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Workplace-specific challenges as a contribution to the diagnosis of occupational asthma

Dept of Chest Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada

CORRESPONDENCE: M. Labrecque, Dept of Chest Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 West Gouin Blvd, Montreal, QC, Canada H4J 1C5. Fax: 1 5143383123. E-mail: manon.labrecque{at}UMontreal.ca

Keywords: Asthma, occupational asthma, specific challenges, workplace

Received: August 3, 2007
Accepted May 7, 2008

The diagnosis of occupational asthma can be made by exposing workers to the relevant agent either in a hospital laboratory through specific inhalation challenges (SICs) or in the workplace. As suggested by several authors, workers with negative laboratory SIC can be monitored at the workplace under supervision. The present study aims to assess the frequency of, and identify factors associated with, a positive workplace reaction in workers with negative SIC in the laboratory.

The results of workplace challenges were examined in 99 workers who underwent negative SIC between 1994 and 2004. A positive reaction either in the SIC or in the workplace was defined as a sustained fall in forced expiratory volume in one second of 20%.

In total, 22 (22.2%) workers showed positive responses at the workplace. These subjects more often had increased baseline methacholine responsiveness (90.5 versus 67.6%). They also underwent more days of SIC testing (4.9 versus 3.3 days) and were exposed more often to two or more agents (56 versus 28.4%) and for a longer period of time (363.3 versus 220.4 min) in the laboratory.

The present study illustrates the usefulness of workplace monitoring of airway function in the investigation of occupational asthma and identifies factors that are more often associated with a positive reaction.