Occupational Asthma Reference

Vandenplas O, Suojalehto H, Aasen T, Baur X, Burge PS, de Blay F, Fishwick D, Hoyle J, Maestrelli P, Muñoz X, Moscato G, Sastre J, Sigsgaard T, Suuronen K, Walusiak-Skorupa J, Cullinan P, the ERS Task Force on Specific Inhalation Challenges with Occupational Agents, Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement, Eur Respir J, 2014;43:1573-1587,
(Plain text: Vandenplas O, Suojalehto H, Aasen T, Baur X, Burge PS, de Blay F, Fishwick D, Hoyle J, Maestrelli P, Munoz X, Moscato G, Sastre J, Sigsgaard T, Suuronen K, Walusiak-Skorupa J, Cullinan P, the ERS Task Force on Specific Inhalation Challenges with Occupational Agents, Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement, Eur Respir J)

Keywords: Specific Inhalation challenge, SIC, guidelines, review, ERS, key

Known Authors

Paul Cullinan, Royal Brompton Hospital, London, UK Paul Cullinan

Olivier Vandenplas, Universite Mont-Goginne, Yvoir Olivier Vandenplas

David Fishwick, Royal Hallamshire Hospital, Sheffield, UK David Fishwick

Joaquin Sastre, Fundacion Jimenez Diaz, Madrid Joaquin Sastre

Torben Sigsgaard, University of Aarhus Torben Sigsgaard

Tor Aasen, Haukeland University Hospital, Bergen Tor Aasen

Xaver Baur, Institute of occupational medicine, Hamburg Xaver Baur

Piero Maestrelli, Padova University, Italy Piero Maestrelli

Jennifer Hoyle, North Manchester General Hospital Jennifer Hoyle

Giana Moscato, Fondazione Salvatore Maugeri, Pavia Giana Moscato

Xavier Munoz, Barcelona Xavier Munoz

Hille Suojalehto, Finnish Institute of Occupational Health Hille Suojalehto

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Abstract

This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 so15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum
eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma.

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