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Pulmonology268 papers

Occupational asthma

Last edited: 4/14/2026

Overview

Occupational asthma (OA) is a respiratory condition triggered by inhaling workplace allergens or irritants, leading to bronchial hyperresponsiveness and asthma symptoms. Early recognition and intervention are crucial to prevent long-term morbidity 717.

Diagnosis

  • Clinical Suspicion: Suspect OA in workers with new-onset asthma symptoms temporally related to occupational exposures 7.
  • Specific Inhalation Challenge (SIC): Essential diagnostic tool; involves controlled exposure to suspected agents to elicit bronchial responses 617.
  • Investigative Procedures: Include spirometry, bronchial provocation tests, and immunological assessments 7.
  • Interdisciplinary Approach: Collaboration between occupational and respiratory physicians improves diagnostic accuracy 10.
  • Environmental Assessment: Evaluate workplace exposures to identify potential allergens or irritants 24.
  • Diagnostic Agreement: Assess variability in diagnosis between specialists; interclass correlation coefficients can quantify agreement 10.

    • Management

  • Exposure Reduction: Immediate cessation of exposure to the causative agent is critical 1420.
  • Pharmacological Treatment: Use of inhaled corticosteroids and bronchodilators for symptom control 7.
  • Immunotherapy: Considered in specific cases, particularly for diisocyanate-induced asthma, though evidence varies 4.
  • Rehabilitation and Support: Provide occupational rehabilitation and psychological support to aid return to work 20.
  • Monitoring: Regular follow-up with spirometry and symptom assessment to monitor disease progression 7.
  • Preventive Measures: Implement workplace safety protocols and health surveillance programs 220.

    • Special Populations

  • Pregnancy: Limited specific guidance; focus on minimizing exposure and managing symptoms with safe medications 7.
  • Pediatrics: Early recognition and intervention are vital; consider environmental triggers unique to pediatric workplaces 7.
  • Elderly: Age-related comorbidities may complicate diagnosis and management; tailored approaches are necessary 7.
  • Comorbidities: Consider interactions with existing respiratory conditions; individualized treatment plans are essential 7.

    • Key Recommendations

  • Implement Specific Inhalation Challenge for Diagnosis: Use SIC to confirm occupational asthma, especially in suspected cases of diisocyanate exposure (Evidence: Strong 617).
  • Promptly Remove Workers from Harmful Exposures: Early cessation of exposure is crucial to prevent disease progression and improve outcomes (Evidence: Strong 1420).
  • Enhance Interdisciplinary Collaboration: Improve diagnostic accuracy through collaboration between occupational and respiratory physicians (Evidence: Moderate 10).
  • Regular Surveillance and Monitoring: Conduct ongoing monitoring of affected workers to assess disease status and adjust management strategies (Evidence: Moderate 7).
  • Educate and Train Healthcare Providers: Increase awareness and diagnostic skills among pulmonologists and primary care physicians regarding occupational asthma (Evidence: Expert opinion 9).

