Speaker's Highlight

• Don Sin University of British Columbia, St. Paul Hospital (Canada)
  Kenneth R. Chapman Toronto General Hospital Research Institute (Canada)
• Parameswaran Nair McMaster University (Canada)
  Carolyn Calfee UCSF (U.S.A.)
• Gregory P. Downey University of Colorado School of Medicine (U.S.A.)
  David A. Schwartz University of Colorado School of Medicine (U.S.A.)
• Neil Schluger Tuberculosis Control Branch, California Department of Public Health (U.S.A.)
  Nick Kim Critical Care & Sleep Medicine, University of California San Diego (U.S.A.)
• Nicola Hananiah Baylor College of Medicine (U.S.A.)
  Jae-Joon Yim Seoul National University College of Medicine (Republic of Korea)
• Koichiro Asano Tokai University School of Medicine (Japan)
  Diahn-Warng Perng Taipei Veterans General Hospital (Taiwan)
• Konstantinos Kostikas University of Ioannina (Greece)
  Karin Klooster University Medical Center Groningen (Kingdom of the Netherlands)

• Managing Occupational Asthma in Today’s Australian Workplace

  Occupational asthma is asthma caused or aggravated by conditions at work. It may develop after repeated exposure to substances such as flour dust, isocyanates, cleaning chemicals, wood dust, latex, welding fumes or laboratory agents. Symptoms can include wheeze, chest tightness, cough and breathlessness that improve during weekends or holidays and return after work.

  Early recognition matters because ongoing exposure can lead to persistent airway sensitivity and reduced lung function. Management therefore extends beyond prescribing an inhaler. It involves confirming the diagnosis, identifying the workplace trigger, reducing exposure and coordinating care between the worker, employer, general practitioner, respiratory specialist and occupational health team.

  Recognising Work-Related Airway Symptoms

  A careful clinical history is the starting point. Clinicians should ask when symptoms began, whether they worsen during particular shifts, and whether they improve during leave. The timing of symptoms after starting a job, changing duties or introducing a new product can provide important clues. Details about ventilation, protective equipment, spills, maintenance work and co-workers with similar symptoms are also useful.

  Occupational asthma can be confused with allergic rhinitis, chronic obstructive pulmonary disease, vocal cord dysfunction or asthma unrelated to work. Symptoms may appear several hours after exposure, so a worker may not immediately connect them with a specific task. A symptom and exposure diary covering workdays, days off and holidays can help reveal a pattern.

  In Australia, a baker in Melbourne, a spray painter in Brisbane or a healthcare worker in Sydney may encounter very different respiratory hazards. Seasonal bushfire smoke, dust storms and poor indoor ventilation can further complicate assessment, particularly when symptoms occur both at work and in the community.

  Confirming The Diagnosis

  Spirometry is usually central to assessment, with bronchodilator testing used to identify reversible airflow obstruction. If results are normal but suspicion remains high, serial peak expiratory flow measurements can be taken several times each day during work periods and away from exposure. A consistent difference between work and non-work readings supports the possibility of occupational asthma, although interpretation should be supervised by a clinician.

  Specialist testing may include bronchial provocation, fractional exhaled nitric oxide, skin-prick testing or specific IgE blood tests for relevant allergens. Workplace-specific challenge testing is complex and is generally reserved for specialist centres because it can provoke significant respiratory symptoms. Testing is most informative while the worker is still exposed, but safety takes priority.

  A diagnosis should distinguish occupational asthma from work-exacerbated asthma. In the latter situation, asthma existed before employment but is aggravated by dust, fumes, exertion or temperature changes at work. The distinction can affect exposure controls, workers’ compensation documentation and decisions about whether a worker can safely remain in the same role.

  Reducing Exposure At Its Source

  The strongest intervention is removal or substantial reduction of the causative exposure. Employers should apply the hierarchy of controls: eliminate the hazardous product where possible, substitute a safer alternative, isolate the process, improve engineering controls and use administrative measures. Local exhaust ventilation, enclosed mixing systems and effective dust capture are often more reliable than relying on a mask.

  Personal protective equipment has an important supporting role, but it should not be the only control. Respirators must be selected for the hazard, correctly fitted and maintained. Facial hair, poor fit, incorrect filters and inconsistent use can greatly reduce protection. Training should cover safe handling, cleaning procedures, spill response and the early reporting of symptoms.

  Australian workplaces are regulated through state and territory systems, including SafeWork NSW, WorkSafe Victoria and WorkSafe Queensland. Safe Work Australia provides national model guidance, while local duties and compensation arrangements differ. Employers should review safety data sheets, exposure monitoring and incident reports with an occupational hygienist when the hazardous agent is uncertain.

  Using Medication And Follow-Up

  Medication follows standard asthma principles and should be tailored to symptom severity, airway inflammation and the person’s response. Inhaled corticosteroids are commonly used as an anti-inflammatory treatment, while reliever and combination inhalers may be prescribed according to current asthma guidelines. Inhaler technique, adherence and an up-to-date written asthma action plan should be reviewed regularly.

  Medication cannot reliably offset continuing exposure to a causative agent. A worker who needs progressively more treatment, experiences frequent symptoms at work or has declining lung function requires prompt reassessment. Severe breathlessness, difficulty speaking, blue lips or poor response to a reliever require urgent medical attention.

  Follow-up should include symptom review, lung function testing and assessment of the workplace controls. Some workers improve after exposure is removed, but airway hyper-responsiveness may persist for months or years. Continuing specialist care may be needed even after a worker changes jobs, especially when exposure was prolonged or symptoms were severe.

  Supporting Safe Work And Long-Term Health

  A coordinated return-to-work plan can allow continued employment while protecting respiratory health. Options may include temporary reassignment, changing products, reducing time in a contaminated area or moving to a permanently lower-exposure role. Decisions should be based on objective testing and workplace assessment rather than symptoms alone.

  Clear communication is essential. Workers may fear lost income, stigma or job insecurity, while employers may be concerned about staffing and productivity. Confidential medical information should be handled appropriately, with only necessary functional advice shared with the workplace. In Australia, workers’ compensation pathways and notification requirements vary by jurisdiction, so clinical records should document exposure history, test results and treatment carefully.

  Prevention remains a major goal. Regular hazard assessments, health surveillance for higher-risk tasks and prompt investigation of respiratory complaints can identify problems before they become permanent. This is particularly relevant in industries using flour, polyurethane products, disinfectants, wood materials and animal proteins.

  For Australian clinicians and workplaces, the central principle is straightforward: identify the agent early, measure its effect on the airways, control the exposure and review the worker’s health over time. Effective management combines evidence-based asthma treatment with practical occupational hygiene, so that respiratory safety becomes part of normal work design rather than an afterthought.

  Richard Russell Nuffield Department of Clinical Medicine, University of Oxford (United Kingdom)
• Mona Bafadhel King’s College London (United Kingdom)
  David Jackson Guy’s and St Thomas’ Hospital, King’s College London (United Kingdom)
• James Chalmers University of Dundee (United Kingdom)
  David Price University of Aberdeen (United Kingdom)