scholarly journals Barriers to the Recognition and Reporting of Occupational Asthma by Canadian Pulmonologists

2011 ◽  
Vol 18 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Anu Parhar ◽  
Catherine Lemiere ◽  
Jeremy R Beach
Keyword(s):  
Occupational Asthma ◽  
Postal Questionnaire ◽  
Perceived Barriers ◽  
Work Related ◽  
Inhalation Challenge ◽  
Patient Concerns ◽  
Analogue Scales ◽  
Possible Cause ◽  
New Onset

BACKGROUND: Occupational asthma is a common, but probably under-recognized problem.OBJECTIVE: To identify the factors that suggest work-related asthma when a pulmonologist encounters an adult patient with new-onset asthma, and to identify the barriers to recognizing and reporting such cases.METHODS: A postal questionnaire was sent to all pulmonologists in Canada. The questionnaire asked participants to respond to several questions about recognizing, diagnosing and reporting occupational asthma. Answers were scored using visual analogue scales.RESULTS: A total of 201 eligible responses were received from 458 pulmonologists. Pulmonologists identified that the most important factor in initially considering the role of work in occupational asthma was having seen others affected at the same workplace, or exposed to the same agent. Important perceived barriers to considering a diagnosis of occupational asthma were physicians’ low awareness, lack of knowledge and time. The most important barriers to reporting cases were the pulmonologists’ perceived patient concerns regarding job security and income. Quebec pulmonologists generally perceived barriers to recognizing and reporting occupational asthma to be less important, and believed that the use of specific inhalation challenge was more important in considering a diagnosis.CONCLUSIONS: Pulmonologists most readily recognized occupational asthma caused by a substance or process that they previously encountered as a possible cause of asthma. Time constraints and knowledge may hamper their ability to recognize occupational asthma. Concerns regarding the effect of the diagnosis on the patient’s job and income may discourage reporting.

scholarly journals Integrated Approach to Diagnosis of Associated Occupational Asthma and Rhinitis

2012 ◽  
Vol 19 (6) ◽  
pp. 385-387 ◽  
Author(s):  
Sébastien Nguyen ◽  
Roberto Castano ◽  
Manon Labrecque
Keyword(s):  
Occupational Asthma ◽  
Integrated Approach ◽  
Forced Expiratory Volume ◽  
Allergen Exposure ◽  
Prick Test ◽  
Work Related ◽  
Asthma Symptoms ◽  
Specific Inhalation Challenge ◽  
Inhalation Challenge ◽  
Baseline Values

Patients with coexisting work-related rhinitis and asthma would benefit from an adequate and simultaneous recognition of both diseases. The present case illustrates the advantages and importance of using an integrated approach to confirm a diagnosis of occupational rhinitis (OR) and occupational asthma (OA).A 38-year-old woman, who worked as an animal laboratory technician since 2004, first noticed the appearance of rhinitis and conjunctivitis symptoms in 2007 when she was exposed to rats. A skin-prick test with rat extract was strongly positive. A specific inhalation challenge with parallel assessment of nasal and bronchial responses was conducted. After 10 min of exposure, she developed rhinitis and conjunctivitis symptoms, her forced expiratory volume in 1 s dropped by 27.5% and her nasal volume, measured by acoustic rhinometry, decreased by 80% from baseline values. After allergen exposure, induced sputum and nasal lavage examination demonstrated an increase in eosinophils (11% and 20%, respectively). A diagnosis of associated allergic OA and OR was confirmed and she was advised to stop working with rats.A systematic and parallel diagnostic approach enables confirmation of a diagnosis of OA and OR in patients complaining of work-related rhinitis and asthma symptoms.

scholarly journals Do laboratory challenge tests for occupational asthma represent what happens in the workplace?

2018 ◽  
Vol 51 (6) ◽  
pp. 1800059 ◽  
Author(s):  
P. Sherwood Burge ◽  
Vicky C. Moore ◽  
Alastair S. Robertson ◽  
Gareth I. Walters
Keyword(s):  
Occupational Asthma ◽  
Occupational Exposures ◽  
Reference Standard ◽  
Early Recovery ◽  
Work Related ◽  
Specific Inhalation Challenge ◽  
Challenge Tests ◽  
Delayed Recovery ◽  
Occupational Work ◽  
Inhalation Challenge

