Work‐Related Asthma From Exposure to Cardboard and Paper Products

BACKGROUND: We assess the contribution of cardboard dust exposure to the development of work-related asthma (WRA). Prior studies on paper-dust-related breathing problems have focused on exposures in the paper milling and pulp industries. There have been no reports of asthma linked to workplace exposure to cardboard dust. METHODS: From 1988 to 2022, all cases of asthma associated with paper and cardboard dust exposure reported to the Michigan statewide surveillance system were identified. We summarize the characteristics of these workers. RESULTS: Eight cases of paper-dust-related asthma were identified. Seven of the cases were attributed to cardboard dust, and one to paper dust exposure. Half were exposed to cardboard dust while packaging and shipping products in cardboard containers. Five of the cases were new-onset asthma; the other three were work-aggravated asthma. No exposures were reported from paper milling or pulp industries. CONCLUSIONS: Cardboard dust was identified as a major contributor to the incidence of asthma associated with paper products. No cases were identified from the paper milling or pulping industry, despite most research studies reporting respiratory disease in that industry. Cardboard dust within manufacturing industries disproportionately contributed to cases of WRA in the state of Michigan, which is not reflected in the medical literature.