New developments in work-related asthma.
Although work-related asthma is the most commonly recognized occupational lung disease, the condition remains underrecognized and underreported. New-onset occupational asthma and work aggravated asthma can have deleterious medical and socioeconomic consequences for the individual. Although interpretation and comparison between studies are hampered by the use of variable definitions of WRA and criteria for the diagnosis, as many as 20% of cases of new or aggravated adult asthma has important work-related factors. Thus, all asthmatic patients should be asked about their work, if their respiratory symptoms are worse when they work, or if a new job/exposure preceded the onset of symptoms. A series of longitudinal inception and apprentice cohort studies were undertaken to address significant weakness in the previous medical literature. These studies are just beginning to produce results, and provide strong evidence for asthma caused by exposure to specific occupational environments. They have begun to produce new understanding of the risk factors for developing OA, the natural history of OA and immune sensitization, and the existence of the healthy worker effect. New, non-invasive measures of airway inflammation have been developed with the potential for broad applications in the field of WRA. Although the measurement of exhaled NO and induced sputum analysis are primarily used as research tools, their place in clinical practice is likely to become clearer. These methods also have the potential to elucidate the various pathophysiologic mechanisms involved in WRA and may broaden our concept of occupational exposures that can initiate the onset of asthma.