It is widely held that 10–15% of adult asthma is causally related to occupation. It is likely that this fraction varies importantly depending on historical and international variations in employment. Further uncertainties arise from misclassification in the diagnosis of asthma and in exposure assessment, particularly if based on self-report. We carried out a postal survey of adults listed as asthmatic through general practices across the UK. Cases, who were defined as those who had experienced onset of asthma or worsening of pre-existing childhood asthma within 2 years of starting a new job, were compared to controls who declared an equivalent onset or deterioration more than 2 years from the start of a job. Of 8535 individuals targeted, 3115 (37%) returned a completed questionnaire. Almost 40% of these (n=1198) experienced a deterioration of pre-existing childhood asthma or onset of adult asthma whilst working; 441 were cases and 757 controls. A priori analysis of risk was performed using an asthma-specific JEM, the ECRHS asthma ‘high risk occupations’ and data from the UK SWORD surveillance scheme. Odds ratios (adjusted for sex, smoking and era of onset and stratified by onset type)—displayed in Abstract S157 Table 1—did not suggest an increased risk of asthma within 2 years of starting a high-risk job. A posteriori analysis of all occupations demonstrated an increased risk of asthma within 2 years of starting a new job in sales and elementary occupations. The calculated population attributable risk (PAR) for these occupations was 15.9% and was higher in women than men. The results from this study suggest that a priori assessment of risk does not identify occupation as a significant cause of asthma in this contemporary adult workforce in the UK. Jobs which do appear to increase risk of new asthma are not those typically associated with an excess risk of the disease. These findings highlight the disparity between epidemiological and clinical assessments of asthma related to occupation, and the need to consider novel occupations as a cause of asthma.
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