The Guidelines Management of Work-related Asthma as an example of necessary international collaboration

Abstract

It is a pleasure to write this in honour of Xaver Bauer’s Festschrift. Xaver Baur’s enthusiasm and persistence carried this project to a very successful conclusion, providing the first European evidence-based guidelines for the management of occupational asthma (Baur, Sigsgaard et.al. 2012). The problems to overcome were considerable; the project had 13 contributors from 8 political administrations, speaking 7 native languages with one leader. The guidelines define occupational asthma as “a disease characterised by variable airflow limitation and/or hyper-responsiveness associated with inflammation due to causes and conditions attributable to a particular occupational environment and not to stimuli encountered outside the workplace” (Baur, Sigsgaard et.al. 2012). European countries interpret this differently as reflected in national statistics. The numbers (per million workers/year) recorded with occupational asthma is shown in figure 1 (Baur, Aasen et al 2012). It is very unlikely that the incidence of occupational asthma differs more than twentyfold between European countries. The differences are much more likely to reflect the rules for compensation and access to specialist centres. Defining a disease legally rather than medically is a dangerous way forward and unlikely to lead to the best care for patients and the necessary control of exposures needed to reduce occupational asthma. Finland probably has the best services and standards of care for workers with occupational asthma, and some of the better working conditions. The high numbers (which they believe are an underestimate) are likely to reflect countrywide standards of diagnosis and care, rather than rely on pockets of enthusiasm which is the more common European approach.