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Another fresh start in the UK
To the uninitiated occupational asthma, accompanied as it usually is by lists of obscure agents and processes, appears a rather exotic disease. In public health terms it shares a surprising number of features with another exotic disease: imported malaria. In temperate countries both are rare but represent subsets of commonly presenting conditions—non-occupational asthma and fever. Their incidence rates in the UK are also about the same and, more significantly, show a marked reluctance to drop. That of occupational asthma has remained broadly constant throughout the past 10 years—allowing for under-reporting, between 1500 and 3000 cases per year. For both diseases, interventions at a number of stages in their natural history are required if serious developments are to be prevented.
There are common problems of education, complacency, and timely recognition. Once the correct diagnosis has been arrived at (and it is the recognition of the possibility rather than the diagnosis itself which causes the crucial delay), the management of both conditions is relatively straightforward and those tragic outcomes—complicated malaria, usually leading to death, and irreversible asthma, whatever the occupational cause—can be averted. The analogy ends here.
THE POSITION PRE-2000
The regulatory position concerning occupational asthma in the UK is clear: the Control of Substances Hazardous to Health (COSHH) Regulations1 apply, along with a general COSHH Approved Code of Practice (AcoP).2 Maximum exposure limits have been set for a number of substances that cause occupational asthma, and the main causes are given in the Health and Safety Executive (HSE) publication Asthmagen? Critical assessments of the evidence for agents implicated in occupational asthma.3
There have been previous attempts in Britain by way of improved guidance and regulation, to reduce occupational asthma. In 1992 the Health and Safety Commission (HSC) deferred the introduction of an ACoP to …