Materiały źródłowe

• #1 Diagnosis of Occupational Asthma – Quirce S, Sastre J (Updated 2020)

  https://www.worldallergy.org/component/content/article/diagnosis-of-occupational-asthma-quirce-s-sastre-j-updated-2020?catid=16&Itemid=101

  Occupational allergy refers to those disorders or conditions that are caused by exposure to allergenic substances in the work environment. […] OA is now the most common work-related respiratory disorder in many industrialized countries. […] The frequency of OA, however, varies among types of industries, and it is dependent on physiochemical properties of the inhaled agent, level and duration of exposure, host factors and industrial hygiene practices. […] OA is defined as a disease characterized by variable airflow limitation and/or airway hyperresponsiveness due to causes and conditions attributable to a particular environment and not to stimuli encountered outside the workplace. […] The diagnosis of OA should be performed using objective methods. […] Thus, proper management of a patient in whom OA is suspected depends on the establishment of a definite diagnosis.

• #1 Occupational asthma: an approach to diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC151995/

  Irritant-induced occupational asthma should be suspected if the symptoms first began within 24 hours after accidental exposure to a high inhaled concentration of a workplace irritant, whereas sensitizer-induced occupational asthma should be suspected if the symptoms begin during a period when the patient is working, are worse at work or in the evenings after work, and diminish during weekends or holidays. If any of these situations apply, further investigations are needed. […] The most definitive form of irritant-induced asthma is reactive airways dysfunction syndrome. The diagnostic criteria for reactive airways dysfunction syndrome are shown in Table 1. […] If this form of occupational asthma is suspected from the patient’s history, objective investigation is required to confirm or refute the diagnosis, since the implications for the patient’s work situation differ for this and other forms of work-related asthma.

• #1 Occupational asthma: Clinical features, evaluation, and diagnosis – UpToDate

  https://www.uptodate.com/contents/occupational-asthma-clinical-features-evaluation-and-diagnosis

  Occupational asthma (OA) is a form of work-related asthma characterized by variable airflow obstruction, airway hyperresponsiveness, and airway inflammation attributable to exposures in the workplace and not due to stimuli encountered outside the workplace. […] The clinical features, evaluation, and diagnosis of suspected sensitizer-induced OA will be reviewed here. […] The typical symptoms of OA are the same as nonoccupational asthma and include cough, sputum production, dyspnea, wheeze, and chest tightness. […] Some patients report a pattern of increased symptoms while at work or within several hours of the completion of a work shift and improvement on weekends or during vacations, but this is variable. […] Once sensitized, workers exposed to high molecular weight (HMW) agents are more likely to report early (eg, within an hour of workplace exposure) asthmatic reactions.

• #1 Occupational asthma: Clinical features, evaluation, and diagnosis – UpToDate

  https://www.uptodate.com/contents/occupational-asthma-clinical-features-evaluation-and-diagnosis

  In contrast, workers exposed to low molecular weight (LMW) agents are more likely to experience late asthmatic reactions, chest tightness at work, daily sputum production, and a higher risk of severe exacerbations. […] The delay in symptom onset with LMW agents may reflect mediation by a non-immunoglobulin E (IgE) mechanism.

• #1 Definition and diagnosis of occupational asthma | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-7643-8556-9_5

  Occupational asthma is a disease characterized by variable airflow limitation and/or hyperresponsiveness and/or inflammation due to causes and conditions attributable to a particular occupational environment and not to stimuli encountered outside the workplace. […] The diagnosis of occupational asthma should be based on objective means and cannot rely only on history (which is, although very sensitive, not sufficiently specific) or even on confirming the presence of asthma with positive skin tests to the relevant allergen/agent found at work. […] Monitoring of peak expiratory flows at and off work is a useful tool but may not be sufficiently sensitive or specific; combining it with monitoring of the provocative concentration of methacoline inducing a 20% fall in FEV1 and possibly sputum induction may improve the accuracy of the diagnosis. […] Specific inhalation challenges in the laboratory or in the workplace are the reference standard for confirming the diagnosis of occupational asthma. […] Any new case of occupational asthma should be considered as a sentinel event.

• #1 Occupational asthma: an approach to diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC151995/

  The initial diagnostic step is to objectively confirm or refute the diagnosis of asthma by means of pulmonary function tests before and after administration of a bronchodilator, with or without a histamine or methacholine challenge test, according to a standard protocol. […] Several studies, including guidelines from the Canadian Thoracic Society, have assessed the value of investigations for occupational asthma. […] Objective investigations are needed, because a diagnosis of occupational asthma often has significant implications for the person’s working situation. Furthermore, a history consistent with occupational asthma has poor specificity for the diagnosis. […] Early referral to a specialist is usually needed for full investigation. […] In cases of sensitizer-induced occupational asthma, early, accurate diagnosis and avoidance of further exposure are associated with the best prognosis. […] A patient with irritant-induced occupational asthma may be able to continue with his or her job, with changes in the workplace, if necessary, to prevent further high-level exposure to irritants.

