Occupational asthma history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

## Overview[edit | edit source]

## History and Symptoms[edit | edit source]

* Less than five years of exposure to an occupational agent can be enough for the appearance of the first occupational asthma symptoms. This depends on whether the reason for the occupational asthma to occur was exposure to the causative agent over a period of time (with a latency period) or a single exposure to an irritant but at a very high concentration (without latency period). Both eventually result in OA.

* Coughing, wheezing, nasal irritation, difficulty in breathing, tightness of chest are the most common symptoms and can be recognized more easily by asking oneself the following questions:

1. Are any of the above symptoms recurrent/chronic?
2. Are they present at work?
3. Do they worsen towards the end of the work day and/or end of the week?
4. Does the employee/worker feel an improvement in his condition when away from work, on vacation or on weekends?

* If these symptoms persist, the person is most likely suffering from occupational asthma. However, one must be aware that this could also be because the person is already suffering from asthma and his condition was simply aggravated by workplace irritants (Work-aggravated asthma). In this case, although he will suffer similar consequences as someone who is suffering from OA (loss of work, medical expenses, etc.), his disease cannot be considered as having an occupational origin.

* Like for any other disease correct diagnosis is important. According to Dr. Susan Tarlo:

> “It is important to recognize, since if due to a workplace sensitizer and, if undetected and if the patient continues to work with even small exposure to the relevant sensitizing agent, the prognosis is worse”. She also concluded that, “the chance of eventual improvement in Asthma severity after stopping exposure decreases with the duration of exposure after the onset of the symptoms. The best chance of asthma clearing or significantly improving is associated with early diagnosis and early removal from ongoing exposure.”[1]

* The biggest challenge, clinically, is that family doctors and patients alike do not have sufficient information about occupational asthma. Only 15% of asthmatic patients are asked by their clinician if symptoms relate to work conditions.[2]. Patients often avoid mentioning work-related asthma triggers for fear of losing their jobs or simply because they are unaware of the association between working conditions and asthmatic symptom onset. Patients run the risk of irreversible damange. An incorrect diagnosis can result in considerable decrements in quality of life measures such as medical, social, and financial status.

* Diagnosis of OA is complex and requires a period of time. First, the patient’s occupational and clinical history is taken and his symptoms are charted (Charting is usually done at the end of a typical work week and within 24 hours of the occurrence of symptoms in order to get objective information). Once this has been established, the following diagnostic methods are used:
* Non-specific bronchial hyperreactivity
* Skin prick tests
* IgE-specific tests
* Spirometric tests
* Peak Expiratory Flow at work
* Specific inhalation challenge

## References[edit | edit source]

1. ↑ Diagnosis of Occupational Asthma Tarlo S.
2. ↑ Diagnosis and Management of Work-Related Asthma. Evidence Report/Technology Assessment number 129. Beach J, Rowe B, Blitz S, Crumley E, Hooton N, Russell K, Spooner C

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