Inhalation of a range of agents can result in airway inflammation and/or irritation. This may result in occupational asthma or reactive airways dysfunction syndrome. Reactive airways dysfunction syndrome follows a single large exposure to a chemical agent but is now frequently embraced under the wider term of irritant-induced asthma, a term that also includes asthma due to persistent, lower dose irritant exposures.
Bronchial hyperresponsiveness is a hallmark of both occupational asthma and reactive airways dysfunction syndrome, although some patients with occupational asthma may occasionally have typical clinical features without increased bronchial hyperresponsiveness. Following removal of the causal agent in occupational asthma, bronchial hyperresponsiveness generally returns towards normal over a 2-year period, although some individuals demonstrate increased bronchial hyperresponsiveness for longer. Measurement of specific bronchial hyperresponsiveness to the primary causal agent in occupational asthma is used diagnostically but not for assessing prognosis.
Bronchial hyperresponsiveness to inhaled methacholine can be measured across individual workshifts to assess work-related change. It may also be measured at the end of a work period when exposure has occurred, and compared with values following a period away from work. There have been no direct, systematic comparisons of changes in methacholine responsiveness in the diagnosis of occupational asthma compared with the more frequently used serial peak flow measurements. Patients with reactive airways dysfunction syndrome classically exhibit non-specific bronchial hyperresponsiveness, which can be readily measured by evaluating responses to inhaled methacholine. Bronchial hyperresponsiveness in reactive airways dysfunction syndrome can persist for many years after initial exposure and serial changes can be used to assess recovery and subsequent disability over time.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guidelines on the management of asthma. Thorax 2003; 58Suppl. 1: i1–94
Hendrick DJ, Burge PS, Beckett WS, et al. Occupational disorders of the lung: recognition, management, and prevention. London: WB Saunders, 2002: 37–42
Chan-Yeung M, Malo JL, Tarlo SM, et al. Proceedings of the first Jack Pepys Occupational Asthma Symposium. Am J Respir Crit Care Med 2003; 167: 450–71
Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures. Chest 1985; 88: 376–84
Bardana Jr EJ. Occupational asthma and related respiratory disorders. Dis Mon 1995; 41: 143–99
Tarlo SM. Workplace irritant exposures: do they produce true occupational asthma? Ann Allergy Asthma Immunol 2003; 90: 19–23
Gautrin D, Leroyer C, Infante-Rivard C, et al. Longitudinal assessment of airway caliber and responsiveness in workers exposed to chlorine. Am J Respir Crit Care Med 1999; 160: 1232–7
Chan-Yeung M. Assessment of asthma in the workplace: American College of Chest Physicians consensus statement. Chest 1995; 108: 1084–117
Luo JC, Nelsen KG, Fischbein A. Persistent reactive airway dysfunction syndrome after exposure to toluene diisocyanate. Br J Ind Med 1990; 47: 239–41
Balmes JR. Occupational airways diseases from chronic low-level exposures to irritants. Clin Chest Med 2002; 23: 727–35, vi
Banauch GI, Alleyne D, Sanchez R, et al. Persistent hyperreactivity and reactive airway dysfunction in firefighters at the World Trade Center. Am J Respir Crit Care Med 2003; 168: 54–62
Burge PS, Pantin CF, Newton DT, et al. Development of an expert system for the interpretation of serial peak expiratory flow measurements in the diagnosis of occupational asthma. Midlands Thoracic Society Research Group. Occup Environ Med 1999; 56: 758–64
Currie GP, Jackson CM, Lipworth BJ. Does bronchial hyperresponsiveness in asthma matter? J Asthma 2004; 41: 247–58
Xu X, Niu T, Chen C, et al. Association of airway responsiveness with asthma and persistent wheeze in a Chinese population. Chest 2001; 119: 691–700
