Work-Related Asthma

by Michael_Koger

Exposure to noxious agents at work accounts for many cases of asthma and subsequent disability.

Many centuries ago, Hippocrates observed a connection between bronchial asthma and employment in certain patients. This was especially evident in fishermen, metal workers, farmhands, horsemen, and tailors [1]. The questions that arise include—are these essentially clients with previous bronchial asthma whose medical condition worsens because of their work environment, or are there irritants in the workplace which in fact cause the problem from the start?

In the United States, approximately 11 million workers encounter chemicals and other substances which lead to hyperreactive airways disease [2]. These patients may have lung conditions which resemble bronchial asthma; however, there are several varieties in how they present [2, 3]. Hence, the physician must differentiate between work-related asthma and other forms of airway hyperresponsiveness or airflow limitation.

Of all new asthma diagnoses in the United States, 15 percent of them probably begin in the workplace [1].

Employment and Asthma

Work-related asthma is not synonymous with occupational asthma or work-exacerbated asthma [1].  In fact, work-related asthma encompasses occupational asthma and work-exacerbated asthma.  Work-exacerbated asthma, on the other hand, is when there is aggravation of bronchospasm by work exposure.  However, airflow limitation or hyperreactivity which occurs as a result of exposure to sensitizers or allergens at the workplace is occupational asthma [1]. 

Moreover, airway hyperreactivity which occurs from stimuli outside the workplace is not occupational asthma.  Such exposures may be allergic asthma or pre-existing asthma.  Nevertheless, the presence of pre-existing asthma does not necessarily exclude the possibility of occupational asthma [1].

In some instances, there may be genetic predisposition to work-related asthma [1].

Other Disease Possibilities

Additionally, the health care provider has to differentiate occupational asthma from endotoxin-induced asthma-like syndromes such as grain fever, byssinosis, or pneumoconiosis. Chronic obstructive lung disease, bronchiolitis obliterans, and vocal cord dysfunction are other considerations [1].

Conclusion

Work-related asthma is a global public health problem which involves many complex interactions between employees and the environment.

References

1.  Tan, J. and Bernstein, J.  (2014).  Occupational asthma:  An overview.  Current Allergy and Asthma Reports, 14, 431.

2.  United States Department of Labor.  (2014).  Occupational asthma.  Retrieved July 17, 2014.

3.  University at Albany.  School of Public Health.  (2014).  Work-related asthma:  Recognition and diagnosis.

4.  The photo is an image of workers in a ceramics factory where they may encounter exposure to airborne particulates.  Reprinted with permission from Centers for Disease Control/Barbara Jenkins/National Institute for Occupational Safety and Health.

Disclaimer

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 07/17/2014, Michael_Koger
 
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