All of these entities have the potential to adversely alter the health of workers and, in many instances, require the worker to leave the job. Of these three entities, it appears that most is known about the natural history of occupational asthma. The recognition that workers must leave the workplace when this diagnosis is made is generally agreed upon. The second entity, reactive airways dysfunction syndrome, is not as clearly understood, particularly when one recognizes that there appears to be a considerable difference in the prevalence of this illness when one compares prospective and retrospective reporting of the disease. Finally, work-aggravated asthma remains the least well described and has only been accepted as a part of the triad of work-related asthma in the past several years. The most appropriate clinical response to the diagnosis of this entity in workers has yet to be fully explored.

Over the last half century, there has been a sustained decline in the prevalence of silicosis in developed countries. This success has primarily been the result of an emphasis on engineering controls, with the capture of generated silica dust. This has allowed for adherence to exposure limits and the protection of the respiratory health of the worker. Yet sporadic cases continue to occur in developed countries and epidemics are still recognized in underdeveloped countries.In this review, we address data describing the pathogenesis of silicosis. Although untried, much of this research suggests that pathways associated with the development and progression of silicosis may be altered by currently available interventions.

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