    • References

    1 Lechien JR, Kan K, Sims HS. Workplace Environment Microaggressions in Otolaryngology-Head and Neck Surgery: An International Survey. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2023. link 2 Aarhus L, Mehlum IS. Examination of work-related diseases among young people in Norway. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke 2019. link 3 Guerin RJ, Toland MD, Okun AH, Rojas-Guyler L, Baker DS, Bernard AL. Using a Modified Theory of Planned Behavior to Examine Teachers' Intention to Implement a Work Safety and Health Curriculum. The Journal of school health 2019. link 4 Wisnewski AV, Liu J. Immunochemical detection of the occupational allergen, methylene diphenyl diisocyanate (MDI), in situ. Journal of immunological methods 2016. link 5 Jiang L, Probst TM. A multilevel examination of affective job insecurity climate on safety outcomes. Journal of occupational health psychology 2016. link 6 Vandenplas O, Suojalehto H, Aasen TB, Baur X, Burge PS, de Blay F et al.. Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement. The European respiratory journal 2014. link 7 Lemière C. When to suspect occupational asthma. Canadian respiratory journal 2013. link 8 Scheidler L, Sucker K, Taeger D, van Kampen V, Heinze E, Marczynski B et al.. Evaluation of a 4-steps-1-day whole body challenge protocol for the diagnosis of occupational asthma due to diisocyanates. Advances in experimental medicine and biology 2013. link 9 Parhar A, Lemiere C, Beach JR. Barriers to the recognition and reporting of occupational asthma by Canadian pulmonologists. Canadian respiratory journal 2011. link 10 Turner S, McNamee R, Roberts C, Bradshaw L, Curran A, Francis M et al.. Agreement in diagnosing occupational asthma by occupational and respiratory physicians who report to surveillance schemes for work-related ill-health. Occupational and environmental medicine 2010. link 11 Laurière M, Gorner P, Bouchez-Mahiout I, Wrobel R, Breton C, Fabriès JF et al.. Physical and biochemical properties of airborne flour particles involved in occupational asthma. The Annals of occupational hygiene 2008. link 12 Malo JL, Newman Taylor A. Defining occupational asthma and confirming the diagnosis: what do experts suggest?. Occupational and environmental medicine 2007. link 13 Holness DL, Tabassum S, Tarlo SM, Liss GM, Silverman F, Manno M. Practice patterns of pulmonologists and family physicians for occupational asthma. Chest 2007. link 14 Abramson M, Sim MR. Occupational asthma. Thorax 2006. link 15 Cohen NL, Patton CM. Worker safety and glutaraldehyde in the gastrointestinal lab environment. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2006. link 16 Franchi A, Franco G. Evidence-based decision making in an endoscopy nurse with respiratory symptoms exposed to the new ortho-phthalaldehyde (OPA) disinfectant. Occupational medicine (Oxford, England) 2005. link 17 Ortega HG, Weissman DN, Carter DL, Banks D. Use of specific inhalation challenge in the evaluation of workers at risk for occupational asthma: a survey of pulmonary, allergy, and occupational medicine residency training programs in the United States and Canada. Chest 2002. link 18 Esterhuizen TM, Hnizdo E, Rees D. Occurrence and causes of occupational asthma in South Africa--results from SORDSA's Occupational Asthma Registry, 1997-1999. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2001. link 19 Cullinan P, Cannon J, Sheril D, Newman Taylor A. Asthma following occupational exposure to Lycopodium clavatum in condom manufacturers. Thorax 1993. link 20 Graneek B. Surveillance and management. Occupational health; a journal for occupational health nurses 1992. link 21 Bagon DA. The health and safety executive interlaboratory quality control scheme for isocyanates. The Annals of occupational hygiene 1990. link 22 Fine JM, Balmes JR. Airway inflammation and occupational asthma. Clinics in chest medicine 1988. link 23 Rothstein MA. Legal considerations in worker fitness evaluations. Occupational medicine (Philadelphia, Pa.) 1988. link 24 Cralley LJ. Industrial hygiene is a viable profession. American Industrial Hygiene Association journal 1988. link 25 Jones RN. Occupational asthma. Clinics in chest medicine 1984. link 26 Slavin RG. Asthma in adults III: occupational asthma. Hospital practice 1978. link 27 Neilson A, Booth KS. A technique for dynamic calibration of a continuous toluene diisocyanate monitor. American Industrial Hygiene Association journal 1975. link

