Diagnosing occupational asthma
Open accessAbstract
Making an accurate diagnosis of occupational asthma (OA) is, generally, important. The condition has not only significant health consequences for affected workers, but also substantial socio-economic impacts for workers, their employers and wider society. Missing a diagnosis of OA may lead to continued exposure to a causative agent and progressive worsening of disease; conversely, diagnosing OA when it is not present may lead to inappropriate removal from exposure and unnecessary financial and social consequences. While the most accurate investigation is specific inhalation challenge in an experienced centre, this is a scarce resource, and in many cases, reliance is on other tests. This review provides a technical dossier of the diagnostic value of the available methods which include an appropriate clinical history, the use of specific immunology and measurement of inflammatory markers, and various methods of relating functional changes in airway calibre to periods at work. It is recommended that these approaches are used iteratively and in judicious combination, in cognizance of the individual patient's circumstances and requirements. Based on available evidence, a working diagnostic algorithm is proposed that can be adapted to the suspected agent, purpose of diagnosis and available resources. For better or worse, many of the techniques - and their interpretation - are available only in specialized centres and where there is room for doubt, referral to such a centre is probably wise. Accordingly, the implementation or development of such specialized centres with appropriate equipment and expertise should greatly improve the diagnostic evaluation of work-related asthma.
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Objective evidence of poorer asthma control is often difficult to demonstrate.
“To contrast, work-related exacerbations can occur frequently in 20–25% of working adults who have pre-existing asthma (147), although objective evidence of poorer asthma control is often difficult to demonstrate (140).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [140]
OA is typically subclassified into IgE-mediated or sensitizer-induced OA (90%) and irritant-induced occupational asthma (10%).
“OA is typically subclassified into immunoglobulin (Ig)-E-mediated or sensitizer-induced OA (90%) and irritant-induced occupational asthma (10%) (140).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [140]
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- Nicholson P, Cullinan P, Burge P, Boyle C. Occupational asthma: preven- tion, identification & management: sys- tematic review & recommendations. London: British Occupational Health Research Foundation, 2010.
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- Authors
- Vandenplas, O., Suojalehto, H., & Cullinan, P.
- Affiliations
- UCLouvain (BE)
- Finnish Institute of Occupational Health (FI)
- Royal Brompton Hospital (GB)
- Corresponding author
- Vandenplas, O.
- Venue
- Clinical & Experimental Allergy
- Publisher
- Wiley
- Published
- 2016-12-27
- Volume
- 47
- Issue
- 1
- Pages
- 6-18
- ISSN
- 0954-7894 (ISSN-L)
- 1365-2222
- OpenAlex
- W2550811817
- Cited by
- 87
- References
- 86
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 7 · 2022: 14 · 2021: 12 · 2020: 15 · 2019: 14 · 2018: 9 · 2017: 6
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical & Experimental Allergy (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- Fondation Louvain
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Keywords
- occupational asthma, diagnosis, specific inhalation challenge, inflammatory markers, medical history, airway function, diagnostic algorithm, work-related asthma, exposure assessment
- MeSH terms
- Algorithms, Diagnostic Techniques, Respiratory System, Humans, Occupational Diseases, Sensitivity and Specificity, Reproducibility of Results, Biomarkers, Occupational Exposure, Asthma, Occupational
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