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Standards of care for occupational asthma
  1. Susan M Tarlo
  1. Dr S M Tarlo, Toronto Western Hospital EW7-449, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada; susan.tarlo{at}

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Work-related asthma has been reported to be frequent among adults with asthma.1 2 Most cases (>90%) of occupational asthma (asthma caused by work) are caused by specific sensitisation to a workplace agent3 (rather than irritant-induced occupational asthma), and it is this sensitiser-induced occupational asthma that is addressed in this issue of Thorax in a paper from the British Thoracic Society recommending standards of care for occupational asthma (see page 240).4 It is especially important that occupational asthma is recognised early with appropriate intervention (including removal from further exposure to the causative workplace sensitiser when possible), since early recognition and such management improves the possibility that the asthma will clear or significantly improve.5 6

Identification of occupational asthma in an individual can also serve as a “sentinel event”, offering the opportunity to alert workplaces and public health agencies that there may be an increased risk to co-workers in the same workplace and to other workers with similar exposures which can result in intervention measures to reduce or eliminate this risk.

Unfortunately, there has often been a period of several years between the onset of symptoms from occupational asthma and diagnosis.7 8 Potential reasons for delay in diagnosis include workers’ lack of awareness of work-related asthma and of the association between their symptoms and workplace exposures. This is especially likely when the sensitiser is a low molecular weight (chemical) sensitiser which may cause isolated late asthmatic responses occurring several hours after exposure. Symptoms may then be worst after leaving a work shift or during sleep after work. Even if they do recognise a work association, workers may be afraid to report this to their physician for fear of losing their job or transfer to a lower paid job (especially if working in a small company and/or …

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  • Funding: The author acknowledges and thanks Dr Gary Liss and Dr Marcos Ribeiro for helpful discussions relevant to this editorial.

  • Competing interests: Dr Tarlo has a clinical practice that includes seeing and/or performing file reviews of workers with suspected occupational asthma for consultation at the request of other physicians, the Ontario Workplace Safety and Insurance Board and occasionally at the request of employers.

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