Overview of occupational health

INTRODUCTION — 

The epidemiology, clinical health, and exposure concerns related to occupation are presented here. Occupational issues present both diagnostic and preventive care opportunities as well as treatment opportunities in primary care practice, emergency medicine, and other medical specialties. Patients may present with specific exposure or hazard concerns, or with specific illness or injury, and questions about relationship to work exposures (table 1 and table 2). Practitioners should be knowledgeable about occupational and environmental health risks, and which populations are most at risk.

Medical consequences related to occupational exposure during military service are discussed separately. (See "Medical care of the military veteran", section on 'Environmental hazards'.)

Occupational risks to reproduction are discussed separately. (See "Occupational and environmental risks to reproduction in females: Specific exposures and impact".)

EPIDEMIOLOGY — 

The full extent of occupational injuries and illnesses is difficult to measure due to underreporting and global variation. Further, some work-related illnesses and injuries may occur acutely and are easily identified, while others only become apparent after a prolonged period of exposure or latency. In 2022, the United States Department of Labor Bureau of Labor Statistics reported 2.8 million nonfatal injuries and illnesses from private employers, an increase of 7.5 percent in 2021, driven by a rise in respiratory illness cases [1]. Nearly two-thirds of reported cases necessitated days away from work, job transfer, or restricted duties at work, and workers in transportation and material moving jobs experienced the most fatalities. The United States National Census of Fatal Occupational Injuries reported 5486 fatal work injuries in 2022, a 5.7 percent increase from the previous year [2]. The International Labor Organization estimated that, globally, nearly three million people die yearly of work-related accidents and illnesses, and 395 million workers experience nonfatal work injuries [3]. This report attributed the greatest number of fatalities to diseases, although accidents account for 330,000 deaths, the greatest number coming from agriculture, construction, forestry and fishing, and manufacturing.

CLINICAL ISSUES

Emerging occupational risks — Risk factors for occupational injury and illness are myriad, and many are well recognized. Some emerging and perhaps underappreciated risks include:

●Effects of climate change – Climate change creates many health effects that impact workers. These include but are not limited to (figure 1):

•Heat-related illnesses are becoming more common due to a global increase in average temperatures, with many population areas experiencing prolonged periods of higher temperatures as well as increased frequency and intensity of extreme heat events [4,5]. Outdoor, and some indoor, workers are at risk from increased heat. (See "Climate emergencies", section on 'Heat' and "Exertional heat illness in adolescents and adults: Management and prevention".)

•Poor air quality due to the increasing risks of wildfire smoke affects outdoor workers. (See "Climate emergencies", section on 'Wildfires'.)

•Severe weather events and disasters put many workers at risk, including emergency responders, electrical/home line repair workers, employees having to work excessive hours, and transportation workers.

●Nanotechnology – Nanotechnology involves the production of materials in near-atomic size (1 to 100 nanometers) [6,7], and raises health concerns for industry workers. Nanosized materials exhibit unique properties that affect physical, chemical, and biologic behavior, and preliminary research suggests that breathing certain types of nanomaterials may affect the respiratory system [8]. There are efforts to create registries, approaches to medical surveillance, and numerous guidelines for exposure protection and handling nanomaterials [8].

●Engineered stone – The cutting and grinding of engineered stone poses a new and potent risk, resulting in outbreaks of silicosis in stone fabrication workers worldwide [9]. (See "Silicosis", section on 'Silica in the work environment'.)

Common clinical presentations

Lung disease — Many lung diseases and respiratory complaints can result from occupational exposure to dust, fumes, smoke, and biologic agents. Some of the most common occupational lung diseases include occupational asthma, bronchitis, bronchiolitis, hypersensitivity pneumonitis, acute toxic inhalant syndromes, pneumoconioses, and tumors. Further information on imaging of these diseases is provided separately. (See "Imaging of occupational lung diseases".)

