Occupational asthma is a type of asthma (or exacerbation of existing asthma) caused by occupational exposure of irritants. Symptoms typically develop over months to years due to sensitization to allergens at work. Once sensitized, workers will always respond to concentrations much lower than the initial allergen concentration.(1)
Can You Die From Occupational Asthma?
Similar to other asthma types, occupational asthma can also cause severe symptoms as stated above. If it is not diagnosed properly and you are not protected or cannot avoid the risk of exposure to the same irritants causing the problem, occupational asthma can lead to permanent lung damage, disability, or death. So, it is not advisable to take occupational asthma lightly and proper treatment or preventive measures should be taken after making an early diagnosis.
Is There Any Surgery To Relieve Symptoms Of Occupational Asthma?
There is no specific surgery to treat occupational asthma. This is just like common asthma and the only difference is that the trigger, in this case, is associated with your workplace. In fact, many surgical procedures can cause occupational asthma to doctors and operation theater attendants or veterinary surgeons. Surgery can only help if your airway is blocked due to some overgrown tissues or get constricted due to some physiological issues.(3)
Diagnosis Of Occupational Asthma
- History of occupational exposure to allergens
- Immunological test
- Sometimes inhalation provocation test
Diagnosis is by determining the association between workplace allergens and asthma. Suspect the disease based on a history of occupational exposure to allergens. Safety data sheets of the workplace can be used to identify potential allergens and may be listed to demonstrate that workplace causative agents are affecting workers. The substance can be used to direct immunological testing for suspected antigens (eg, skin prick test, scratch test, or patch test). Enhanced bronchial responsiveness after exposure to the suspect antigen also helps in making a diagnosis.
In difficult-to-diagnose cases, under careful management, a type of inhalation provocation test is performed in the laboratory to determine the cause of airway obstruction. Such tests should be performed only in specialized facilities proficient in inhalation provocation testing and can monitor and treat potentially severe reactions.
Differentiation from idiopathic asthma is generally based on symptom patterns, evidence of workplace allergens, and the relationship between allergen exposure and symptoms and physiological dysfunction.(4)
Etiology Of Occupational Asthma
Occupational asthma is caused by both immune-mediated and non immune-mediated mechanisms. Immune mechanisms involve IgE-mediated and non-IgE-mediated hypersensitivity to workplace allergens. There are hundreds of occupational allergens, ranging from small molecule chemicals to large proteins. Examples include cereal dust, proteolytic enzymes used in the detergent manufacturing industry, cedar, isocyanates, formalin (rare), antibacterials (eg, ampicillin, spiramycin), epoxy resins, and tea.
Non-immune inflammatory mechanisms cause direct stimulation of the airway epithelium and upper airway mucosa. Other possible causes include emissions from outdoor garbage incineration pits and industrial fires, desert dust, and vehicle emissions.(2)
Symptoms And Signs Of Occupational Asthma
Symptoms include shortness of breath, chest tightness, wheezing, and coughing, often with upper respiratory symptoms such as sneezing, rhinorrhea, and lacrimation. Upper respiratory and conjunctival symptoms may appear months or years before typical asthmatic symptoms.
Symptoms may occur during work after exposure to certain dust and vapors, but often only appear a few hours after leaving the workplace, making the association with occupational exposure less clear.
Nocturnal wheezing may be the only symptom. Symptoms often resolve during holidays and vacations, but continued exposure makes it difficult to identify temporary exacerbations and relief.(3)
Treatment Of Occupational Asthma
Treatment is the same as for idiopathic asthma, including inhaled bronchodilators and corticosteroids (asthma drug therapy). Treatment should also include keeping the patient from continuing exposure to the causative agent.
Dust control is essential if you want to prevent occupational asthma. However, it is not possible to ensure that no sensitization or clinical disease occurs. Once sensitized, patients with occupational asthma may respond to very low levels of airborne allergens.
When a patient returns to an environment with residual allergens, the prognosis is generally worse, respiratory symptoms, abnormalities in pulmonary physiology, and drug requirements are all increased, and the frequency and severity of the exacerbations are on the rise.
Individuals with symptoms should be kept away from environments known to cause allergic reactions and asthma symptoms where possible. With continued exposure, symptoms tend to persist. With early diagnosis and cessation of exposure, occupational asthma can sometimes be cured.(5)
- Tarlo SM, Lemiere C. Occupational asthma. New England Journal of Medicine. 2014;370(7):640-649.
- Bernstein IL, Chan-Yeung M, Malo J-L, Bernstein DI. Asthma in the workplace. New York. 2006;149:71-75.
- Bernstein JA. Occupational asthma. Allergy and Asthma: Springer; 2016:253-270.
- Vandenplas O, Suojalehto H, Cullinan P. Diagnosing occupational asthma. Clinical & Experimental Allergy. 2017;47(1):6-18.
- Brown NJ. Occupational Asthma or Work-Related Exacerbation of Asthma. 2019.
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