Occupational asthma: still an underestimated burden?

Work-related asthma remains one of the most complex and underappreciated dimensions of adult-onset respiratory disease. Estimated to account for 25% of adult-onset cases,1 it encompasses a heterogeneous set of phenotypes, including immunologic occupational asthma, irritant-induced asthma and work-exacerbated asthma, each with distinct pathophysiological mechanisms and diagnostic challenges.2 This diversity complicates not only diagnosis and management but also surveillance efforts and preventive strategies across different occupations and settings. Nevertheless, surveillance systems remain fragmented and many cases go unrecognised in clinical practice, especially in non-specialist settings.3 Despite increasing awareness of occupational exposures as contributors to airway inflammation and sensitisation, definitive longitudinal evidence linking workplace conditions to asthma incidence remains limited. In this context, the study by Alif and colleagues,4 published in this issue of Thorax , offers a significant advancement. Using data from the European Community Respiratory Health Survey (ECRHS), the authors provide 20-year longitudinal evidence of persistent occupational risk for asthma across Europe. Initiated in the early 1990s, ECRHS has helped define the role of environmental and occupational exposures in adult asthma. ECRHS I included over 15 000 adults in 12 countries, assessing asthma through questionnaires and methacholine challenge. It identified increased risks in occupations like farming, painting and cleaning, with 5–10% of cases attributable to occupational exposures.5 ECRHS II followed symptom-free participants, confirming significant roles for high and low-molecular-weight agents, biocides and cleaning …