Work-exacerbated asthma and occupational asthma: Do they really differ?

Developing and Emerging Clinical Asthma Phenotypes

“…17,18 Risk factors for some types of occupational asthma include atopy 19 and genetic factors. 20 Smoking also may play a role in the onset of occupational asthma.…”

Asthma control in the workplace

“…We can suppose that the poor asthma control and more frequent exacerbations in workers with occupational asthma (although this was not formally diagnosed in the present survey) is due to sensitiser exposure-related increases in airway inflammation, probably on top of progressively increasing airway remodelling [7,14,16,17]. For work-exacerbated asthma, this is still unclear.…”

“…In this regard, we previously showed the various inflammatory phenotypes of occupational asthma according to the type of offending agent, and also that independently of the diagnosis of occupational or work-exacerbated asthma, a neutrophilic phenotype was associated with poorer asthma control and a longer duration of exposure than eosinophilic or paucigranulocytopenic asthma [7,14]. Furthermore, we showed that workers with work-exacerbated asthma seemed, surprisingly, to even have an increased asthma severity compared to workers with occupational asthma, in addition to having a more noneosinophilic asthma phenotype [7]. In this last study, both workers with occupational or workexacerbated asthma had greater health care use and a 10-fold higher direct care costs than non-work-related asthma.…”

“…In this last study, both workers with occupational or workexacerbated asthma had greater health care use and a 10-fold higher direct care costs than non-work-related asthma. The more troublesome asthma in workers with work-exacerbated asthma may be due in part to the fact that some of those with occupational asthma may have left work, creating the healthy worker effect [7,15]. Nevertheless, the above studies stress the need to better evaluate the effects of environmental workplace exposures on asthma control, even in non-sensitised workers, as they can lead to more severe and troublesome asthma in both groups.…”

“…Prevention of exacerbations is an important goal in asthma management, as stressed by all recent guidelines, as they may result in an accelerated decline in lung function, reduced quality of life and increased socioeconomic burden of disease [7,11,24,25]. Search for contributing and causal factors in the uncontrolled asthmatic patient should, therefore, not only include respiratory infections, common airborne allergen exposures and other factors, such as non-adherence to therapy, but workplace exposures should also be carefully documented.…”