ABC of Work Related Disorders: OCCUPATIONAL ASTHMA AND OTHER RESPIRATORY DISEASES

Changing pattern of occupational lung disease

In the United Kingdom, over the past 40 years, there has been a shift away from manufacturing industries and a sharp reduction in the numbers of coal miners. These factors, together with stricter health and safety legislation, have resulted in a substantial decline in the prevalence of silicosis and pneumoconiosis. In contrast, occupational asthma has become increasingly recognised. In developing countries, however, the traditional occupational lung diseases of silicosis, pneumoconiosis, and asbestosis remain common in rapidly industrialising areas.

Our understanding of the epidemiology of occupational lung disease in Britain has been greatly enhanced by the SWORD project (surveillance of work related and occupational respiratory disease), which was established in 1989 sponsored by the Health and Safety Executive. Occupational and respiratory physicians are invited to report new cases of occupational lung diseases together with the suspected agent. The data are regularly analysed and the results published. Further information is available from the Department of Occupational and Environmental Medicine, National Heart and Lung Institute, London.

Occupational asthma

Occupational asthma is caused by specific sensitising agents inhaled in the workplace—it does not include bronchoconstriction induced by irritants such as exercise and cold air that are encountered at work. There are over 200 known respiratory sensitisers, and more are identified each year. Some sensitisers may not be immediately obvious: thus, it has recently been recognised that workers such as those in health services can develop occupational asthma as a result of wearing latex gloves. The allergen is latex protein, which becomes airborne as the gloves are used.

Diagnosis

A comprehensive and detailed occupational history is essential in the initial assessment of a …