Asthma is widely recognised to be a heterogenous disease with several ‘endotypes’; differentiation of these is not necessarily straightforward and requires assessment from several different angles. Moreover there is increasing evidence that the label is (over-) applied inappropriately.
The often close relationships between occupation and asthma are equally well recognised. Employees, for example, may develop a work-related exacerbation of their pre-existing disease or, de novo, ‘occupational asthma’, usually as a result of an acquired hypersensitivity to a, airborne, workplace sensitising agent; differentiation between these two conditions is often, but not always, straightforward.
However, not infrequently, respiratory symptoms are erroneously attributed to asthma when they are in fact, a reflection of other conditions originating in the upper airway or in relation to disordered breathing patterns. Correct identification of these conditions allows individuals to remain in their current job and avoids the use of protracted polypharmacy; novel approaches are available to assist in making these diagnoses and help to direct appropriate management.
In addition to assessment of current symptoms, a key question often posed is how an individual’s asthma will affect their future employment? There is good evidence that variation between individuals is greater than that within an individual-;this allows the prediction of risk of future exacerbations and of the risks of recurrence of remitted childhood disease.
This presentation will review modern approaches to diagnosis and management of asthma and related conditions, including the appropriate role of novel, ‘biologic, treatments.