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British Thoracic Society Clinical Statement on occupational asthma
  1. Christopher Michael Barber1,
  2. Paul Cullinan2,
  3. Johanna Feary3,
  4. David Fishwick1,
  5. Jennifer Hoyle4,
  6. Hayley Mainman5,
  7. Gareth Iestyn Walters6
  1. 1Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2National Heart and Lung Institute, Imperial College, London, UK
  3. 3Occupational and Environmental Medicine, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK
  4. 4North Manchester General Hospital, Manchester, UK
  5. 5Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
  6. 6NHS Occupational Lung Disease Service, Birmingham Chest Clinic and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Christopher Michael Barber, Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK; chris.barber4{at}

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This British Thoracic Society (BTS) Clinical Statement addresses occupational asthma and includes key clinical practice points. In an era in which medical practice is increasingly determined by evidence-based guidelines, it must be acknowledged from the outset that there is little or no published evidence for some of the areas covered in this statement1 2; thus, much of the advice is based on expert opinion and accumulated clinical experience.


The Clinical Statement Group (CSG) was chaired by Dr Chris Barber. Membership was drawn from current and former members of the BTS Occupational and Environmental Lung Disease Specialist Advisory Group. The CSG identified key areas requiring clinical practice points. The overall content was developed to reflect the scope approved by the BTS Standards of Care Committee (SOCC). Following discussions of broad statement content, individual sections were drafted by group members. A final edited draft was reviewed by the BTS SOCC before posting for public consultation and peer review on the BTS website (August/September 2021). The revised document was approved by the BTS SOCC in November 2021 before final publication.

Summary of clinical practice points

Section 1—introduction

  • Healthcare professionals should be aware that occupational exposures account for around one in six cases of asthma in adults of working age.

  • Over 400 causes of Occupational Asthma (OA) have been described; these are categorised as high-molecular weight (HMW) or low-molecular weight (LMW) ‘respiratory sensitisers’.

  • Although individual susceptibility plays a key role, the main risk factor for the development of OA is the level of allergen exposure in the workplace.

Section 2—work context

  • Health surveillance is a form of workplace screening that can identify OA cases early. In the UK, it usually consists of an annual symptom questionnaire and spirometry.

  • Workers found at health surveillance to have new asthma symptoms or abnormal lung function should be referred as soon as possible to a specialist …

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  • Contributors All authors were responsible for the drafting and review of the document. The corresponding author, CB, was responsible for final approval of the manuscript. CB—drafting, review and final approval. PC—drafting and review. JF—drafting and review. DF—drafting and review. JH—drafting and review. HM—drafting and review. GIW—drafting and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer A Clinical Statement reflects the expert views of a group of specialists who are well versed on the topic concerned, and who carefully examine the available evidence in relation to their own clinical practice. A Clinical Statement does not involve a formal evidence review and is not developed in accordance with clinical practice guideline methodology. Clinical Statements are not intended as legal documents or a primary source of detailed technical information. Readers are encouraged to consider the information presented and reach their own conclusions.

    The contents of this publication express the views of the authors, and not necessarily of HSE policy or policy makers.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.