Management of work-related asthma: guidelines and challenges

Abstract

Asthma is one of the most common chronic diseases in working populations. Overall, ∼15% of all adult-onset asthma is estimated to be caused by occupational exposure to a respiratory sensitiser or irritant [1–3]. Although occupational asthma is probably the most frequently reported respiratory disorder in varying occupations [4, 5], the disease is still underdiagnosed. Systematic research on incidence rates, health impact and socioeconomic burden of occupational asthma is sparse and national estimates are difficult to compare [5–7]. Work-related asthma imposes a significant financial cost that is mainly borne by affected employees and government [8, 9]. On top of physical impairment, the patient faces problems regarding employment [10] and other psychosocial problems [11]. However, proper management is not expensive [12] and even a low reduction in disease burden would be cost effective [13]. Moreover, prevention management towards occupational asthma influences the health impact of diseases with overlapping risk factors, such as chronic obstructive pulmonary disease. Work-related asthma covers occupational asthma and work aggravated/exacerbated asthma. Occupational asthma includes asthma caused by (allergic) sensitisation to a workplace agent, with sensitisation occurring during an asymptomatic latency period via immunoglobulin (Ig)E-mediated mechanisms or other hitherto largely unknown mechanisms, and irritant-induced asthma which occurs without evidence of sensitisation to the offending agent [14]. The clinical course of immunological occupational asthma with latency period does not differ from non-occupational allergic asthma, where a low amount of allergen is sufficient to provoke symptoms and where an evolution towards persistent “nonspecific” asthma is possible if exposure persists. This clinical course and the high prevalence of occupational asthma underscore the need to invest further in the challenging prevention of occupational asthma at both the individual and …