms may disappear.”

In other words, the sooner an employer detects symptoms of occupational asthma in an employee, the sooner treatment can begin that could eliminate the symptoms and the condition altogether.

“Detecting health effects early allows for earlier management and adjustment of employer controls,” explains Ronda McCarthy, MD, MPH, FACOEM, Concentra national director of medical surveillance services. An example of employer worksite controls could be reassigning an asthmatic employee away from the work area that triggered the asthma-related symptoms.

Pulmonary function tests can increase awareness of work-related asthma to ensure the right steps are taken to mitigate the risk of developing the condition. During the winter, an employee may dismiss early symptoms of asthma as signs of cold, flu, or other seasonal ailments. Plus, an employee may not associate the symptoms with the work environment. Ignoring possible asthma symptoms could lead to something more severe. Pulmonary function tests can be performed periodically to help diagnose and detect the condition — thereby, helping to better manage symptoms resulting from exposure to cold weather or other occupational asthmagens.

Schedule allergy and asthma surveillance for your workforce

Concentra offers noninvasive pulmonary function testing and other testing as part of allergy and asthma surveillance. These tests can detect signs, symptoms, and sensitivity to occupational exposures that can lead to asthma or exacerbate underlying asthma. As a result, diseases or abnormal trends in an employee’s health status can be discovered and treated before an occupational lung condition develops and/or emergency medical attention is needed.

Learn more about Concentra’s pulmonary function tests or contact your nearby Concentra medical center to schedule service for your workforce.


  1. Jamieson, A. (2021, March 4). People with asthma don't face higher COVID-19 risk. Healthline. Retrieved December 1, 2021
  2. Centers for Disease Control and Prevention. (2021, March 30). Most recent national asthma data. Centers for Disease Control and Prevention. Retrieved December 1, 2021.
  3. MediLexicon International. Asthma complications: Medical and lifestyle. Medical News Today. Retrieved December 1, 2021.
  4. American Journal of Respiratory and Critical Care Medicine. The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society statement. Accessed November 22, 2021.
  5. Morbidity and mortality weekly report. Centers for Disease Control and Prevention. Retrieved December 1, 2021.
  6. American College of Occupational and Environmental Medicine. ACOEM advises suspension of routine occupational spirometry testing during COVID-19 pandemic. Accessed November 22, 2021.
  7. American Lung Association. What is spirometry and why it is done? Accessed November 22, 2021.