ocuupational asthma

1. OCCPATIONAL
ASTHMA
PRESENTED BY SAURABH SHARMA TO PROFESSOR
ANA KARLEI

2. References
"Occuptational Asthma". MedlinePlus Medical Encyclopedia
"Occupational/Work-Related Asthma Medical Treatment Guideline“
Murray & Nadel's Textbook of Respiratory Medicine. Elsevier.
2016. pp. 1295–1306
"Occupational asthma". Mayo Clinic. 23 May 2009.
Wikipedia

3. Introduction
Occupational asthma is new
onset asthma or the recurrence
of previously quiescent asthma
directly caused by exposure to an
agent at workplace. It is
an occupational lung disease and
a type of work-related asthma.
Agents that can induce
occupational asthma can be
grouped into sensitizers and
irritants

4. Occupational asthma is one of the most common occupational
lung disease.
Approximately 17% of all adult-onset asthma cases are related to
occupational exposures.
About one fourth of adults with asthma have work-exacerbated
asthma.
Patients with work-related asthma are more likely to experience
asthma attacks, emergency room visits, and worsening of their
asthma symptoms compared with other adult asthma patients.

5. Types
Sensitizer-induced occupational asthma is an immunologic form of
asthma which occurs due to inhalation of specific substances (i.e., high-
molecular-weight proteins from plants and animal origins, or low-
molecular-weight agents that include chemicals, metals and wood
dusts) and occurs after a latency period of several weeks to years.
Irritant-induced (occupational) asthma is a non-immunologic form of
asthma that results from a single or multiple high dose exposure to
irritant products. It is usually develops early after exposure; however
can also develop insidiously over a few months after a massive exposure
to a complex mixture of alkaline dust and combustion products

6. Signs and symptoms
shortness of breath,
tightness of the chest,
coughing,
sputum production and wheezing.
Some patients may also develop upper
airway symptoms such as itchy eyes,
tearing, sneezing, nasal congestion
and rhinorrhea.

7. Risk factor
Agents such as flour, diisocyanates, latex, persulfate salts,
aldehydes, animals, wood dusts, metals, enzymes usually
account for the majority
the industries most affected are bakeries and cake-
shops, automobile
The occupations most at risk are: adhesive handlers
(e.g. acrylate), animal handlers and veterinarians (animal
proteins), bakers and millers (cereal grains), carpet makers
(gums), electronics workers (soldering resin), forest workers,
carpenters and cabinetmakers (wood dust), hairdressers
(e.g. persulfate), health care workers (latex and chemicals such
as glutaraldehyde), janitors and cleaning staffe industry and
hairdressers cases

9. Diagnosis
To diagnose occupational asthma it is
necessary to confirm the symptoms of asthma
and establish the causal connection with the
work environment.
A spirometer is a device used to measure
timed expired and inspired volumes, and can
be used to help diagnose asthma.
Peak expiratory flow rate (PEFR) is a hand
held device which measures how fast a person
can exhale and is a reliable test for
occupational asthma. Serial PEFR can be
measured to see if there is a difference in
ability to exhale at work compared to that in a
controlled environment.

10. A non-specific bronchial hyperreactivity test can be used to
support the diagnose occupational asthma. It involves measuring
the forced expiratory volume in 1 second (FEV-1) of the patient
before and after exposure to methacholine or mannitol. Presence
of airway responsiveness i.e. significant drop in FEV-1 can be
seen in patients with occupational asthma.
Specific inhalation challenges test consist of exposing the
subjects to the suspected occupational agent in the laboratory
and/or at the workplace and assess for asthma symptoms as well
as a reduction in FEV1.
Other tests such as skin prick test, serum immunologic testing and
measurement of sputum eosinophils can also be useful in
establishing the diagnosis of occupational asthma.[

12. Prevention
Several forms of preventive measures have been suggested to
prevent development of occupational asthma and also detect risk
or disease early to allow intervention and improve outcomes.
These include: comprehensive programs, education and training,
medical examinations, use of medications, reduction of exposures
and elimination of exposures.
Asthma symptoms and airway hyperresponsiveness can persist
for several years after removal from the offending
environment. Thus, early restriction from exposure to the trigger is
advisable.

14. Management
Medications used for occupational asthma are similar to those
used for other types of asthma such as-
1. short-acting beta-agonists like salbutamol or terbutaline,
2. long-acting beta-agonists like salmeterol and formoterol
3. inhaled corticosteroids.
Immunotherapy can also be used in some cases of sensitizer
induced occupational asthma.[

15. Ginna guideline