Workplace exposures may result, in susceptible workers, in the development of occupational asthma from sensitising or toxic/irritant exposure, or in the worsening of a pre-existing asthmatic condition, so-called “work-exacerbated asthma” [1–3]. Occupational asthma is a relatively common condition, although it is often unrecognised [1, 4]. Exposure to the sensitising agents can lead to permanent airway changes, so that even when stopped, the majority of workers will still experience persistent asthma symptoms and show residual airway hyperresponsiveness [2–5]. Early cessation from exposure to the offending agent, however, results in a better prognosis, while persistent exposure can lead to more severe asthma and more frequent acute asthma events [5, 6].
It has become evident from recent studies of work-exacerbated asthma that exposure to “asthmagens” and irritants at the workplace can lead to troublesome symptoms and trigger exacerbations of asthma [1, 6, 7]. As for non-work-related asthma, poor asthma control can result from common environmental exposures, such as allergens or pollutants in susceptible subjects, or from insufficient controller therapy or non-adherence to it. Such poor “baseline” airway control may render the worker more susceptible to the effects of various dusts, aerosols and other contaminants at work, and predispose to asthma exacerbations [1, 8, 9]. However, the contribution of various exposures at work to asthma control and exacerbations remains to be better documented.
The European Community Respiratory Health Survey (ECRHS) I and II have been a rather useful source of information on asthma and these data are certainly still currently relevant. In this issue of the European Respiratory Journal, Le Moual et al. [10] looked at the relationship between occupational exposures and asthma control, as defined …