Management of an individual worker with occupational asthma
The aim of management of an individual with occupational asthma is to preserve their health and wealth, preferably to leave their employer in business, and to prevent other workers from developing occupational asthma. To do this a confident diagnosis must be made. Occupational asthma should be suspected when asthma symptoms improve on days away from work or on holiday. As these questions have many false-positive answers, the diagnosis needs objective confirmation. The most appropriate first test is to carry out good quality peak flow measurements every 2 hours for about 3 weeks during periods of usual work exposure. Specific IgE is helpful for most highmolecular-weight allergens, and can be used to monitor allergen avoidance. Specific bronchial challenge testing is required in new or difficult situations. Non-specific bronchial hyperresponsiveness is not sufficiently sensitive to use as a screening test for those requiring further investigation. Once a diagnosis has been made workers should be separated into those in whom further (usual level) exposure is unlikely to cause further deterioration in their asthma (mostly those with acute irritantinduced asthma) and those who are sensitised to a workplace agent in whom further usual level exposure commonly leads to deteriorating asthma. There is a hierarchy of control methods when exposure must be eliminated or substantially reduced, going from substitution, source exposure control and individual protection. Examples of each strategy are given. The availability and scope of compensation schemes also affect management; some facilitate re-training and ensuring income preservation much better than others. Successful management nearly always involves cooperation between the affected worker, their employer and their compensation scheme. An accurate clinical diagnosis is a requirement for all of these.
KeywordsSkin Prick Test Peak Expiratory Flow Individual Worker Occupational Asthma Confidence Inter
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