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Respiratory

Occupational Lung Disease

Occupational lung disease is respiratory disease caused or worsened by workplace exposure, spanning occupational asthma, hypersensitivity pneumonitis, pneumoconioses and asbestos-related pleural or malignant disease; the diagnosis changes care because exposure control, specialist referral, workplace protection and compensation pathways become part of treatment.

In a nutshell

Occupational lung disease includes occupational asthma, hypersensitivity pneumonitis, pneumoconioses and asbestos-related pleural or malignant disease. The key is a structured exposure history linked to objective physiology and imaging. Management adds early specialist referral, exposure control, workplace protection, reporting and compensation advice to ordinary respiratory care.

Classic presentation

A spray painter develops wheeze that improves on days away and returns at work, or a retired construction worker presents with progressive breathlessness and pleural or upper-zone radiographic abnormalities after historical asbestos or silica exposure.

Key points

  • Ask whether adult-onset or poorly controlled asthma is better on weekends and holidays and worse at work.
  • Serial peak flow at work and away can support occupational asthma, but specialist referral and objective interpretation are required.
  • Pleural plaques are benign markers of asbestos exposure and are not the same as asbestosis or mesothelioma.
  • Silica exposure can cause irreversible silicosis, COPD and lung cancer and may continue to cause progression after exposure stops.
  • Exposure elimination or redeployment is central to occupational asthma; medication alone does not control the workplace cause.
  • Confirmed diseases may trigger HSE reporting and/or Industrial Injuries Disablement Benefit pathways, which have specific legal criteria.

First-line investigation

A detailed job, task and exposure history with symptom timing, followed by objective spirometry/serial peak flow and targeted imaging or specialist tests.

Management

Identify danger and exposure

  • Assess acute asthma, hypoxaemia, respiratory failure, haemoptysis and cancer red flags while documenting the full work and exposure history.7,3,1

Confirm phenotype and refer

  • Use objective respiratory testing and targeted imaging, and refer suspected occupational asthma or complex occupational interstitial/pleural disease to the appropriate specialist service.7,1,2

Control the workplace cause

  • Pursue elimination, substitution, engineering controls and occupational-health redeployment; complete avoidance is often needed for sensitiser-induced occupational asthma.4,2,1

Investigate cancer and report disease

  • Use NICE NG12 for asbestos-related lung or pleural cancer red flags and the HSE criteria for confirmed reportable occupational disease; liaise with occupational health to protect co-workers.3,5

Support long-term care and compensation

  • Follow lung function, exposure control, fibrosis, tuberculosis risk, cancer symptoms and employment impact, and provide current IIDB and civil-compensation information where relevant.6,8,1

Exam traps

  • A normal clinic spirometry result does not exclude occupational asthma if symptoms improve away from exposure.
  • Pleural plaques are benign exposure markers and do not equal asbestosis or mesothelioma.
  • Do not wait for compensation paperwork before controlling a hazardous exposure or referring the patient.
  • Silicosis increases tuberculosis risk and may progress after silica exposure stops.
  • Respirator masks are not the first or only control; workplace hierarchy-of-control measures are required.
  • A positive sensitisation test alone does not prove occupational asthma; link objective asthma physiology to work exposure.

Illustrations

Calcified pleural plaque from asbestos exposureA lateral chest radiograph showing a calcified pleural plaque along the diaphragm in a retired worker with previous asbestos exposure, clearly labelled as a marker of exposure rather than a diagnosis of mesothelioma.Clinical Cases, Wikimedia Commons · CC-BY-SA-2.5

Key sources

  1. British Thoracic Society, Clinical Statement on Occupational Asthma (Current UK specialist statement on work-related asthma phenotypes, occupational history, serial peak flow, specialist testing, exposure cessation, workplace adaptation and compensation information; published March 2022 and currently valid)Published 1 Mar 2022
  2. Health and Safety Executive, Working engineered stone: control silica risk (Current UK HSE guidance on respirable crystalline silica, irreversible silicosis/COPD/cancer risk, COSHH controls and health surveillance; current page accessed 4 August 2026)
  3. NICE NG12, Suspected cancer: recognition and referral (Current NICE lung and pleural cancer referral recommendations, including asbestos-exposure symptoms and mesothelioma; published 23 June 2015 and last updated 15 April 2026)Published 23 Jun 2015
  4. Health and Safety Executive, Advice for employers: occupational asthma (Current HSE COSHH, hazard-control, health-surveillance and reporting information for occupational asthma; page crawled and current at access)
  5. Health and Safety Executive, Reportable occupational diseases (Current RIDDOR Regulation 8 information on diagnosed reportable occupational diseases, specified workplace hazards and the employer/self-employed reporting duty)
  6. GOV.UK, Industrial Injuries Disablement Benefit: eligibility (Current UK eligibility information for prescribed occupational diseases including asthma, pneumoconiosis, asbestos-related disease and selected occupational lung cancer)
  7. NICE NG245, Asthma: diagnosis, monitoring and chronic asthma management (Current BTS/NICE/SIGN asthma guideline, including checking for occupational asthma and referral to an occupational-asthma specialist; published 27 November 2024)Published 27 Nov 2024
  8. GOV.UK, Industrial Injuries Disablement Benefits: technical guidance (Current UK technical guidance on prescribed diseases, industrial disablement and dust-related worker-compensation schemes; updated 1 April 2026)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.