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Occupational asthma: a practical approach
1Department of Internal Medicine, Division of Allergy and Immunology, Saint Louis University School of Medicine, 1402 S. Grand Boulevard R209, St. Louis, MO 63104, USA.
Allergy and Asthma Proceedings
|September 13, 2001
Summary
Diagnosing occupational asthma requires a systematic approach, combining detailed patient history with objective tests like spirometry and specific IgE or IgG antibody levels. Early intervention and avoidance of workplace triggers are crucial for preventing long-term lung impairment.
Area of Science:
- Occupational Medicine
- Pulmonology
- Allergy and Immunology
Background:
- Occupational asthma diagnosis is complex, often relying on patient history, which can be unreliable.
- Distinguishing workplace-induced asthma from non-occupational causes requires a structured evaluation.
Purpose of the Study:
- To outline a systematic approach for diagnosing occupational asthma.
- To emphasize the importance of objective measurements alongside clinical history.
- To guide intervention and disability assessment for occupational asthma.
Main Methods:
- Systematic assessment including presence of asthma and workplace causality.
- Detailed occupational and medical history.
- Objective measurements: spirometry, peak flow, skin testing, in vitro IgE/IgG antibody tests, specific inhalation challenges.
- Assessment of permanent impairment after 2 years of exposure removal.
Main Results:
- Detailed histories alone can lead to diagnostic inaccuracies.
- Work-related changes in spirometry/peak flow can confirm diagnosis in current workers.
- Specific IgE tests are useful for some sensitizers, while IgG levels may correlate better for isocyanates.
- Controlled inhalation tests require expert supervision.
Conclusions:
- A comprehensive, objective approach is essential for accurate occupational asthma diagnosis.
- Prompt intervention focused on exposure reduction is key to preventing chronic lung disease.
- Disability assessment should occur after maximal medical improvement is achieved post-exposure cessation.
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