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Occupational asthma from isocyanates — DOccMed MCQ

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HardOccupational Lung DiseaseOccupational asthma from isocyanatesDOccMed

A 41-year-old spray painter has six months of wheeze and cough that improve on holidays. Peak-flow records show >20% diurnal variability on workdays and normal readings after two weeks away; he uses two-pack polyurethane paints despite booth extraction. What is the most likely occupational diagnosis?

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Correct answer: B — Occupational asthma due to isocyanate exposure

The temporal relationship, work-related peak-flow variability and exposure to isocyanates strongly support sensitiser-induced occupational asthma. Improvement away from work is a key clue. COPD would not usually normalise during holidays. Hypersensitivity pneumonitis tends to cause systemic symptoms and interstitial features rather than variable airflow obstruction.

Reference: HSE Occupational Asthma guidance; BTS/SIGN Asthma guidance