Workplace interventions for treatment of occupational asthma

Henneberger, Paul K.; Patel, Jenil; Groene, Gerda J de; Beach, Jeremy; Tarlo, Susan M.; Pal, Teake; Curti, Stefania

doi:10.1002/14651858.cd006308.pub4

Cited by 27 publications

(41 citation statements)

References 67 publications

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“…aContents of table based on the three tables in the Summary of Findings section of the 2019 Cochrane review “Workplace interventions for treatment of occupational asthma.” 13 We rated the quality of the evidence as very low for all outcomes in this table. See original document for details.…”

Section: Resultsmentioning

confidence: 99%

“…However, the subset of studies on exposure to LMW agents showed more favorable results for exposure removal versus T A B L E 1 Relative effects of workplace interventions for occupational asthma on the absence of asthma symptoms, improvement of asthma symptoms, change in FEV1%, and change in NSBH, for three different comparisons a "Workplace interventions for treatment of occupational asthma." 13 We rated the quality of the evidence as very low for all outcomes in this…”

Section: Resultsmentioning

confidence: 99%

“…Several studies of workplace interventions for OA were published after the 2011 review. With a comprehensive approach of including recently published studies, 9‐12 along with those studies already identified in the 2011 Cochrane review, we produced an updated systematic review of evidence on the effectiveness of workplace interventions for the treatment of OA 13 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

Henneberger

Patel

Groene

et al. 2020

American J Industrial Med

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Background: The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. Methods: A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and metaanalyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. Conclusions: Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

Henneberger

Patel

Groene

et al. 2020

American J Industrial Med

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“…Ideally, patients with SI-OA should be completely relocated to a different occupation either in or outside the workplace [3]. A Cochrane review recently published evaluated the effectiveness of workplace interventions on OA and showed that complete removal from exposure, but not reduction of exposure, may improve lung function [98]. Conversely, a meta-analysis found that the reduction of exposure is associated with a lower likelihood of improvement (OR 0.16, 95%CI [0.03-0.91]) or recovery (OR 0.30, 95%CI [0.11-0.84]) of asthma symptoms, a higher risk of worsening of the symptoms (OR 10.23, 95%CI [2.97-35.28]) and non-specific BHR (OR 5.65, 95%CI [1.…”

Section: Sensitizer-induced Occupational Asthmamentioning

confidence: 99%

Progress in Occupational Asthma

Tiotiu

Novakova²,

Labor

et al. 2020

IJERPH

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Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.

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“…Furthermore, the inability to diagnose new conditions objectively, for example occupational asthma, may worsen long-term outcomes. 5 As such, it is important to address this issue as soon as possible. With the decrease in in-person consultations, virtual and digital technologies may play an important role going forward, 6 but it is vital to consider the technical, administrative, ethical, and financial implications that will arise as newer technologies replace, complement, or augment conventional PFT.…”

mentioning

confidence: 99%

Addressing Reduced Laboratory-Based Pulmonary Function Testing During a Pandemic

Kouri

Gupta

Yadollahi

et al. 2020

Chest

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To reduce the spread of the severe acute respiratory syndrome coronavirus 2, many pulmonary function testing (PFT) laboratories have been closed or have significantly reduced their testing capacity. Because these mitigation strategies may be necessary for the next 6 to 18 months to prevent recurrent peaks in disease prevalence, fewer objective measurements of lung function will alter the diagnosis and care of patients with chronic respiratory diseases. PFT, which includes spirometry, lung volume, and diffusion capacity measurement, is essential to the diagnosis and management of patients with asthma, COPD, and other chronic lung conditions.Both traditional and innovative alternatives to conventional testing must now be explored.These may include peak expiratory flow devices, electronic portable spirometers, portable exhaled nitric oxide measurement, airwave oscillometry devices, and novel digital health tools such as smartphone microphone spirometers and mobile health technologies along with integration of machine learning approaches. The adoption of some novel approaches may not merely replace but could improve existing management strategies and alter common diagnostic paradigms. With these options comes important technical, privacy, ethical, financial, and medicolegal barriers that must be addressed. However, the coronavirus disease 19 pandemic also presents a unique opportunity to augment conventional testing by including innovative and emerging approaches to measuring lung function remotely in patients with respiratory disease.The benefits of such an approach have the potential to enhance respiratory care and empower patient self-management well beyond the current global pandemic.

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Workplace interventions for treatment of occupational asthma

Cited by 27 publications

References 67 publications

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

Progress in Occupational Asthma

Addressing Reduced Laboratory-Based Pulmonary Function Testing During a Pandemic

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