●Asthma – Asthma is the most common occupational lung disease. It can be caused or exacerbated (work-exacerbated asthma) by a workplace sensitizer or irritant. Occupational asthma is discussed in detail elsewhere. (See "Occupational asthma: Definitions, epidemiology, causes, and risk factors".)

Symptoms of hyperreactive airways may develop after a single large exposure to an irritant such as chlorine gas or sulfur dioxide. This has been termed "reactive airways disease syndrome" (RADS) [10]. Some firefighters and rescue workers exposed to a variety of inhaled materials during and after the collapse of the Twin Towers at the World Trade Center developed chronic cough, chronic laryngitis, and persistent bronchial hyperreactivity [11-14].

There is a World Trade Center (WTC) Health Program that provides treatment for designated WTC-covered medical conditions [15].

The term "irritant-induced occupational asthma" has less stringent criteria than RADS, including cases with induced airway symptoms after one or more exposures [16,17]. (See "Irritant-induced asthma".)

●Silicosis – Occupations that involve the processing or use silica-containing rock or ores have the potential to cause silicosis, including the cutting and grinding of engineered stone. (See "Silicosis", section on 'Silica in the work environment'.)

●Hypersensitivity pneumonitis – A less common lung disease, hypersensitivity pneumonitis can be caused by a wide range of occupations and avocations that result in contact with airborne organic antigens. (See "Hypersensitivity pneumonitis (extrinsic allergic alveolitis): Epidemiology, causes, and pathogenesis".)

●Other interstitial lung disease – A variety of occupational exposures are related to the development of interstitial lung disease. These are discussed separately. (See "Approach to the adult with interstitial lung disease: Clinical evaluation", section on 'Occupational and environmental exposures'.)

●Metal fume fever – Zinc oxide inhalation in welders. (See "Common occupational chemical exposures: General approach and management of selected exposures".) This causes an acute flu-like temporary illness.

Rhinitis — The prevalence of occupational rhinitis is not precisely known, although it appears to be two to three times more prevalent than occupational asthma. High-risk occupations include furriers; bakers; livestock breeders; food processing workers; veterinarians and animal handlers; farmers; assemblers of electrical, electronic, and telecommunication products; boat builders; woodworkers; medical workers; pharmacists; and laboratory employees working with small animals [18-21]. This is discussed in detail separately (see "Occupational rhinitis").

Musculoskeletal issues — Many workers are at risk for acute musculoskeletal injuries due to falls, injuries related to using tools, and other mechanisms. There are also work-related musculoskeletal disorders due to tasks such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures, or performing repetitive movements. Some common conditions include lateral and medial epicondylitis, carpal or tunnel syndrome, tendinitis, bursitis, muscle strains, and low back injuries. Occupational low back pain is discussed separately. (See "Occupational low back pain: Evaluation and management".)

Some, if not most, of these chronic conditions can be reduced by the use of ergonomic practices, if workers are able to implement them [22]. Clinicians may be able to play a role in advocating for workers in this regard, and may be called upon to advise about work restrictions or accommodations.

Hazardous chemical exposures — Occupational exposures to potentially hazardous chemicals are common and can result in conditions ranging from skin and mucus membrane irritation to serious illness. These exposures are discussed separately. (See "Common occupational chemical exposures: General approach and management of selected exposures".)

Topical chemical burns and inhalational chemical injury are also discussed separately (See "Topical chemical burns: Initial evaluation and management" and "Inhalation injury from heat, smoke, or chemical irritants".)

Other presentations

Cardiovascular disease — Certain occupations carry a greater risk of cardiovascular disease, including firefighters, professional drivers (including long-haul truck drivers), and first responders (including police officers; machine operators; and farming, fishing, or forestry employees) [23-25].

Other — Certain occupational conditions have historically been more common, but still remain important.

