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.
- Improvement on rest days or holidays supports a work relationship but is not diagnostic because treatment, infections and exposure patterns also change.
- Arrange early specialist occupational-respiratory assessment; delay can allow continued injury and may erase the chance to demonstrate an exposure-response pattern.
- Serial peak expiratory flow is most informative while the person is still in the relevant work, provided continued exposure is clinically safe.
- Do not advise abrupt resignation as a diagnostic strategy; health, income, legal rights and safer redeployment must be considered with informed specialist support.
- Exposure control is disease-modifying. Inhalers reduce inflammation and symptoms but do not make continued uncontrolled exposure safe.
- Communicate with an employer or occupational-health service only with the person's informed consent, except where a separate overriding legal duty has been established and explained.
- Local reporting, occupational-disease and workplace safety duties vary across UK jurisdictions and roles; use current HSE or devolved guidance and specialist advice.
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.
Fever, systemic upset, inspiratory crackles, reduced gas transfer, focal imaging, fixed obstruction or progressive breathlessness should prompt consideration of hypersensitivity pneumonitis, silicosis, COPD, infection, bronchiolitis or another occupational disorder.
Rapid worsening, attacks requiring urgent care, a major spill, inadequate respiratory protection or several affected workers makes continued workplace challenge unsafe and requires immediate exposure removal and specialist coordination.
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.
- Assess current asthma severity and immediate exposure safety, provide an action plan, and arrange objective asthma testing without delaying urgent treatment.
- Refer early to a clinician experienced in occupational asthma while exposure-response measurements remain feasible and employment advice can be coordinated.