Published: 2021-10-27

Causes, diagnosis and treatment of occupational asthma

Rahmathulla Safiyul Rahman, Hussain Radhi Al Ebrahim, Jarallah Hadi Alqahtani, Danah Jazaa Alomani, Atheer Yusof Al-lihaibi, Mubarak Mohamed Althaidy, Mansour Saad Mohammed, Haneen Sameer Aldosari, Reem Emad Alsayed, Marah Rashed Aljassar, Farah Rashed Aljassar


Occupational asthma is usually characterized by airway hyperresponsiveness, airway obstruction, and airway inflammation that usually result from exposure to specific irritants in the workplace and is not usually associated with any evidence of exacerbation outside the workplace. Occupational asthma can be associated with complicated long-term outcomes because affected patients are not usually aware of the hazards of the condition. Therefore, applying adequate diagnostic and management approaches is essential to enhance the outcomes among high-risk workers. In the present literature review, we have discussed the causes, diagnosis, and management of occupational asthma based on the evidence obtained from the current studies in the literature. Our findings indicated the presence of various environmental triggers that can lead to the development of asthma in the workplace, including HMW and LMW compounds. The diagnosis of asthma is based on obtaining a thorough personal and clinical history from the affected patient. However, such approaches have been reported to have low specificity rates, and therefore, the diagnosis should be established by other measures as lung function tests. The management of asthma is hugely dependent on the clinical phenotypes of occupational asthma. Nevertheless, applying adequate interventions can significantly enhance the outcomes in the affected patients, in addition to the other measures that have been adequately discussed in the manuscript.


Occupational asthma, Etiology, Diagnosis, Treatment

Full Text:



Dykewicz MS. Occupational asthma: current concepts in pathogenesis, diagnosis, and management. J Allergy Clin Immunol. 2009;123(3):519-28.

Maestrelli P, Boschetto P, Fabbri LM, Mapp CE. Mechanisms of occupational asthma. J Allergy Clin Immunol. 2009;123(3):531-42.

Malo JL, Vandenplas O. Definitions and classification of work-related asthma. Immunol Allergy Clin North Am. 2011;31(4):645-62.

Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, et al. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest. 2008;134(3):1-41.

Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med. 2014;370(7):640-9.

Malo JL, Yeung M. Agents causing occupational asthma. J Allergy Clin Immunol. 2009;123(3):545-50.

Rosenman KD, Beckett WS. Web based listing of agents associated with new onset work-related asthma. Respir Med. 2015;109(5):625-31.

Nicholson PJ, Cullinan P, Taylor AJ, Burge PS, Boyle C. Evidence based guidelines for the prevention, identification, and management of occupational asthma. Occup Environ Med. 2005;62(5):290-9.

Donald JC, Keynes HL, Meredith SK. Reported incidence of occupational asthma in the United Kingdom, 1989-97. Occup Environ Med. 2000;57(12):823-9.

Piipari R, Keskinen H. Agents causing occupational asthma in Finland in 1986-2002: cow epithelium bypassed by moulds from moisture-damaged buildings. Clin Exp Allergy. 2005;35(12):1632-7.

Siracusa A, Marcucci F, Spinozzi F, Marabini A, Pettinari L, Pace ML, et al. Prevalence of occupational allergy due to live fish bait. Clin Exp Allergy. 2003;33(4):507-10.

Lindström I, Karvonen H, Suuronen K, Suojalehto H. Occupational asthma from biological pest control in greenhouses. J Allergy Clin Immunol Pract. 2018;6(2):692-4.

Cullinan P, Harris JM, Newman TAJ, Hole AM, Jones M, Barnes F, et al. An outbreak of asthma in a modern detergent factory. Lancet. 2000;356(9245):1899-900.

Quirce S, Baeza ML, Tornero P, Blasco A, Barranco R, Sastre J. Occupational asthma caused by exposure to cyanoacrylate. Allergy. 2001;56(5):446-9.

Jaakkola MS, Leino T, Tammilehto L, Ylöstalo P, Kuosma E, Alanko K. Respiratory effects of exposure to methacrylates among dental assistants. Allergy. 2007;62(6):648-54.

Moscato G, Pignatti P, Yacoub MR, Romano C, Spezia S, Perfetti L. Occupational asthma and occupational rhinitis in hairdressers. Chest. 2005;128(5):3590-8.