●Asbestos-related lung disease – Asbestos can cause many lung diseases, including asbestosis, which occurs after heavy exposure and can manifest decades afterward. Despite substantial reductions in occupational asbestos exposure, some asbestos exposure still occurs in a variety of settings. (See "Asbestos-related pleuropulmonary disease".) Asbestos exposure also increases the risk of lung and other cancers.

●Chronic beryllium disease – Chronic beryllium disease, also called berylliosis, is a rare granulomatous disease caused by exposure to beryllium. (See "Chronic beryllium disease (berylliosis)".)

●Coal worker's pneumoconiosis

●Byssinosis and flock worker's lung. (See "Hypersensitivity pneumonitis (extrinsic allergic alveolitis): Epidemiology, causes, and pathogenesis".)

ROLE OF THE CLINICIAN — 

The clinician's role when considering occupational health concerns is threefold:

●Prevention – Acquire an understanding of the job role and environment to educate patients on how to reduce or prevent potential risks. Sometimes clinicians are asked to perform preplacement examinations. These are examinations for potential workers who have been hired for a job pending medical evaluation or clearance. In these circumstances, it is important that the clinician know the job description and tasks. The clinician then needs to determine if the worker may have any conditions that would interfere with their ability to do the job safely and without harm to themselves or others. In some cases the clinician determines if the potential worker could do the job with accommodations or some restrictions. For some positions such as public safety (firefighters, police) there may be specific state criteria and medical exclusions (ie, Commonwealth of Massachusetts Medical Standards for Municipal Fire Fighters [26]). Drivers who drive commercial vehicles for interstate commerce are required to meet certain physical criteria and to pass medical examinations performed by a certified FMCSA medical examiner in order to obtain a Department of Transportation card. Clinicians who do these types of examinations must complete a training and pass an examination [27].

●Assess and treat acute condition – Assess for the potential contribution of occupational exposure to the patient's acute injury or illness and treat condition. Consider identifying other workers at risk if hazardous exposures involve others.

●Assess impairment – If a work-related illness or injury is identified, take the appropriate actions, which can include determining the type and level of impairment and how that will relate to workplace tasks, requesting appropriate accommodations or restrictions, and completing paperwork related to a worker compensation claim.

Education and prevention for high-risk occupations — All patients should be asked about their work environments and tasks. Having an understanding of risks in the occupations can lead to education regarding risks and anticipatory guidance related to protective and preventive actions [4]. Clinicians can play an important role in identifying those workers at greatest risk, providing anticipatory advice to reduce exposures and risks, as well as recognizing (and reducing) work-related exposures/hazards that are contributing to a person's illness.

Some examples of high-risk work environments or occupations include:

●Workers exposed to excessive heat – Clinicians should make inquiries regarding job tasks and provide relevant guidance if heat-related risks are identified. Persons at increased risk include outside workers, such as roofers, farm workers, and construction workers, as well as indoor workers, such as those working in kitchens and machine shops, aircraft cleaners, baggage handlers, and others. The clinician can also identify individuals with "heat-sensitive" illnesses, and help patients recognize symptoms of heat-related illness. Workers could be shown a free useful app (Occupational Safety and Health Administration [OSHA] Heat Safety Tool), which can be downloaded to a smartphone. This tool gives immediate location-based temperature and humidity readings, and a heat index keyed to the level of risk of heat-related illness, along with symptoms and first aid actions. (See "Exertional heat illness in adolescents and adults: Management and prevention" and "Exertional heat illness in adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis".)

●Workers exposed to poor outdoor air quality – Outdoor workers are at risk of exposure to poor air quality. Awareness of how to use smartphone apps that provide information on the air quality index can be useful to patients. (See "Overview of environmental health", section on 'Air pollution'.)

