Occupational Asthma Reference

Barber CM, Cullinan P, Feary J, Fishwick D, Hoyle J, Mainman H, Walters GI, British Thoracic Society Clinical Statement on occupational asthma, Thorax, 2022;77:433-442,http:// dx. doi. org/ 10. 1136/ thoraxjnl- 2021- 218597

Keywords: OA, standard of care, guideline, uk

Known Authors

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

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

Jennifer Hoyle, North Manchester General Hospital Jennifer Hoyle

Chris Barber, Health and Safety Laboratories, Buxton Chris Barber

Gareth Walters, Heartlands Gareth Walters

Jo Feary, Royal Brompton Hospital Jo Feary

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Section 3—diagnosis
? Many patients with OA in the UK are diagnosed at a late stage; healthcare professionals should be aware of the important benefits of recognising cases early.
? All patients of working age with new symptoms suggestive of asthma, reappearance of childhood asthma, deteriorating asthma control or unexplained airflow obstruction should be asked about their job, and whether their symptoms are the same, better or worse on days away from work (eg, rest days or holidays).
? Symptomatic asthma patients in high-risk jobs, and those reporting improvement away from work, should be referred as quickly as possible for specialist assessment (where possible, directly to a specialist occupational lung disease service)
? A diagnosis of OA has important health and employment implications and should not be made based on a compatible history alone.
? The diagnosis of OA is most easily made prior to workplace adaptations and starting maintenance treatment.
? Objective tests commonly used in the UK include skin prick tests (SPTs), specific IgE antibody levels and serial measures of peak expiratory flow (PEF) or airway responsiveness; workplace and specific inhalation challenges (SIC) are less commonly required for OA diagnosis.
Section 4—management
? Managing patients with OA can be complex and should wherever possible be carried out by a physician with specialist expertise in this condition.
? It is important to educate patients with OA that the best opportunity for improved asthma control comes from early, and complete, cessation of exposure to the cause.
? Management of OA includes standard pharmacotherapy, asthma education and smoking
cessation advice, following national guidelines.
? Patients with OA may have coexisting and related conditions (eg, occupational rhinitis, breathing pattern disorder, inducible laryngeal obstruction (ILO), anxiety and depression) that require assessment and treatment.
? Clinicians should work in partnership with patients to develop (and adapt as necessary) a personalised management plan aiming for the best possible balance between long-term health and employment outcomes.Where consent is given, liaising directly with occupational health providers and/or employers gives the best chance of suitable workplace adaptations being made, to keep patients and their coworkers safely employed.
? Patients with OA should be provided with written information confirming their diagnosis, the implications this has on their current and future jobs as well as Industrial Injuries Disablement Benefit (IIDB) and civil compensation advice.
? While there is potential for ongoing exposure to the cause, patients with OA should remain under specialist follow-up to monitor asthma control, lung function and the impact of any workplace interventions.

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