Management of occupational asthma.

The importance of occupational asthma and its management is usefully set in perspective by considering recent trends of increasing asthma incidence, morbidity and mortality in the population at large. The contribution to incidence made by asthma of occupational origin is of the order 20-100 cases per million workers per year; the individual worker's lifetime risk approaching 5% in some industrial environments. Management of the affected industry inevitably follows different pathways from that of the affected individual, though both need to start from a definitive diagnosis. For the affected industry, managers must identify the causative agent and assess the extent of the problem. Affected workers can then be removed from hazardous settings, and meaningful strategies of prevention can be introduced. The most promising preventive measures involve improvements in industrial hygiene or the substitution of alternative agents in the manufacturing process. The role of worker selection (i.e. the exclusion of applicant workers who may be unduly susceptible because they smoke, or have existing airway hyperresponsiveness or atopy) is small and controversial. More valuable is a strict surveillance programme of workers perceived to be at risk, so that emerging disease is recognized promptly, before it poses any major threat of permanent ill-health. Management choices beyond conventional medication and the avoidance of irritant environmental triggers are greatly limited for the affected individual worker. A change of job environment with complete cessation of exposure to the relevant asthma-inducing agent is to be favoured and offers the best chance of full recovery, but may not be practical if the worker is to avoid permanent unemployment.(ABSTRACT TRUNCATED AT 250 WORDS)