●Workers exposed to poor indoor air quality – Poor indoor air quality can trigger respiratory and other symptoms. Exposures include carbon monoxide, cyanide, hydrogen sulfide, oxides of nitrogen, and caustics (see "Inhalation injury from heat, smoke, or chemical irritants" and "Common occupational chemical exposures: General approach and management of selected exposures"). There has been publicity about health effects and exposure to damp environments and mold, and there are several excellent resources that summarize current information and approaches [28-31]. (See "Building-related illness and building-related symptoms", section on 'Mold'.)

●Animal handlers and lab workers – Persons who work with animals (or fur), including in a lab setting, are at risk of allergic reactions (see "Occupational rhinitis", section on 'High-risk occupations'). Animal laboratory workers, particularly those working with nonhuman primates, are also at risk of contracting zoonotic infections or sustaining physical injury from bites and scratches. (See "Zoonoses: Animals other than dogs and cats".)

●Other – Commercial fishing and logging workers, health care workers, transportation drivers.

Patients with suspected exposures

Recognizing the clinical presentation — Occupational exposures can cause or aggravate a variety of underlying common diseases, which can make their recognition difficult. The occupational history can be the critical first step in recognizing, treating, and preventing occupational illnesses and injuries. Challenges include:

●Symptoms related to hazardous exposures can appear as complaints involving any body system and mimicking ordinary medical diseases (table 1 and table 2).

●Some exposures cause immediate or subacute symptoms while others lead to more delayed effects.

●The occurrence of an illness in an unexpected person (eg, bladder or lung cancer in a young nonsmoker) should prompt the clinician to delve further into potential contributing environmental or occupational exposures.

The first step in the occupational/environmental history is a survey of all patients, including relevant questions and attention to the chief complaint (or diagnosis) for clues suggesting a relationship to activities at work or at home (algorithm 1) [32-34]. Questions may include a list of current and longest-held jobs, a brief current job description, and inquiries about changes in or concerns regarding exposures or hazards at work or at home, including risks related to hot environments.

Establishing a temporal relationship — In looking for a temporal relationship to work, it is best to start with nonsuggestive questions such as, "Are your symptoms better or worse at home or at work? Weekends or workdays?" Any suggestion that the symptoms may be related to recent or past exposures, or to some change in environment, either at work or at home, then precipitates a more detailed series of questions to obtain additional information about potential exposures and timing of work- or environment-related symptoms.

In some cases, the screening occupational environmental survey reveals suggestive temporal relationships pointing to the role of environmental/work factors. For example, some cases of acute poisoning present with the sudden onset of characteristic signs and symptoms ("toxidromes") (table 3), due to accidental or deliberate release of toxicants, which need prompt recognition and treatment, frequently before diagnostic laboratory tests of the poison can be obtained [35,36]. (See "General approach to drug poisoning in adults".)

In other cases, finding a clear temporal relationship between symptoms and exposure can be difficult. As examples:

●A car painter may have worked for months at their job before developing a dry hacking cough that occurs during or after work. They might be experiencing bronchospasm from exposure to toluene diisocyanate, a well-known sensitizing agent, and one of the chemical components in the car lacquer that they spray. In the case of allergic responses, it may take months of exposure before sensitization and clinical allergy develops. Once the asthma occurs, symptoms can sometimes extend beyond the work period and then be triggered by a range of irritants. (See "Occupational asthma: Clinical features, evaluation, and diagnosis".)

●Initial symptoms related to repetitive movements may improve on nonworkdays or vacations early in the course of illness. However, prolonged exposure can lead to the persistence of symptoms beyond the work week, as tendinitis develops and becomes chronic.

●Certain diseases such as cancer or asbestosis may occur with a long latency (15 to 30 years from the time of exposure to the onset of the disease). (See "Asbestos-related pleuropulmonary disease".)

Once there is suspicion of occupational exposure, the practitioner needs to proceed with more detailed questioning. The worker should describe the tasks they perform, the agents handled, any protective measures, and the working conditions.

