Evaluation and Management of Work-Related Asthma

  • Ambrose Lau
  • Susan M. TarloEmail author
Part of the Respiratory Medicine book series (RM)


Work-related asthma should be considered in all adult working asthmatics. Failure to diagnose a work component to asthma can lead to unnecessary morbidity and increasing medication requirements for asthma. In a patient with confirmed asthma, the clinical history that includes key questions for work-related asthma has a high sensitivity for the diagnosis. However, objective tests are needed to confirm a diagnosis of sensitizer-induced occupational asthma, and these tests can most readily be arranged while the patient is still working. Diagnosis of irritant-induced occupational asthma relies largely on the exposure history and timing of onset of asthma symptoms. Work-exacerbated asthma is more common than occupational asthma and ranges from a single transient episode to daily worsening at work. Management depends on the correct diagnosis; in addition to usual asthma management, work modification may be needed. Outcomes are best with early diagnosis and intervention.


Asthma Work-related asthma Occupational asthma Work-exacerbated asthma Irritant-induced asthma Diagnosis Management 


  1. 1.
    Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med. 2014;370(7):640–9.CrossRefGoogle Scholar
  2. 2.
    Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, et al. American Thoracic Society statement: occupational contribution to the burden of airway disease. Am J Respir Crit Care Med. 2003;167(5):787–97.CrossRefGoogle Scholar
  3. 3.
    Lemiere C, To T, de Olim C, Ribeiro M, Liss G, Lougheed MD, et al. Outcome of work-related asthma exacerbations in Quebec and Ontario. Eur Respir J. 2015;45(1):266–8.CrossRefGoogle Scholar
  4. 4.
    Lim T, Liss GM, Vernich L, Buyantseva L, Tarlo SM. Work-exacerbated asthma in a workers’ compensation population. Occup Med (Lond). 2014;64:206–10.CrossRefGoogle Scholar
  5. 5.
    Brisman J. Baker's asthma. Occup Environ Med. 2002;59(7):498–502; quiz, 426.CrossRefGoogle Scholar
  6. 6.
    Health and Safety Executive UK. Work-related asthma in Great Britain 2017 [last accessed 30th September 2018]. Available from:
  7. 7.
    Baur X, Bakehe P. Allergens causing occupational asthma: an evidence-based evaluation of the literature. Int Arch Occup Environ Health. 2014;87(4):339–63.CrossRefGoogle Scholar
  8. 8.
    Gotzev S, Lipszyc JC, Connor D, Tarlo SM. Trends in occupations and work sectors among patients with work-related asthma at a Canadian Tertiary Care Clinic. Chest. 2016;150(4):811–8.CrossRefGoogle Scholar
  9. 9.
    Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest. 1985;88(3):376–84.CrossRefGoogle Scholar
  10. 10.
    Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, et al. Diagnosis and management of work-related asthma: American College of Chest Physicians Consensus Statement. Chest. 2008;134(3 Suppl):1S–41S.CrossRefGoogle Scholar
  11. 11.
    Banauch GI, Alleyne D, Sanchez R, Olender K, Cohen HW, Weiden M, et al. Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. Am J Respir Crit Care Med. 2003;168(1):54–62.CrossRefGoogle Scholar
  12. 12.
    de la Hoz RE, Shohet MR, Chasan R, Bienenfeld LA, Afilaka AA, Levin SM, et al. Occupational toxicant inhalation injury: the World Trade Center (WTC) experience. Int Arch Occup Environ Health. 2008;81(4):479–85.CrossRefGoogle Scholar
  13. 13.
    Vandenplas O, Wiszniewska M, Raulf M, de Blay F, Gerth van Wijk R, Moscato G, et al. EAACI position paper: irritant-induced asthma. Allergy. 2014;69(9):1141–53.CrossRefGoogle Scholar
  14. 14.
