EAACI Position Paper on assessment of cough in the workplace

Abstract

JL. EAACI Position Paper on assessment of cough in the workplace. AbstractCough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker.Cough is a nonspecific and relatively common disruptive symptom (1) that serves as a crucial protective reflex for upper airways (1) but can also be a warning sign of disease (2). When cough is chronic (i.e. persisting for more than 8 weeks) (1, 3), it can present difficulties in diagnosis and management (2), particularly when reported to be associated with the workplace. Several guidelines and reviews on workrelated chronic cough (WRCC) have recently been published (4-6), but an operative protocol intended to assist the daily practice of allergologists and a consensus definition and classification of WRCC are lacking.

Occupational and Environmental Contributions to Chronic Cough in Adults

“…The previous ACCP Cough Guidelines 3 included a review of these causes as has the more recent European Academy of Allergy Asthma and Clinical Immunology Task Force Statement on Occupational Causes of Cough. 88 The occupational contribution to the burden of asthma is estimated to be about 18% and to COPD approximately 15%, 69,89,90 but there is little evidence for the population-attributable risk of work-related cough. One estimate has been 4% to 18%, but a distinction between personal causes of cough and occupational causes in published articles has not been clear, and the estimate range is wide.…”

Towards a practical clinical use of fractioned exhaled nitric oxide levels in chronic cough

“…Despite published recommendations, both in cough guidelines/protocols and in clinical practice, it is quite frequent that an occupational trigger is not contemplated among the causes of chronic cough (24,25). The lack of recognition of an occupational cause of © Annals of Translational Medicine.…”

Occupational rhinitis and occupational asthma: Association or progression?

“…Notwithstanding this limitation, 6 of the 43 studies lacking cross‐tabulation (plus all four studies lacking objective pulmonary function tests) provided partial associational data, in which either: 1) the proportion of (presumed) occupational rhinitis cases developing occupational asthma (or vice versa) is reported (albeit in the absence of background rates); or 2) the sequence of development of nasal and chest symptoms are tabulated. Individual study characteristics of excluded studies, including study designs, principal exposure(s), health endpoint(s), number of subjects, and measure(s) of effect appear in Supplemental Tables S1‐S4. Briefly summarizing relevant data from these excluded studies, among workers undergoing objective pulmonary function testing, more than half of those diagnosed with occupational asthma to diphenylmethane diisocyanate (MDI), lupin ( Lupinus angustifolius ) flour, or ammonium persulfate (eg, hairdressers) also gave histories consistent with occupational rhinitis .…”