Documenting and quantifying exposure — If the history raises concerns about exposures, it is usually necessary to assess the exposure in order to determine the level of risk and/or relationship to any symptoms. Documenting and quantifying exposures can involve performing biologic monitoring tests of the affected person as well as evaluating the work or environmental site. The practitioner may find it helpful to seek assistance from specialists such as occupational/environmental medicine specialists, toxicologists, governmental agencies, and industrial hygienists.

Chemical and toxicant exposures — Getting more information about chemical exposures can be initiated with obtaining the generic names of the agents used. This can be accomplished by having the patient bring in a label or a Safety Data Sheet ([SDS] previously referred to as a Material Safety Data Sheet); the latter is the manufacturer's description of the product's generic name, ingredients, known health hazards, and recommendation for safe handling. These sheets vary in accuracy and completeness [34,37]. The SDS can be obtained from the manufacturer or employer, and some can be found on internet sites. Information about health effects related to these toxins can also be found by consulting other sources such as poison control centers (in the United States, dial 1-800-222-1222), consultants, agencies, and useful references.

Once it is clear what is being handled, the next question is whether or not there is an opportunity for actual exposure. The patient should describe how a substance is handled: What are the operating or cleanup practices? What protective measures are used? What type of ventilation and exhaust is provided? Does the worker need to wear a respirator, and, if so, is it the proper respirator, and is it worn and properly maintained? A good source for information about respirators can be found at the National Institute for Occupational Safety and Health (NIOSH) website. Then consider the mode of entry: Is it inhaled? Is it ingested by eating at the workplace? Is there skin contact? Is there use of protective clothing or appropriate gloves to prevent skin absorption? Are other workers exposed? Do others have any symptoms?

Certain persons may be particularly at greater risk for exposure. A person with kidney disease, as an example, exposed to lead at acceptable (regulatory) air levels, might accumulate higher levels of lead than expected because of decreased ability to excrete it through the diseased kidneys. A pregnant person might be exposed to toxins, such as lead or carbon monoxide, at doses that would be less dangerous to the adult but would be harmful to the developing fetus, who is more sensitive to the adverse effects. (See "Overview of occupational and environmental risks to reproduction in females" and "Occupational and environmental risks to reproduction in females: Specific exposures and impact".).

Worker testing — Within the clinical office setting, the worker patient can sometimes be tested for exposure in body fluids (biologic monitoring) or evidence of adverse health effects on target organs. The practitioner must know what agent to look for, the desirable test medium (urine, blood, hair, tissue), appropriate timing, and influences upon test results [38-40].

●Carbon monoxide exposure is measured with a carboxyhemoglobin blood test; measurement of carboxyhemoglobin should be performed as soon as possible after exposure since the half-life of carbon monoxide in the body is approximately six to eight hours when breathing room air. (See "Carbon monoxide poisoning".)

●Arsenic is excreted rapidly in the urine within a few days; it is a good marker for recent but not past exposure. Recent consumption of seafood can lead to increases in total urine arsenic due to the contribution of relatively nontoxic forms of organic arsenic, thereby leading to mistaken interpretations of elevated arsenic levels. The solution is to speciate (or fractionate) urine arsenic into inorganic and organic arsenic if elevated levels are identified. (See "Arsenic exposure and chronic poisoning".)

●Some chemicals are detected by measurement of metabolites. As an example, several biologic monitoring tests have been proposed for evaluating exposure to the solvent toluene, including measurements of the urine metabolites hippuric acid, benzoic acid, and o-cresol [38-40]. These tests, however, tend to be less specific, and timing is important. In some cases, environmental sampling is more fruitful for estimating exposure. (See "Common occupational chemical exposures: General approach and management of selected exposures", section on 'Toluene'.)

●Hair analysis performed by commercial laboratories for multiple toxins and elements has been found to be of poor reliability and accuracy and has little applicability in the primary care setting [41,42]. On rare occasions, however, it might be useful to obtain a hair analysis for a single element performed by an accredited commercial laboratory with experience in performing such analyses.

