Skip to main content
SpringerLink
Log in

Evaluation and Management of Work-Related Asthma

  • Chapter
  • First Online:
Difficult To Treat Asthma

Part of the book series: Respiratory Medicine ((RM))

  • 1053 Accesses

Abstract

Work-related asthma should be considered in all adult working asthmatics. Failure to diagnose a work component to asthma can lead to unnecessary morbidity and increasing medication requirements for asthma. In a patient with confirmed asthma, the clinical history that includes key questions for work-related asthma has a high sensitivity for the diagnosis. However, objective tests are needed to confirm a diagnosis of sensitizer-induced occupational asthma, and these tests can most readily be arranged while the patient is still working. Diagnosis of irritant-induced occupational asthma relies largely on the exposure history and timing of onset of asthma symptoms. Work-exacerbated asthma is more common than occupational asthma and ranges from a single transient episode to daily worsening at work. Management depends on the correct diagnosis; in addition to usual asthma management, work modification may be needed. Outcomes are best with early diagnosis and intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med. 2014;370(7):640–9.

    Article  CAS  Google Scholar 

  2. Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, et al. American Thoracic Society statement: occupational contribution to the burden of airway disease. Am J Respir Crit Care Med. 2003;167(5):787–97.

    Article  Google Scholar 

  3. Lemiere C, To T, de Olim C, Ribeiro M, Liss G, Lougheed MD, et al. Outcome of work-related asthma exacerbations in Quebec and Ontario. Eur Respir J. 2015;45(1):266–8.

    Article  Google Scholar 

  4. Lim T, Liss GM, Vernich L, Buyantseva L, Tarlo SM. Work-exacerbated asthma in a workers’ compensation population. Occup Med (Lond). 2014;64:206–10.

    Article  CAS  Google Scholar 

  5. Brisman J. Baker's asthma. Occup Environ Med. 2002;59(7):498–502; quiz, 426.

    Article  Google Scholar 

  6. Health and Safety Executive UK. Work-related asthma in Great Britain 2017 [last accessed 30th September 2018]. Available from: http://www.hse.gov.uk/statistics/causdis/asthma/asthma.pdf.

  7. Baur X, Bakehe P. Allergens causing occupational asthma: an evidence-based evaluation of the literature. Int Arch Occup Environ Health. 2014;87(4):339–63.

    Article  CAS  Google Scholar 

  8. Gotzev S, Lipszyc JC, Connor D, Tarlo SM. Trends in occupations and work sectors among patients with work-related asthma at a Canadian Tertiary Care Clinic. Chest. 2016;150(4):811–8.

    Article  Google Scholar 

  9. Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest. 1985;88(3):376–84.

    Article  CAS  Google Scholar 

  10. Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, et al. Diagnosis and management of work-related asthma: American College of Chest Physicians Consensus Statement. Chest. 2008;134(3 Suppl):1S–41S.

    Article  CAS  Google Scholar 

  11. Banauch GI, Alleyne D, Sanchez R, Olender K, Cohen HW, Weiden M, et al. Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. Am J Respir Crit Care Med. 2003;168(1):54–62.

    Article  Google Scholar 

  12. de la Hoz RE, Shohet MR, Chasan R, Bienenfeld LA, Afilaka AA, Levin SM, et al. Occupational toxicant inhalation injury: the World Trade Center (WTC) experience. Int Arch Occup Environ Health. 2008;81(4):479–85.

    Article  Google Scholar 

  13. Vandenplas O, Wiszniewska M, Raulf M, de Blay F, Gerth van Wijk R, Moscato G, et al. EAACI position paper: irritant-induced asthma. Allergy. 2014;69(9):1141–53.

    Article  CAS  Google Scholar 

  14. Aaron SD, Boulet LP, Reddel HK, Gershon A. Under-diagnosis and over-diagnosis of asthma. Am J Respir Crit Care Med. 2018;198:1012–20.

    Article  Google Scholar 

  15. Goe SK, Henneberger PK, Reilly MJ, Rosenman KD, Schill DP, Valiante D, et al. A descriptive study of work aggravated asthma. Occup Environ Med. 2004;61(6):512–7.

    Article  CAS  Google Scholar 

  16. Santos MS, Jung H, Peyrovi J, Lou W, Liss GM, Tarlo SM. Occupational asthma and work-exacerbated asthma: factors associated with time to diagnostic steps. Chest. 2007;131(6):1768–75.

