Standards of care for occupational asthma: an update

Fishwick, David; Barber, Christopher M.; Bradshaw, Lisa; Ayres, Jon G.; Barraclough, Richard; Burge, Sherwood; Corne, Jonathan; Cullinan, Paul; Frank, Timothy L; Hendrick, D. J.; Hoyle, Jennifer; Curran, Andrew; Niven, Robert; Pickering, Tony; Reid, PC; Robertson, Alastair; Stenton, Chris; Warburton, Chris; Nicholson, Paul J

doi:10.1136/thoraxjnl-2011-200755

Cited by 39 publications

(32 citation statements)

References 5 publications

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“…Most workers who are removed from exposure to the causal agent maintain persistent symptoms and BHR [26]. The prognosis of occupational asthma is improved by early and complete removal from exposure [30]. Therefore, work-related asthma might be more often uncontrolled due to the persistence of exposures.…”

Section: Figurementioning

confidence: 99%

“…Both exposures to LMW and HMW agents and to cleaning agents seem related to uncontrolled asthma. Occupational exposure is a preventable risk factor and the importance of prevention has been recently underlined [21,30,34]. Preventing asthma exacerbations, an important asthma control domain [4,11], is essential since severe asthma exacerbations have been related to accelerated decline in lung function [2].…”

Section: Figurementioning

confidence: 99%

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Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II

Moual¹,

Carsin²,

Siroux³

et al. 2013

European Respiratory Journal

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Occupational exposure is a well-recognised modifiable risk factor for asthma, but the relationship between occupational exposure and asthma control has not been studied. We aimed to study this association among working-age adults from the European Community Respiratory Health Survey (ECRHS).Data were available for 7077 participants (mean age 43 years, 45% never-smokers, 5867 without asthma and 1210 with current asthma). Associations between occupational exposure to specific asthmagens and asthma control status (33% with uncontrolled asthma, based on the Global Initiative for Asthma guidelines) were evaluated using logistic and multinomial regressions, adjusted for age, sex and smoking status, with study areas included as a random effect.Statistically significant positive associations were observed between uncontrolled adult-onset asthma and both past 12-month and 10-year exposure to any occupational asthmagens (OR (95% CI) 1.6 (1.0-2.40) and 1.7 (1.2-2.5), respectively); high (1.7 (1.0-2.8) and 1.9 (1.3-2.9), respectively) and low (1.6 (1.0-2.7) and 1.8 (1.2-2.7), respectively) molecular weight agents; and cleaning agents (2.0 (1.1-3.6) and 2.3 (1.4-3.6), respectively), with stronger associations for long-term exposures. These associations were mainly explained by the exacerbation domain of asthma control and no associations were observed between asthmagens and partly controlled asthma.These findings suggest that occupational exposure to asthmagens is associated with uncontrolled adult-onset asthma. Occupational risk factors should be quickly identified to prevent uncontrolled asthma. @ERSpublications Occupational exposure to asthmagens is associated with uncontrolled adult-onset asthma in ECRHS II

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II

Moual¹,

Carsin²,

Siroux³

et al. 2013

European Respiratory Journal

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“…However, the use of respirators and personal protective equipment after confirming the diagnosis of OA does not reduce or prevent exposure, nor prevent the deterioration of asthma symptoms. Therefore, respirators and personal protective equipment are not considered adequate substitutes for absolute avoidance measures in workers with a confirmed diagnosis of OA [21,22].…”

Section: Management Of Oamentioning

confidence: 96%

“…Having an early diagnosis, well-preserved lung function, and less airway hyperreactivity has been associated with a better prognosis than workers with persistent symptoms, longer exposure periods in the work place, and greater deterioration in lung function. Occupational asthma is, otherwise, treated similar to non-OA with inhaled corticosteroids, long-acting β2-agonists, leukotriene modifying agents, xanthine oxidase inhibitors, and oral corticosteroids [21]. In situations where workers are exposed to known causes of OA (i.e., enzymes, isocyanates, or acid anhydrides), use of respirators, and personal protective equipment should be enforced.…”

Section: Management Of Oamentioning

confidence: 97%

Occupational Asthma: An Overview

Tan

Bernstein

2014

Curr Allergy Asthma Rep

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Occupational asthma is a form of asthma that is often under-diagnosed and under-reported. Unrecognized occupational asthma can lead to progression of disease and increased morbidity. The medical history is a critical element for establishing a diagnosis of OA. The history should include a detailed assessment of the workplace environment, the work process, changes in symptoms in and away from the workplace, and a review of relevant material safety data sheets that may provide clues regarding exposure(s) and the potential cause(s). Objective testing including spirometry pre- and post-bronchodilators, peak expiratory flow rate monitoring in and out of the workplace, provocation testing (i.e., methacholine challenge) to assess for airway hyperresponsiveness, and, if feasible, specific provocation by experienced personnel in a controlled setting to a suspected inciting agent are necessary for confirming a diagnosis. Skin or serologic testing for specific IgE to aeroallergens to assess the worker's atopic status is useful especially when considering certain forms of OA where atopy is a risk factor. Specialized laboratory testing may be useful for specific OA causes. It is important to correctly make the diagnosis of OA as the impact on the worker's future employment and earning power can be significantly affected.

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“…9,10 Airflow obstruction in asthma is worse during the night and early morning, so lung function indices obtained during office hours may not accurately reflect variability. When spirometry is normal in people with suspected asthma, a pragmatic alternative is to provide a peak flow meter and instructions to record the best of three readings twice a day, when symptoms occur, and if appropriate, in combination with a trial of treatment.…”

Section: The Importance Of Training and Experiencementioning

confidence: 99%

Is spirometry essential in diagnosing asthma? No

Levy

2016

Br J Gen Pract

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Standards of care for occupational asthma: an update

Cited by 39 publications

References 5 publications

Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II

Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II

Occupational Asthma: An Overview

Is spirometry essential in diagnosing asthma? No

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