Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement.
ABSTRACT A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA).
A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007.
The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed.
The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers.
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ABSTRACT: Effective patient-physician communication is the key component of the patient-physician relationship. To assess the proportion of ever-employed adults with current asthma who talked about asthma associated with work with their physician or other health professional and to identify factors associated with this communication. The 2006 to 2010 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey data from 40 states and the District of Columbia for ever-employed adults (≥18 years old) with current asthma (N = 50,433) were examined. Multivariable logistic regression analyses were conducted to identify factors associated with communication with a health professional about asthma and work. Among ever-employed adults with current asthma, 9.1% were ever told by a physician that their asthma was related to any job they ever had and 11.7% ever told a physician or other health professional that this was the case. When responses to the 2 questions were combined, the proportion of those who communicated with a health professional about asthma and work was 14.7%. Communication with a health professional about asthma and work was associated with age, race or ethnicity, employment, education, income, insurance, and urgent treatment for worsening asthma. A small proportion of patients with asthma might communicate with a health professional about asthma associated with work. Future studies should examine whether patients with asthma ever discussed with a health professional the possibility that their asthma might be related to work to provide information on the frequency of patient-clinician communication about asthma related to work. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 12/2014; 114(2). DOI:10.1016/j.anai.2014.10.022 · 2.75 Impact Factor
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ABSTRACT: The objective of this study was to estimate the prevalence of current asthma and the proportion of current asthma that is related to work on the farm among primary farm operators. The 2011 Farm and Ranch Safety Survey data were used to produce estimates and prevalence odds ratios. An estimated 5.1% of farm operators had asthma. Of these, 15.4% had farm work-related asthma. Among operators with farm work-related asthma, 54.8% (95% confidence interval [CI]: 41.8%-68.2%) had an asthma attack in the prior 12 months and 33.3% (95% CI: 21.2%-45.4%) had an asthma attack that occurred while doing farm work. Of those who had an asthma attack that occurred while doing farm work, 65.0% associated their asthma attack with plant/tree materials. This study provides updated information on asthma and the proportion of current asthma that is related to work on the farm and identifies certain groups of farm operators that might benefit from workplace asthma prevention intervention.Journal of Agromedicine 01/2015; 20(1):31-42. DOI:10.1080/1059924X.2014.976729 · 0.92 Impact Factor
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ABSTRACT: Das Risiko für allergische Atemwegserkrankungen durch berufliche Tätigkeiten steigt mit Höhe und Umfang der Allergenexposition. Daher ist die wichtigste primärpräventive Maßnahme eine Optimierung des Arbeitsschutzes zur Expositionsreduktion. Wenngleich eine vorbestehende Atopie gleichfalls das Risiko einer Berufsallergie erhöht, so ist bei einer medizinischen Berufsberatung nur bei klinisch relevantem, schwererem Asthma von der Berufstätigkeit in einem Beruf mit hoher Allergenexposition abzuraten. Da Symptome einer Sensibilisierung meist in den ersten zwei Jahren nach Tätigkeitsbeginn auftreten, sollten Berufsanfänger bezüglich möglicher Beschwerden instruiert und in Abhängigkeit vom individuellen Risiko engmaschig ärztlich untersucht werden. Summary The risk of occupational respiratory allergies depends on height and extent of allergen exposure. Therefore the most important primary prevention measure is the improvement of work place safety in order to reduce exposure. Even though a preexisting atopy also increases the risk of an occupational allergy, only in case of clinical relevant more severe asthma should the employment in a profession with high allergen exposure be discouraged in medical occupational counselling. Since symptoms of sensitization mostly occur in the two first years after the start of exposure, apprentices should be instructed about symptoms and be examined medically depending on their individual risk.Allergo Journal: interdisziplinäre Zeitschrift für Allergologie und Umweltmedizin: Organ der Deutschen Gesellschaft für Allergie- und Immunitätsforschung 09/2012; 21(6):354-362. DOI:10.1007/s15007-012-0354-7