Muñoz X, Cruz MJ, Orriols R, Bravo C, Espuga M, Morell F. Occupational asthma due to persulfate salts: diagnosis and follow-up. Chest. 2003;123(6):2124-9.

Trivedi V, Apala DR, Iyer VN. Occupational asthma: diagnostic challenges and management dilemmas. Curr Opin Pulm Med. 2017;23(2):177-83.

Vandenplas O, Suojalehto H, Cullinan P. Diagnosing occupational asthma. Clin Exp Allergy. 2017;47(1):6-18.

Cormier M, Lemière C. Occupational asthma. Int J Tuberc Lung Dis. 2020;24(1):8-21.

Vandenplas O, Dressel H, Nowak D, Jamart J, ERS Task Force on the Management of Work-related Asthma. What is the optimal management option for occupational asthma? Eur Respir Rev. 2012;21(124):97-104.

Malo JL, Ghezzo H, Archevêque J, Lagier F, Perrin B, Cartier A. Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis. 199;143(3):528-32.

Quirce S, Campo P, Ortega J, Nieto M, Gómez E, Arcediano A, et al. New developments in work-related asthma. Expert Rev Clin Immunol. 2017;13(3):271-81.

Bardy JD, Malo JL, Séguin P, Ghezzo H, Desjardins J, Dolovich J, et al. Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium. Am Rev Respir Dis. 1987;135(5):1033-8.

Burge PS. Single and serial measurements of lung function in the diagnosis of occupational asthma. Eur J Respir Dis Suppl. 1982;123:47-59.

Malo JL, Cartier A. Occupational asthma in workers of a pharmaceutical company processing spiramycin. Thorax. 1988;43(5):371-7.

Malo JL, Côté J, Cartier A, Boulet LP, L'Archevêque J, Yeung M. How many times per day should peak expiratory flow rates be assessed when investigating occupational asthma? Thorax. 1993;48(12):1211-7.

Kampen V, Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, et al. EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies. Allergy. 2013;68(5):580-4.

Moscato G, Pala G, Barnig C, Blay F, Giacco SR, Folletti I, et al. EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy. 2012;67(4):491-501.

Vandenplas O, Froidure A, Meurer U, Rihs HP, Rifflart C, Soetaert S, et al. The role of allergen components for the diagnosis of latex-induced occupational asthma. Allergy. 2016;71(6):840-9.

Aranda A, Campo P, Palacin A, Doña I, Gomez C, Galindo L, Perales A, et al. Antigenic proteins involved in occupational rhinitis and asthma caused by obeche wood (Triplochiton scleroxylon). PLoS One. 2013;8(1):53926.

Raulf M, Quirce S, Vandenplas O. Addressing Molecular Diagnosis of Occupational Allergies. Curr Allergy Asthma Rep. 2018;18(1):6.

Quirce S, Sastre J. Occupational asthma: clinical phenotypes, biomarkers, and management. Curr Opin Pulm Med. 2019;25(1):59-63.

Vandenplas O, Alpaos V, Heymans J, Jamart J, Thimpont J, Huaux F, et al. Sputum eosinophilia: an early marker of bronchial response to occupational agents. Allergy. 2009;64(5):754-61.

Henneberger PK, Patel JR, Groene GJ, Beach J, Tarlo SM, Pal TM, et al. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2019;10(10):6308.

Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P, S, et al. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J. 2011;38(4):804-11.

Baur X, Sigsgaard T, Aasen TB, Burge PS, Heederik D, Henneberger P, et al. Guidelines for the management of work-related asthma. Eur Respir J. 2012;39(3):529-45.

Tiotiu AI, Novakova S, Labor M, Emelyanov A, Mihaicuta S, Novakova P, et al. Progress in Occupational Asthma. Int J Environ Res Public Health. 2020;17(12):4553.

Moscato G, Pala G, Sastre J. Specific immunotherapy and biological treatments for occupational allergy. Curr Opin Allergy Clin Immunol. 2014;14(6):576-81.

Lavaud F, Bonniaud P, Dalphin JC, Leroyer C, Muller D, Tannous R, et al. Usefulness of omalizumab in ten patients with severe occupational asthma. Allergy. 2013;68(6):813-5.

Bernstein DI. Management of the individual worker with occupational asthma. Ann Allergy Asthma Immunol. 2013;111(3):167-9.