• #1 Occupational asthma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/occupational-asthma/diagnosis-treatment/drc-20375777

  Diagnosing occupational asthma is similar to diagnosing other types of asthma. However, your healthcare professional also will try to identify whether a workplace substance is causing your symptoms and what substance is causing problems. […] An asthma diagnosis needs to be confirmed with a test called a lung function test. This test shows how well your lungs work. An allergy skin prick test can show if you have allergic reactions to some allergy-causing substances. Blood tests, X-rays or other tests may be necessary to rule out a cause other than occupational asthma. […] Spirometry. During this 10- to 15-minute test, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. A spirometer measures how much air your lungs can hold and how quickly you can breathe out. This is the preferred test for diagnosing asthma.

• #1 Occupational asthma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/occupational-asthma/diagnosis-treatment/drc-20375777

  You’ll likely be asked to use your peak flow meter at certain times during working and nonworking hours. If your breathing improves significantly when you’re away from work, you may have occupational asthma. […] You may need tests to see whether you have a reaction to specific substances. These include: Allergy skin tests. During a skin test, small amounts of common allergy-causing substances are scratched into your skin. Then the area is observed for about 15 minutes. Swelling or a change in skin color indicates an allergy to the substance. […] You inhale a mist containing a small amount of a suspected chemical to see if it triggers a reaction. Your lung function will be tested before and after the test is given to see if the chemical affects your ability to breathe. […] You might need a chest X-ray to diagnose other kinds of job-related breathing problems.

• #1 Work-Related Asthma | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1201/p1839.html

  The initial step is to confirm the diagnosis of asthma. Symptoms and objective examination findings of work-related asthma are indistinguishable from other forms of asthma. Objective tests should confirm the diagnosis. A pulmonary function test should demonstrate postbronchodilator reversible airway obstruction, or a methacholine (or histamine) challenge can enable evaluation of nonspecific bronchial hyper-responsiveness. […] When the diagnosis of asthma is made, the work-relatedness of symptoms should also be confirmed. Thorough medical and work histories are essential to enable evaluation of the temporal association between symptoms and work, and to rule out other causes of the respiratory symptoms. […] Objective testing is often required to differentiate allergic occupational asthma from work-aggravated asthma. Demonstrating skin sensitization to a workplace agent by cutaneous testing supports the possibility of airway sensitization. […] The specific inhalation challenge is considered the gold standard for diagnosing allergic occupational asthma, but it is not frequently used.

• #1 Progress in Occupational Asthma

  https://www.mdpi.com/1660-4601/17/12/4553

  The best diagnostic approach for OA is to combine a detailed clinical history with objective diagnostic tests. The latter include evidence for work-related changes in the airways—peak expiratory flow (PEF), non-specific BHR, sputum eosinophil count, FeNO and/or evidence for specific sensitization—SPT, sIgE, SIC, and basophil activation test (BAT). […] The typical history of OA is the appearance or worsening of asthma symptoms at work and their improvement outside the work environment. […] The presence of non-specific BHR to methacholine/histamine has a high sensitivity (87–95%) for the diagnosis of OA. […] SIC is considered to be the gold standard for confirmation of OA. It mimics the workplace exposure in a controlled environment. […] SPT and assessments of sIgE represent effective ways to support the diagnosis of SI-OA IgE-mediated and can identify the offending agent for most HMW and some LMW agents. […] Biomarkers could increase the likelihood for a diagnosis of OA. According to a recent review the most accurate biomarkers for diagnosis and follow up are those associated with type 2 airway inflammation- sputum eosinophilia and FeNO.

• #1 Diagnosis of Occupational Asthma – Quirce S, Sastre J (Updated 2020)

  https://www.worldallergy.org/component/content/article/diagnosis-of-occupational-asthma-quirce-s-sastre-j-updated-2020?catid=16&Itemid=101

  When the clinical history raises the suspicion of work-relatedness, further action should be taken. […] The assessment of environmental exposures begins with a focused occupational and environmental history. […] Serial monitoring of PEF or spirometry for periods at work and off work has been found to be both sensitive and specific in the diagnosis of OA. […] Specific inhalation challenges are the „gold standard” in the diagnosis of OA. […] Induced sputum can be a useful, noninvasive, tool to support the evidence related to the occurrence of an asthmatic reaction following specific inhalation challenge and to differentiate between truly occupational asthma from aggravation of asthma due to irritants.