Specific inhalation challenge (SIC) is the diagnostic reference standard for occupational asthma; however, a positive test cannot be considered truly significant unless it can be reproduced by usual work exposures. We have compared the timing and responses during SIC in hospital to Oasys analysis of serial peak expiratory flow (PEF) during usual work exposures.All workers with a positive SIC to occupational agents between 2006 and 2015 were asked to measure PEF every 2 h from waking to sleeping for 4 weeks during usual occupational exposures. Responses were compared between the laboratory challenge and the real-world exposures at work.All 53 workers with positive SIC were included. 49 out of 53 had records suitable for Oasys analysis, 14 required more than one attempt and all confirmed occupational work-related changes in PEF. Immediate SIC reactors and deterioration within the first 2 h of starting work were significantly correlated with early recovery, and late SIC reactors and a delayed start to workplace deterioration were significantly correlated with delayed recovery. Dual SIC reactions had features of immediate or late SIC reactions at work rather than dual reactions.The concordance of timings of reactions during SIC and at work provides further validation for the clinical significance of each test.

Occupational asthma; the limited role of air-fed respiratory protective equipment

2019 ◽  
Vol 69 (5) ◽  
pp. 329-335 ◽  
Author(s):  
Aslihan Ilgaz ◽  
Vicky C Moore ◽  
Alastair S Robertson ◽  
Gareth I Walters ◽  
P Sherwood Burge
Keyword(s):  
Occupational Asthma ◽  
Source Control ◽  
Working Fluid ◽  
Protective Equipment ◽  
Metal Working ◽  
Inclusion Criteria ◽  
Manufacturing Facility ◽  
Work Related ◽  
Before And After

Abstract Background Evidence-based reviews have found that evidence for the efficacy of respiratory protective equipment (RPE) in the management of occupational asthma (OA) is lacking. Aims To quantify the effectiveness of air-fed RPE in workers with sensitizer-induced OA exposed to metal-working fluid aerosols in a car engine and transmission manufacturing facility. Methods All workers from an outbreak of metal-working fluid-induced OA who had continuing peak expiratory flow (PEF) evidence of sensitizer-induced OA after steam cleaning and replacement of all metal-working fluid were included. Workers kept 2-hourly PEF measurements at home and work, before and after a strictly enforced programme of RPE with air-fed respirators with charcoal filters. The area-between-curve (ABC) score from the Oasys plotter was used to assess the effectiveness of the RPE. Results Twenty workers met the inclusion criteria. Records were kept for a mean of 24.6 day shifts and rest days before and 24.7 after the institution of RPE. The ABC score improved from 26.6 (SD 16.2) to 17.7 (SD 25.4) l/min/h (P > 0.05) post-RPE; however, work-related decline was <15 l/min/h in only 12 of 20 workers, despite increased asthma treatment in 5 workers. Conclusions Serial PEF measurements assessed with the ABC score from the Oasys system allowed quantification of the effect of RPE in sensitized workers. The RPE reduced falls in PEF associated with work exposure, but this was rarely complete. This study suggests that RPE use cannot be relied on to replace source control in workers with OA, and that monitoring post-RPE introduction is needed.

Work-Related Asthma

Public Health ◽  
2021 ◽  
Keyword(s):  
Occupational Asthma ◽  
Developed Countries ◽  
The United States ◽  
Etiologic Agent ◽  
Work Related ◽  
Mineral Dusts ◽  
Etiological Agents ◽  
As Stress ◽  
Reactive Airways ◽  
New Onset

Work-related asthma encompasses both new-onset asthma and aggravation of pre-existing asthma from work exposures/conditions. New-onset asthma can be caused by exposure to an irritant or a substance that causes sensitization. Approximately 350 substances have been identified by which exposure at work can lead to sensitization and asthma. When the term occupational asthma is used, it generally does not include work-aggravated asthma. Some authors limit the use of occupational asthma to new-onset asthma from sensitization to a substance at work, while others also include new-onset asthma from exposure to an irritant at work under this category. New-onset asthma from an acute single exposure is called reactive airways dysfunction Syndrome (RADS) (note this is not the same as reactive airways disease). New-onset asthma from repeated chronic exposure to an irritant at work as a cause of asthma has also been described, but it is not as well accepted as an entity as RADS. Aggravation of pre-existing asthma by work can occur from any exposure as well as stress, physical activity, and temperature/humidity. Unlike the work-related lung diseases such as the pneumoconioses, which cause irreversible fibrosis, work-related asthma is potentially completely reversible if diagnosed soon after onset of symptoms and the patient’s exposure to the etiologic agent ceases. Beginning in the early 1900s, asthma from exposure at work to plant material and metals first began to be reported in the medical literature. In the 1970s, Dr. Jack Pepys from England markedly advanced the identification of etiological agents by developing a practical way to perform specific inhalation challenge testing. The field has continued to advance with the recognition of an increased number of etiological agents, an understanding of the pathophysiology, an understanding of the prognosis and factors associated with a better prognosis, and the initiation of work on the interaction with genetic variability. At least in more developed countries, such as in European countries and the United States, which have implemented controls or banned the use of the mineral dusts (i.e., asbestos, silica) that have caused the most common pneumoconioses, work-related asthma has become a more important cause of new-onset work-related lung disease than the more traditional pneumoconioses.

