Health surveillance: Respiratory

Asthma

A history of asthma should not mean that someone is excluded from work. However, if asthma is likely to be aggravated by exposure to substances at work, you may need specialist advice.

Employees who are likely to be exposed to respiratory sensitisers (eg isocyanates) should be provided with suitable health surveillance. The exact details will depend of the nature and likelihood of exposure. An occupational health practitioner should be able to ensure that health surveillance fits your particular circumstances.

Generally, a pre-placement assessment should be used to establish a baseline for respiratory health. Health surveillance should then include an assessment at the following intervals:

• three months into employment (questionnaire and spirometry);
• every six months for the first two years of employment with an annual review thereafter if no problems are identified (questionnaire and spirometry).

It is good practice to nominate a ‘responsible person' who workers can report symptoms to. This person will need some training, as will the workers.

Sample health surveillance questionnaires:

• Notes for responsible person (includes advice on frequency)
• Initial questionnaire
• Follow up questionnaire
• Health surveillance for occupational asthma G402

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Silica/silicosis

Consider providing heath surveillance for construction workers who do the following tasks, if they are exposed to respirable crystalline silica (RCS) dust:

• cutting or breaking stone, concrete or brick;
• abrasive blasting;
• tunnelling.

If the risk of exposure is low, you may decide, with the help of an occupational health professional, that health surveillance (involving an X-ray and symptom enquiry) is unnecessary.

However, where there is a reasonable likelihood of silicosis developing, health surveillance will usually be necessary. You need to consider, in discussion with your occupational health professional, the risk of silicosis developing due to RCS and decide what health surveillance is appropriate.

The health professional may, in any case, recommend an X-ray as part of the clinical investigation of someone who reports new or worsening respiratory symptoms.

• Health surveillance for those exposed to respirable crystalline silica (RCS) G404

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Chronic obstructive pulmonary disease (COPD)

If you detect an employee's symptoms early enough and reduce their exposure to dust, you will prevent further damage.

Your health monitoring programme could include:

• Assess workers' respiratory health to provide a baseline before they start a job (perhaps using a questionnaire and lung function assessment).
• Introduce regular testing as advised by your health professional. This could involve further questionnaires and lung function assessments. The health professional must explain the test results to the worker and report to you on their fitness to work.
• Health professionals should interpret trends for groups and individuals, and advise whether your risk assessment needs revising.
• Appoint a responsible person, supported by the health professional, to report any symptoms that occur between tests.
• Keep simple attendance records to identify any patterns in sick absence.

• Health monitoring for chronic obstructive pulmonary disease G401

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