• #1 Occupational Asthma Causes, Diagnosis, Treatment & Symptoms

  https://www.emedicinehealth.com/occupational_asthma/article_em.htm

  These tests may be done at the workplace to determine how your airways react to the work environment. The tests are performed before you go to the workplace and then after you have been in the workplace for some time, and the results are compared. […] There is no blood test than can pinpoint the cause of asthma. […] A chest X-ray may also be taken. This is mostly to rule out other conditions that can cause similar symptoms.

• #1 Occupational asthma: an approach to diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC151995/

  A 40-year-old woman comes to the family practice clinic for a routine annual visit. She reports a 6-month history of progressively severe episodic shortness of breath, cough, wheeze and chest tightness. […] Occupational asthma from various causes is being diagnosed with increasing frequency. This article reviews the classification, diagnosis, investigation and management of occupational asthma. […] Occupational asthma is asthma caused by some aspect of the workplace environment. It is important to distinguish occupational asthma from aggravation of pre-existing asthma, because the management and compensation can differ. […] The less common form of occupational asthma, accounting for about 7% of cases, is irritant-induced occupational asthma, which occurs after accidental exposure to very high inhaled concentrations of a workplace irritant. Given that both forms account for only a small proportion of all cases of adult asthma and can be caused by numerous workplace agents, the diagnosis of occupational asthma can easily be overlooked in primary care practice unless it is routinely considered in the assessment of new-onset asthma in a working adult.

• #1 Work-Related Asthma – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/environmental-and-occupational-pulmonary-diseases/work-related-asthma

  Work-related asthma includes both occupational asthma and work-exacerbated asthma. […] Diagnosis is based primarily on occupational history, including assessment of job activities, exposures in the work environment, and a temporal association between work and symptoms. […] Work-related asthma should be suspected in all adults with asthma, especially those with new-onset or worsening asthma. […] Diagnosis of Work-Related Asthma: Clarify the diagnosis of asthma (including pulmonary function testing), Identify work exposures that are associated with asthma, Clarify the temporal relationships between asthma and work. […] Improvement in asthma symptoms when the patient is away from work (eg, on weekends or holidays) should raise suspicion of work-related asthma. […] The diagnosis of work-exacerbated asthma is based on history of pre-existing asthma (symptoms, medical history, medication usage, variable airflow obstruction) and the presence of conditions at work that can exacerbate asthma, which includes common irritants, allergens, extremes of temperature and humidity, and physical exertion in conjunction with increase in asthma symptoms and/or inhaler use.

• #1 Employers’ Guide to Occupational Asthma | The Society of Occupational Medicine

  https://www.som.org.uk/employers-guide-occupational-asthma

  Occupational asthma is a serious condition which can cause workers to be severely disabled; unable to continue in the normal jobs and sometimes having to be retired on the grounds of ill health. […] The best opportunity to reverse or improve occupational asthma occurs with early diagnosis, before lung function is too impaired and with early removal from further exposure to the causative agent. […] The most important measure is the primary prevention of occupational asthma by eliminating or reducing exposure to its causes at work. Secondary prevention involves detecting signs of asthma in employees at an early stage, ideally before they are aware of any symptoms. […] Confirming a diagnosis of occupational asthma is not a simple matter and requires the knowledge and skills of a doctor who has expertise in occupational asthma.

• #1 Diagnostic approach in cases with suspected work-related asthma | Journal of Occupational Medicine and Toxicology | Full Text

  https://occup-med.biomedcentral.com/articles/10.1186/1745-6673-8-17

  The diagnosis of WRA can be performed in three steps: 1. Making the diagnosis of asthma. 2. Identification of the workplace as the cause of the patient’s asthma. 3. Identification of a specific agent causing WRA. […] Objective verification of the association between work exposure and airflow limitation is a basis for diagnosing WRA, both for new onset occupational asthma (OA) and WAA. […] Recognized exposure to a known allergen at work and a provisional diagnosis of WRA should lead to an extensive diagnostic work-up to identify the agent and objectively confirm its causal role. […] Diagnostic tests can be divided into those which should be available to all respiratory physicians and those generally confined to specialists in occupational lung diseases. […] All working patients with asthma and COPD should be asked whether their symptoms improve on days away from work or on holidays. Further investigation is required for all positive respondents.

