Table 4

 Principal recommendations

Recommendations
Good practice points appear as † where there is no evidence, and are based on the clinical experience of the authors.
1Employers, health and safety personnel, and health practitioners should be aware that at least 1 in 10 cases of new or recurrent asthma in adult life are attributable to occupation (ES1)***SIGN A
2Employers and their health and safety personnel should be aware of the very large number of agents known to cause occupational asthma and the risk of exposure to such agents (ES5)**SIGN B
3Employers and their health and safety personnel should be aware that the major determinant of risk for the development of occupational asthma is the level of exposure to its causes (ES8)**SIGN B
4Health practitioners should not use poorly discriminating factors—such as atopy, family or personal history of asthma, cigarette smoking, and HLA phenotype—which increase individual susceptibility to exposure as a reason to exclude individuals from employment (ES18, ES19)*SIGN D
5Employers should implement programmes to prevent (i.e. reduce the incidence) of occupational asthma by removing or reducing exposure to its causes through elimination or substitution and where this is not possible, by effective control of exposure (ES8, ES16, ES17)**SIGN B
6Employers and their health and safety personnel should ensure that when respiratory protective equipment is worn, the appropriate type is used and maintained, fit testing is performed and workers understand how to wear, remove and replace their respiratory protective equipment (ES17)*SIGN D
7Employers and their health and safety personnel should inform workers about any causes of occupational asthma in the workplace and the need to report any relevant symptoms as soon as they develop (ES43, ES44)**SIGN D
8Employers and their health and safety personnel should be aware that for most causes the risk of developing occupational asthma is greatest during the early years of exposure (ES15)**SIGN C
9Employers and their health and safety personnel should provide regular health surveillance to workers where a risk of occupational asthma is identified. Surveillance should include a respiratory questionnaire enquiring about work related upper and lower respiratory symptoms, with additional functional and immunological tests, where appropriate (ES20, ES44, ES45)**SIGN C
10Health practitioners should provide workers at risk of occupational asthma with health surveillance at least annually and more frequently in the first two years of exposure (ES15)**SIGN C
11Health practitioners should provide more frequent health surveillance to workers who develop rhinitis when working with agents known to cause occupational asthma and ensure that the workplace and working practices are investigated to identify potential causes and implement corrective actions (ES12, ES13, ES14)**SIGN C
12Health practitioners should provide more frequent health surveillance to any workers who have pre-existing asthma to detect any evidence of deterioration
13Health practitioners should consider the use of skin prick or serological tests as part of the health surveillance of workers exposed to agents that cause IgE associated occupational asthma to assess the effectiveness of the control of exposure and the risk of occupational asthma among workers (ES24)
14Health practitioners should enquire of any adult patient with new, recurrent, or deteriorating symptoms of rhinitis or asthma about their job, the materials with which they work and whether their symptoms improve regularly when away from work (ES1, ES5, ES6, ES7, ES25)***SIGN A
15Employers and their health and safety personnel should assess exposure in the workplace and enquire of relevant symptoms among the workforce when any one employee develops confirmed occupational rhinitis or occupational asthma and identify opportunities to institute remedial measures to protect other workers
16Health practitioners should be aware that the prognosis of occupational asthma is improved by early identification and early avoidance of further exposure to its cause (ES45, ES46)**SIGN B
17Health practitioners who suspect a worker of having occupational asthma should make an early referral to a physician with expertise in occupational asthma
18Health practitioners who suspect a worker of having occupational asthma should arrange for workers to perform serial peak flow measurements at least four times a day**SIGN D
19Physicians should confirm a diagnosis of occupational asthma supported by objective criteria (functional, immunological, or both) and not on the basis of a compatible history alone because of the potential implications for future employment (ES25, ES26, ES49, ES50)**SIGN B
20Employers and their health and safety personnel should ensure that measures are taken to ensure that workers diagnosed as having of occupational asthma avoid further exposure to its cause in the workplace (ES43, ES46, ES47)**SIGN B
21Physicians treating patients with occupational asthma should follow published clinical guidelines for the pharmacological management of patients with asthma in conjunction with recommendations to avoid exposure to the causative agent
22Health practitioners should enquire about pre-existing occupational asthma to agents that job applicants might be exposed to in their new job and advise affected applicants that they are not fit to undertake this work (ES43, ES46, ES47)**SIGN B