Synopsis
Recognise when work has caused or aggravated respiratory disease, establish exposure–response evidence without jeopardising employment prematurely, and coordinate early specialist, occupational-health and workplace action.
- Ask every patient with new asthma, cough, breathlessness or interstitial disease what they do now, what they previously did, and which dusts, fumes, vapours, aerosols, animals or biological materials they encounter.
- A pattern that improves on rest days or holidays and worsens during particular tasks is a diagnostic clue, but delayed reactions mean symptoms need not begin during the shift.
- Occupational asthma is new asthma caused by work; work-aggravated asthma is pre-existing or coincidental asthma worsened by workplace conditions. The distinction affects prognosis and workplace control.
Key red flags
Symptoms begin after a high-level irritant exposure or repeated intense peaks, sometimes without a sensitisation latency. Acute hypoxaemia, bronchospasm or radiographic infiltrates require emergency assessment.
Investigation priorities
Establish plausible agents, dose pattern, latency and relation between symptoms and work.
Management branches
New or worsening respiratory symptoms in anyone currently or previously employed.
- Stabilise acute illness, document oxygenation and ask whether symptoms began during a specific exposure, spill, fire or confined-space event.
- Create a lifetime job and task chronology, including materials, processes, controls, personal protective equipment, coworkers and symptom variation away from work.
Key medicines
Inhaled corticosteroid-containing asthma treatmentUse the current joint BTS/NICE/SIGN step appropriate to symptoms, attacks and objective response; verify the device and regimen in the current BNF.
Smoking-cessation pharmacotherapyOffer an evidence-based licensed option with behavioural support, selected and prescribed using the current NICE tobacco guidance and BNF.