• #1 Occupational asthma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1111

  Occupational asthma (OA) should be suspected in all adult patients with asthma. […] Occupational history may identify work-related causes. Details of work exposures should be obtained from material safety data sheets available to the patient from their workplace. […] Objective evidence of asthma should be obtained from spirometry, a bronchodilator response, and/or a methacholine challenge. Tests should be performed when the patient is symptomatic and/or within days of exposure to a suspected etiologic agent. […] In sensitizer-induced OA, removal from any further exposure to that agent is recommended if an immunologic response to the work sensitizer is demonstrated by skin or in vitro tests. […] In irritant-induced OA, preventive measures should be implemented in the workplace to reduce future exposures and episodes.

• #1 Work-Related Asthma – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/environmental-and-occupational-pulmonary-diseases/work-related-asthma

  The pharmacologic treatment of work-related asthma is similar to that of other types of asthma. […] Both sensitizer-induced and irritant-induced asthma commonly persists even when patients are away from the causative exposure, and patients may require long-term use of asthma medications. […] Diagnosis consists in clarifying the diagnosis of asthma, identifying workplace exposures associated with asthma, and clarifying the temporal relationship between asthma and work.

• #1 Employers’ Guide to Occupational Asthma | The Society of Occupational Medicine

  https://www.som.org.uk/employers-guide-occupational-asthma

  The outlook is best in those employees who have shorter duration of symptoms and better lung function both at the time of diagnosis and prior to beginning to avoid exposure. […] The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed to identify early signs or symptoms of asthma, rhinitis and conjunctivitis. Employees suspected to have occupational asthma should be referred for further tests immediately that suspicions arise.

• #2 Occupational asthma: Clinical features, evaluation, and diagnosis – UpToDate

  https://www.uptodate.com/contents/occupational-asthma-clinical-features-evaluation-and-diagnosis

  Occupational asthma (OA) is a form of work-related asthma characterized by variable airflow obstruction, airway hyperresponsiveness, and airway inflammation attributable to exposures in the workplace and not due to stimuli encountered outside the workplace. […] The clinical features, evaluation, and diagnosis of suspected sensitizer-induced OA will be reviewed here. […] The typical symptoms of OA are the same as nonoccupational asthma and include cough, sputum production, dyspnea, wheeze, and chest tightness. […] Some patients report a pattern of increased symptoms while at work or within several hours of the completion of a work shift and improvement on weekends or during vacations, but this is variable. […] Once sensitized, workers exposed to high molecular weight (HMW) agents are more likely to report early (eg, within an hour of workplace exposure) asthmatic reactions.

• #2 Diagnosis of Occupational Asthma – Quirce S, Sastre J (Updated 2020)

  https://www.worldallergy.org/component/content/article/diagnosis-of-occupational-asthma-quirce-s-sastre-j-updated-2020?catid=16&Itemid=101

  In the diagnosis of OA, a combination of various functional, environmental, and immunological methods should be used in a stepwise fashion. […] The main aspects that need to be considered in the diagnosis of OA are: Clinical features (bedside); Exposure assessment (workplace); Immunologic responses (molecular); Physiologic assessment (functional); Inflammatory component. […] The clinical history is a key element of the investigation of OA, and it usually provides crucial information on the diagnosis of asthma and the likelihood of its work-relatedness. […] The suspicion is increased if the patient reports worsening of asthma symptoms on working days compared with weekends or holidays. […] The medical history should also identify risk factors. […] The diagnosis of irritant-induced OA depends entirely on the clinical and occupational/environmental history, along with documentation of decreases in airway caliber and objective evidence of nonspecific bronchial hyperresponsiveness.

• #2 Occupational Asthma: Symptoms and Treatment | Doctor

  https://patient.info/doctor/occupational-asthma

  Occupational asthma is a disease characterised by variable airflow limitation and/or airway hyper-responsiveness due to causes and conditions attributable to a particular occupational environment and not to stimuli encountered outside the workplace. The diagnosis of occupational asthma should be suspected in all adults with symptoms of airflow limitation and it should be positively searched for in those with high-risk occupations or exposures. Individuals with suspected occupational asthma should be referred early for specialist assessment; ideally in an occupational lung disease service, if available, or secondary care asthma service, if not. A diagnosis of occupational asthma cannot be made on history alone, even if highly suggestive. Standard objective criteria should be used to confirm the diagnosis of asthma. Diagnostic tests for occupational asthma tend to become less sensitive over time if exposure to the cause has stopped, or reduced significantly, so should be carried out as early as possible. Specific bronchial provocation testing is the gold standard for making a diagnosis of occupational asthma. However, this is a specialised diagnostic technique, and not widely available in the UK; most patients are diagnosed using other investigations.

