Occupational airways disease

Airway disease can be either caused or exacerbated 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% of adult asthma presentations (either new cases or exacerbation 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 by employers. Obtaining a full, precise job history together with careful application of simple but powerful diagnostic investigations are the key processes in distinguishing successfully between the two conditions. Appropriate management may result in cure, although in most cases there is a significant socio-economic cost to the patient.Toxic exposures to workplace respiratory irritants can also result in airway disease; symptoms are generally short lived and self-limiting but can occasionally result in an asthma-like syndrome (‘irritant-induced asthma’). A number of specific occupational exposures have been causally associated with chronic obstructive airways disease (COPD); diagnosis can be complicated due to the long latency period between exposure and clinically evident disease, and confounding by smoking. Other rare, occupationally induced airway diseases such as obliterative bronchiolitis require specialist consideration.