Employees with Respiratory 

Impairments 

Accommodation and Compliance Series
Practical Solutions • Workplace Success 

2 

Preface 

The Job Accommodation Network (JAN) is a service of the Office of Disability 

Employment Policy of the U.S. Department of Labor. JAN makes documents available 

with the understanding that the information be used solely for educational purposes. 

The information is not intended to be legal or medical advice. If legal or medical advice 

is needed, appropriate legal or medical services should be contacted. 

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publication. Although every effort is made to update resources, JAN encourages 

contacting product manufacturers/vendors and service providers directly to ensure that 

they meet the intended purposes. This guarantees that the most up-to-date information 

is obtained. 

The following document is not copyrighted and reproduction is encouraged. Section 

105 of the Copyright Law provides that no copyright protection is available for works 

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provision. While individuals may use such work with impunity, individuals may not 

claim copyright in the original government work, only in the original material added. 

Individuals may access the full text of the law from the U.S. Copyright Office 

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are not altered, and that proper credit is given to JAN as the source of the information. 

For further information regarding this or any other document provided by JAN, please 

contact JAN. 

Authored by Tracie DeFreitas Saab, M.S. Updated 03/23/10. 
Practical Solutions • Workplace Success 

3 

JAN’S ACCOMMODATION AND COMPLIANCE SERIES

Introduction 

JAN’s Accommodation and Compliance Series is designed to help employers determine 

effective accommodations and comply with Title I of the Americans with Disabilities Act 

(ADA). Each publication in the series addresses a specific medical condition and 

provides information about the condition, ADA information, accommodation ideas, and 

resources for additional information. 

The Accommodation and Compliance Series is a starting point in the accommodation 

process and may not address every situation. Accommodations should be made on a 

case by case basis, considering each employee’s individual limitations and 

accommodation needs. Employers are encouraged to contact JAN to discuss specific 

situations in more detail. 

For information on assistive technology and other accommodation ideas, visit JAN's 

Searchable Online Accommodation Resource (SOAR) at http://askjan.org/soar. 

Information about Respiratory Impairments 

What is a respiratory impairment? 

Respiratory impairment is a generic term that refers to a number of medical conditions 

that can affect the respiratory system and may result in limitations such as labored 

breathing or asthma attacks, fatigue and difficulty with mobility, heightened sensitivity to 

ordinary substances and chemicals, and compromised immunity to infection. 

What causes respiratory impairments? 

The following is a non-comprehensive list of many of the medical conditions that may 

result in respiratory impairments: Allergies, Asthma, Chemical Sensitivity (MCS), 

Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Environmental Illness (EI), 

Fragrance Sensitivity, Lung Cancer, Pulmonary Sarcoidosis, Tuberculosis, 

Emphysema, Pulmonary Hypertension, Latex Allergy, and AIDS Related Lung Disease. 

For more detailed information, see Appendix A at the end of this document. 

How are respiratory impairments treated? 

Treatment of respiratory impairments depends on many factors, such as the type and 

stage of impairment; family history; and the individual’s medical history, health, and age. 

Any of the following may be used for treating respiratory impairments: Inhalers or 

nebulizers containing bronchodilators or corticosteroids, expectorants, antibiotics, 

oxygen therapy, chemotherapy, lung transplantation, lung reduction surgery, natural 

treatments such as N-Acetyl Cysteine and Carnitine, and complementary/integrative 

therapies and treatments (About.com, 2006). 
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Respiratory Impairments and the Americans with Disabilities Act 

Are respiratory impairments disabilities under the ADA? 

The ADA does not contain a list of medical conditions that constitute disabilities. 

Instead, the ADA has a general definition of disability that each person must meet 

(EEOC, 1992). Therefore, some people with respiratory impairments will have a 

disability under the ADA and some will not. 

A person has a disability if he/she has a physical or mental impairment that substantially 

limits one or more major life activities, a record of such an impairment, or is regarded as 

having such an impairment (EEOC, 1992). For more information about how to 

determine whether a person has a disability under the ADA, visit 

http://askjan.org/corner/vol02iss04.htm. 