• #2 Work-Related Asthma | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1201/p1839.html

  The initial step is to confirm the diagnosis of asthma. Symptoms and objective examination findings of work-related asthma are indistinguishable from other forms of asthma. Objective tests should confirm the diagnosis. A pulmonary function test should demonstrate postbronchodilator reversible airway obstruction, or a methacholine (or histamine) challenge can enable evaluation of nonspecific bronchial hyper-responsiveness. […] When the diagnosis of asthma is made, the work-relatedness of symptoms should also be confirmed. Thorough medical and work histories are essential to enable evaluation of the temporal association between symptoms and work, and to rule out other causes of the respiratory symptoms. […] Objective testing is often required to differentiate allergic occupational asthma from work-aggravated asthma. Demonstrating skin sensitization to a workplace agent by cutaneous testing supports the possibility of airway sensitization. […] The specific inhalation challenge is considered the gold standard for diagnosing allergic occupational asthma, but it is not frequently used.

• #2 Occupational asthma

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20375754

  Diagnosing occupational asthma is similar to diagnosing other types of asthma. However, your healthcare professional also will try to identify whether a workplace substance is causing your symptoms and what substance is causing problems. […] An asthma diagnosis needs to be confirmed with a test called a lung function test. This test shows how well your lungs work. An allergy skin prick test can show if you have allergic reactions to some allergy-causing substances. Blood tests, X-rays or other tests may be necessary to rule out a cause other than occupational asthma. […] Lung function tests include: […] Spirometry. During this 10- to 15-minute test, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. A spirometer measures how much air your lungs can hold and how quickly you can breathe out. This is the preferred test for diagnosing asthma.

• #2 Occupational asthma

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20375754

  You will repeat the test after inhaling asthma medicine that helps open airways. Improved lung function after using the medicine supports a diagnosis of asthma. […] Peak flow measurement. You may be asked to carry a small hand-held device called a peak flow meter. This device measures how quickly you can force air out of your lungs. The slower you exhale, the worse your condition. […] You’ll likely be asked to use your peak flow meter at certain times during working and nonworking hours. If your breathing improves significantly when you’re away from work, you may have occupational asthma. […] You may need tests to see whether you have a reaction to specific substances. These include: […] Allergy skin tests. During a skin test, small amounts of common allergy-causing substances are scratched into your skin. Then the area is observed for about 15 minutes. Swelling or a change in skin color indicates an allergy to the substance. These tests can show an allergy to animals, mold, dust mites, plants and latex. They can’t be used to measure a reaction to chemicals.

• #2 Progress in Occupational Asthma

  https://www.mdpi.com/1660-4601/17/12/4553

  The best diagnostic approach for OA is to combine a detailed clinical history with objective diagnostic tests. The latter include evidence for work-related changes in the airways—peak expiratory flow (PEF), non-specific BHR, sputum eosinophil count, FeNO and/or evidence for specific sensitization—SPT, sIgE, SIC, and basophil activation test (BAT). […] The typical history of OA is the appearance or worsening of asthma symptoms at work and their improvement outside the work environment. […] The presence of non-specific BHR to methacholine/histamine has a high sensitivity (87–95%) for the diagnosis of OA. […] SIC is considered to be the gold standard for confirmation of OA. It mimics the workplace exposure in a controlled environment. […] SPT and assessments of sIgE represent effective ways to support the diagnosis of SI-OA IgE-mediated and can identify the offending agent for most HMW and some LMW agents. […] Biomarkers could increase the likelihood for a diagnosis of OA. According to a recent review the most accurate biomarkers for diagnosis and follow up are those associated with type 2 airway inflammation- sputum eosinophilia and FeNO.

• #2 Occupational Asthma

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/occupational-asthma/

  The diagnosis of OA should be considered in all working-age individuals with new-onset asthma or worsening asthma. A detailed history of occupational and potential occupational exposures is just as important as identifying environmental triggers when evaluating an asthmatic patient. […] Although taking a good occupational history is important in establishing a link between symptoms and potential workplace exposures, a history by itself is inadequate to make the diagnosis of OA. Algorithms and information on the diagnosis of OA can be found below and in Figure 1. More detailed information may also be found in the references. […] If possible, skin testing and/or specific IgE assessment should be performed. This is generally most useful for the diagnosis of OA caused by HMW agents. […] A determination of nonspecific bronchial hyperresponsiveness (NSBH) with methacholine or histamine challenge should be performed in all patients suspected of having OA.

