Occupational Asthma. Current Practice

Abstract

Exposures at work are an often overlooked but important cause of asthma and other airway diseases. Evidence from large pop- ulation-based studies shows that 1 in 10 cases of asthma occurring, recurring, or worsening in adulthood can be related to occupational factors. The majority of cases are of pre-existing asthma made worse by employment (work-exacerbated asthma (WEA)). Adults presenting with increased or new asthma symptoms should be carefully assessed so that WEA can be distinguished from true occupational asthma (OA), a disease that is directly caused by a workplace exposure. Airways disease may also arise from toxic exposures to respiratory irritants at work. In most cases, symptoms are self-limiting, but an asthma-like syndrome (irritant-induced asthma) occasionally results. OA and WEA require different diagnostic and management approaches. Key steps required to make a definitive diagnosis of either condition are an awareness of the disease with an associated low threshold of suspicion, time spent acquiring a full and detailed job history followed by care- fully considered application of a few simple important diagnostic investigations. A satisfying part of managing OA is the opportunity for cure (provided that the necessary management advice can be imple- mented), although the socioeconomic consequences—mainly to the patient themselves—can be high.