    Article  Google Scholar 

  17. Walters GI, Soundy A, Robertson AS, Burge PS, Ayres JG. Understanding health beliefs and behaviour in workers with suspected occupational asthma. Respir Med. 2015;109(3):379–88.

    Article  Google Scholar 

  18. Ellis PR, Walters GI. Missed opportunities to identify occupational asthma in acute secondary care. Occup Med (Lond). 2018;68(1):56–9.

    Article  CAS  Google Scholar 

  19. Mazurek JM, White GE, Moorman JE, Storey E. Patient-physician communication about work-related asthma: what we do and do not know. Ann Allergy Asthma Immunol. 2015;114(2):97–102.

    Article  Google Scholar 

  20. Malo JL, Ghezzo H, L'Archeveque J, Lagier F, Perrin B, Cartier A. Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis. 1991;143(3):528–32.

    Article  CAS  Google Scholar 

  21. Fishwick D, Barber CM, Bradshaw LM, Harris-Roberts J, Francis M, Naylor S, et al. Standards of care for occupational asthma. Thorax. 2008;63(3):240–50.

    Article  CAS  Google Scholar 

  22. Nicol AM, Hurrell AC, Wahyuni D, McDowall W, Chu W. Accuracy, comprehensibility, and use of material safety data sheets: a review. Am J Ind Med. 2008;51(11):861–76.

    Article  Google Scholar 

  23. Blanc PD, Eisner MD, Balmes JR, Trupin L, Yelin EH, Katz PP. Exposure to vapors, gas, dust, or fumes: assessment by a single survey item compared to a detailed exposure battery and a job exposure matrix. Am J Ind Med. 2005;48(2):110–7.

    Article  CAS  Google Scholar 

  24. Siracusa A, Marabini A, Folletti I, Moscato G. Smoking and occupational asthma. Clin Exp Allergy. 2006;36(5):577–84.

    Article  CAS  Google Scholar 

  25. Baldwin DR, Gannon P, Bright P, Newton DT, Robertson A, Venables K, et al. Interpretation of occupational peak flow records: level of agreement between expert clinicians and Oasys-2. Thorax. 2002;57(10):860–4.

    Article  CAS  Google Scholar 

  26. Malo JL, Trudeau C, Ghezzo H, L'Archeveque J, Cartier A. Do subjects investigated for occupational asthma through serial peak expiratory flow measurements falsify their results? J Allergy Clin Immunol. 1995;96(5 Pt 1):601–7.

    Article  CAS  Google Scholar 

  27. Huggins V, Anees W, Pantin C, Burge S. Improving the quality of peak flow measurements for the diagnosis of occupational asthma. Occup Med (Lond). 2005;55(5):385–8.

    Article  Google Scholar 

  28. Chiry S, Cartier A, Malo JL, Tarlo SM, Lemiere C. Comparison of peak expiratory flow variability between workers with work-exacerbated asthma and occupational asthma. Chest. 2007;132(2):483–8.

    Article  Google Scholar 

  29. Pralong JA, Lemiere C, Rochat T, L'Archeveque J, Labrecque M, Cartier A. Predictive value of nonspecific bronchial responsiveness in occupational asthma. J Allergy Clin Immunol. 2016;137(2):412–6.

    Article  Google Scholar 

  30. Malo JL, Ghezzo H. Recovery of methacholine responsiveness after end of exposure in occupational asthma. Am J Respir Crit Care Med. 2004;169(12):1304–7.

    Article  Google Scholar 

  31. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000;161(1):309–29.

    Article  CAS  Google Scholar 

  32. Vandenplas O, Suojalehto H, Aasen TB, Baur X, Burge PS, de Blay F, et al. Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement. Eur Respir J. 2014;43:1573–87.

    Article  Google Scholar 

  33. Kennedy WA, Girard F, Chaboillez S, Cartier A, Cote J, Hargreave F, et al. Cost-effectiveness of various diagnostic approaches for occupational asthma. Can Respir J. 2007;14(5):276–80.

    Article  Google Scholar 

  34. Girard F, Chaboillez S, Cartier A, Cote J, Hargreave FE, Labrecque M, et al. An effective strategy for diagnosing occupational asthma: use of induced sputum. Am J Respir Crit Care Med. 2004;170(8):845–50.

