Current Reviews of Allergy and Clinical ImmunologyOccupational asthma☆,☆☆
Section snippets
Historical aspects and definition
Although the influence of the working environment on the onset of asthma was recognized long ago, especially by Ramazzini in the early 18th century, the ongoing interest in the condition arose from the work, enthusiasm, and insight of the late Jack Pepys. Between 1960 and 1980, Pepys described numerous causes of occupational asthma (OA) and rightly suggested an experimental reproduction of the asthmatic reaction in a hospital laboratory (Fig 1), renewing interest in the late asthmatic reaction
Physiopathology
Although some agents induce asthma through type I hypersensitivity reaction with the production of specific IgE antibodies, the immunologic mechanism or mechanisms responsible for other agents, such as plicatic acid, the agent responsible for Western red cedar asthma, have not yet been clearly identified. For other agents, such as diisocyanates, both immunologic and nonimmunologic mechanisms are involved.
Frequency
The role of epidemiology and methodological issues of this discipline, as well as outcome measurements in the specific field of OA, have been thoroughly reviewed in other contributions.26, 27 In recent years, several large population-based studies of asthma, including some information on the occupation, have been carried out; a major impetus came from the European Community Respiratory Health Survey.28 Such community-based surveys have yielded estimates of the attributable risk, causative
Clinical aspects
It is important to confirm OA by means of objective testing. An open questionnaire administered during a medical consultation has a reasonable sensitivity but lacks specificity.61 Diagnosing OA on the ground of a compatible history only is unacceptable. This is especially important because the diagnosis of OA carries significant social and financial consequences. Unlike pneumoconiosis, subjects with OA tend to be young. Liss et al62 showed that subjects with OA have higher rates of
Compensation
Medicolegal agencies should require objective testing before accepting a claim for OA. Once this essential step has been taken, proper rehabilitation programs should be offered. The cost-effectiveness of the Quebec system of compensation has been reported previously.78 This scheme provides workers with a full salary generally for up to 2 years (ie, the time required for proper retraining into a new occupation for workers who can no longer stay with the same employer). In a survey of 134 workers
Conclusion
In the past 2 decades, there have been considerable advances in the field of OA through the identification of new agents, methods of diagnosis, knowledge of pathophysiology, and natural history of disease. However, a great deal of work has to be done, especially in the primary prevention of the disease. Although the reduction of exposure in high-risk industries remains the single most important tool of primary prevention, we look forward to exciting possibilities in the coming decade. Advances
Acknowledgements
We thank Denyse Gautrin for providing useful data and criticism and Lori Schubert for reviewing the manuscript.
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2011, Respiratory MedicineCitation Excerpt :OA may result either from immunologically-mediated sensitization to occupational agents (i.e. ‘hypersensitivity induced OA’ or ‘allergic’ occupational asthma) or from exposure(s) to high concentrations of irritant compounds (i.e., ‘acute irritant-induced asthma’), best typified by the ‘reactive airways dysfunction syndrome’.2,4,5 Much of what is currently known about the incidence and etiological agents of immunological OA is based upon voluntary notification programs6–14 and medico-legal statistics or occupational disease registers.15–18 However, there is not much information available on the changes over time in the pattern of OA.
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Supported by a grant from Glaxo Wellcome Inc., Research Triangle Park, NC
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Reprint requests: Jean-Luc Malo, MD, Department of Respiratory Medicine, Sacré-Coeur Hospital, 5400 West Gouin Blvd, Montreal, Canada H4J 1C5.