• #2 Diagnostic approach in cases with suspected work-related asthma | Journal of Occupational Medicine and Toxicology | Full Text

  https://occup-med.biomedcentral.com/articles/10.1186/1745-6673-8-17

  Spirometry is required in all patients considered for WRA. It is used as a main instrument for monitoring lung function longitudinally during surveillance, also during measurement of non-specific bronchial hyperresponsiveness (NSBHR) and in specific inhalation challenge. […] Serial PEF and spirometry measurements have been shown to be superior to cross-shift change in diagnosing WRA. […] Specific inhalation challenge tests (SIC) are commonly regarded as a reference method for diagnosing sensitizer-induced WRA. However, the test is in practice not well standardized internationally and is sparsely available. […] Specific bronchial provocation testing can produce false positive and false negative results. […] In summary, in spite of their limitations carefully controlled specific challenges come closest to a gold standard test for some agents causing OA.

• #2 Definition and diagnosis of occupational asthma | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-7643-8556-9_5

  Occupational asthma is a disease characterized by variable airflow limitation and/or hyperresponsiveness and/or inflammation due to causes and conditions attributable to a particular occupational environment and not to stimuli encountered outside the workplace. […] The diagnosis of occupational asthma should be based on objective means and cannot rely only on history (which is, although very sensitive, not sufficiently specific) or even on confirming the presence of asthma with positive skin tests to the relevant allergen/agent found at work. […] Monitoring of peak expiratory flows at and off work is a useful tool but may not be sufficiently sensitive or specific; combining it with monitoring of the provocative concentration of methacoline inducing a 20% fall in FEV1 and possibly sputum induction may improve the accuracy of the diagnosis. […] Specific inhalation challenges in the laboratory or in the workplace are the reference standard for confirming the diagnosis of occupational asthma. […] Any new case of occupational asthma should be considered as a sentinel event.

• #2 Occupational asthma

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20375754

  Challenge test. You inhale a mist containing a small amount of a suspected chemical to see if it triggers a reaction. Your lung function will be tested before and after the test is given to see if the chemical affects your ability to breathe. […] Chest X-ray. Occupational asthma is one kind of occupational lung disease. You might need a chest X-ray to diagnose other kinds of job-related breathing problems.

• #2 An overview of Occupational Asthma: Causes, diagnosis, symptoms and prevention 

  https://ioh.org.uk/2022/11/an-overview-of-occupational-asthma-causes-diagnosis-symptoms-and-prevention/

  Occupational Asthma (OA) is a type of asthma caused by inhaling hazardous substances or irritants at work. […] Initial diagnosis of OA involves a consultation with a doctor, to go over the prevalence of symptoms when they occur, type of work, and medical history, example questions are highlighted in table 3. […] However, a diagnosis of occupational asthma should not be made based on a positive history alone, diagnostic tests performed in secondary care are highly valuable in aiding the diagnosis, the tests include: […] Spirometry test – This is a lung function test where a person will need to take a deep breath and blow air out into the spirometer forcibly. […] Fractional exhaled nitric oxide (FeNO) test—the FeNO test measures the amount of nitric oxide present in the breath, which can determine the presence of inflammation in the airways, which might indicate asthma.

• #2 Occupational asthma | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/asthma/occupational-asthma

  If you develop asthma symptoms when you did not have any before, you may have occupational asthma. […] How is occupational asthma diagnosed? […] If your GP thinks you may have occupational asthma, they will refer you to a specialist. You will do tests to confirm a diagnosis. These may include: […] A peak flow test. You will need to do this at least four times a day for at least three weeks and keep a diary of the results. […] Blood tests or skin prick tests. These test whether you may be allergic to something you are exposed to at work. […] Some people also have challenge tests. A challenge test involves exposing you to the substance or substances that may be causing the symptoms.

• #2 Understanding Occupational Asthma | Severe Asthma Toolkit

  https://toolkit.severeasthma.org.au/diagnosis-assessment/triggers-occupational-asthma/

  Work-related asthma includes both asthma that has been caused by work (occupational asthma) and asthma that is exacerbated by work (work-exacerbated asthma). […] Occupational asthma can be subdivided into sensitiser-induced and irritant-induced subtypes. […] Diagnosis of occupational asthma requires objective confirmation of the diagnosis of asthma and demonstration of an association between asthma and the workplace. […] The diagnosis must be made accurately due to the potential negative socioeconomic implications of the management of the condition, therefore should be confirmed by a specialist with expertise in occupational asthma. […] Diagnosis of occupational asthma requires a combination of investigations: Confirmation of asthma diagnosis, Clinical history and screening questions, Lung function assessment and monitoring, Allergy testing, Specific inhalation challenge, Workplace challenge.

