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Current Allergy and Asthma Reports

, Volume 12, Issue 3, pp 221–231 | Cite as

Diagnosis of Occupational Asthma: An Update

  • Edgardo J. JaresEmail author
  • Carlos E. Baena-Cagnani
  • R. Maximiliano Gómez
ASTHMA (WJ CALHOUN AND J BOUSQUET, SECTION EDITORS)

Abstract

Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, “Does asthma improve away from work?” is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.

Keywords

Occupational asthma Diagnosis Work related Peak expiratory flow Serial PEF measurement 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Edgardo J. Jares
    • 1
    Email author
  • Carlos E. Baena-Cagnani
    • 2
  • R. Maximiliano Gómez
    • 3
  1. 1.Immunology and Allergy UnitHospital Nacional Alejandro PosadasRamos MejíaArgentina
  2. 2.CIMER (Research Centre for Respiratory Medicine. Faculty of MedicineCatholic University, CordobaCórdobaArgentina
  3. 3.Allergy and Asthma UnitHospital San BernardoSaltaArgentina

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