Clinical surveillance and management of occupational asthma. Tertiary prevention by the primary practitioner.

sthma and other idiosyncratic respiratory diseases have become an increasingly important component of the occupational lung disease burden in the United States and other developed countries as more cases are recognized and the pneumoconioses come under control (see Mao, “Cornpensation for Occupational Asthma in Quebec, “ this issue). Unfortunately, control of occupational asthma cannot be achieved by the same strategy that has begun to prove effective in reducing risk for the dust diseases. This report reviews the theoretical and practical reasons why alternative approaches must be sought and delineates one modality that may well be the cornerstone in the foreseeable future: early recognition and management by primary care practitioners. Since occupational asthma has been the subject of flumerous and excellent recent papers,’2 I will not review current data on its prevalence and causes; for convenience, a list ofknown causes is summarized in Table 1. For present purposes I will define occupational asthma broadly, as the development or recrudescence of documentable, reversible drops in air flow (>10% FEy,) during or after a work shift in a previously unaffected worker or one who has been free of bronchospasm for a prolonged time (eg, since childhood). As such, I am adopting the current (albeit untested) criteria developed by the National Institute for Occupational Safety and Health (NIOSH) Surveillance Subcommittee of the Board of Scientific Counselors for use in the SENSOR reporting system (see article by Matte et al, this issue) rather than the perhaps more restrictive criteria used by