Occupational asthma: a review.

Occupational asthma is the most common form of occupational lung disease in the developed world at the present time. In this review, the epidemiology, pathogenesis/mechanisms, clinical presentations, management, and prevention of occupational asthma are discussed. The population attributable risk of asthma due to occupational exposures is considerable. Current understanding of the mechanisms by which many agents cause occupational asthma is limited, especially for low-molecular-weight sensitizers and irritants. The diagnosis of occupational asthma is generally established on the basis of a suggestive history of a temporal association between exposure and the onset of symptoms and objective evidence that these symptoms are related to airflow limitation. Early diagnosis, elimination of exposure to the responsible agent, and early use of inhaled steroids may play important roles in the prevention of long-term persistence of asthma. Persistent occupational asthma is often associated with substantial disability and consequent impacts on income and quality of life. Prevention of new cases is the best approach to reducing the burden of asthma attributable to occupational exposures. Future research needs are identified

Surveillance of occupational illness through a national poison control center: an approach to reach small-scale enterprises?

A pilot study was performed in order to evaluate the usefulness of the Swiss Toxicological Information Center (STIC) in detecting cases of occupational illness. One hundred and fifty-two symptomatic occupational exposure cases were collected, comprising 3.2% of 4830 cases reported to the STIC between 1 April 1992 and 15 August 1992. In 114 cases a follow-up could be performed by a structured telephone interview. On the basis of these interview data it was estimated that 72% of the cases in small enterprises were reported to the STIC without additional notification to an occupational insurance fund. By contrast, only 28% of the occupational illness cases that occurred in companies employing more than 15 workers were not reported to an occupational insurance fund. This discrepancy could have resulted in part from the fact that occupational insurance in Switzerland is mandatory only for salaried employees, not for self-supporting persons. It is concluded that the monitoring of the occurrence of occupational illnesses in small-scale enterprises must be improved. Poison control centers could play a major role in this respect