Abstract
This paper focuses on the prevention of asthma caused by exposure to sensitizing agents in the workplace. Control of exposure (primary prevention) is the most direct method of reducing the number of incident cases. Screening programmes are also necessary as a "safety net", and have value as secondary prevention, because early detection may improve long-term prognosis. It is recommended that regulatory or advisory bodies with responsibility for occupational asthma publish a guidance document on occupational asthma explaining their current concepts. Surveillance activities provide information on how common asthma is relative to other occupational lung diseases, and on the relative frequency of occurrence of asthma caused by different agents. Publication of a list of sensitizing agents would aid those with responsibility for control of exposure in the workplace. Epidemiological research on exposure-response relations is is necessary as a background to prevention. This paper recommends such studies. Immunotoxicological research also has a role in testing hypotheses that cannot be tested in human subjects. Some standardization of screening programmes in industry is desirable. A short symptoms questionnaire is economical and acceptable to workers, but there are other approaches. Finally, evaluative research on prevention measures gives information on their effectiveness and efficiency.
Highlights
Surveillance activities give information on how common asthma is relative to other occupational lung diseases, and on the relative frequency with which different agents cause asthma
In inhalation challenge tests with tetrachlorophthalic anhydride, patients with occupational asthma caused by this chemical showed late and dual asthmatic responses after 30 min exposures to airborne levels orders of magnitude lower than those recommended as occupational standards [48]
In a group of pharmaceutical research workers, symptoms consistent with occupational asthma caused by laboratory animals showed no relationship with job type, and showed an inverse relationship with increasing duration of exposure [52]
Summary
Because this paper envisages direct prevention as taking place in the workplace, another underlying assumption behind its writing is that the people with primary responsibility for prevention are in the workplace: managers and supervisors, worker representatives, and health and safety professionals working within industry. It is clear that they have considerable influence In general, such agencies and individuals have no direct authority to control the work process and, where their influence is felt, they act indirectly through those with such authority. Those with responsibility are usually less knowledgeable than advisors and regulators about asthma and its relation to work, but more knowledgeable about practical ways in which control measures can be implemented. Successful prevention depends on co-operation between employers, workers and their representatives, regulators, and medical and nonmedical specialist advisors
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