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Diagnosing occupational asthma: how, how much, how far?

¹ Servizio Autonomo di Allergologia e Immunologia Clinica, Fondazione "S. Maugeri", Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia, Italy. ² Dept of Chest Medicine, Sacré-Cur Hospital, Montreal, Canada. ³ Division of Immunology and Allergy, University of Cincinnati, OH, USA

CORRESPONDENCE: J-L. Malo, Dept of Chest Medicine, Sacré-Cur Hospital, 5400 West Gouin, Montreal, H4J 1C5, Canada. Fax: 1 5143383123. E-mail: malojl@meddir.umontreal.ca

Keywords: environmental hypersensitivity, immediate hypersensitivity, respiratory function tests, respiratory hypersensitivity, respiratory system diagnostic techniques

Received: January 13, 2003
Accepted January 17, 2003

Abstract

Diagnosing occupational asthma is still a challenge because it is based on a stepwise approach in which the depth of investigative means may vary depending on resources. The authors herewith review the existing investigative means from the approach of outlining controversies and queries.

There is no validated clinical questionnaire for diagnosing occupational asthma. Immunological investigation is limited by the lack of standardised extracts for skin-prick testing and specific immunoglobulin E assessments. Criteria for interpretation of changes in peak expiratory flow rates and bronchial responsiveness to pharmacological agents are still open to discussion.

It is worth improving the methodology of specific inhalation challenges, either in the laboratory or in the workplace, to facilitate more extensive use of these tests. Validation of new means that assess airway inflammation, such as exhaled nitric oxide and induced sputum, needs to be performed. There is a need to increase the use of these diagnostic tests because the diagnosis is still too often based on "clinical impression".

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