Management of sensitizer-induced occupational asthma: avoidance or reduction of exposure?

To address the following question: in the management of occupational asthma does current evidence support complete avoidance of further exposure to the causative agent, or is reduction in exposure sufficient to control asthma and less likely to result in loss of income or job loss?

A recently published Cochrane review of workplace interventions in the management of occupational asthma compared complete removal from exposure to the causative agent with reduction of exposure and continued exposure. Results suggested that complete removal from exposure resulted in the best outcome in terms of symptoms, lung function, and airway hyper-responsiveness. Reduction of exposure appeared to be less effective in terms of improving asthma but was also less likely to result in loss of income or unemployment. A second systematic review reported similar results.

There is no single solution to the question about ongoing workplace exposure for an individual with occupational asthma. There are good reasons for removing an individual from exposure in terms of clinical improvement, but this may have consequences in terms of income and employment. It is necessary to consider all these aspects when advising patients if their health is to be maximized.