Occupational Asthma Reference

Fishwick D, Barber CM, Bradshaw LM, Ayres JG, Barraclough R, Burge S, Corne JM, Cullinan P, Frank TL, Hendrick D, Hoyle J, Curran AD, Niven R, Pickering T, Reid P, Robertson A, Stenton C, Warburton CJ, Nicholson PJ, Standards of care for occupational asthma: an update, Thorax, 2012;67:278-280,

Keywords: guidelines, key, UK, occupational asthma

Known Authors

Paul Cullinan, Royal Brompton Hospital, London, UK Paul Cullinan

Tony Pickering, Wythenshawe Hospital, Manchester, UK Tony Pickering

Andrew Curran, HSL, Sheffield, UK Andrew Curran

David Fishwick, Royal Hallamshire Hospital, Sheffield, UK David Fishwick

Chris Stenton, Newcastle upon Tyne, UK Chris Stenton

Sherwood Burge, Oasys Sherwood Burge

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Lisa Bradshaw, Health and Safety Laboratories Lisa Bradshaw

Jon Ayres, University of Birmingham Jon Ayres

Paul Nicholson, Procter And Gamble Occupational Health Paul Nicholson

Chris Warburton, Liverpool Chris Warburton

Jennifer Hoyle, North Manchester General Hospital Jennifer Hoyle

David Hendrick, Newcastle-upon-Tyne David Hendrick

Chris Barber, Health and Safety Laboratories, Buxton Chris Barber

Rob Niven, Wythenshawe Hospital, Manchester Rob Niven

Peter Reid, Edinburgh Western General Hospital Peter Reid

Richard Barraclough, Manchester Richard Barraclough

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The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF).

BOHRF updated the evidence base from 2004–2009 in 2010.

This article summarises the changes in evidence and is aimed at physicians, nurses and other healthcare professionals in primary and secondary care, occupational health and public health and at employers, workers and their health, safety and other representatives.

Various recommendations and evidence ratings have changed in the management of asthma that may have an occupational cause.

Full Text


The audit tool, against which clinical activity should be measured, is revised as follows. All
patients with suspected OA should, as a minimum, have the following clearly documented in
their health records.

By first visit
o Presence or absence of asthma prior to potentially harmful asthmagen exposure at work
o Presence or absence of work-related eye or nasal symptoms
o Presence or absence of work-related respiratory symptoms and their duration
o A full list of occupations held, their durations, and likely associated occupational exposures
o Current ongoing asthmagen exposure
o Whether other workers at the same workplace are affected
o FEV1, FVC, and the degree of airflow limitation, compared to predicted values

By second visit
o If at work and appropriate; serial PEF measurements taken for at least 3 continuous weeks including rest days, with at least 4 good quality readings per day, analysed to assess work relatedness.
o If performed, the results of non specific bronchial responsiveness
o If exposed to allergen with appropriate specific IgE measure or skin prick test, the result of this test.

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