Synopsis
Recognise asthma caused or worsened by work, preserve the opportunity for objective diagnosis, and coordinate exposure control, clinical treatment and confidential employment advice.
- Ask every working-age adult with new or deteriorating asthma what they do, which agents they handle, whether symptoms change across shifts and whether colleagues are affected.
- Occupational asthma means new asthma caused by work; work-exacerbated asthma is pre-existing or coincidental asthma made worse by workplace conditions, and the distinction affects prevention and prognosis.
- Sensitiser-induced disease often follows a symptom-free latency period, whereas irritant-induced asthma may follow a substantial exposure without allergic sensitisation.
Key red flags
Asthma begins after a clearly described high-level irritant event or repeated substantial irritant exposures, without a sensitisation latency pattern. Document the event, co-workers, emergency attendance and exposure controls precisely.
Investigation priorities
Identify plausible agents and the temporal disease pattern.
Management branches
Adult-onset asthma, unexplained deterioration or symptoms linked to work.
- List current and past jobs, then break each job into tasks, products, airborne agents, spills, ventilation, respiratory protection and affected colleagues.
- Build a calendar of symptom onset, latency, shift timing, weekends, holidays, sick leave, treatment changes and major exposure events.
Key medicines
Low-dose inhaled corticosteroid-formoterol anti-inflammatory relieverFor eligible people aged twelve and over, use the exact inhaler and as-needed regimen specified by NICE and the local formulary after technique training.
Maintenance inhaled corticosteroid-formoterol MART regimenUse the locally selected low- or moderate-dose maintenance schedule with the same inhaler as reliever, following NICE steps and product limits.