Work-Related Asthma

Aka: Work-Related Asthma, Occupational Asthma, Work-Aggravated Asthma, Asthma in the Workplace, Occupational Lung Disease

II. Epidemiology

  1. Occupational Asthma accounts for 15% of new Asthma cases in adults
    1. Estimated 1.9 million new cases/year (2012)
    2. (2012) MMWR Morb Mortal Wkly Rep 25;61(20):375-8 [PubMed]

III. Types: Occupational Lung Disease

  1. Work-Aggravated Asthma
    1. Preexisting Asthma worsened by workplace exposure
    2. See Intrinsic Asthma
  2. Occupational Asthma
    1. Allergic Occupational Asthma (90% of cases)
      1. Caused by sensitizers (immune-mediated response)
      2. High molecular weight sensitizers induce IgE response and are most common
    2. Irritant-induced Asthma (10% of cases)
      1. Reactive Airway Dysfunction Syndrome
      2. Irritants cause direct cell damage and inflammation
  3. Non-Asthma Occupational Lung Disease
    1. Occupational COPD (accounts for 15-19% of all COPD cases)
      1. Associated with exposures to coal dust, silica, cotton dust, and cadmium fumes
      2. Compounded by concurrent Tobacco use
    2. Interstitial Lung Disease
      1. Asbestosis
      2. Eosinophilic Pneumonia
      3. Hypersensitivity Pneumonitis or extrinsic allergic alveolitis (bird fancier’s lung, farmer’s lung)
      4. Silicosis

IV. Risk Factors

  1. Atopy
  2. Tobacco Abuse

V. Findings

  1. See Asthma

VI. Approach

  1. Diagnose Asthma
    1. Spirometry
  2. Determine if Asthma is work related
    1. Pre-work and post-work Spirometry
    2. Serial Peak Expiratory Flow log four times daily
    3. Symptoms improve on days away from work
  3. Determine type of Occupational Asthma (see above)
    1. Work-Aggravated Asthma (Preexisting Asthma worsened by workplace exposure)
    2. Allergic Occupational Asthma
    3. Irritant-induced Asthma

VII. Management

  1. Completely avoid causative agent
    1. However, up to 70% of patients have persistent symptoms for years after exposure cessation
  2. Treat with standard Asthma Management (e.g. Inhaled Corticosteroids, Bronchodilators)
    1. See Asthma Management
    2. Tobacco Cessation

VIII. Prevention

  1. Offending irritant or allergen exposure
  2. Adequate respiratory protection

IX. Resources

  1. National Institute Occupational Safety Health (NIOSH)
    1. http://www.cdc.gov/niosh/homepage.html
  2. Occupational Safety and Health (OSHA)
    1. http://www.osha.gov/index.html
  3. American Thoracic Society - Occupational Lung Disease
    1. https://www.thoracic.org/patients/patient-resources/breathing-in-america/resources/chapter-13-occupational-lung-diseases.pdf

X. References

  1. Bebko (2016) Am Fam Physician 93(12): 1000-6 [PubMed]
  2. Chan-Yeung (1995) Chest 108:1084-117 [PubMed]
  3. Friedman-Jimenez (2000) Am J Ind Med 37:121-41 [PubMed]
  4. Youakim (2001) Am Fam Physician 64(11):1839-48 [PubMed]

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Related Studies

Ontology: Occupational lung disease (C0264421)

Concepts Disease or Syndrome (T047)
SnomedCT 196004000, 86157004
English diseases lung occupational, disorders lung occupational, occupational respiratory disease, occupational lung disease, lung disease occupational, diseases lungs occupational, disease lung occupational, Occupational inhalation disease, Occupational lung disease (disorder), Occupational lung disease, Occupational lung disorder, Occupational pulmonary disease, Occupational respiratory disease, Occupational inhalation disease, NOS, Occupational lung disease, NOS, Occupational lung disorder, NOS, Occupational pulmonary disease, NOS, Occupational respiratory disease, NOS
Spanish enfermedad ocupacional por inhalación, enfermedad respiratoria ocupacional, enfermedad respiratoria relacionada con el ambiente laboral, neumopatía laboral (trastorno), neumopatía laboral, neumopatía ocupacional, trastorno pulmonar laboral, trastorno pulmonar ocupacional
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Asthma, Occupational (C0264423)

Definition (MSH) Asthma attacks caused, triggered, or exacerbated by OCCUPATIONAL EXPOSURE.
Concepts Disease or Syndrome (T047)
MSH D059366
SnomedCT 57607007
English occupational asthma (diagnosis), occupational asthma, asthma industrial, asthma occupational, industrial asthma, Asthmas, Occupational, Asthma, Occupational, Occupational Asthma, Occupational Asthmas, Asthma, Occupational [Disease/Finding], Industrial asthma, Occupational asthma, Occupational asthma (disorder)
Dutch beroepsastma
Spanish Asma ocupacional, Asma Ocupacional, asma laboral, asma ocupacional (trastorno), asma ocupacional
Portuguese Asma ocupacional, Asma Ocupacional
Italian Asma occupazionale, Asma professionale
Japanese 職業性喘息, ｼｮｸｷﾞｮｳｾｲｾﾞﾝｿｸ
Czech Profesionální astma, astma profesionální
Hungarian Foglalkozási asthma
French Asthme professionnel
Russian АСТМА БРОНХИАЛЬНАЯ ПРОФЕССИОНАЛЬНАЯ, ASTMA BRONKHIAL'NAIA PROFESSIONAL'NAIA
Polish Astma zawodowa
German Asthma, berufsbedingtes, Berufsasthma
Norwegian Yrkesbetinget astma
Derived from the NIH UMLS (Unified Medical Language System)

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