Has there been any ADA cases involving people with respiratory impairments? 

Yes, there have been several ADA cases involving people with respiratory impairments. 

The following are examples of those cases: 

Kelly v. Metallics West, Inc., 10th Circuit, 2005 (Pulmonary embolism) 

Buckles v. First Data Resources Inc., 8th Circuit, 1999 (Rhinosinusitis) 

Homeyer v. Stanley Tulchin Associates, 7th Circuit, 1996 (Severe allergies) 
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Accommodating Employees with Respiratory Impairments 

(Note: People with respiratory impairments may develop some of the limitations 

discussed below, but seldom develop all of them. Also, the degree of limitation will vary 

among individuals. Be aware that not all people with respiratory impairments will need 

accommodations to perform their jobs and many others may only need a few 

accommodations. The following is only a sample of the possibilities available. 

Numerous other accommodation solutions may exist.) 

Questions to Consider: 

1. What limitations is the employee with respiratory impairment experiencing? 

2. How do these limitations affect the employee and the employee’s job performance? 

3. What specific job tasks are problematic as a result of these limitations? 

4. What accommodations are available to reduce or eliminate these problems? Are all 

possible resources being used to determine possible accommodations? 

5. Has the employee with respiratory impairment been consulted regarding possible 

accommodations? 

6. Once accommodations are in place, would it be useful to meet with the employee 

with respiratory impairment to evaluate the effectiveness of the accommodations and 

to determine whether additional accommodations are needed? 

7. Do supervisory personnel and employees need training regarding respiratory 

impairments? 

Accommodation Ideas: 

Avoiding Environmental Triggers: 

Some respiratory impairments are aggravated by environmental triggers. It may be 

helpful to: 

• Maintain a clean and healthy work environment 

• Provide air purification 

• Condition, heat, dehumidify, or add moisture to the air as appropriate 

• Provide additional rest breaks for the individual to get fresh air or take medication 

• Create a smoke and fragrance-free work environment 

• Consider an alternative work arrangement such as work from home 

• Allow for alternative work arrangements when construction is taking place 

• Use alternative pest management practices 

• Implement a flexible leave policy 
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• Allow for alternative means of communication such as telephone, e-mail, instant 

messaging, fax, or memos 

Accessibility Accommodations: 

An individual who experiences respiratory limitations may have difficulty performing 

activities that require gross motor movement, such as walking long distances, or 

performing activities that require excessive physical activity. It may be necessary to 

address access concerns for an individual who has difficulty approaching the work 

facility, moving around the facility, getting to work, or traveling as an essential job 

function. 

• Modify the work-site to make it accessible

• Provide an accessible parking space with an unobstructed and easily traveled 

path into the workplace 

• Provide an entrance free of steps with doors that open automatically or that have 

a maximum opening force of five pounds 

• Provide an accessible route of travel to and from work areas used by the 

individual throughout the work environment 

• Consider providing a scooter or motorized cart for the employee to use for long 

distances if the employee does not already use a mobility aid 

• Move the individual’s workstation closer to equipment, materials, and rooms the 

individual uses frequently 

• Modify the workstation to accommodate a wheelchair, scooter, or the use of 

oxygen therapy equipment 

• Arrange the workstation so materials and equipment are within reach range 

• Provide restrooms that are easily accessed from the individual's workstation 

• Review emergency evacuation procedures 

Modify Policies: 

Due to the unpredictable nature of the onset of respiratory limitations, an individual may 

have difficulty maintaining regular attendance or a regular schedule. It may be 

necessary to: 

• Modify the location where work is performed 

• Modify the attendance policy 

• Provide leave as an accommodation

• Provide a modified or part-time work schedule

• Provide breaks 

Maintain Air Quality: 

The U.S. Environmental Protection Agency (EPA) provides suggestions for improving 

indoor air quality in its article, An Office Building Occupant's Guide to Indoor Air Quality 

found at http://www.epa.gov/iaq/pubs/occupgd.html. Employers should keep indoor air 
Practical Solutions • Workplace Success 

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quality concerns in mind for employees with and without respiratory impairments. Good 

IAQ can improve worker productivity for everyone. To maintain air quality, it may be 

necessary to: 

• Provide an office or workspace that has working windows 

• Maintain the heating, ventilation, and air conditioning (HVAC) system 

• Test indoor air quality 

• Use air purification systems throughout the building or in personal workstations 

• Reduce workplace pollutants 

• Provide a mask 

• Adjust indoor temperature to meet the individual’s needs 

• Institute a fragrance-free workplace 

• Provide pre-notification of construction and cleaning in the workplace 

• Use non-toxic building materials, furnishings, supplies, and flooring 

• Use non-toxic solvents, primers, stains, paints, etc. 