• #2 Occupational asthma: Definitions, epidemiology, causes, and risk factors – UpToDate

  https://www.uptodate.com/contents/occupational-asthma-definitions-epidemiology-causes-and-risk-factors

  Occupational asthma (OA) is a form of work-related asthma characterized by variable airflow obstruction, airway hyperresponsiveness, and airway inflammation attributable to a particular exposure in the workplace and not due to stimuli encountered outside the workplace. […] Two types of OA are distinguished based on their appearance after a latency period: (1) OA caused by workplace sensitizers: allergic or immunological (with a latency period); (2) OA caused by irritants: nonallergic or nonimmunologic, irritant-induced asthma. […] Occupational asthma accounts for approximately 10 to 25 percent of adult onset asthma. […] In the case of allergic OA, a high degree of clinical suspicion is needed as the asymptomatic latency period of exposure for sensitization varies from a few months to several years, depending on several factors, including the intensity of exposure, the specific sensitizing agent, and individual susceptibility.

• #2 Occupational asthma: an approach to diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC151995/

  Irritant-induced occupational asthma should be suspected if the symptoms first began within 24 hours after accidental exposure to a high inhaled concentration of a workplace irritant, whereas sensitizer-induced occupational asthma should be suspected if the symptoms begin during a period when the patient is working, are worse at work or in the evenings after work, and diminish during weekends or holidays. If any of these situations apply, further investigations are needed. […] The most definitive form of irritant-induced asthma is reactive airways dysfunction syndrome. The diagnostic criteria for reactive airways dysfunction syndrome are shown in Table 1. […] If this form of occupational asthma is suspected from the patient’s history, objective investigation is required to confirm or refute the diagnosis, since the implications for the patient’s work situation differ for this and other forms of work-related asthma.

• #2

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2021/01000/novel_approaches_in_occupational_asthma_diagnosis.4.aspx?generateEpub=Article%7Cco-pulmonarymedicine:2021:01000:00004%7C10.1097/mcp.0000000000000737%7C

  To describe the recent findings of the last 2 years on the epidemiology and phenotypes of occupational asthma, as well as new developments in its diagnosis and management. […] Recently, a specific inhalation challenge (SIC)-independent model has been developed to calculate the probability of occupational asthma diagnosis in workers exposed to HMW agents. […] An early and precise diagnosis of occupational asthma is crucial, allowing appropriate management and implementation of preventive strategies.

• #2 Employers’ Guide to Occupational Asthma | The Society of Occupational Medicine

  https://www.som.org.uk/employers-guide-occupational-asthma

  The outlook is best in those employees who have shorter duration of symptoms and better lung function both at the time of diagnosis and prior to beginning to avoid exposure. […] The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed to identify early signs or symptoms of asthma, rhinitis and conjunctivitis. Employees suspected to have occupational asthma should be referred for further tests immediately that suspicions arise.

• #2

  https://aaem.pl/Occupational-asthma-diagnosis-in-workers-exposed-to-organic-dust-,72853,0,2.html

  Occupational asthma diagnosis in workers exposed to organic dust. The clinical evaluation of newly developed asthma in an adult should always include consideration of his occupational environment, since an abundance of different exposures, which are known causes of asthma, occur in workplaces. Two types of occupational asthma (OA) are distinguished, by whether they appear after a latency period: 1) Immunological OA, characterised by a latency period, caused by high and low-molecular-weight agents, with or without an IgE mechanism 2) Non-immunological, i.e. irritant induced asthma. The first step of the clinical evaluation is to confirm a diagnosis of asthma. Second step is to find out if there is a temporo-spatial distribution of symptoms and lung function that are indicative of OA. Third step is to determine if the disease at hand is an IgE or a non-IgE mediated disease. Last step is a challenge test that can be either unspecific, in order to assess the responsiveness of the lung, or specific challenge test, especially for the non-IgE mediated OA. The depth of clinical evaluation may vary from a situation in which a classical history confirms the clinical symptoms in e.g. a baker with confirmed allergy towards well-known allergens and a characteristic pattern in serial measurements of lung function, to more elaborate investigations in a situation with no or unknown allergen. In the latter situation, a specific challenge test might be necessary in order to find the offending agent. Finally, challenge tests are important in order to distinguish a causal relation from unspecific hyperresponsiveness in persons with pre-existing asthma. In these situations, extended sick leave and challenge tests can be the only way to find the answer.

