Occupational respiratory diseases
Obstructive respiratory diseases in hair salons
Respiratory symptoms such as coughing, shortness of breath, and rhinoconjunctivitis during work are often described by employees in hair salons. The current scientific knowledge does not provide a uniform picture of underlying conditions or possible causes. An increased prevalence for symptoms in the upper and lower respiratory tracts appears to be the most controversial, although there are varying results regarding an increased risk of contracting asthma, chronic bronchitis, and rhinoconjunctivitis allergica (see Albin et al. 2002; Bradshaw et al. 2011; Gosh et al. 2013; Leino et al. 1997, 2006).
There is a similarly broad spectrum for discussion regarding occupational factors which may affect the respiratory tract, ranging from possible chemically irritating effects to potential allergens and even to workplace conditions regarding vapours, dusts, and humidity. Moreover, various (singular) case studies describe different causes and disease progressions. In particular, possible pathomechanisms and commonalities are very important for effective preventive measures as well as for individual cases and on a collective level. In order to enable a better understanding of workplace-related respiratory symptoms in hair salons, we collected the data from all hair stylists who have reported respiratory symptoms in our outpatient clinic starting in 2012 and searched for anomalies and commonalities among their cases.
A prick test showed that many stylists exhibited a positive skin reaction to ammonium persulfate – one of the most frequently described triggers in this context. In combination with a complete anamnesis and a description of symptoms with regard to immediate-type allergies, about 15–20% of cases seemed to indicate a possible allergic asthma or allergic rhinoconjunctivitis in response to specific substances.
The underlying diagnoses frequently (~30%) remained unclear, as tests for the analysis of lung function could not even confirm an obstructive respiratory disease. In the majority of the collective (>50%), however, workplace-related components could not be conclusively attributed to a confirmed obstructive respiratory disease. Possibilities include both an unspecific cause in cases of asthma/COPD as well as workplace-related causes which have not yet been identified. For this reason, it is an important goal to reduce this high number of unclear cases and to enable a better understanding of the various pathomechanisms.
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Process quality, benefits, and satisfaction with respiratory consultation hours
According to SGB VII, the providers of statutory accident insurance in Germany are required to investigate suspected cases of occupational diseases in the context of the Ordinance on Occupational Diseases (Berufskrankheiten-Verordnung, BKV) and, on the basis of their investigation, to establish next steps as part of an appropriate administrative procedure. For especially frequent clinical presentations in the context of occupational diseases (Berufskrankheiten, BK), there is an established, nationwide procedure to be followed.
The Employers’ Liability Insurance Association for Health Services and Welfare Work (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, BGW) offers their members with reported, unclarified, and workplace-related respiratory symptoms, under certain prerequisites, specialised respiratory consultation hours (Atemwegssprechstunde, AWS) which focus on a concurrent occupational-medical assessment. The AWS is intended to help guide the patient through the insurance-law process at an early stage by providing an additional basis for decision-making. Moreover, it should enable a diagnostic clarification of symptoms and a confirmed diagnosis as well as a rapid assessment of needs and a solution to the patient’s problem, therefore improving care for insured parties.
Since 2012, the IPASUM of FAU Erlangen-Nürnberg has functioned as a cooperative partner for the BGW regional offices in Würzburg and Munich, and therefore offers specialised respiratory consultation hours for patients with workplace-related respiratory symptoms.
The primary study goal of the research project on the “Process quality, benefits, and satisfaction with respiratory consultation hours” is the explorative investigation of the process quality of the AWS for both insured partiers and insurers as part of the administrative procedures necessary for statutory accident insurance providers in cases of suspected work-related occupational disease as well as the satisfaction of all involved parties (patients on one hand and insurance clerks on the other) with regard to this process. The data gleaned from this project will be used to optimise both the procedure and the AWS itself.
Project partner: BGW