Situations and Solutions: 

A teacher diagnosed with sick building syndrome was required to attend weekly faculty 

meetings in the school building. She usually taught class from a portable classroom 

outside of the building and could not be in the school building for extended time. JAN 

suggested that she use either a speakerphone or PA system from her classroom to 

listen in and participate in the meetings, be provided with meeting minutes, or attend the 

meetings and wear a respirator mask if she felt comfortable doing so. 

An office worker with fragrance sensitivity was having difficulty because of the cleaning 

products used in the employee restroom. JAN provided information about non-toxic 

cleaning products. 

An employee with bronchial asthma could not work in hot environments. JAN discussed 

air-conditioning, including a window unit for the employee’s office if the employer could 

not install central air. 

A hospital worker with COPD had difficulty walking from the employee lot to the worksite. The parking lot was very large and employees parked on a first-come, first-serve 

basis. JAN suggested providing a reserved parking space close to the work-site. 

Products: 

There are numerous products that can be used to accommodate people with limitations. 

JAN's Searchable Online Accommodation Resource at http://askjan.org/soar is designed 

to let users explore various accommodation options. Many product vendor lists are 

accessible through this system; however, JAN provides these lists and many more that 

are not available on the Web site upon request. Contact JAN directly if you have specific 

accommodation situations, are looking for products, need vendor information, or are 

seeking a referral. 
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Resources 

Job Accommodation Network 

West Virginia University 

PO Box 6080 

Morgantown, WV 26506-6080 

Toll Free: (800)526-7234 

TTY: (877)781-9403 

Fax: (304)293-5407 

jan@askjan.org 

http://askjan.org 

The Job Accommodation Network (JAN) is a free consulting service that provides 

information about job accommodations, the Americans with Disabilities Act (ADA), and 

the employability of people with disabilities. 

Office of Disability Employment Policy 

200 Constitution Avenue, NW, Room S-1303 

Washington, DC 20210 

Toll Free: (866)633-7635 

TTY: (877)889-5627 

Fax: (202)693-7888 

http://www.dol.gov/odep/ 

The Office of Disability Employment Policy (ODEP) is an agency within the U.S. 

Department of Labor. ODEP provides national leadership to increase employment 

opportunities for adults and youth with disabilities while striving to eliminate barriers to 

employment. 

American Cancer Society 

250 Williams Street 

Atlanta, GA 30303 

Toll Free: (800)227-2345 

Direct: (404)315-1123 

Fax: (404)315-9348 

http://www.cancer.org 

The American Cancer Society is the nationwide community-based voluntary health 

organization dedicated to eliminating cancer as a major health problem by preventing 

cancer, saving lives, and diminishing suffering from cancer, through research, 

education, advocacy, and service. 
Practical Solutions • Workplace Success 

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American Lung Association 

61 Broadway, 6th Floor 

New York, NY 10006 

Direct: (212)315-8700 

http://www.lungusa.org/ 

Conducts educational programs, sponsors conferences, publications, fellowships and 

research grants. 

Asthma and Allergy Foundation of America 

1233 20th Street, NW, Suite 402 

Washington, DC 20036 

Direct: (202)466-7643 

Fax: (202)466-8940 

http://www.aafa.org/ 

The Asthma and Allergy Foundation of America (AAFA) is the premier patient 

organization dedicated to improving the quality of life for people with asthma and 

allergies and their caregivers, through education, advocacy and research. AAFA, a notfor-profit organization founded in 1953, provides practical information, community based 

services, support and referrals through a national network of chapters and educational 

support groups. AAFA also sponsors research toward better treatments and a cure for 

asthma and allergic diseases. 
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References 

About.com. (2006). What is lung disease? (2006). Retrieved September 5, 2008, from 

http://lungdiseases.about.com/od/basicinformation/a/basicinfo.htm 

Equal Employment Opportunity Commission. (1992). A technical assistance manual on 

the employment provisions (title I) of the Americans with Disabilities Act. 

