Work-exacerbated asthma

  • Paul K. Henneberger
  • Carrie A. Redlich
Part of the Progress in Inflammation Research book series (PIR)


Exposures at work can contribute to both the onset and exacerbation of asthma. This chapter summarizes key information regarding work-exacerbated asthma (WEA), a common condition that has received little attention compared to new occupational asthma. WEA refers to pre-existing or concurrent asthma that is worsened by factors at work. WEA, as with asthma in general, is heterogeneous, with multiple phenotypes and triggers. The prevalence of WEA has ranged from about 15% to over 50% among working adults with asthma in published studies, but is rarely diagnosed by clinicians. WEA occurs in a wide range of industries and occupations, including education, services, manufacturing and construction, and can lead to job changes and unemployment. Multiple factors at work can exacerbate asthma, including various irritants, allergens, molds, cold and exertion. Cleaning products and building renovation in non-industrial workplaces such as schools and offices are commonly implicated. WEA can lead to substantial adverse outcomes, similar to OA. Management of WEA should focus on reducing work exposures and optimizing standard medical management.


Allergy Clin Immunol Asthma Symptom Asthma Exacerbation Peak Expiratory Flow Rate Occupational Asthma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, Scalia MR, Akinbami LJ (2007) National surveillance for asthma — United States, 1980–2004. MMWR Surveill Summ 56: 1–54PubMedGoogle Scholar
  2. 2.
    Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, Milton D, Schwartz D, Toren K, Viegi G (2003) American Thoracic Society Statement: Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med 167: 787–797CrossRefPubMedGoogle Scholar
  3. 3.
    Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F et al (2008) Diagnosis and management of work-related asthma: American College of Chest Physicians Consensus Statement. Chest 134: 1S–41SCrossRefPubMedGoogle Scholar
  4. 4.
    Kavura MS, Wiedemann HP (2005) Asthma. In: RB George, RW Light, MA Matthay, RA Matthay (eds): Chest Medicine. Lippincott Williams& Wilkins, Philadelphia, 131–162Google Scholar
  5. 5.
    Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O’Byrne P, Pedersen SE et al (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31: 143–178CrossRefPubMedGoogle Scholar
  6. 6.
    Abramson MJ, Kutin JJ, Rosier MJ, Bowes G (1995) Morbidity, medication and trigger factors in a community sample of adults with asthma. Med J Aust 162: 78–81PubMedGoogle Scholar
  7. 7.
    Blanc PD, Ellbjar S, Janson C, Norback D, Norrman E, Plaschke P, Toren K (1999) Asthma-related work disability in Sweden. The impact of workplace exposures. Am J Respir Crit Care Med 160: 2028–2033PubMedGoogle Scholar
  8. 8.
    Bolen AR, Henneberger PK, Liang X, Sama SR, Preusse PA, Rosiello RA, Milton DK (2007) The validation of work-related self-reported asthma exacerbation. Occup Environ Med 64: 343–348CrossRefPubMedGoogle Scholar
  9. 9.
    Goh LG, Ng TP, Hong CY, Wong ML, Koh K, Ling SL (1994) Outpatient adult bronchial asthma in Singapore. Singapore Med J 35: 190–194PubMedGoogle Scholar
  10. 10.
    Henneberger PK, Deprez RD, Asdigian N, Oliver LC, Derk S, Goe SK (2003) Workplace exacerbation of asthma symptoms: Findings from a population-based study in Maine. Arch Environ Health 58: 781–788PubMedGoogle Scholar
  11. 11.
