Book Review

Asthma in the Workplace

N Engl J Med 2000; 342:1145April 13, 2000

Article

Asthma in the Workplace
Second edition. Edited by I. Leonard Bernstein, Moira Chan-Yeung, Jean-Luc Malo, and David I. Bernstein. 742 pp. New York, Marcel Dekker, 1999. $255. ISBN: 0-8247-1963-8

Occupational accidents and diseases are ancient problems. Occupational asthma was known to Hippocrates and Paracelsus (1493–1541), and in his book De Morbis Artificium Diatriba, published in 1700, Ramazzini (1633–1714) described occupational asthma in detail. In modern industrialized countries, numerous natural and synthetic respiratory allergens and irritants frequently occur in high concentrations in the workplace. We know of more than 250 substances that can cause occupational asthma, and the list is expanding. Occupational asthma not only represents a substantial proportion of all cases of asthma but also is one of the main occupational diseases. The unsolved scientific questions concerning the increasing incidence of occupational asthma in recent decades, the socioeconomic effects of the disease, and prevention are the current challenges. Despite the transition from industrial societies to information societies, these challenges will remain, and new ones will arise as a result of novel forms of technology, new types of work, and globalization.

Asthma in the Workplace provides a valuable overview of many important aspects of occupational asthma. This second edition was updated and includes important new chapters on animal models of occupational asthma, related disorders such as upper-airway involvement, and special hazards, such as enzymes, flour, latex, and chemical substances. Most of the chapters are by leading clinicians and researchers in their field. They include “Epidemiological Approaches” (by Chan-Yeung, Becklake, and Malo), “Pathophysiology” (by Fabbry et al.), “Clinical Assessment and Management” and “Immunological Evaluation” (by Grammer and Patterson), “Environmental Monitoring of Protein Aeroallergens” (by Reed et al.), and “Environmental Monitoring of Chemical Agents” (by Lesage and Perrault). Other important chapters deal with diagnostic tests, the description of diseases caused by natural and chemical substances, and various disease entities, such as reactive airway dysfunction syndrome or irritant-induced asthma and grain-dust–induced lung diseases. The tabular overview of major inducers of occupational asthma by Chan-Yeung and Malo is of great value.

A new chapter, “Genetics and Occupational Asthma,” points out that the present knowledge of the genetic basis of occupational asthma is limited because of the lack of relevant genetic markers, the complexity of asthma in general, and gene–environment interactions in particular. Nevertheless, rapidly accumulating data lead me to expect clarification of this problem in the near future.

Excellent chapters on medicolegal and compensation aspects and surveillance and prevention reveal the need for better global strategies of regulation and prevention as well as compensation for occupational asthma. More current data on these important topics from the Old World would be desirable, especially for European readers. An intriguing aspect of these chapters involves their indications of deficits in our knowledge, especially because of the lack of epidemiologic studies and basic research. We have insufficient information on thresholds and dose–response relations of inducers of asthma, the prevalence and incidence of occupational diseases in different work areas and countries, and clinical outcomes. There have been few interdisciplinary studies, and the results of preventive strategies are poor. The chapters on medicolegal aspects, compensation, surveillance, and prevention remind us of the ongoing conflict between health and well-being and economic interests. How much is society willing to pay for healthy workplaces?

The editors have gathered the experience of many experts from different parts of the world. They provide the basis for discussions of the status of present research, preventive strategies, and goals for the future. Because of the steady increase in knowledge, this book is a must for occupational physicians, for health care workers in industrial and public institutions, and for medical libraries. It supplies a foundation for understanding occupational asthma and may help in efforts to prevent this disease.

Xaver Baur, M.D.
University of Bochum, 44789 Bochum, Germany

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