Retrieved September 5, 2008, from http://askjan.org/links/ADAtam1.html 

 
Practical Solutions • Workplace Success 

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Appendix A 

The following is a non-comprehensive summary of many of the medical conditions that 

may result in respiratory limitations. For more detailed information, contact an 

appropriate medical professional or the resources listed at the end of this document. 

Allergies: According to the Asthma and Allergy Foundation of America (AAFA), an 

estimated 50 to 60 million Americans are affected by allergies. In fact, allergies are the 

sixth leading cause of chronic disease in the United States (AAFA, n.d.). It is common 

for an individual to be sensitive to more than one particular irritant. A substance that 

may normally not affect the average person may produce nasal congestion, itchy, 

watery eye, or an asthma attack for someone who is allergic. Allergic symptoms may 

occur due to dust, mold, mildew, pollen, foods, and insects among any number of other 

substances. 

Asthma: According to the American Lung Association (ALA), asthma is a chronic lung 

disease that can be life threatening (ALA, 2008d). Asthma causes breathing problems 

known as asthma attacks or episodes of asthma. A person with asthma might get an 

asthma attack when they have a cold or some other kind of respiratory infection or when 

they breathe something that bothers the lungs such as cigarette smoke or dust. Asthma 

symptoms are often triggered by changes in weather (cold or hot), emotional distress 

and exercise. Asthma attacks may start suddenly or may take an extended period of 

time, even days, to develop. Attacks can be severe, moderate or mild and can require a 

period of recuperation. 

Chemical Sensitivity (MCS), Environmental Illness (EI), and Fragrance Sensitivity: 

Chemical sensitivity, or MCS, is characterized by such symptoms as headaches, 

dizziness, nausea, breathing difficulties, tightening of the throat, chronic laryngitis, 

difficulty concentrating, memory loss, learning disorders, eczema, arthritis-like 

sensations, and muscle pain (About.com, 2006). A person who experiences limitations 

due to MCS or EI may have any of the above mentioned symptoms when exposed to 

such irritants as fragrances, cleaning agents, smoke, pesticides, molds, fumes from 

office machines, car exhaust, paint, new carpeting, solvents and other irritants.

For more specific information regarding MCS/EI, see JAN's Accommodation and 

Compliance Series: Employees with Chemical Sensitivity or Environmental Illness at 

http://askjan.org/media/MCS.html. 

For more specific information regarding fragrance sensitivity, see JAN's Accommodation 

and Compliance Series: Employees with Fragrance Sensitivity at 

http://askjan.org/media/fragrance.html. 

Chronic Obstructive Pulmonary Disease (COPD): The American Lung Association 

indicates that COPD is the fourth leading cause of death in America. Approximately 

16.4 million Americans are diagnosed with COPD. COPD includes diseases that are 

characterized by obstruction to airflow such as emphysema or chronic bronchitis. It 

does not include other obstructive diseases such as asthma. Chronic bronchitis is an 
Practical Solutions • Workplace Success 

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inflammation and eventual scarring of the lining of the bronchial tubes and is evidenced 

by a chronic cough, increased mucus, frequent clearing of the throat and shortness of 

breath. Emphysema causes irreversible lung damage and is evidenced by cough, 

shortness of breath and limited exercise tolerance (ALA, 2002a). 

Lung Cancer: According to the American Cancer Society's Lung Cancer Resource 

Center, it is estimated that there will be 169,400 new cases of lung cancer in the United 

States in 2002. Statistics show that lung cancer is the leading cause of cancer death 

among both men and women. More people die of lung cancer than of colon, breast, and 

prostate cancers combined (ACS, n.d.a). 

