Medline ® Abstracts for References 2,53,54
of 'Reactive airways dysfunction syndrome and irritant-induced asthma'
Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement.
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
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.
Toronto Western Hospital EW7-449, 399 Bathurst St, Toronto, ON, Canada M5T 2S8. firstname.lastname@example.org.
Persistent asthma following accidental exposure to formaldehyde.
Vandenplas O, Fievez P, Delwiche JP, Boulanger J, Thimpont J
Service de Pneumologie Cliniques universitaires UCL de Mont-Godinne, B-5530 Yvoir, Belgium. email@example.com
Effects of accidental chlorine inhalation on pulmonary function.
Charan NB, Lakshminarayan S, Myers GC, Smith DD
West J Med. 1985;143(3):333.
In an industrial accident, 19 previously healthy workers were briefly exposed to high concentrations of chlorine gas. Pulmonary function tests were done at intervals for about two years but complete follow-up data were available in only 11 subjects. Immediately following the exposure, airway obstruction was detected in 10 of 19 patients; 700 days later this was found in only 3 of 11 patients. Two of these three patients had a history of smoking, however. The mean residual volume was 141% +/- 97 (mean +/- standard error of the mean) on day 1. In subsequent follow-up studies, the residual volume progressively fell in all patients, and 700 days later the mean residual volume was 90% +/- 5. In 5 of the 19 subjects, all pulmonary function test results were within normal limits on day 1. Apparently in some subjects acute exposure to chlorine gas may cause immediate changes in the lung functions, but these changes gradually resolve. Because of the small number of patients in our series, however, the long-term effects of chlorine are less apparent.