This British Thoracic Society (BTS) Clinical Statement addresses occupational asthma and includes key clinical practice points. In an era in which medical practice is increasingly determined by evidence-based guidelines, it must be acknowledged from the outset that there is little or no published evidence for some of the areas covered in this statement1 2; thus, much of the advice is based on expert opinion and accumulated clinical experience.


The Clinical Statement Group (CSG) was chaired by Dr Chris Barber. Membership was drawn from current and former members of the BTS Occupational and Environmental Lung Disease Specialist Advisory Group. The CSG identified key areas requiring clinical practice points. The overall content was developed to reflect the scope approved by the BTS Standards of Care Committee (SOCC). Following discussions of broad statement content, individual sections were drafted by group members. A final edited draft was reviewed by the BTS SOCC before posting for public consultation and peer review on the BTS website (August/September 2021). The revised document was approved by the BTS SOCC in November 2021 before final publication.

Summary of clinical practice points

Section 1—introduction

  • Healthcare professionals should be aware that occupational exposures account for around one in six cases of asthma in adults of working age.

  • Over 400 causes of Occupational Asthma (OA) have been described; these are categorised as high-molecular weight (HMW) or low-molecular weight (LMW) ‘respiratory sensitisers’.

  • Although individual susceptibility plays a key role, the main risk factor for the development of OA is the level of allergen exposure in the workplace.

Section 2—work context

  • Health surveillance is a form of workplace screening that can identify OA cases early. In the UK, it usually consists of an annual symptom questionnaire and spirometry.

  • Workers found at health surveillance to have new asthma symptoms or abnormal lung function should be referred as soon as possible to a specialist …

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