    Article  Google Scholar 

  35. Beretta C, Rifflart C, Evrard G, Jamart J, Thimpont J, Vandenplas O. Assessment of eosinophilic airway inflammation as a contribution to the diagnosis of occupational asthma. Allergy. 2018;73(1):206–13.

    Article  CAS  Google Scholar 

  36. Global Initiative for Asthma. Global strategy for asthma management and prevention [Last accessed 10th June 2019]. Available from: www.ginasthma.org.

  37. de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma: a Cochrane systematic review. Occup Environ Med. 2012;69(5):373–4.

    Article  Google Scholar 

  38. Nicholson PJ, Cullinan P, Taylor AJ, Burge PS, Boyle C. Evidence based guidelines for the prevention, identification, and management of occupational asthma. Occup Environ Med. 2005;62(5):290–9.

    Article  CAS  Google Scholar 

  39. Rachiotis G, Savani R, Brant A, MacNeill SJ, Newman Taylor A, Cullinan P. Outcome of occupational asthma after cessation of exposure: a systematic review. Thorax. 2007;62(2):147–52.

    Article  Google Scholar 

  40. Lipszyc JC, Silverman F, Holness DL, Liss GM, Lavoie KL, Tarlo SM. Comparison of psychological, quality of life, work-limitation, and socioeconomic status between patients with occupational asthma and work-exacerbated asthma. J Occup Environ Med. 2017;59(7):697–702.

    Article  Google Scholar 

  41. Vandenplas O, Henneberger PK. Socioeconomic outcomes in work-exacerbated asthma. Curr Opin Allergy Clin Immunol. 2007;7(3):236–41.

    Article  Google Scholar 

  42. Larbanois A, Jamart J, Delwiche JP, Vandenplas O. Socioeconomic outcome of subjects experiencing asthma symptoms at work. Eur Respir J. 2002;19(6):1107–13.

    Article  CAS  Google Scholar 

  43. de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, et al. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2011;(5):CD006308.

    Google Scholar 

  44. Patel O, Syamlal G, Wood J, Dodd KE, Mazurek JM. Asthma mortality among persons aged 15-64 years, by industry and occupation - United States, 1999-2016. MMWR Morb Mortal Wkly Rep. 2018;67(2):60–5.

    Article  Google Scholar 

  45. Lee SA, Adhikari A, Grinshpun SA, McKay R, Shukla R, Zeigler HL, et al. Respiratory protection provided by N95 filtering facepiece respirators against airborne dust and microorganisms in agricultural farms. J Occup Environ Hyg. 2005;2(11):577–85.

    Article  CAS  Google Scholar 

  46. Casey ML, Mazurek JM. Respirator use among US Farm operators with asthma: results from the 2011 Farm and Ranch safety survey. J Agromedicine. 2017;22(2):78–88.

    Article  Google Scholar 

  47. Szeinuk J, Beckett WS, Clark N, Hailoo WL. Medical evaluation for respirator use. Am J Ind Med. 2000;37(1):142–57.

    Article  CAS  Google Scholar 

  48. Zacharisen MC, Kadambi AR, Schlueter DP, Kurup VP, Shack JB, Fox JL, et al. The spectrum of respiratory disease associated with exposure to metal working fluids. J Occup Environ Med. 1998;40(7):640–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Toronto Western Hospital, Toronto, ON, Canada

    Ambrose Lau

  2. St Michael’s Hospital, Toronto, ON, Canada

    Ambrose Lau

  3. Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Respiratory Division, Toronto Western Hospital, Toronto, ON, Canada

    Susan M. Tarlo

Authors
  1. Ambrose Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan M. Tarlo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan M. Tarlo .

Editor information

Editors and Affiliations

  1. Mary Parkes Center for Asthma, Allergy & Pulmonary Care, University of Rochester School of Medicine, Rochester, NY, USA

    Sandhya Khurana

  2. Asthma Clinical & Research Programs Pulmonary Sciences and Critical Care, University of Colorado, Denver, CO, USA

    Fernando Holguin

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lau, A., Tarlo, S.M. (2020). Evaluation and Management of Work-Related Asthma. In: Khurana, S., Holguin, F. (eds) Difficult To Treat Asthma. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-20812-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-20812-7_5

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-20811-0

  • Online ISBN: 978-3-030-20812-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation