Occupational upper airway disease: pharyngitis and laryngitis

Occupational asthma and bronchitis impose a greater burden of respiratory impairment on affected workers than is commonly realized, beyond the cardinal symptoms of episodic shortness of breath. Cough has been found to be the single most troublesome complaint for patients with stable, chronic asthma and often interferes socially because of misplaced concern over communicable disease, as does sputum production. Voice changes and unreliability are also manifestations of hyperactive or inflamed airways. Asthma may affect the voice due to breathlessness, vocal cord edema due to inhaled corticosteroids (a common side effect), concurrent allergies, and a condition called “paradoxical vocal fold motion dysfunction”, a common condition which is often observed in asthma. This means that many people with asthma and similar airways problems have problems in any job requiring them to use their voice to communicate. In addition to the above, voice quality may be unpredictable and unreliable in asthma and related diseases. Therefore a person with this problem is not only impaired in using their voice, but cannot depend on their voice at any given time, making it impractical to take a job requiring public contact. As well, the combination of phlegm-producing cough and a heightened cough reflex causes choking and gagging in some people with reactive airways, especially when they swallow or eat. This is very distressing, unpredictable, and interrupts communication. The mechanism is thought to be shared nervous system receptors and reflexes in the esophagus and airways and the secondary effects of GERD (both aspiration and irritation of these receptors) but the phenomenon has not been extensively studied. Other symptoms and signs besides cough and shortness of breath may be present in affected workers that interfere with daily life and especially fitness for duty in strenuous job or those requiring extensive oral communication.