• #2 British Thoracic Society Clinical Statement on occupational asthma | Thorax

  https://thorax.bmj.com/content/77/5/433

  Healthcare professionals should be aware that occupational exposures account for around one in six cases of asthma in adults of working age. […] Health surveillance is a form of workplace screening that can identify OA cases early. In the UK, it usually consists of an annual symptom questionnaire and spirometry. […] Many patients with OA in the UK are diagnosed at a late stage; healthcare professionals should be aware of the important benefits of recognising cases early. […] All patients of working age with new symptoms suggestive of asthma, reappearance of childhood asthma, deteriorating asthma control or unexplained airflow obstruction should be asked about their job, and whether their symptoms are the same, better or worse on days away from work (eg, rest days or holidays). […] A diagnosis of OA has important health and employment implications and should not be made based on a compatible history alone.

• #2 Occupational asthma: an approach to diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC151995/

  The initial diagnostic step is to objectively confirm or refute the diagnosis of asthma by means of pulmonary function tests before and after administration of a bronchodilator, with or without a histamine or methacholine challenge test, according to a standard protocol. […] Several studies, including guidelines from the Canadian Thoracic Society, have assessed the value of investigations for occupational asthma. […] Objective investigations are needed, because a diagnosis of occupational asthma often has significant implications for the person’s working situation. Furthermore, a history consistent with occupational asthma has poor specificity for the diagnosis. […] Early referral to a specialist is usually needed for full investigation. […] In cases of sensitizer-induced occupational asthma, early, accurate diagnosis and avoidance of further exposure are associated with the best prognosis. […] A patient with irritant-induced occupational asthma may be able to continue with his or her job, with changes in the workplace, if necessary, to prevent further high-level exposure to irritants.

• #3 Occupational asthma: Definitions, epidemiology, causes, and risk factors – UpToDate

  https://www.uptodate.com/contents/occupational-asthma-definitions-epidemiology-causes-and-risk-factors

  Occupational asthma (OA) is a form of work-related asthma characterized by variable airflow obstruction, airway hyperresponsiveness, and airway inflammation attributable to a particular exposure in the workplace and not due to stimuli encountered outside the workplace. […] Two types of OA are distinguished based on their appearance after a latency period: (1) OA caused by workplace sensitizers: allergic or immunological (with a latency period); (2) OA caused by irritants: nonallergic or nonimmunologic, irritant-induced asthma. […] Occupational asthma accounts for approximately 10 to 25 percent of adult onset asthma. […] In the case of allergic OA, a high degree of clinical suspicion is needed as the asymptomatic latency period of exposure for sensitization varies from a few months to several years, depending on several factors, including the intensity of exposure, the specific sensitizing agent, and individual susceptibility.

• #3

  https://link.springer.com/article/10.1007/s11882-012-0259-2

  Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, Does asthma improve away from work? is of the highest sensitivity. […] A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test, a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.

• #3 Occupational asthma

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20375754

  You will repeat the test after inhaling asthma medicine that helps open airways. Improved lung function after using the medicine supports a diagnosis of asthma. […] Peak flow measurement. You may be asked to carry a small hand-held device called a peak flow meter. This device measures how quickly you can force air out of your lungs. The slower you exhale, the worse your condition. […] You’ll likely be asked to use your peak flow meter at certain times during working and nonworking hours. If your breathing improves significantly when you’re away from work, you may have occupational asthma. […] You may need tests to see whether you have a reaction to specific substances. These include: […] Allergy skin tests. During a skin test, small amounts of common allergy-causing substances are scratched into your skin. Then the area is observed for about 15 minutes. Swelling or a change in skin color indicates an allergy to the substance. These tests can show an allergy to animals, mold, dust mites, plants and latex. They can’t be used to measure a reaction to chemicals.

• #3 Diagnostic approach in cases with suspected work-related asthma | Journal of Occupational Medicine and Toxicology | Full Text

  https://occup-med.biomedcentral.com/articles/10.1186/1745-6673-8-17

  Spirometry is required in all patients considered for WRA. It is used as a main instrument for monitoring lung function longitudinally during surveillance, also during measurement of non-specific bronchial hyperresponsiveness (NSBHR) and in specific inhalation challenge. […] Serial PEF and spirometry measurements have been shown to be superior to cross-shift change in diagnosing WRA. […] Specific inhalation challenge tests (SIC) are commonly regarded as a reference method for diagnosing sensitizer-induced WRA. However, the test is in practice not well standardized internationally and is sparsely available. […] Specific bronchial provocation testing can produce false positive and false negative results. […] In summary, in spite of their limitations carefully controlled specific challenges come closest to a gold standard test for some agents causing OA.

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