User:Saltrabook/Clinical diagnostic guidelines/Enfermedades respiratorios

Diagnostics of work-related asthma

Definitions

• Occupational Asthma and -rhinitis: Asthma and rhinitis, which occurs as a result of exposure to factors in the work environment
• Asthma aggravated by work / -rhinitis: increased symptoms of asthma / rhinitis by exposure at work in people who have the disease prior to release;
• Inflammatory asthma: A state with increased increased bronchial reactivity and asthma after exposure to high concentrations of respiratory irritants
• Occupational-related asthma / -rhinitis is a generic term for occupational asthma, inflammatory and aggravated by the work

Occurrence

• Approximately 10% (9-15%) of asthma in adulthood is related to work. About half of this is occupational asthma, caused by exposure at work
• Occupational-related rhinitis is assumed to be 3 times more common than asthma. Work-related rhinitis is the risk of asthma increased
• Bakers, farmers and people who work with animals, enzymes, isocyanates and anhydrides have an increased risk of sensitization and development of occupational asthma / rhinitis. Overall, exposure to airborne protein and reactive chemicals increased risk of asthma
• Board of industrial Injuries receives about 300 notifications of allergic respiratory disease per year, about half recognized
• Strong exposure (accidents) for respiratory irritants such as chlorine or fire smoke can in rare cases cause inflammatory asthma. It is debatable whether repeated moderate exposure can induce mode

Risk Factors

• Exposure to high molecular weight proteins (plants, animals, enzymes)
• Low-molecular substances: latex, isocyanates, formaldehyde, acid anhydrides, certain metals
• Atopics and people with asthma in the family are at increased risk for allergic reactions to high molecular weight allergens
• Smokers appear to have an increased risk of asthma by exposure to low molecular weight substances
• High level of exposure leads to increased risk of allergies - the possibility of prevention!

Clinic and diagnostics

• Work-related asthma and rhinitis have the same appearance as the diseases in general, see the section on allergy

The disease occurs after exposure for weeks to months, if necessary. only after several years

• The relation to exposure at work can be immediately response and delayed response after 6-8 hours. Dual response - the presence of both reactions are common in IgE mediated asthma
• Study of atopy (total IgE) and allergy to standard respiratory sensitisers RAST, skin prick test

Study of specific allergies in relation to the work: RAST, skin prick test, histamine release (HR) test

• When exposed to low molecular weight chemicals detected specific allergy, in most cases
• Inflammatory asthma is probably due to direct damage to the mucosa and attack Outpouring of nonspecific irritation
• Possibly. provocation with the suspected allergen. emergency treatment required
• Peak flow monitoring at least 4 daily measurements during periods of work and leisure, for example. a week of each. Any sick leave, which means elimination
• Temporary interruption of medication considered for peak flow monitoring, testing for bronchial hyperreactivity, reversibilitetstest and provocation

Causation

• The criteria for occupational asthma / rhinitis (asthma caused by work) is a) debut after recruitment, b) appropriate temporal relation to work, c) exposure to a pathogenic topic at work
• Positive RAST or skin prick test detected most frequently by allergies to high molecular weight allergens, less often (about 30%) with low molecular weight substances
• Occupational aggravated disease assessed from a) disease history , b) the relationship of symptoms to exposure at work and c) identifying relevant hazardous exposures in the workplace including allergens, irritants, cold and exertion

Differential diagnoses

• include chronic obstructive pulmonary disease with asthmatic component, allergic alveolitis, hyper-responsive airways, nonspecific cough
• Competing interpretations is currently at the occurrence of the same allergen in private and working life and uncertain diagnosis

Follow-up

• In allergic asthma patient is removed from the operative exposure. The longer exposure time, the greater the risk of permanent asthma results.
• For non-allergic asthma may reorganizing the work environment is attempted with close assessment of whether measures reverses disease progression

Prevention

• Primary prevention by elimination or reduction of exposure including occasional peak exposures
• Vocational guidance to young people with asthma and atopy
• Secondary prevention with the monitoring of employees is practiced in some high-risk business

Review

• Upon reasonable suspicion erhversrelateret asthma notification shall be made to the Labour Inspection and Injuries via the EASY system. If work-related asthma verified or disproved sent additional information, regardless of prior review
• Is causation unsure refer to the Occupational Medicine Department, allergist or pulmonary diseases

Information for the patient

• Information about allergens and irritants, most likely the cause of the symptoms, to be reorganized from work and at home
• Both occupational and private exposure (cat, dog, dust mites, mold) is assessed and if necessary. counteracted by allergy redevelopment
• Smoking can be a problem in both places
• Advice in relation to possible. workers' compensation
• Written patient information is available on the Danish arbejdsmedicineres online information Armoni

References

• Schlünssen V Sigsgaard T, Omland Island. Respiratory Allergy and occupation. Ugeskr Physicians 2005; 167: 637-42
• Bonde JP. Occupational lung diseases: Medical Compendium 17th edition. Eds. Schaffalitzky the Genealogy OB, Haunsø S, Vilstrup H. New Nordic Publishing Arnold Busck, Copenhagen 2009
• Cullinan P, Taylor AN. Occupational asthma: Hunter's diseases of occupation 10th edition. Eds. Baxter PJ, Aw TC, Cockcroft A, Durrington P, Harrington JM. Hodder Arnold, London 2010
• Peak flow monitoring: www: Web pef.com

About RAST: www.phadia.se and HR test: www.reflab.dk

• Patient information: Asthma and Allergy Association: Your Job, your choice, your options
• Occupational Medicine online information Armoni: http://www.armoni.dk/client/CursumClientViewer.aspx?CAID=163680&ChangedCourse=true