Occupational asthma is the most prevalent form of occupational lung disease in industrialized
nations. As increasing numbers of new chemicals are produced and new manufacturing
processes are introduced, the variety of environments in which individuals may become
exposed to respiratory sensitizers and irritants makes diagnosing and treating this
illness even more challenging. In addition to adverse pulmonary effects, the diagnosis
of occupational asthma may bring with it negative social and financial implications
that may ultimately affect the patient's quality of life. For this reason, it is important
for clinicians to recognize work-related respiratory symptoms early on in their course,
maintain a high clinical suspicion for an occupational cause in the diagnostic work-up
of asthma, and have a high degree of certainty in the diagnosis. While a number of
classification schemes have been proposed to simplify the diagnostic approach to occupational
asthma, the inciting factors typically involve sensitization (often by an IgE mechanism),
direct airway inflammation, various pharmacologic responses, or irritant reflex pathways.
Clinicians must first document the presence of asthma, then establish a relationship
between asthma and the workplace. The occupational history is the key diagnostic tool,
and clinical suspicions may be evaluated further by serial peak expiratory flow measurements,
nonspecific hypersensitivity challenges with histamine or methacholine, collaboration
with industrial/occupational hygienists to obtain workplace exposure measurements,
and specific challenge testing at tertiary referral centers providing specialized
laboratories. Removal from the inciting exposure is the mainstay of therapy, and pharmacologic
treatment of patients with occupational asthma is similar to the treatment of patients
with other forms of asthma.
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© 2001 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
