TOPIC: Occupational and Environmental Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Occupational asthma is one of the significant public health problems. We present a patient exposed to substances at her workplace, which eventually caused her to develop sensitivity to several other substances and unemployment. CASE PRESENTATION: A 67-year-old female who worked an administrative job at an organization developed progressive dyspnea, wheezing, conjunctivitis, poor concentration, and chronic fatigue within few months of starting work. The patient felt better during weekends, at night times, and when she stayed away from her workplace. In addition, several of her other colleagues also had similar symptoms. An inspection was performed, which revealed that building construction had exposed the employees to several chemicals such as phenol, ethylbenzene, formaldehyde, and glycol. The building was eventually closed due to this. The patient of ours visited several pulmonologists and occupational medicine specialists concerned about her respiratory symptoms over a span of 25years. Over several years, spirometry revealed mild obstruction and restriction. The patient's symptoms improved for a short duration after she stopped working at that facility and with the use of inhaled corticosteroids. Subsequently, her symptoms returned and she developed marked sensitivity to several other agents such as smoke, pollen, odors, hair products, cleaning agents making it difficult for her to step out of the house. She came to our clinic for pulmonary disability evaluation. Further history revealed that she is a lifetime non-smoker, did not have asthma before the exposure history at the workplace. After prolonged investigation and tests, she was deemed unable to work due to her inability to avoid complete exposure to irritants and chemicals at any workplace. DISCUSSION: Occupational asthma is of two types, immunological and non-immunological. The first is sensitization to a stimulant over a while and has a latency period before the overt manifestation of symptoms. The non-immunological type is caused due to sudden high-level exposure to specific irritants with rapid onset of symptoms. Clinical history plays a significant role in recognizing this association early. As mentioned in our case, a typical history is that the patient has symptoms while at work and feels better outside of the workplace. Diagnosis and treatment of immunological type are challenging. Due to latency, there is prolonged and persistent exposure, increasing their risk of developing severe disease, as seen in our case. Management is to avoid exposure to sensitizing agents in addition to bronchodilators and steroids similar to non-occupational asthma. CONCLUSIONS: This case illustrates the potential long-term effects that occupational asthma may have on the socio-economic, physical, and mental status of a patient. Early identification and appropriate intervention can help prevent severe sensitization and disability. REFERENCE #1: Mapp CE, Boschetto P, Maestrelli P, Fabbri LM. Occupational Asthma. American Journal of Respiratory and Critical Care Medicine. 2005;172(3):280-305. REFERENCE #2: Tiotiu AI, Novakova S, Labor M, et al. Progress in Occupational Asthma. Int J Environ Res Public Health. 2020;17(12). REFERENCE #3: Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med. 2014;370(7):640-649. DISCLOSURES: No relevant relationships by Bhanusowmya Buragamadagu, source=Web Response No relevant relationships by Bharath Ganesh, source=Web Response No relevant relationships by Aliza Khanam, source=Web Response No relevant relationships by Michael Korman, source=Web Response No relevant relationships by Rakin Rashid, source=Web Response