Occupational asthma. Sigsgaard T, Heederik D, eds. Basel, Switzerland: Birkhauser, 2010 Jun; :281-298
Work-related asthma (WRA) includes occupational asthma and work-exacerbated asthma. WRA is by definition preventable. This chapter discusses available tools for prevention of WRA, divided into primary and secondary prevention. For each tool, the available evidence for the effectiveness of the tool is summarized, and examples are provided. Primary prevention addresses healthy workers or persons with asthma due to causes unrelated to work. The principal tool is control of occupational exposure, reached by elimination or reduction in exposure, but vocational guidance and pre-employment screening are also regarded as primary prevention tools. Secondary prevention addresses early detection of work-related sensitization or WRA to prevent further progression. The principal tool for secondary prevention is medical surveillance. Prediction models represent a promising new tool in medical surveillance; this tool is described here in general and by an example. To set priorities for the prevention of WRA, the monitoring of occurrence in populations as well as in specific industries is crucial, and this chapter therefore briefly describes different sources for surveillance data including sentinel reporting systems, population studies, and occupational disease registers. In the future, focus should be on well-conducted intervention studies, improved exposure assessment, improved medical surveillance (e.g., using prediction models) and good quality national surveillance programs.