Summary
Definition
History and exam
Key diagnostic factors
- occupational exposure to sensitizing agents or irritants
- symptoms of asthma that improve during holidays
- initial onset of asthma symptoms during a work period
Risk factors
- high-level exposure to sensitizer
- atopy
- genetic factors
- smoking
Diagnostic tests
1st tests to order
- spirometry
- chest x-ray
- skin prick testing (SPT)
- nonspecific bronchial hyper-responsiveness (NSBHR)
- serial peak expiratory flow (PEF)
Tests to consider
- specific serum IgE assay
- specific inhalation challenge (SIC)
Emerging tests
- induced sputum cytology
- fractional exhaled nitric oxide (FeNO)
Treatment algorithm
sensitizer-induced
irritant-induced
symptomatic asthma
Contributors
Authors
Ryan Hoy, MB BS, MOEH, FRACP
Respiratory Physician
The Alfred Hospital
Melbourne
Victoria
Australia
Disclosures
RH is an author of a reference cited in the topic.
Susan M. Tarlo, MB BS FRCP(C)
Professor of Medicine
University of Toronto
Respiratory Physician
Toronto Western Hospital
Toronto
Ontario
Canada
Disclosures
SMT has received grant support from the Ontario Workplace Safety and Insurance Board (WSIB) and the Centre for Research Expertise in Occupational Disease (funded by Ontario Ministry of Labour). She has acted as a consultant for the Ontario Workplace Safety and Insurance Appeals Tribunal (WSIAT) and has provided clinical case assessments for WSIB. She has been a member of Task Forces for the European Academy of Allergy, Asthma and Clinical Immunology and an expert advisor to a committee of the European Respiratory Society. She is a member of the Occupational Disease Committee of the American Academy of Allergy, Asthma and Clinical Immunology (AAAAI). She has been an invited speaker at meetings of AAAAI and the American Thoracic Society. She is a coeditor of Current Opinion in Allergy and Clinical Immunology, and has received book royalties as coeditor of Asthma in the Workplace. SMT is an author of references cited in the topic.
Peer reviewers
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
Disclosures
WK declares that he has no competing interests.
Karin Pacheco, MD
Associate Professor of Medicine
National Jewish Medical Centre
Denver
CO
Disclosures
KP declares that she has no competing interests.
Philip Harber, MD
Professor of Medicine
University of California
Los Angeles
CA
Disclosures
PH declares that he has no competing interests.
References
Key articles
Barber CM, Cullinan P, Feary J, et al. British Thoracic Society clinical statement on occupational asthma. Thorax. 2022 May;77(5):433-42.Full text Abstract
Tarlo SM, Balmes J, Balkissoon R, et al. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus statement. Chest. 2008 Sep;134(3 suppl):1S-41S. Abstract
Baur X, Sigsgaard T, Aasen TB, et al. Guidelines for the management of work-related asthma. Eur Respir J. 2012 Mar;39(3):529-45.Full text Abstract
Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. May 2025 [internet publication].Full text
American College of Radiology. ACR appropriateness criteria: occupational lung diseases. 2019 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Work-exacerbated asthma
- Occupational eosinophilic bronchitis
- Coincidental nonoccupational asthma
More DifferentialsGuidelines
- Global strategy for asthma management and prevention
- Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)
More GuidelinesPatient information
Asthma in adults
More Patient information
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