    Aaron SD, Boulet LP, Reddel HK, Gershon A. Under-diagnosis and over-diagnosis of asthma. Am J Respir Crit Care Med. 2018;198:1012–20.CrossRefGoogle Scholar
  15. 15.
    Goe SK, Henneberger PK, Reilly MJ, Rosenman KD, Schill DP, Valiante D, et al. A descriptive study of work aggravated asthma. Occup Environ Med. 2004;61(6):512–7.CrossRefGoogle Scholar
  16. 16.
    Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors associated with time to diagnostic steps. Chest. 2007;131(6):1768–75.CrossRefGoogle Scholar
  17. 17.
    Walters GI, Soundy A, Robertson AS, Burge PS, Ayres JG. Understanding health beliefs and behaviour in workers with suspected occupational asthma. Respir Med. 2015;109(3):379–88.CrossRefGoogle Scholar
  18. 18.
    Ellis PR, Walters GI. Missed opportunities to identify occupational asthma in acute secondary care. Occup Med (Lond). 2018;68(1):56–9.CrossRefGoogle Scholar
  19. 19.
    Mazurek JM, White GE, Moorman JE, Storey E. Patient-physician communication about work-related asthma: what we do and do not know. Ann Allergy Asthma Immunol. 2015;114(2):97–102.CrossRefGoogle Scholar
  20. 20.
    Malo JL, Ghezzo H, L'Archeveque J, Lagier F, Perrin B, Cartier A. Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis. 1991;143(3):528–32.CrossRefGoogle Scholar
  21. 21.
    Fishwick D, Barber CM, Bradshaw LM, Harris-Roberts J, Francis M, Naylor S, et al. Standards of care for occupational asthma. Thorax. 2008;63(3):240–50.CrossRefGoogle Scholar
  22. 22.
    Nicol AM, Hurrell AC, Wahyuni D, McDowall W, Chu W. Accuracy, comprehensibility, and use of material safety data sheets: a review. Am J Ind Med. 2008;51(11):861–76.CrossRefGoogle Scholar
  23. 23.
    Blanc PD, Eisner MD, Balmes JR, Trupin L, Yelin EH, Katz PP. Exposure to vapors, gas, dust, or fumes: assessment by a single survey item compared to a detailed exposure battery and a job exposure matrix. Am J Ind Med. 2005;48(2):110–7.CrossRefGoogle Scholar
  24. 24.
    Siracusa A, Marabini A, Folletti I, Moscato G. Smoking and occupational asthma. Clin Exp Allergy. 2006;36(5):577–84.CrossRefGoogle Scholar
  25. 25.
    Baldwin DR, Gannon P, Bright P, Newton DT, Robertson A, Venables K, et al. Interpretation of occupational peak flow records: level of agreement between expert clinicians and Oasys-2. Thorax. 2002;57(10):860–4.CrossRefGoogle Scholar
  26. 26.
    Malo JL, Trudeau C, Ghezzo H, L'Archeveque J, Cartier A. Do subjects investigated for occupational asthma through serial peak expiratory flow measurements falsify their results? J Allergy Clin Immunol. 1995;96(5 Pt 1):601–7.CrossRefGoogle Scholar
  27. 27.
    Huggins V, Anees W, Pantin C, Burge S. Improving the quality of peak flow measurements for the diagnosis of occupational asthma. Occup Med (Lond). 2005;55(5):385–8.CrossRefGoogle Scholar
  28. 28.
    Chiry S, Cartier A, Malo JL, Tarlo SM, Lemiere C. Comparison of peak expiratory flow variability between workers with work-exacerbated asthma and occupational asthma. Chest. 2007;132(2):483–8.CrossRefGoogle Scholar
  29. 29.
    Pralong JA, Lemiere C, Rochat T, L'Archeveque J, Labrecque M, Cartier A. Predictive value of nonspecific bronchial responsiveness in occupational asthma. J Allergy Clin Immunol. 2016;137(2):412–6.CrossRefGoogle Scholar
  30. 30.
    Malo JL, Ghezzo H. Recovery of methacholine responsiveness after end of exposure in occupational asthma. Am J Respir Crit Care Med. 2004;169(12):1304–7.CrossRefGoogle Scholar
  31. 31.
    Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000;161(1):309–29.CrossRefGoogle Scholar
  32. 32.
    Vandenplas O, Suojalehto H, Aasen TB, Baur X, Burge PS, de Blay F, et al. Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement. Eur Respir J. 2014;43:1573–87.CrossRefGoogle Scholar
