Occupational Asthma Reference

Walters GI, Huntley CC, Updated review of reported cases of reactive airways dysfunction syndrome, Occup Med, 2020;70:490-495,https://doi.org/10.1093/occmed/kqaa133

Keywords: acute irritant asthma, review, diagnosis, causes

Known Authors

Gareth Walters, Heartlands Gareth Walters

Chris Huntley, University Hospitals Birmingham Chris Huntley

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Abstract

Background
A previous systematic review of the diagnosis of reactive airways dysfunction syndrome (RADS), undertaken from 1985 to 2004, found a lack of standardization of case reporting, thus misattribution of symptoms can occur.

Aims
We aimed to update the systematic review, update the list of reported causes and see whether a more structured approach to reporting has been adopted.

Methods
We undertook a systematic literature review, using the databases EMBASE and Ovid MEDLINE, with search terms ‘reactive airways dysfunction syndrome’ or ‘asthma AND acute irritant’, and reported according to PRISMA guidelines. We included papers and abstracts published from January 2005 to September 2019, and articles were grouped by the presence or absence of diagnostic features: ‘definite’ RADS (met Brooks’ criteria) or ‘possible’ RADS (Brooks’ criteria not met or insufficient data). We collected demographic and diagnostic data for cases, where given.

Results
Eleven papers and six conference abstracts met the inclusion criteria, 13 of which were case series or reports, and comprised 752 cases in total; seven articles met Brooks’ criteria for RADS diagnosis. A variety of agents were implicated, with chlorine or chlorine-releasing molecules most frequently reported.

Conclusions
A lack of standardized reporting of RADS remains. The majority of published articles and conference abstracts either do not meet, or contain insufficient data to judge against, Brooks’ criteria, particularly in relation to onset of symptoms and bronchial hyper-reactivity or variability of airflow obstruction. Some novel agents are described, in keeping with recognized structural taxonomies.

Plain text: Background A previous systematic review of the diagnosis of reactive airways dysfunction syndrome (RADS), undertaken from 1985 to 2004, found a lack of standardization of case reporting, thus misattribution of symptoms can occur. Aims We aimed to update the systematic review, update the list of reported causes and see whether a more structured approach to reporting has been adopted. Methods We undertook a systematic literature review, using the databases EMBASE and Ovid MEDLINE, with search terms 'reactive airways dysfunction syndrome' or 'asthma AND acute irritant', and reported according to PRISMA guidelines. We included papers and abstracts published from January 2005 to September 2019, and articles were grouped by the presence or absence of diagnostic features: 'definite' RADS (met Brooks' criteria) or 'possible' RADS (Brooks' criteria not met or insufficient data). We collected demographic and diagnostic data for cases, where given. Results Eleven papers and six conference abstracts met the inclusion criteria, 13 of which were case series or reports, and comprised 752 cases in total; seven articles met Brooks' criteria for RADS diagnosis. A variety of agents were implicated, with chlorine or chlorine-releasing molecules most frequently reported. Conclusions A lack of standardized reporting of RADS remains. The majority of published articles and conference abstracts either do not meet, or contain insufficient data to judge against, Brooks' criteria, particularly in relation to onset of symptoms and bronchial hyper-reactivity or variability of airflow obstruction. Some novel agents are described, in keeping with recognized structural taxonomies.

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Associated Questions

Registered users of this website have associated this reference with the following questions. This association is not a part of the BOHRF occupational asthma guidelines.

What is irritant-induced asthma? Causes, diagnosis and prognosis
burgeps A review of acute irritant-induced aasthma showing chlorine-related exposures remain the commonest cause, but most reports do not contain enough information to fulfill the original Brooks definition. It seems reasonable to accept increased diurnal variation in PEF or FEV1, or bronchodilator response, in place of mandatory non-specific bronchial reactivity, as this has been shown to be less frequent in neutrophilic (as opposed to eosinophilic) occupational asthma

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