An Official American Thoracic Society Workshop Report: Presentations and Discussion of the Fifth Jack Pepys Workshop on Asthma in the Workplace. Comparisons between Asthma in the Workplace and Non–Work-related Asthma

Abstract

The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non-work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home.

Do chronic workplace irritant exposures cause asthma?

“…Work-related asthma is commonly classified as occupational asthma (OA), induced by exposure to agents at work, or work-exacerbated asthma (WEA), i.e. pre-existing asthma worsened by workplace conditions 2 . The number of identified occupational asthmagens (hazards known to induce asthma) increased regularly from approximately 150 before 2000 3 to probably almost 500 nowadays [4][5][6] .…”

The usefulness of bronchial challenge tests in the diagnosis of occupational asthma

“…Szacuje się, że częstość występowania zawodowej astmy oskrzelowej (occupational asthma -OA) wynosi ok. 15% wśród dorosłych chorych na astmę oskrzelową [49,50]. W przypadku podejrzenia zawodowej astmy oskrzelowej o podłożu alergicznym ważne jest wykazanie swoistej nadwrażliwości na alergeny z miejsca pracy.…”

Occupational lung diseases in Australia

“…Occupational asthma tends to be more severe, associated with high medication usage, poorer asthma control, more rapid lung function decline and greater socio‐economic impacts, than non‐work‐related asthma 8 . ‐ 10 …”

“…7 Occupational asthma tends to be more severe, associated with high medication usage, poorer asthma control, more rapid lung function decline and greater socio-economic impacts, than non-work-related asthma. [8][9][10] Sensitiser-induced occupational asthma develops due to immune-mediated sensitisation to an occupational agent (sometimes referred to as an asthmagen). Once developed, even a very low level of exposure can induce asthma symptoms.…”