●Assessment of musculoskeletal stresses can be performed qualitatively, by observing the workers performing job tasks, and more quantitatively with biomechanical analyses performed by an ergonomics expert.

●Lead testing and testing for other metals is discussed separately. (See "Lead exposure, toxicity, and poisoning in adults: Clinical manifestations and diagnosis", section on 'Diagnostic evaluation' and "Childhood lead poisoning: Clinical manifestations and diagnosis", section on 'Laboratory evaluation' and "Lead exposure and poisoning in adults: Management".)

Laboratory tests may also be performed to look for toxic effects or end-organ damage. As an example, a blood lead concentration could be ordered to assess exposure, and blood urea nitrogen and creatinine could be ordered to look for effects upon the kidneys. Pulmonary function tests and a chest radiograph and/or computed tomography would be ordered to assess the effects of past or recent silica or asbestos exposure on the lungs. (See "Asbestos-related pleuropulmonary disease" and "Silicosis".)

Site testing — Examination of the environmental or occupational site can be performed by governmental agencies, such as the OSHA or the Environmental Protection Agency, or by qualified private consultants such as certified industrial hygienists. Air sampling is performed with area or personal sampling devices to get results that can lead to estimates of exposure based on an average eight-hour exposure. Many regulatory standards such as OSHA-permissible exposure limits are based on eight-hour, time-weighted averages. However, many of the OSHA standards have not been updated. Toxicants can be measured in air, water, soil, and from surfaces.

In some cases, the correlation between exposure levels (in the environment or the body) and health effects is good, and in other cases it is poor. Lead, as an example, can be measured in air (micrograms/cubic meter) with a reasonable correlation between air levels and blood leads measured in exposed individuals. Although there is considerable individual variation, there is a general correlation between recent lead exposure and acute clinical responses in adults. (See "Lead exposure, toxicity, and poisoning in adults: Clinical manifestations and diagnosis".)

Making the causal connection between exposure and the patient's symptoms requires consistency between the known adverse effects of the toxic agent and the nature of the illness, the presence of an appropriate temporal relationship between exposure and effect, and sufficient exposure to cause the presumed effect. There are a number of excellent resources describing the health effects of various exposures [43-47], as well as agencies and consultants to whom the primary care clinician can turn for assistance in this process.

Poison control centers are another resource that provides quick information about chemical toxicants (in the United States, dial 1-800-222-1222).

Occupational/environmental medicine clinicians — Clinicians specializing in occupational and environmental medicine can be located by contacting the Association of Occupational and Environmental Clinics (AOEC), a group of occupational medicine clinics with board-certified occupational medicine physicians (phone: 202-347-4976; website www.aoec.org) or the American College of Occupational and Environmental Medicine Physicians (www.acoem.org).

Protecting others — Some diagnoses, termed "sentinel health events," are more likely to be linked to current or past jobs. An occupational sentinel health event is a disease, disability, or untimely death that is occupationally related and whose occurrence may provide the impetus for evaluation and interventions that prevent future cases [48,49]. A patient diagnosed with a sentinel health event, such as pulmonary tuberculosis, asthma, contact dermatitis, mesothelioma, bladder cancer, peripheral neuropathy, or pulmonary fibrosis, would be another prompt to taking a more detailed occupational/environmental history in pursuit of potential underlying (preventable) exposures. Sometimes, recognition of unusual presentations, particularly when seen in groups of workers, leads to the discovery of new diseases, such as a cluster of employees in a nylon flocking plant who presented with interstitial lung disease ("flock workers lung") [50,51].

It is important to consider whether others may have been exposed and need to be evaluated and treated once the diagnosis of a work- or environment-related illness has been made. It may be necessary to make an intervention to decrease or eliminate exposures in order to prevent illness in others. The clinician may find it necessary to alert the company medical department, a company health and safety committee, or the state public health or labor department. It is often necessary to obtain additional exposure information to follow up on the initial leads. The OSHA performs work site inspections on a priority basis or at the request of a current worker or management. Fines may be levied in some cases if OSHA standards are violated.