The Role of Positive and Negative Affectivity in Healthy and Unhealthy Work-Related Behavior and Experiences

2019 ◽  
Vol 26 (2) ◽  
pp. 56-67 ◽  
Author(s):  
Hanna Hofmann ◽  
Carl-Walter Kohlmann
Keyword(s):  
Negative Affectivity ◽  
Coping Behavior ◽  
Common Method ◽  
Positive Affectivity ◽  
Work Related ◽  
Teacher Students ◽  
And Behaviors ◽  
Main Effects ◽  
Positive And Negative Affectivity

Abstract. Positive affectivity (PA) and negative affectivity (NA) are basic traits that affect work-related perceptions and behaviors and should be considered in any assessment of these variables. A quite common method to assess healthy or unhealthy types of work-related perceptions and behaviors is the questionnaire on Work-Related Coping Behavior and Experience Patterns (WCEP). However, the association of PA and NA with WCEP remained unclear. In a sample of teachers, physiotherapists, and teacher students ( N = 745; Mage = 35.07, SD = 12.49; 78% females), we aimed to identify the relevance of these basic traits. After controlling for age, gender, and type of occupation, we found main effects of PA and NA, with the specific combination of PA and NA being decisive for predicting the assignment to a WCEP type. The results highlight the need to include PA and NA in future assessments with the WCEP questionnaire.

Investigation of the role of anxiety and depression on the formation of phantom vibration and ringing syndrome induced by working stress during medical internship (Preprint)

2019 ◽  
Author(s):  
Yu-Hsuan Lin ◽  
Kuan-I Lin ◽  
Yuan-Chien Pan ◽  
Sheng-Hsuan Lin
Keyword(s):  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Prospective Longitudinal Study ◽  
Work Related ◽  
Working Stress ◽  
Causal Mediation Analysis ◽  
Accompanying Symptoms ◽  
Prospective Longitudinal ◽  
The Relationship

BACKGROUND Phantom vibrations syndrome (PVS) and phantom ringing syndrome (PRS) are prevalent hallucinations during medical internship. Depression and anxiety are probably understudied risk factors of PVS and PRS. OBJECTIVE The aim of this study was to investigate the role of anxiety and depression on the relationship between working stress during medical internship and PVS and PRS. METHODS A prospective longitudinal study of 74 medical interns was carried out using repeated investigations of the severity of phantom vibrations and ringing, as well as accompanying symptoms of anxiety and depression as measured by Beck Anxiety Inventory and the Beck Depression Inventory before, at the 3rd, 6th, and 12th month during internship, and 2 weeks after internship. We conducted a causal mediation analysis to investigate the role of depression and anxiety in the mechanism of working stress during medical internship inducing PVS and PRS. RESULTS The results showed that depression explained 21.9% and 8.4% for stress-induced PRS and PVS, respectively. In addition, anxiety explained 15.0% and 7.8% for stress-induced PRS and PVS, respectively. CONCLUSIONS Our findings showed both depression and anxiety can explain a portion of stress-induced PVS and PRS during medical internship and might be more important in clinical practice and benefit to prevention of work-related burnout.

scholarly journals Pulmonary Function Testing in Work-Related Asthma: An Overview from Spirometry to Specific Inhalation Challenge

2021 ◽  
Vol 18 (5) ◽  
pp. 2325
Author(s):  
Mathias Poussel ◽  
Isabelle Thaon ◽  
Emmanuelle Penven ◽  
Angelica I. Tiotiu
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Objective Evaluation ◽  
Pulmonary Function Testing ◽  
Initial Assessment ◽  
Work Related ◽  
Specific Inhalation Challenge ◽  
Occupational Setting ◽  
Inhalation Challenge ◽  
Function Testing

Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines.

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