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Clinical Case Study 3

Clinical Case Study in Occupational and Environmental Medicine 

A nurse with persistent cough and wheeze

[b]

    Her  breathlessness was intermittent at first, but became more persistent later.  It got worse as the day went on, but still woke her up at night on occasions. Most importantly she used to feel better when she was not working for example on weekends off but especially when she went away on holiday for a few days. 

Note that asthma - including occupational asthma can be at its worst at night or in the early hours of the morning (even if the patient is not necessarily at work then).  Occupational asthma can manifest as either early, late or mixed responses to the inhaled causal agent. So symptomatically it may be at its worst hours after exposure. 

Moreover after suffering from occupational asthma for several weeks or months, the inflammation might persist and not resolve in between exposures.

Remember therefore that the questions are whether, in the early stages of the illness, the symptoms were better after days not at work.

What further questions could you ask about the nature of the chemicals to which she is exposed to at work? ... or about any possible associations or links between her symptoms and other factors in her history?

If you wish to find out more about taking an occupational history: click here.

 

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Acknowledgement:

The case description on which this educational resource is based is (c) copyright of the University of Manchester. It is temporarily housed on this website for technical and other reasons.