Work-related
asthma is the most common occupational
lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%-33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of
asthma is the first step to managing
occupational asthma, which can be sensitizer-induced or
irritant-induced
asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced
asthma and rapid-onset a defining feature of
irritant-induced
asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for
irritant-induced
asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of
occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced
occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related
asthma. Primary prevention remains the preferred method of reducing the burden of
occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.