Occupational airways disease

Occupational exposures are an important – but probably neglected – cause of airways disease. Nowhere is this more important than in asthma; 10% of all new or recurrent cases of asthma in adulthood can be related to an exposure encountered at work. Pre-existing asthma in which symptoms are provoked at work (‘work-exacerbated asthma’) should be carefully distinguished from disease that has arisen de novo as a result of a workplace exposure (‘occupational asthma’); the two pose quite different diagnostic, management and legal issues. A firm diagnosis of occupational asthma requires a low threshold of suspicion, careful attention to a full job history and the judicious application of simple but powerful diagnostic tools. Once a diagnosis is established, appropriate management allows an important opportunity for cure in many cases, although the socio-economic cost to the patient can be high. Airways disease may also arise from toxic exposures to respiratory irritants at work. In most cases, symptoms are self-limiting, but an asthma-like syndrome (‘irritant-induced asthma’) occasionally results. Other persistent airways diseases from irritant exposures – such as obliterative bronchiolitis – are rare and require specialist consideration.