Abstract
Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition.
The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes.
A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent.
The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03–0.91) and recovery (OR 0.30, 95% CI 0.11–0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97–35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11–28.82), compared with complete avoidance of exposure.
This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach.
Footnotes
This article has supplementary material available from www.erj.ersjournals.com
Support Statement
This document presents the results of a systematic review on this specific issue, which has been completed as part of a larger review conducted by the ERS task force on the management of work-related asthma. This paper is not considered part of the official task force report; the full, official report will be presented in future issues of the European Respiratory Journal and the European Respiratory Review. The work of the task force on the management of work-related asthma was funded by the European Respiratory Society. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.
Statement of Interest
None declared.
- Received November 17, 2010.
- Accepted February 11, 2011.
- ©ERS 2011