    Henneberger PK, Derk SJ, Sama SR, Boylstein RJ, Hoffman CD, Preusse PA, Rosiello RA, Milton DK (2006) The frequency of workplace exacerbation among health maintenance organisation members with asthma. Occup Environ Med 63: 551–557CrossRefPubMedGoogle Scholar
  12. 12.
    Henneberger PK, Hoffman CD, Magid DJ, Lyons EE (2002) Work-related exacerbation of asthma. Int J Occup Environ Health 8: 291–296PubMedGoogle Scholar
  13. 13.
    Mancuso CA, Rincon M, Charlson ME (2003) Adverse work outcomes and events attributed to asthma. Am J Ind Med 44: 236–245CrossRefPubMedGoogle Scholar
  14. 14.
    Saarinen K, Karjalainen A, Martikainen R, Uitti J, Tammilehto L, Klaukka T, Kurppa K (2003) Prevalence of work-aggravated symptoms in clinically established asthma. Eur Respir J 22: 305–309CrossRefPubMedGoogle Scholar
  15. 15.
    Caldeira RD, Bettiol H, Barbieri MA, Terra-Filho J, Garcia CA, Vianna EO (2006) Prevalence and risk factors for work related asthma in young adults. Occup Environ Med 63: 694–699CrossRefPubMedGoogle Scholar
  16. 16.
    Curwick CC, Bonauto DK, Adams DA (2006) Use of objective testing in the diagnosis of work-related asthma by physician specialty. Ann Allergy Asthma Immunol 97: 546–550CrossRefPubMedGoogle Scholar
  17. 17.
    de Fatima Macaira E, Algranti E, Medina Coeli Mendonca E, Antonio Bussacos M (2007) Rhinitis and asthma symptoms in non-domestic cleaners from the Sao Paulo metropolitan area, Brazil. Occup Environ Med 64: 446–453CrossRefPubMedGoogle Scholar
  18. 18.
    Fletcher AM, London MA, Gelberg KH, Grey AJ (2006) Characteristics of patients with work-related asthma seen in the New York State Occupational Health Clinics. J Occup Environ Med 48: 1203–1211CrossRefPubMedGoogle Scholar
  19. 19.
    Goe SK, Henneberger PK, Reilly MJ, Rosenman KD, Schill DP, Valiante D, Flattery J, Harrison R, Reinisch F, Tumpowsky C et al (2004) A descriptive study of work aggravated asthma. Occup Environ Med 61: 512–517CrossRefPubMedGoogle Scholar
  20. 20.
    Larbanois A, Jamart J, Delwiche JP, Vandenplas O (2002) Socioeconomic outcome of subjects experiencing asthma symptoms at work. Eur Respir J 19: 1107–1113CrossRefPubMedGoogle Scholar
  21. 21.
    Lemiere C, Forget A, Dufour MH, Boulet LP, Blais L (2007) Characteristics and medical resource use of asthmatic subjects with and without work-related asthma. J Allergy Clin Immunol 120: 1354–1359CrossRefPubMedGoogle Scholar
  22. 22.
    Pechter E, Davis LK, Tumpowsky C, Flattery J, Harrison R, Reinisch F, Reilly MJ, Rosenman KD, Schill DP, Valiante D et al (2005) Work-related asthma among health care workers: Surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993–1997. Am J Ind Med 47: 265–275CrossRefPubMedGoogle Scholar
  23. 23.
    Reinisch F, Harrison RJ, Cussler S, Athanasoulis M, Balmes J, Blanc P, Cone J (2001) Physician reports of work-related asthma in California, 1993–1996. Am J Ind Med 39: 72–83CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenman KD, Reilly MJ, Schill DP, Valiante D, Flattery J, Harrison R, Reinisch F, Pechter E, Davis L, Tumpowsky CM et al (2003) Cleaning products and work-related asthma. J Occup Environ Med 45: 556–563CrossRefPubMedGoogle Scholar
  25. 25.
    Tarlo SM, Leung K, Broder I, Silverman F, Holness DL (2000) Asthmatic subjects symptomatically worse at work: Prevalence and characterization among a general asthma clinic population. Chest 118: 1309–1314CrossRefPubMedGoogle Scholar
  26. 26.
