[Effectiveness of secondary preventive programs for patients with asthma and rhinitis in the baking industry]

Since 1992 the German industrial professional association for the food industry and gastronomy (Berufsgenossenschaft Nahrungsmittel und Gaststätten), which is responsible for statutory accident insurance has been offering a specific patient education programme to bakers suffering from occupationally induced obstructive pulmonary disease or allergic rhino-conjunctivitis, who do not quit their jobs and wish to continue working as bakers. The programme aims at preventing aggravation of the disease 74 male bakers with a mean duration of illness of 10 years on entering the programme were examined between 1 and 5 years (mean: 2.9) after participating in the patient education seminar. For a subpopulation of 55 of these patients spirometric measurements were available for the time before programme entry and at follow-up. Data on time spent at the bakehouse, prevalence of symptoms, frequency of symptoms at the site of working and during leisure hours, sleep disturbances and emergency situations were collected at the follow-up examination both for the time before programme entry and at follow-up, respectively. Direct ratings of the amount of changes in distress caused by the disease and of the quality of life were also obtained. The prevalence of 8 of the 9 most frequently reported symptoms decreased significantly, e.g. dysponoea from 70% to 42% and fear of suffocation from 30% to 3%. Participants reported on highly significant reductions in the frequency of disease-specific complaints during work and outside the working place, sleep disturbances and situations requiring immediate medical intervention. Between 64% and 85% of the patients experienced improvement of distress, physical and work performance, private and family life, and ability for self-management. Lung function did not deteriorate: mean FEV1 was 88% (+/- 23) at first and 90% (+/- 19) at second measurement. These results could not be explained by changes in medication. It is concluded that the programme is effective in reducing symptoms and distress and in improving quality of life in bakers with occupational respiratory disease who voluntarily continue to work as bakers.