Pattemore PK, Asher MI, Harrison AC, et al. The interrelationship among bronchial hyperresponsiveness, the diagnosis of asthma, and asthma symptoms. Am Rev Respir Dis 1990; 142: 549–54
Woolcock AJ, Peat JK, Salome CM, et al. Prevalence of bronchial hyperresponsiveness and asthma in a rural adult population. Thorax 1987; 42: 361–8
Weiss ST, Van Natta ML, Zeiger RS. Relationship between increased airway responsiveness and asthma severity in the childhood asthma management program. Am J Respir Crit Care Med 2000; 162: 50–6
Ramsdell JW, Nachtwey FJ, Moser KM. Bronchial hyperreactivity in chronic obstructive bronchitis. Am Rev Respir Dis 1982; 126: 829–32
Du Toit JI, Woolcock AJ, Salome CM, et al. Characteristics of bronchial hyperresponsiveness in smokers with chronic air-flow limitation. Am Rev Respir Dis 1986; 134: 498–501
Yan K, Salome CM, Woolcock AJ. Prevalence and nature of bronchial hyperresponsiveness in subjects with chronic obstructive pulmonary disease. Am Rev Respir Dis 1985; 132: 25–9
Crapo RO, Casaburi R, Coates AL, et al. Guidelines for methacholine and exercise challenge testing-1999: this official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 2000; 161: 309–29
Currie GP, Lee DK, Haggart K, et al. Effects of montelukast on surrogate inflammatory markers in corticosteroid-treated patients with asthma. Am J Respir Crit Care Med 2003; 167: 1232–8
Sippel JM, Holden WE, Tilles SA, et al. Exhaled nitric oxide levels correlate with measures of disease control in asthma. J Allergy Clin Immunol 2000; 106: 645–50
Anees W, Huggins V, Pavord ID, et al. Occupational asthma due to low molecular weight agents: eosinophilic and non-eosinophilic variants. Thorax 2002; 57: 231–6
Lee DK, Gray RD, Lipworth BJ. Adenosine monophosphate bronchial provocation and the actions of asthma therapy. Clin Exp Allergy 2003; 33: 287–94
Beach JR, Young CL, Avery AJ, et al. Measurement of airway responsiveness to methacholine: relative importance of the precision of drug delivery and the method of assessing response. Thorax 1993; 48: 239–43
Cockcroft DW, Marciniuk DD, Hurst TS, et al. Methacholine challenge: test-shortening procedures. Chest 2001; 120: 1857–60
Newman Taylor A, Nicholson P. Guidelines for the prevention, identification and management of occupational asthma: evidence review and recommendations. London: British Occupational Health Research Foundation, 2004
Cartier A, Bernstein IL, Burge PS, et al. Guidelines for bronchoprovocation on the investigation of occupational asthma. Report of the Subcommittee on Bronchoprovocation for Occupational Asthma. J Allergy Clin Immunol 1989; 84: 823–9
Tan RA, Spector SL. Diagnostic testing in occupational asthma. Ann Allergy Asthma Immunol 1999; 83: 587–92
Malo JL, Cartier A, Ghezzo H, et al. Patterns of improvement in spirometry, bronchial hyperresponsiveness, and specific IgE antibody levels after cessation of exposure in occupational asthma caused by snow-crab processing. Am Rev Respir Dis 1988; 138: 807–12
Gannon PF, Weir DC, Robertson AS, et al. Health, employment, and financial outcomes in workers with occupational asthma. Br J Ind Med 1993; 50: 491–6
Malo JL, Ghezzo H. Recovery of methacholine responsiveness after end of exposure in occupational asthma. Am J Respir Crit Care Med 2004; 169: 1304–7
Malo JL, Cartier A, Cote J, et al. Influence of inhaled steroids on recovery from occupational asthma after cessation of exposure: an 18-month double-blind crossover study. Am J Respir Crit Care Med 1996; 153: 953–60
Gautrin D, Boulet LP, Boutet M, et al. Is reactive airways dysfunction syndrome a variant of occupational asthma? J Allergy Clin Immunol 1994; 93: 12–22
No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
About this article
Cite this article
Currie, G.P., Ayres, J.G. Assessment of Bronchial Responsiveness Following Exposure to Inhaled Occupational and Environmental Agents. Toxicol Rev 23, 75–81 (2004). https://doi.org/10.2165/00139709-200423020-00002
- Peak Expiratory Flow
- Occupational Asthma
- Bronchial Hyperresponsiveness