    Tarlo SM, Liss G, Corey P, Broder I (1995) A workers’ compensation claim population for occupational asthma. Comparison of subgroups. Chest 107: 634–641CrossRefPubMedGoogle Scholar
  27. 27.
    Berger Z, Rom WN, Reibman J, Kim M, Zhang S, Luo L, Friedman-Jimenez G (2006) Prevalence of workplace exacerbation of asthma symptoms in an urban working population of asthmatics. J Occup Environ Med 48: 833–839CrossRefPubMedGoogle Scholar
  28. 28.
    Cox-Ganser JM, White SK, Jones R, Hilsbos K, Storey E, Enright PL, Rao CY, Kreiss K (2005) Respiratory morbidity in office workers in a water-damaged building. Environ Health Perspect 113: 485–490CrossRefPubMedGoogle Scholar
  29. 29.
    Gouge SF, Daniels DJ, Smith CE (1994) Exacerbation of asthma after pyridostigmine during Operation Desert Storm. Mil Med 159: 108–111PubMedGoogle Scholar
  30. 30.
    Jacobs JH, Spaan S, van Rooy GB, Meliefste C, Zaat VA, Rooyackers JM, Heederik D (2007) Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers. Eur Respir J 29: 690–698CrossRefPubMedGoogle Scholar
  31. 31.
    Kreiss K, Esfahani RS, Antao VC, Odencrantz J, Lezotte DC, Hoffman RE (2006) Risk factors for asthma among cosmetology professionals in Colorado. J Occup Environ Med 48: 1062–1069CrossRefPubMedGoogle Scholar
  32. 32.
    Sauni R, Oksa P, Vattulainen K, Uitti J, Palmroos P, Roto P (2001) The effects of asthma on the quality of life and employment of construction workers. Occup Med (Lond) 51: 163–167CrossRefGoogle Scholar
  33. 33.
    Jajosky RA, Harrison R, Reinisch F, Flattery J, Chan J, Tumpowsky C, Davis L, Reilly MJ, Rosenman KD, Kalinowski D et al (1999) Surveillance of work-related asthma in selected U.S. states using surveillance guidelines for state health departments — California, Massachusetts, Michigan, and New Jersey, 1993–1995. MMWR CDC Surveill Summ 48: 1–20PubMedGoogle Scholar
  34. 34.
    Petsonk EL, Daniloff EM, Mannino DM, Wang ML, Short SR, Wagner GR (1995) Airway responsiveness and job selection: A study in coal miners and non-mining controls. Occup Environ Med 52: 745–749CrossRefPubMedGoogle Scholar
  35. 35.
    Lemanske RF, Jr., Busse WW (2006) 6. tAsthma: Factors underlying inception, exacerbation, and disease progression. J Allergy Clin Immunol 117: S456–461CrossRefGoogle Scholar
  36. 36.
    Pelissier S, Chaboillez S, Teolis L, Lemiere C (2006) Outcome of subjects diagnosed with occupational asthma and work-aggravated asthma after removal from exposure. J Occup Environ Med 48: 656–659PubMedGoogle Scholar
  37. 37.
    Girard F, Chaboillez S, Cartier A, Cote J, Hargreave FE, Labrecque M, Malo JL, Tarlo SM, Lemiere C (2004) An effective strategy for diagnosing occupational asthma: Use of induced sputum. Am J Respir Crit Care Med 170: 845–850CrossRefPubMedGoogle Scholar
  38. 38.
    Breton CV, Zhang Z, Hunt PR, Pechter E, Davis L (2006) Characteristics of work related asthma: Results from a population based survey. Occup Environ Med 63: 411–415CrossRefPubMedGoogle Scholar
  39. 39.
    Cannon J, Cullinan P, Newman Taylor A (1995) Consequences of occupational asthma. BMJ 311: 602–603PubMedGoogle Scholar

Copyright information

© Birkhäuser / Springer Basel 2010

Authors and Affiliations

  • Paul K. Henneberger
    • 1
  • Carrie A. Redlich
    • 2
  1. 1.Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownUSA
  2. 2.Occupational and Environmental Medicine and Pulmonary & Critical Care MedicineYale University School of MedicineNew HavenUSA

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