Chronic cough due to occupational factors

Apart from acute accidents and incidental exposures which may lead to an acute form of cough, there are numerous sources for the development of chronic cough within the workplace. Over the last years, a large number of studies has focused on occupational causes of respiratory diseases and it has emerged that chronic cough is one of the most prevalent work-related airway diseases. Best-known examples of occupations related to the development of cough are coal miners, hard-rock miners, tunnel workers, or concrete manufacturing workers.As chronic cough is often based on a variety of non-occupational factors such as tobacco smoke, a distinct separation into either occupational or personally -evoked can be difficult. However, revealing the occupational contribution to chronic cough and to the symptom cough in general, which is the commonest cause for the consultation of a physician, can significantly lead to a reduction of the socioeconomic burden of the disease.Not only since its association to exposed firefighters after the collapse of the World Trade Center [1] or work-related stress [2] is chronic cough discussed as a potential work-related disease. Chronic cough is a common disease [3] and the entity occupation-related chronic cough could be defined as a disease state that is characterized bythe presence of cough for a period longer than three months per year which is caused by an occupational exposure to an airway irritant. A cessation of the symptoms should be observed when the occupational exposure is discontinued.Pathophysiologically, the disease is most probably dependant on the activation of two different types of sensory receptors in the respiratory innervation: C-fibre receptors with non-myelinated afferent nerve fibres, and rapidly adapting receptors (RARs) which are localized to thin myelinated A. fibres [4,5]. Also, an increased expression of transient receptor potential vanilloid-1 has been recently demonstrated in airway nerves of patients with chronic