Lung cancer generally develops over a period of years and typically affects people over 

the age of 50. The American Lung Association's, Facts About Lung Cancer, describes 

cancers that begin in the lungs. Lung related cancers are divided into two major types, 

non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer 

generally spreads to distant organs more slowly than small cell lung cancer. Squamous 

cell carcinoma, adenocarcinoma, and large cell carcinoma are three types of non-small 

cell lung cancer (ACS, n.d.a). 

Pulmonary Sarcoidosis: Pulmonary sarcoidosis affects lung volume decreasing the 

amount of air the lungs can hold. The American Lung Association describes the 

disease as being characterized by the presence of granulomas, small areas of inflamed 

cells. They can appear on the walls of the alveoli (small air sacs in the lungs), or on the 

walls of the bronchioles (breathing tubes in the lungs), or in the lymph nodes 

surrounding the lungs. Symptoms include a dry cough, shortness of breath, or mild 

chest pain. Additionally, the person may experience fatigue, weakness, and weight loss. 

In cases where symptoms do appear outside the lung, they can include a scaly rash, 

red bumps on the legs, fever, soreness of the eyes, and pain and swelling of the ankles 

(ALA, 2008b). 

Tuberculosis (TB): TB is an infection that primarily affects the lungs but can also affect 

other organs and tissues in the body. The infection is spread by airborne TB bacteria. 

A person may have TB infection or TB disease. If a person has TB infection they are 

essentially a carrier of the bacteria but are not affected by the bacteria. A person 

infected with TB disease, however, is ill and requires treatment. A person with TB 

disease can spread the disease. Symptoms of TB disease include excessive coughing 

(including coughing blood), repeated night sweats, unexplained weight loss, loss of 

appetite, fever, chills, and general lethargy. According to the American Lung 

Association, the rate of reported tuberculosis dropped 45 percent between 1992 and 

2000. The decrease in reported TB has been attributed to improved TB control 

programs (ALA, 2008f). 

Emphysema: According to the American Lung Association, emphysema ranks 15th 

among chronic conditions that contribute to activity limitations. An estimated 44 percent 

of individuals with emphysema report that daily activities have been limited by the 

disease. Emphysema develops gradually, usually from exposure to cigarette smoke. 

Some individuals are born with a deficiency of a protein known as alpha 1-antitrypsin 
Practical Solutions • Workplace Success 

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(AAT) which can lead to an inherited form of emphysema called alpha 1-antitrypsin 

(AAT) deficiency-related emphysema. For individuals with emphysema, the air sacs in 

the lungs become damaged and less able to transfer oxygen to the bloodstream. The 

individual then becomes short of breath and has difficulty exhaling because the lungs 

also lose their elasticity (ALA, 2008a). 

Pulmonary Hypertension (PH): There are two forms of pulmonary hypertension, 

primary (PPH) and secondary (SPH). According to the American Lung Association, it is 

estimated that there are 300 new cases of PPH per year. PPH is defined as a rare 

disease of unknown cause that results in the progressive narrowing of the blood vessels 

of the lungs, causing high blood pressure in these blood vessels which eventually leads 

to heart failure. Secondary pulmonary hypertension (SPH) results from other types of 

lung disease, abnormal breathing processes, or heart disease (ALA, 2002h). According 

to the Mayo Clinic, symptoms and limitations of PPH include shortness of breath with 

exertion and general fatigue, passing-out spells, dizziness, ankle or leg swelling, and 

chest pain or pressure (ALA, 2008a). 

Latex Allergy: The Occupational Safety and Health Administration (OSHA) states the 

following about latex allergy, “Allergy to latex was first recognized in the late 1970s. 

Since then, it has become a major health concern as an increasing number of people in 

the work place have been affected. Health care workers exposed to latex gloves or 

medical products containing latex are especially at risk. It is estimated that 8-12% of 

health care workers are latex sensitive. Between 1988 and 1992, the Federal Drug 

Administration (FDA) received more than 1,000 reports of adverse health effects from 

exposure to latex, including 15 deaths due to such exposure” (OSHA, n.d). 

