Work-Related Asthma: An Occupational Medicine Perspective

Work-related asthma (WRA), encompassing occupational asthma and work-exacerbated asthma, is among the most prevalent yet preventable occupational respiratory diseases, with population-based studies estimating that 10% to 25% of adult asthma cases are attributable to workplace exposure. This review examines epidemiology, causative agents, pathogenesis, clinical evaluation, management, and WRA prevention from an occupational medicine perspective, with emphasis on Korean surveillance data. The Korea Work-related Asthma Surveillance program (2004-2009) identified 236 cases with a crude incidence of 3.31 per million workers, revealing a 40- to 90-fold detection gap when compared to European population-based estimates of 250 to 300 per million workers annually. Korean cases showed a distinctive agent profile, with isocyanates accounting for 46.6%-a figure that far exceeds the 13% to 23% in Western surveillance systems-which reflects the prominence of the furniture manufacturing industry. Temporal trends demonstrated successful prevention, with isocyanate-related cases decreasing from 65.0% to 26.9% during the period 2004-2009. Despite treatment advances, the prognosis remains poor: only 32% of patients achieve symptomatic recovery following the complete avoidance of exposure, and continued exposure increases the symptom burden 10-fold. Workers' compensation data confirm persistent underdiagnosis, with only 0 to 5 cases annually approved during the period 2013-2023 despite expanding recognition of occupational diseases overall. The Korea Occupational Disease Surveillance Center, established in 2022, offers an opportunity to bridge the prolonged surveillance gap. Clinicians treating working adults should maintain a high index of suspicion for the occupational causes of asthma, pursue early diagnosis and exposure cessation, and integrate workplace assessments into their routine clinical evaluations.