The recent article on asthma management by Kemp1 did not mention the importance of considering occupational asthma in the initial assessment of adult-onset cases.
In the United States and Japan, up to 15% of adult cases of asthma are thought to be due to occupational factors.2,3
In Quebec, occupational asthma has become the most frequently accepted occupational lung disorder in claims to the Workers Compensation Board.4 Similarly in Britain, the Surveillance of Work Related and Occupational Respiratory Disease (SWORD) group reported occupational asthma to be the most frequent diagnosis (26%) in new cases of occupational respiratory disease.5
Occupational asthma is related causally to exposure to the work environment.6 This distinguishes it from preexisting asthma exacerbated rather than caused by the work environment. It is most often due to a specific agent acting as a sensitizer or irritant.2,6,7 Over 200 such occupational agents are known.
Donoghue AM. Asthma Management: Don't Forget Occupational Asthma. Arch Intern Med. 1994;154(4):457. doi:10.1001/archinte.1994.00420040139017