The Revitalising Health and Safety strategy1 was launched jointly by the British government and Health and Safety Commission in June 2000 across England, Scotland and Wales, with Northern Ireland working in close partnership. This 10-year strategy seeks significant improvements in workplace health and safety, setting a target to reduce the incidence of cases of work-related ill-health by 20% by 2010. The predominant work-related disorders are musculoskeletal, mental, dermatological and respiratory diseases.2 Occupational asthma is the most frequently reported occupational respiratory disease in Great Britain, accounting for almost 1000 cases reported to the SWORD (Surveillance of Work-related and Occupational Respiratory Disease) scheme for occupational and work-related respiratory disease every year.3 Reporting schemes are likely to underestimate true incidences because not all cases come to light,4 with some workers not seeking medical advice.5
The scale of the problem
Most patients with occupational respiratory disease are not seen by a consultant physician and thus their cases are not officially reported. The Health and Safety Executive (HSE) estimate that 1500–3000 people develop occupational asthma each year, that is, adult asthma caused by workplace exposure and not by factors outside the workplace.6 This figure rises to 7000 cases a year if work-aggravated asthma is included, that is, pre-existing or coincidental new onset adult asthma, which is made worse by non-specific factors in the workplace.6 The symptoms and functional impairment of occupational asthma caused by various agents may persist for many years after avoidance of further exposure to the causative agent, leaving people disabled or unable to continue in the job that caused their asthma. About a third of workers with occupational asthma are unemployed within 6 years after diagnosis.7
Between a third and two-thirds of adult asthmatic patients develop asthma for the first time during working years.8- …