Asthmatic Subjects Symptomatically Worse at Work: Prevalence and Characterization Among a General Asthma Clinic Population

doi:10.1378/chest.118.5.1309

Chest

Volume 118, Issue 5, November 2000, Pages 1309-1314

https://doi.org/10.1378/chest.118.5.1309 Get rights and content

Study objectives

To assess the prevalence of ahistorical occupational component to asthma in an adult asthma clinicand to compare characteristics of asthmatic subjects with and withoutwork-attributed symptoms.

Design

A retrospectivereview of data obtained from a physician-administered questionnaire,answers to which were obtained at the initial patient visit ofasthmatic subjects, and which included specific questions regarding therelationship of work to symptoms. Chart review data were used tosupplement information on workplace exposures and investigations.

Setting

A university-based secondary- andtertiary-referral asthma clinic.

Patients

Sevenhundred thirty-one adult asthmatic subjects who were referred forassessment and management of asthma.

Interventions

Statistical analyses of asthmatic subjects with and withoutwork-attributed symptoms and a determination, from chart review, of thelikelihood of causes for symptomatic worsening of asthma at work.

Measurements and results

Sixty percent of the patients(435) had adult onset of asthma, among whom 310 patients (71%) wereemployed at the time of their visit. Fifty-one patients reported theirasthma to be worse at work (ie, 16% of adult-onsetworking asthmatic subjects). Sixteen of these patients (31%) hadlikely or possible sensitizer-induced occupational asthma (OA), and49% likely had aggravation of underlying asthma. The other 20% ofpatients had possible OA or aggravation of underlying asthma atwork.

Conclusions

Adult-onset asthmatic subjectscommonly report a worsening of asthma at work, more commonly on thebasis of likely aggravation of underlying asthma than on the basis oflikely or possible OA.

Section snippets

Materials and Methods

The clinic population consisted of 900 referrals to The GageResearch Institute Asthma Clinic (a secondary-referral andtertiary-referral clinic) during a 19-year period (ie,between 1972 and 1990). At the initial referral visit, a questionnairewas completed by all patients that was suitable for computeranalysis. Questions included details of the nature and severityof respiratory symptoms, requirements for emergency visits and hospitaladmissions, triggering factors, details of the home

Prevalence of Asthma Worse at Work

Among the 682 adults who had received a clinical diagnosis ofasthma, the onset of asthma, according to their history, occurredduring adulthood in 435 (64%). Among the 435 patients, 310(71%) were employed at the time of their initial asthma clinic visit.Fifty-one patients reported at their initial visit that their asthmawas worse at work and was not worse on weekends or holidays off work(ie, 16% of the adult-onset employed asthmatics, 12% ofall the adult-onset asthmatic subjects, and 7% of all

Discussion

Our findings of the reported prevalence of worsening asthma atwork of 7% among all adult asthmatic subjects (and 16% of alladult-onset employed asthmatic subjects) in a secondary-referral andtertiary-referral asthma clinic are very similar to those of previousreports among other populations of adult asthmaticsubjects.⁸⁹¹⁰¹¹¹²¹³¹⁴ The advantage of this study includes thedetailed, physician-administered questionnaire and the physiologicdocumentation of all subjects at the time of their initial

ACKNOWLEDGMENT

We thank Justina Greene for assistance in datamanagement, Drs. Arthur Leznoff, Shelley Mintz, Peter Thomas, and thelate Geoff Davies for contributing to the completion of patientquestionnaires, and Laurel O'Connor for secretarial assistance.

