ABSTRACT
Developing workplace and healthcare approaches, that primarily aim to prevent cases, or identify possible cases early for further diagnostic assessment, is of upmost importance. How these approaches develop will depend on local and national expertise and will vary by resource available and medical practice in different countries. Some countries link claims for compensation with investigations for occupational asthma (OA), whilst others separate these requirements. Others have well-developed local protocols that consider in detail local allergen types and diagnostic processes. Despite differences in approach by country, it is likely that globally the diagnosis of OA remains underreported, delayed when the diagnosis is made, and undercompensated.
The authors discuss the best practices in health surveillance of asthma in the workplace, from the point of view of occupational health professionals (nurse, physician) as well as general and specialist physicians who have to offer expertise in their clinic. The respective roles of each health professional for the initial assessment of workers with possible OA are presented and discussed. The authors outline how confirming the diagnosis is to be carried out in a step-by-step approach using various approaches: clinical questionnaire, assessment of lung function, possible IgE-mediated immunity, airway inflammation through induced sputum and FeNO, serial PEF assessment, and specific inhalation challenges. A flowchart to follow in the investigation of work-related asthma (WRA) is proposed. Finally, the authors discuss the other diagnoses that should be considered when investigating a worker for WRA.