Consultative sources include academically affiliated occupational health clinics (AOEC), board-certified occupational and environmental medicine specialists (American College of Occupational and Environmental Medicine), Pediatric Environmental Health Specialty Units, and worker education/advocacy groups such as Coalition for Safety and Health groups. NIOSH can provide the practitioner with toxicologic information and perform health hazard evaluations of workers to detect work-related health problems. Industrial hygienists from private consulting groups or from workers' compensation carriers can conduct worksite evaluations and monitoring and advise about interventions. The practitioner may find it useful to contact the local state Department of Environmental Protection or city departments of public health for environmental problems.

DISABILITY AND WORKER'S COMPENSATION — 

Work-related injuries or illnesses may require assessment of impairment, disability, and eligibility for workers' compensation. The clinician's role is to characterize the impairment of function. However, whether there is a disability or not depends on the type and degree of impairment and the job tasks. For example, a person unable to walk due to a lower extremity injury may not be disabled from a sedentary job, but would be disabled from a job in which the major tasks involve climbing ladders. The practitioner can help an affected worker obtain workers' compensation when justified. The definition of "work-related" may vary by state but usually implies that it is more likely than not that some activity at work precipitated, hastened, aggravated, or contributed to the injury or illness. The workers' compensation system is state based; the practitioner needs to become familiar with the state regulations of their practice. Workers' compensation can provide benefits for work time lost, permanent disability, medical care expenses, and rehabilitation.

Disability assessment in the United States is discussed separately. (See "Disability assessment and determination in the United States".)

SOCIETY GUIDELINE LINKS — 

Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Occupational health".)

SUMMARY AND RECOMMENDATIONS

●Epidemiology – The full extent of occupational injuries and illnesses is difficult to measure due to underreporting and global variation. Some of the most prone industries include agriculture, construction, forestry and fishing, and manufacturing. (See 'Epidemiology' above.)

●The clinician's role may involve prevention, assessment for work-related contributing factors to an illness or injury, and/or determination of impairment or disability.

●Clinical issues – Common clinical presentations of occupational health issues include lung disease, rhinitis and other allergic conditions, and musculoskeletal concerns and injuries. (See 'Common clinical presentations' above.)

Climate change also presents health concerns for workers, especially those who work outdoors and in other conditions subject to extreme heat and vectors and are rescue workers. (See 'Emerging occupational risks' above.)

●Hazardous chemical exposures – Occupational exposures to potentially hazardous chemicals are common and can result in conditions ranging from skin and mucus membrane irritation to serious illness. These are discussed separately. (See "Common occupational chemical exposures: General approach and management of selected exposures".)

Topical chemical burns and inhalational chemical injury are also discussed separately. (See "Topical chemical burns: Initial evaluation and management" and "Inhalation injury from heat, smoke, or chemical irritants".)

●Education and prevention – All patients should be asked about their work environments and tasks. Having an understanding of high-risk occupations can lead to education regarding risks and anticipatory guidance related to protective and preventive actions. (See 'Education and prevention for high-risk occupations' above.)

●Patients with suspected exposures – For patients with suspected occupational exposures and health consequences, the role of the clinician is to recognize the clinical presentation, establish a likely causal relationship, document and quantify the exposure, treat the condition, and alert others who may be at risk. (See 'Patients with suspected exposures' above.)

●Disability and worker's compensation – Work-related injuries or illnesses may require assessment of impairment, disability, and eligibility for workers' compensation. The clinician's primary role is to characterize the impairment of function. Workers' compensation can provide benefits for work time lost, permanent disability, medical care expenses, and rehabilitation. (See 'Disability and worker's compensation' above and "Disability assessment and determination in the United States".)