Latex allergy reactions can range from mild to very severe. Typically, the allergy begins 

with an irritant contact dermatitis and can develop into an immediate allergic reaction 

with respiratory symptoms. An individual with a latex allergy can be affected after 

coming into physical contact with products like latex gloves, elastic from waist bands, 

rubber bands, or medical equipment, by inhaling proteins from powdered latex gloves or 

balloons or by ingesting food products that have been prepared by workers using latex 

products. 

For more specific information regarding latex allergy, see JAN's Accommodation and 

Compliance Series: Employees who are Allergic to Natural Rubber Latex at 

http://askjan.org/media/LATEX.html. 

AIDS Related Lung Disease: A person with AIDS may experience any number of lung 

infections. Most common are pneumocystis carinii pneumonia (PCP), which is caused 

by a fungus, and tuberculosis and mycobacterium avium complex (MAC) which are 

caused by bacterium. AIDS also predisposes an individual to a variety of other lung 

infections from bacteria and molds (ACS, n.d.b). It is important for an individual with a 

compromised immune system to make an effort to avoid exposure to viruses and 

bacteria to stay healthy. 
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References for Appendix A 

About.com. (2006). Multiple chemical sensitivity (MCS) the controversy? (2006). 

Retrieved September 5, 2008, from 

http://allergies.about.com/library/weekly/aa011899.htm?terms=Multiple+Chemic

al+Sensitivity 

American Cancer Society (n.d.a). All about lung cancer. Retrieved September 5, 2008, 

from http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=15 

American Cancer Society (n.d.b). AIDS-related lung cancers. Retrieved September 5, 

2008, http://www.cancer.org/docroot/CRI/content/CRI_2_4_4x_AIDSRelated_Cancers_78.asp 

American Lung Association (2008a). Chronic obstructive pulmonary disease (COPD). 

Retrieved September 5, 2008, from 

http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=205882

9&content_id={12C9AADB-157F-4ABB-A4C4-FC694FBE0323}¬oc=1 

American Lung Association (2008b). Sarcoidosis. Retrieved September 5, 2008, from

http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=206072

7&content_id={96FE4972-D321-4E95-B03F-042FEFB92682}¬oc=1 

American Lung Association (2008c). Tuberculosis fact sheet. Retrieved September 5, 

2008, from 

http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=206073

1&content_id={1ED78388-82B6-4D6B-A242-C6794FB77034}¬oc=1 

American Lung Association (2008d). Asthma in adults fact sheet. Retrieved September 

5, 2008, from 
Practical Solutions • Workplace Success 

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http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=205881

7&content_id={39966A20-AE3C-4F85-B285-68E23EDC6CA8}¬oc=1 

American Lung Association (2008e). Lung cancer fact sheet. Retrieved September 5, 

2008, from 

http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=206024

5&content_id={BD3F3387-3AA3-4660-9EF7-3F5BD8B6D251}¬oc=1 

American Lung Association (2008f). Tuberculosis fact sheet. Retrieved September 5, 

2008, from 

http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=206073

1&content_id={1ED78388-82B6-4D6B-A242-C6794FB77034}¬oc=1 

American Lung Association (2003). Primary pulmonary hypertension (PPH) fact sheet. 

Retrieved September 5, 2008, from 

http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=206032

1&content_id={FA692DC0-B9A9-4BDC-88F4-2609BD6E0EDD}¬oc=1 

American Lung Association (2008f). Tuberculosis fact sheet. Retrieved January 26, 

2006, from http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35804 

Asthma and Allergy Foundation of America (n.d.). Allergy facts and figures. Retrieved 

January 26, 2006, from http://www.aafa.org/display.cfm?id=9&sub=30 

Occupational Safety and Health Administration (n.d.). Safety and health topics latex 

allergy. Retrieved September 5, 2008, from 

http://www.osha.gov/SLTC/latexallergy/index.html 
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This document was developed by the Job Accommodation Network, funded by a 

contract agreement from the U.S. Department of Labor, Office of Disability Employment 

Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the 

position or policy of the U.S. Department of Labor. Nor does mention of trade names, 

commercial products, or organizations imply endorsement by the U.S. Department of 

Labor.