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.

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 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.

scholarly journals 1512 Asthma control and work disability in subjects previously evaluated for work-related asthma with specific inhalation challenge

2018 ◽  
Author(s):  
Ilenia Folletti ◽  
Umberto Giovannelli ◽  
Giulia Paolocci ◽  
Marco dell’Omo ◽  
Angela Gambelunghe ◽  
...  
Keyword(s):  
Asthma Control ◽  
Work Disability ◽  
Work Related ◽  
Specific Inhalation Challenge ◽  
Inhalation Challenge

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.

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