Protective equipment is the last resort, not the plan

Work-related asthma is caused or worsened by something in the workplace, which
means it is preventable by changing the workplace. The framework for doing
that is the hierarchy of controls, and the order is the entire point:

1. Eliminate the hazardous process or material from the task
2. Substitute a less hazardous process or material
3. Engineering controls — isolate or enclose the process, install local
   exhaust ventilation
4. Administrative controls — work practices, policies, worker training
5. Personal protective equipment — respiratory protection

Why PPE is last

PPE should not be the sole method for protecting workers.

Each step down the list depends on more things going right. Elimination
protects every worker in the building, permanently, whether or not anyone is
paying attention. A respirator protects one worker, if it fits, if it is worn,
if it is worn correctly, if it is maintained, and if it does not fail — and it
is the option that shifts the burden from the employer to the person exposed.

It is also the cheapest and easiest to introduce, which is why it is so often
where organisations start. The hierarchy exists to say: **use PPE together with
the controls above it, not instead of them.**

Medical surveillance, and what it is for

Employers may establish a plan to monitor workers for asthma, which can
identify workers with asthma at earlier stages — early enough to **remove
them from the exposure and prevent the disease progressing.**

Surveillance can be as simple as periodically completing a questionnaire. A
plan should include periodic screening for asthma symptoms and **follow-up
medical testing when appropriate**; allergy skin tests for sensitisation
have also been used. Without an existing programme, **consult an occupational
physician about monitoring options.**

The purpose is worth stating plainly: this is not about certifying people fit
to work. It is about catching the disease while it is still reversible, which
for occupational asthma means before continued exposure makes it permanent.

What a worker can do

• Identify and avoid exposure to asthma triggers
• Take part in the employer's surveillance plan, if there is one
• Report new or worsening breathing problems — to your doctor and to
  the designated person at work
• Report failures of protective equipment or engineering controls to your
  supervisor
• **If you have asthma, take your medication as prescribed and see your doctor
  regularly**

The double reporting in the third item is deliberate. Telling a doctor gets you
treated; telling the workplace is what gets the cause fixed, for you and for
whoever does the job next.

Source: Centers for Disease Control and Prevention (NIOSH).