  33. 33.
    Kennedy WA, Girard F, Chaboillez S, Cartier A, Cote J, Hargreave F, et al. Cost-effectiveness of various diagnostic approaches for occupational asthma. Can Respir J. 2007;14(5):276–80.CrossRefGoogle Scholar
  34. 34.
    Girard F, Chaboillez S, Cartier A, Cote J, Hargreave FE, Labrecque M, et al. An effective strategy for diagnosing occupational asthma: use of induced sputum. Am J Respir Crit Care Med. 2004;170(8):845–50.CrossRefGoogle Scholar
  35. 35.
    Beretta C, Rifflart C, Evrard G, Jamart J, Thimpont J, Vandenplas O. Assessment of eosinophilic airway inflammation as a contribution to the diagnosis of occupational asthma. Allergy. 2018;73(1):206–13.CrossRefGoogle Scholar
  36. 36.
    Global Initiative for Asthma. Global strategy for asthma management and prevention [Last accessed 10th June 2019]. Available from:
  37. 37.
    de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma: a Cochrane systematic review. Occup Environ Med. 2012;69(5):373–4.CrossRefGoogle Scholar
  38. 38.
    Nicholson PJ, Cullinan P, Taylor AJ, Burge PS, Boyle C. Evidence based guidelines for the prevention, identification, and management of occupational asthma. Occup Environ Med. 2005;62(5):290–9.CrossRefGoogle Scholar
  39. 39.
    Rachiotis G, Savani R, Brant A, MacNeill SJ, Newman Taylor A, Cullinan P. Outcome of occupational asthma after cessation of exposure: a systematic review. Thorax. 2007;62(2):147–52.CrossRefGoogle Scholar
  40. 40.
    Lipszyc JC, Silverman F, Holness DL, Liss GM, Lavoie KL, Tarlo SM. Comparison of psychological, quality of life, work-limitation, and socioeconomic status between patients with occupational asthma and work-exacerbated asthma. J Occup Environ Med. 2017;59(7):697–702.CrossRefGoogle Scholar
  41. 41.
    Vandenplas O, Henneberger PK. Socioeconomic outcomes in work-exacerbated asthma. Curr Opin Allergy Clin Immunol. 2007;7(3):236–41.CrossRefGoogle Scholar
  42. 42.
    Larbanois A, Jamart J, Delwiche JP, Vandenplas O. Socioeconomic outcome of subjects experiencing asthma symptoms at work. Eur Respir J. 2002;19(6):1107–13.CrossRefGoogle Scholar
  43. 43.
    de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2011;(5):CD006308.Google Scholar
  44. 44.
    Patel O, Syamlal G, Wood J, Dodd KE, Mazurek JM. Asthma mortality among persons aged 15-64 years, by industry and occupation - United States, 1999-2016. MMWR Morb Mortal Wkly Rep. 2018;67(2):60–5.CrossRefGoogle Scholar
  45. 45.
    Lee SA, Adhikari A, Grinshpun SA, McKay R, Shukla R, Zeigler HL, et al. Respiratory protection provided by N95 filtering facepiece respirators against airborne dust and microorganisms in agricultural farms. J Occup Environ Hyg. 2005;2(11):577–85.CrossRefGoogle Scholar
  46. 46.
    Casey ML, Mazurek JM. Respirator use among US Farm operators with asthma: results from the 2011 Farm and Ranch safety survey. J Agromedicine. 2017;22(2):78–88.CrossRefGoogle Scholar
  47. 47.
    Szeinuk J, Beckett WS, Clark N, Hailoo WL. Medical evaluation for respirator use. Am J Ind Med. 2000;37(1):142–57.CrossRefGoogle Scholar
  48. 48.
    Zacharisen MC, Kadambi AR, Schlueter DP, Kurup VP, Shack JB, Fox JL, et al. The spectrum of respiratory disease associated with exposure to metal working fluids. J Occup Environ Med. 1998;40(7):640–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Toronto Western HospitalTorontoCanada
  2. 2.St Michael’s HospitalTorontoCanada
  3. 3.Department of Medicine and Dalla Lana School of Public HealthUniversity of Toronto, Respiratory Division, Toronto Western HospitalTorontoCanada

Personalised recommendations