Occupational Asthma Reference

Carlsen KH, Anderson SD, Bjermer L, Bonini S, Brusasco V, Canonica W, Cummiskey J, Delgado L, Del Giacco SR, Drobnic F, Haahtela T, Larsson K, Palange P, Popov T, van Cauwenberge P, Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: Part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN, Allergy, 2008;63:387-403,

Keywords: review,ski, swim,exercise

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Kjell Larsson, Karolinska Institute of Environmental Medicine Kjell Larsson

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Aims: To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features of these conditions and to make recommendations for their diagnosis.

Methods: The Task Force reviewed present literature by searching Medline up to November 2006 for relevant papers by the search words: asthma, bronchial responsiveness, EIB, athletes and sports. Sign criteria were used to assess level of evidence and grades of recommendation.

Results: The problems of sports-related asthma and allergy are outlined. Epidemiological evidence for an increased prevalence of asthma and BHR among competitive athletes, especially in endurance sports, is provided. The mechanisms for development of asthma and bronchial hyperresponsiveness in athletes are outlined. Criteria are given for the diagnosis of asthma and exercise induced asthma in the athlete.

Conclusions: The prevalence of asthma and bronchial hyperresponsiveness is markedly increased in athletes, especially within endurance sports. Environmental factors often contribute. Recommendations for the diagnosis of asthma in athletes are outlined.

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This paper is interesting when considered from an occupational health point of view. Elite athletes are professionals, and so asthma induced by their work comes within the compass of occupational asthma. Guidance for the management of occupational asthma emphasises removal from exposure as the best means of improving prognosis, rather than giving drugs so that even more exposure can take place. The review does not consider the long-term effects of exercise induced asthma, when the exercise is the cause of the asthma and not a non-specific provoker of pre-existing asthma. Does the asthma disappear when the athlete stops exercising? Is there accelerated loss of FEV1 with continuing high-level exercise as has been demonstrated in occupational asthmatics who continue exposure to the causative agent? Are the structural changes in the airways reversible?
If the prognosis is better than most occupational asthma, are there others with occupational asthma who have a better prognosis and how can they be identified? Occupational asthma spans a spectrum from those with clear IgE mediated hypersensitivity, such as laboratory animal allergy, through agents which are at least irritant in high concentrations, such as colophony, to regular low-level exposure to agents which are generally regarded as irritants such as formaldehyde. Limited data suggests that the prognosis in all these groups is not very good.
I hope these issues will be addressed by the expert group and the occupational health advisers to elite athletes.

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