Work-associated irritable larynx syndrome

Background Work-associated respiratory symptoms may be caused by disorders of both the lower and upper respiratory tract. We propose that occupational exposures may initiate and/or trigger recurrent hyperkinetic laryngeal symptoms, predominantly episodic dyspnoea, dysphonia, cough and sensation of tension in the throat-work-associated irritable larynx syndrome (WILS). Aims To examine characteristics of individual and work-related factors that are associated with WILS, occupational asthma (OA) and work-exacerbated asthma (WEA). Methods Subjects with WILS, OA and WEA were identified from an occupational lung disease clinic. A review of 448 charts of patients attending the clinic between 2002 and 2006 was undertaken, with information entered onto a standardized abstraction form. Results Fifty subjects were identified with OA, 40 with WEA and 30 with WILS. Subjects with the diagnosis of WILS were more likely to be female and more frequently reported symptoms of gastro-oesophageal reflux. The most common triggers of workplace symptoms in the WILS group were odours, fumes, perfumes and cleaning agents. Fourteen patients with WILS identified a specific precipitating event at the workplace at the time of the onset of their symptoms and five of these subjects presented to an emergency department within 24 h of the event. Conclusions Dysfunction of the upper airway is an important cause of work-associated respiratory symptoms. The identification and management of WILS requires a multidisciplinary approach with a focus on modifying work-related and intrinsic factors that may perpetuate symptoms.