Abstract

New guidelines for the identification, management, and prevention of occupational asthma are published this month in Occupational and Environmental Medicine.1 The first evidence based guidelines for occupational asthma, they were prepared by a working group that included clinicians, patients, occupational hygienists, and representatives of the Health and Safety Executive. The work was supported by a grant from the British Occupational Health Research Foundation (BOHRF). The guidelines will be supplemented by an abbreviated version for primary care practitioners, occupational health practitioners, employers, employees, and workplace safety representatives.

These guidelines are intended to increase awareness and improve the management of occupational asthma by all practitioners who encounter such patients, and to stimulate the means to reduce its incidence by those able to effect this.

The important issues in occupational asthma concern its aetiology, diagnosis, outcome and prevention. Questions about these are not readily answered by randomised controlled trials (RCTs) and, arguably, conventional hierarchies with the RCT at the apex are not appropriate for assessing the strength of evidence used in the generation of guidelines.2 Although not having the high internal validity of the RCT, strong inferences can be drawn from observational studies (whose external validity can be greater than that of an RCT) when these are well designed and their findings consistent and plausible.

The guidelines address several questions that are of key importance to respiratory physicians:

What proportion of asthma in adult life is attributable to occupation?

What are the most frequent causes of occupational asthma and in which occupations are they encountered?
What methods are most useful in the diagnosis of occupational asthma?
How is a case of occupational asthma best managed?
What is the prognosis of occupational asthma and what factors influence this?

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