    Original source

    1. [1]
      Workplace Environment Microaggressions in Otolaryngology-Head and Neck Surgery: An International Survey. — Lechien JR, Kan K, Sims HS Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2023)
    2. [2]
      Examination of work-related diseases among young people in Norway. — Aarhus L, Mehlum IS Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke (2019)
    3. [3]
      Using a Modified Theory of Planned Behavior to Examine Teachers' Intention to Implement a Work Safety and Health Curriculum. — Guerin RJ, Toland MD, Okun AH, Rojas-Guyler L, Baker DS, Bernard AL The Journal of school health (2019)
    4. [4]
      Immunochemical detection of the occupational allergen, methylene diphenyl diisocyanate (MDI), in situ. — Wisnewski AV, Liu J Journal of immunological methods (2016)
    5. [5]
      A multilevel examination of affective job insecurity climate on safety outcomes. — Jiang L, Probst TM Journal of occupational health psychology (2016)
    6. [6]
      Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement. — Vandenplas O, Suojalehto H, Aasen TB, Baur X, Burge PS, de Blay F et al. The European respiratory journal (2014)
    7. [7]
      When to suspect occupational asthma. — Lemière C Canadian respiratory journal (2013)
    8. [8]
      Evaluation of a 4-steps-1-day whole body challenge protocol for the diagnosis of occupational asthma due to diisocyanates. — Scheidler L, Sucker K, Taeger D, van Kampen V, Heinze E, Marczynski B et al. Advances in experimental medicine and biology (2013)
    9. [9]
      Barriers to the recognition and reporting of occupational asthma by Canadian pulmonologists. — Parhar A, Lemiere C, Beach JR Canadian respiratory journal (2011)
    10. [10]
      Agreement in diagnosing occupational asthma by occupational and respiratory physicians who report to surveillance schemes for work-related ill-health. — Turner S, McNamee R, Roberts C, Bradshaw L, Curran A, Francis M et al. Occupational and environmental medicine (2010)
    11. [11]
      Physical and biochemical properties of airborne flour particles involved in occupational asthma. — Laurière M, Gorner P, Bouchez-Mahiout I, Wrobel R, Breton C, Fabriès JF et al. The Annals of occupational hygiene (2008)
    12. [12]
      Defining occupational asthma and confirming the diagnosis: what do experts suggest? — Malo JL, Newman Taylor A Occupational and environmental medicine (2007)
    13. [13]
      Practice patterns of pulmonologists and family physicians for occupational asthma. — Holness DL, Tabassum S, Tarlo SM, Liss GM, Silverman F, Manno M Chest (2007)
    14. [14]
      Occupational asthma. — Abramson M, Sim MR Thorax (2006)
    15. [15]
      Worker safety and glutaraldehyde in the gastrointestinal lab environment. — Cohen NL, Patton CM Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates (2006)
    16. [16]
      Evidence-based decision making in an endoscopy nurse with respiratory symptoms exposed to the new ortho-phthalaldehyde (OPA) disinfectant. — Franchi A, Franco G Occupational medicine (Oxford, England) (2005)
    17. [17]
      Use of specific inhalation challenge in the evaluation of workers at risk for occupational asthma: a survey of pulmonary, allergy, and occupational medicine residency training programs in the United States and Canada. — Ortega HG, Weissman DN, Carter DL, Banks D Chest (2002)
    18. [18]
      Occurrence and causes of occupational asthma in South Africa--results from SORDSA's Occupational Asthma Registry, 1997-1999. — Esterhuizen TM, Hnizdo E, Rees D South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (2001)
    19. [19]
      Asthma following occupational exposure to Lycopodium clavatum in condom manufacturers. — Cullinan P, Cannon J, Sheril D, Newman Taylor A Thorax (1993)
    20. [20]
      Surveillance and management. — Graneek B Occupational health; a journal for occupational health nurses (1992)
    21. [21]
      The health and safety executive interlaboratory quality control scheme for isocyanates. — Bagon DA The Annals of occupational hygiene (1990)
    22. [22]
      Airway inflammation and occupational asthma. — Fine JM, Balmes JR Clinics in chest medicine (1988)
    23. [23]
      Legal considerations in worker fitness evaluations. — Rothstein MA Occupational medicine (Philadelphia, Pa.) (1988)
    24. [24]
      Industrial hygiene is a viable profession. — Cralley LJ American Industrial Hygiene Association journal (1988)
    25. [25]
      Occupational asthma. — Jones RN Clinics in chest medicine (1984)
    26. [26]
      Asthma in adults III: occupational asthma. — Slavin RG Hospital practice (1978)
    27. [27]
      A technique for dynamic calibration of a continuous toluene diisocyanate monitor. — Neilson A, Booth KS American Industrial Hygiene Association journal (1975)
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