|Could Your Patient Have Work-Related Asthma?
Work-related asthma (WRA) should be considered in every case of adult-onset asthma or asthma that worsens in adult life. WRA is asthma that is attributable to, or is made worse by, environmental exposures in the workplace. The diagnosis of WRA is made by confirming the diagnosis of asthma and by establishing a relationship between asthma and work.1 It is important to recognize that this type of asthma is preventable and, if diagnosed early, may be partially or completely reversible if exposures are adequately controlled or stopped.2
WRA falls into three categories3:
- Immunologically mediated asthma resulting from exposure to sensitizers in the workplace (occupational asthma with latency);
- Asthma resulting from acute exposure to irritants in the workplace (reactive airways dysfunction syndrome or RADS); and
- Pre-existing asthma exacerbated by workplace environmental exposures (work-aggravated asthma) Work-aggravated asthma occurs in individuals with symptomatic asthma that is significantly worsened by workplace environmental exposures. This can include an increase in frequency or severity of symptoms, an increase in medication required to control symptoms, or clinical improvement when exposures are reduced or eliminated.
The preliminary evaluation for WRA should include a full clinical evaluation for asthma, and completion of a full occupational and environmental history. The latter should include an employment history, history of temporal pattern of symptoms with respect to work, history of occupational and environmental exposures and symptom triggers, and if possible, objective verification of exposures.2 Early and accurate diagnosis of WRA, accompanied by appropriate modification or cessation of exposures, is important in the treatment of the individual.
Patients demonstrating clinical evidence of occupational asthma, as well as other occupational lung diseases, are required by the State Sanitary Code to be reported to the New York State Department of Health’s Occupational Lung Disease Registry. Reports can be made to the Registry at 518-402-7900 or download the reporting form at: http://www.health.ny.gov/forms/doh-384.pdf.
Reporting diagnosed cases of WRA to the Registry can help in the prevention of ongoing exposure for the reported individual and coworkers. New York State Department of Health staff investigate the reported case to identify workplaces and industries where exposures may cause lung disease among the employees. Program staff work with both employees and employers, to educate them about appropriate work practices and to assist them in preventing workplace exposures. For further information about the Occupational Lung Disease Registry, please call the New York State Department of Health Bureau of Occupational Health and Injury Prevention at 518-402-7900, or e-mail firstname.lastname@example.org.
Another registry within the Bureau of Occupational Health is the Pesticide Poisoning Registry. Medical and laboratory personnel are required to report all suspected pesticide poisonings directly to the NYS Pesticide Poisoning Registry at 1-800-322-6850.
1Lombardo LJ, Balmes JR. Occupational Asthma: A Review. Environmental Health Perspectives 108(4):697-704, 2000.
2Friedman-Jiménez G, Beckett WS, Szeinuk J, Petsonk EL. Clinical Evaluation, Management, and Prevention of Work-Related Asthma. American Journal of Industrial Medicine 37:121-141, 2000.
3Wagner G, Wegman D. Occupational asthma: Prevention by definition. American Journal of Industrial Medicine 33:427-429, 1998.