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Can medical surveillance measures improve the outcome of occupational asthma?

Occupational asthma (OA) has been reported to account for 3% to 20% of all asthma cases in studies that have included populations in Europe, North America, Australia, New Zealand, and Japan.1 Even after the diagnosis has been confirmed and the worker removed from ongoing exposure to the causative work agent, it can still be associated with ongoing asthma, significant morbidity,2 and even mortality.3 For some workplace sensitizers the risk of OA in the workplace can be reduced by primary prevention, particularly control of workplace respiratory exposure. It has been shown for several workplace sensitizers4-6 that the population risk of sensitization relates to the airborne exposure level. Reduced inhalation exposure levels have been achieved as a result of process or product changes (eg, for detergent enzymes by encapsulation of the enzymes7 and for natural rubber latex by powder-free lowprotein glove use8). Other measures may include use of alternative nonsensitizing agents (elimination/substitution), occupational hygiene measures of ventilation, robots in high-exposure areas, and appropriate respirators. Regulations to control and monitor airborne concentrations of common sensitizers such as diisocyanates may enhance the likelihood of reducing work exposures to safer levels. An additional method for primary prevention of OA would be to identify workers at risk of sensitization to specific workplace agents at the time of pre-employment and exclude their exposure to these agents. Unfortunately, at present those at risk cannot be predicted with sufficient sensitivity and specificity for this to be practical: although risk markers for those exposed to sensitizers, such as genetic markers, atopy, and smoking history9