Occupational airways disease

Airway disease can be either caused or made worse by occupational exposures; early recognition of work-related disease is crucial to achieving a successful outcome for the patient. It has been estimated from population research that 10–15% of adult asthma presentations (either new cases or exacerbations of existing disease) can be attributed to a work exposure. Work-exacerbated and occupational asthma have different causal pathways and therefore require different management by healthcare professionals as well as employers. Obtaining a full, precise job history and carefully applying simple but powerful diagnostic investigations are key in successfully distinguishing between the two conditions. Appropriate management can result in cure, although in most cases there is a significant socioeconomic cost to the patient. Toxic exposures to workplace respiratory irritants can also result in airways disease; symptoms are generally short lived and self-limiting but can occasionally result in an asthma-like syndrome (‘irritant-induced asthma’). Several specific occupational exposures have been causally associated with chronic obstructive airways disease; diagnosis can be complicated because of the long latency between exposure and clinically evident disease, and can be confounding by smoking. Other rare, occupationally induced airway diseases such as obliterative bronchiolitis require specialist consideration.