Occupational asthma

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Última revisão: 23 Sep 2025

Última atualização: 15 Aug 2025

Occupational asthma (OA) should be suspected in all adult patients with asthma.

Occupational history may identify work-related causes. Details of work exposures should be obtained from material safety data sheets available to the patient from their workplace.

Objective evidence of asthma should be obtained from spirometry, a bronchodilator response, and/or a methacholine challenge. Tests should be performed when the patient is symptomatic and/or within days of exposure to a suspected etiologic agent.

In sensitizer-induced OA, removal from any further exposure to that agent is recommended if an immunologic response to the work sensitizer is demonstrated by skin or in vitro tests.

In irritant-induced OA, preventive measures should be implemented in the workplace to reduce future exposures and episodes.

For all causes of OA, the clinician should continue treating the asthma as appropriate, assist in the initiation of any appropriate compensation claim, and consider other workers at risk.

Definição

OA is asthma caused by the workplace and may result from immunologic or nonimmunologic stimuli.[1]

Sensitizer-induced OA is caused by immunologic stimuli and develops after a latency period between first exposure and the onset of symptoms.[2][3] Irritant-induced OA (including reactive airways dysfunction syndrome) is caused by nonimmunologic stimuli.[4]

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

Full details

Risk factors

high-level exposure to sensitizer
atopy
genetic factors
smoking

Full details

Diagnostic tests

1st tests to order

spirometry
chest x-ray
skin prick testing (SPT)
nonspecific bronchial hyper-responsiveness (NSBHR)
serial peak expiratory flow (PEF)

Full details

Tests to consider

specific serum IgE assay
specific inhalation challenge (SIC)

Full details

Emerging tests

induced sputum cytology
fractional exhaled nitric oxide (FeNO)

Treatment algorithm

ACUTE

sensitizer-induced

irritant-induced

ONGOING

symptomatic asthma

Contributors

Authors

Ryan Hoy, MB BS, MOEH, FRACP

Respiratory Physician

The Alfred Hospital

Melbourne

Victoria

Australia

Declarações

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

Declarações

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.

Revisores

Ware Kuschner, MD

Associate Professor of Medicine

Stanford University

Stanford

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

Declarações

WK declares that he has no competing interests.

Karin Pacheco, MD

Associate Professor of Medicine

National Jewish Medical Centre

Denver

Declarações

KP declares that she has no competing interests.

Philip Harber, MD

Professor of Medicine

University of California

Los Angeles

Declarações

PH declares that he has no competing interests.

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Referências

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Principais artigos

Barber CM, Cullinan P, Feary J, et al. British Thoracic Society clinical statement on occupational asthma. Thorax. 2022 May;77(5):433-42.Texto completo Resumo

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. Resumo

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.Texto completo Resumo

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. May 2025 [internet publication].Texto completo

American College of Radiology. ACR appropriateness criteria: occupational lung diseases. 2019 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Work-exacerbated asthma
- Occupational eosinophilic bronchitis
- Coincidental nonoccupational asthma
Mais Diagnósticos diferenciais
Diretrizes
- Global strategy for asthma management and prevention
- Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)
Mais Diretrizes
Folhetos informativos para os pacientes
Asthma in adults
Mais Folhetos informativos para os pacientes
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Occupational asthma

Resumo

Definição

History and exam

Key diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

sensitizer-induced

irritant-induced

symptomatic asthma

Contributors

Authors

Ryan Hoy, MB BS, MOEH, FRACP

Declarações

Susan M. Tarlo, MB BS FRCP(C)

Declarações

Revisores

Ware Kuschner, MD

Declarações

Karin Pacheco, MD

Declarações

Philip Harber, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice