Occupational Asthma Reference
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Lantto J, Suojalehto H, Karvala K, Remes J, Soini S, Suuronen K, Lindström I,
Clinical Characteristics of Irritant-Induced Occupational Asthma,
J Allergy Clin Immunol Pract,
2022;10:1554-1561,https://doi.org/10.1016/j.jaip.2022.02.021
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(Plain text:
Lantto J, Suojalehto H, Karvala K, Remes J, Soini S, Suuronen K, Lindstrom I,
Clinical Characteristics of Irritant-Induced Occupational Asthma,
J Allergy Clin Immunol Pract)
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Keywords: Finland, irritant asthma, follow-up, fu,
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Abstract
Background
Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete.
Objectives
To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA.
Methods
This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients.
Results
Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting ß-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively).
Conclusions
Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
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Comments
This is the best study of outcome from acute or recurrent irritant exposures at work. The outcome after 6-8 months was worse than with sensitiser-induced occupational asthma, with more treatment and more exacerbations. Those with single and repeated large exposures had similar outcomes. At follow-up 46% were in their original jobs, 16% in modified jobs, 10% unemployed, 19% off sick and 9% with other outcomes.
The identified exposures were mixtures (18), Acids and alkalis (25)Inorganic gasses (6), endotoxin (4) and oxidisers (2)
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