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Work-related asthma in a sample of subjects with established asthma
2017, Respiratory Medicine
Citation Excerpt :
These studies show a lower prevalence of WEA respect to our survey, but our population and our methods of assessment (e.g. the questionnaire) were different with respect to Tarlo and Saarinen studies. Tarlo studied a clinic population (without an age limit) during a 19-year period, and it is likely that these patients represented a more severe subgroup of asthmatic subjects [9]. On the contrary, Saarinen carried out a population-based cross-sectional survey of asthmatic subjects (aged 20–65 yrs) and the respondents were asked about the average frequency of work-related asthma symptoms during the last month; these two aspects of the study might have reduced the rate of perception of the work exposure effect [27].
To assess the impact of occupational exposure to irritants or sensitizers on the occurrence, recrudescence and worsening of asthma and to identify unrecognized cases of work related asthma (WRA) including Work-Exacerbated Asthma (WEA) and Occupational Asthma (OA), in a general asthma clinic population sample.
The study was a population-based cross sectional survey. 1289 asthmatic subjects (from 15 to 46 yrs old) living in a vast district of Tuscany (Italy) were identified from the Medical Reimbursement Register of the National Health System. 893 subjects agreed to take part in the study. Subjects who were currently working or had worked in past were classified in different categories of occupational risk exposure (No, Low or High) according to the italian standard classification for industries and job titles, associated with the judgment of occupational hygiene experts.
41% of subjects worked in industries and in job titles at risk for exposure to airway irritants and/or sensitizers, 48.6% reported an occupational exposure to gases, dust and fumes, more males than females. Prevalence of WEA and OA was higher in subjects who worked at higher risk exposure; these subjects reported a higher prevalence of markers of asthma severity (asthma control, level of treatment, FEV1) than subjects without WRA. Risk of WEA was significantly associated to female gender, older age, and self-reported exposure, while risk of OA was associated to job title with higher exposure risk to occupational asthmogens.
Our study shows a high prevalence of WRA (especially WEA) associated with employment in industries and job titles at risk for airways sensitizers and/or irritants; data also support a role for occupational exposure in determining a poor asthma control and a higher level of asthma severity.
Asthma in the Workplace
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition
Diagnosis and frequency of work-exacerbated asthma among bakers
2013, Annals of Allergy, Asthma and Immunology
Work-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment.
To evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA).
The study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test.
Occupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients.
Work-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA.
Incidence of severe asthmatic reactions after challenge exposure to occupational agents
2013, Chest
Specific inhalation challenges (SICs) with occupational agents are used to establish the diagnosis and etiology of occupational asthma. The aim of this study was to assess the frequency and determinants of severe asthmatic reactions induced by various occupational agents during SICs performed using realistic methods of exposure.
The SIC records of 335 consecutive subjects with a positive SIC (ie, ≥ 20% fall in FEV₁) due to various occupational agents were reviewed. Asthmatic reactions were graded as moderate when requiring repeated administration of an inhaled short-acting β₂-agonist (SABA) and severe when requiring repeated SABA and systemic corticosteroids.
Overall, 68 of the 335 subjects (20%) required an inhaled SABA during the SICs. The multivariate logistic regression analysis showed that the need for an inhaled SABA increased when the SIC involved a low-molecular-weight agent (LMW) (OR, 2.47; 95% CI, 1.43-4.28) and marginally so when the subjects required regular treatment with an inhaled corticosteroid (OR, 1.62; 95% CI, 0.93-2.80). The severity of asthmatic reactions was graded as moderate in 12% and severe in 3% of the subjects. Of the 10 severe reactions, five developed after exposures ≤ 5 min. Multivariate logistic regression analysis showed that challenging subjects with a LMW agent was the only significant determinant for the development of moderate/severe reactions (OR, 3.05; 95% CI, 1.62-5.73).
Challenges with LMW agents are associated with a higher risk of an asthmatic reaction requiring pharmacologic treatment. This study may provide useful guidelines for further improving the safety of SICs.
Occupational asthma
2013, Clinical Immunology: Principles and Practice: Fourth Edition
Direct Health Care Costs of Occupational Asthma in Spain: An Estimation From 2008
2012, Archivos de Bronconeumologia
Occupational asthma (OA) is the most common work-related disease in industrialised countries. In 2008, only 556 cases of OA had been diagnosed in Spain, which is quite far from even the most conservative estimates. In this context, the aim of this paper is to estimate the number of asthma cases attributable to the work setting in Spain in 2008 as well as the related health care costs for the same year.
The number of cases of OA was calculated from estimates of attributable risk given by previous studies. The cost estimation focused on direct health-care costs and it was based both on data from the National Health System's (NHS) analytical accounting and from secondary sources.
The number of prevalent cases of work-related asthma in Spain during 2008 ranges between 168 713 and 204 705 cases based on symptomatic diagnosis, entailing an associated cost from 318.1 to 355.8 million Euros. These figures fall to a range between 82 635 and 100 264 cases when bronchial hyperreactivity is included as a diagnostic criterion, at a cost of 155.8–174.3 million Euros. Slightly more than 18 million Euros represent the health-care costs of those cases requiring specialised care.
Estimations of OA are very relevant to adequately prevent this disease. The treatment of OA, which involves a significant cost, is being financed by the NHS, although it should be covered by Social Security.
El asma laboral es la enfermedad respiratoria profesional más frecuente en países industrializados. En 2008 se reconocieron en España 556 casos de asma profesional, lo que contrasta incluso con las estimaciones más conservadoras. El objetivo es estimar el número de casos de asma atribuibles al trabajo en España en 2008, así como el coste de su atención sanitaria el mismo año.
El número de casos de asma derivados del trabajo se calculó partiendo de las estimaciones de riesgo atribuible obtenidas en la literatura científica. La estimación de los costes se centró en los costes sanitarios directos, y se basó en el empleo de datos procedentes tanto de la contabilidad analítica del Sistema Nacional de Salud (SNS) como de fuentes secundarias.
El número de casos prevalentes de asma en España en 2008 atribuido a exposiciones laborales oscilaría entre 168.713 y 204.705 casos cuando el diagnóstico es sintomático, con un coste asociado entre 318,1 y 355,8 millones de euros. Estas cifras descenderían a entre 82.635 y 100.264 casos al añadir la hiperreactividad bronquial como criterio diagnóstico, con un coste de entre 155,8 y 174,3 millones de euros. Algo más de 18 millones corresponden al tratamiento sanitario de los casos que requieren atención especializada.
Estimar la magnitud del asma laboral constituye un elemento muy relevante para activar su adecuada prevención. El SNS asume unos costes significativos relativos a su tratamiento, que en todo caso deberían ser financiados por el sistema de Seguridad Social.

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Chest

Clinical InvestigationsAsthmaAsthmatic Subjects Symptomatically Worse at Work: Prevalence and Characterization Among a General Asthma Clinic Population

Study objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Section snippets

Materials and Methods

Prevalence of Asthma Worse at Work

Discussion

ACKNOWLEDGMENT

Chest

Chest

Chest

Chest

Chest

Lancet

Chest

Chest

Occupational asthma: measures of frequency from four countries

Thorax

Recognition of occupational asthma

Pract Allergy Immunol

Physician based surveillance system for occupational respiratory diseases: the experience of PROPULSE, Quebec, Canada

Occup Environ Med

Clinical Investigations
Asthma
Asthmatic Subjects Symptomatically Worse at Work: Prevalence and Characterization Among a General Asthma Clinic Population