Medline ® Abstracts for References 2,53,54

of 'Reactive airways dysfunction syndrome and irritant-induced asthma'

2
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Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement.
AU
Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F, Harber P, Lemiere C, Liss GM, Pacheco KA, Redlich CA, Rowe B, Heitzer J
SO
Chest. 2008;134(3 Suppl):1S.
 
BACKGROUND: A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA).
METHODS: A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007.
RESULTS: The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed.
CONCLUSIONS: The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers.
AD
Toronto Western Hospital EW7-449, 399 Bathurst St, Toronto, ON, Canada M5T 2S8. susan.tarlo@utoronto.ca.
PMID
53
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Irritant-associated vocal cord dysfunction.
AU
Perkner JJ, Fennelly KP, Balkissoon R, Bartelson BB, Ruttenber AJ, Wood RP 2nd, Newman LS
SO
J Occup Environ Med. 1998;40(2):136.
 
Vocal cord dysfunction (VCD) is a poorly understood entity that is often misdiagnosed as asthma. We report eleven cases of VCD in which there was a temporal association between VCD onset and occupational or environmental exposure. We conducted a case-control study to determine if the characteristics of irritant-exposed VCD (IVCD) cases differed from non-exposed VCD controls. Chart review of VCD patients at the authors' institution produced 11 cases that met IVCD case criteria. Thirty-three control VCD subjects were selected by age matching. There were statistical differences between the groups in ethnicity and chest discomfort. There were no statistical differences between the groups for gender, tobacco, smoking habits, symptoms, or pulmonary function parameters. Varied irritant exposures were associated with IVCD. IVCD should be considered in patients presenting with respiratory symptoms occurring after irritant exposures.
AD
Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA.
PMID
54
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Eosinophilic bronchitis in the workplace.
AU
Quirce S
SO
Curr Opin Allergy Clin Immunol. 2004;4(2):87.
 
PURPOSE OF REVIEW: The purpose of this review is to report that eosinophilic bronchitis without asthma may occur as an occupational airway disease. This condition is characterized by cough that is responsive to corticosteroids and eosinophilia detectable in the sputum, without variable airflow obstruction or airway hyperresponsiveness.
RECENT FINDINGS: Eosinophilic bronchitis can be regarded as an occupational respiratory disorder when it develops as a consequence of work exposures. Recently, exposure to certain occupational allergens or sensitizers, such as natural rubber latex, mushroom spores, acrylates and an epoxy resin hardener, have been reported to cause eosinophilic bronchitis without asthma. Several hypotheses have been put forward trying to explain why patients with eosinophilic bronchitis do not have airway hyperresponsiveness. It is unknown whether eosinophilic bronchitis may progress to typical occupational asthma, or if eosinophilic airway inflammation may persist when asthma symptoms and airway hyperresponsiveness have waned after the cessation of exposure to the occupational agent.
SUMMARY: Eosinophilic bronchitis, like asthma, may arise from occupational exposures. The examination of induced sputum should be added to the objective monitoring of lung function during periods at work and away from work, as well as before and after specific inhalation challenges with occupational agents.
AD
Fundación Jiménez Díaz, Allergy Department, Madrid, Spain. sequirce@fjd.es
PMID