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Work-related asthma

Key sources
The following summarized guidelines for the evaluation and management of work-related asthma are prepared by our editorial team based on guidelines from the European Respiratory Society (ERS 2012).
1

Guidelines

1.Screening and diagnosis

Screening: obtain questionnaire-based identification for surveillance of asthma in all workers at risk of developing work-related asthma.
A
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  • Diagnosis

2.Classification and risk stratification

Risk stratification
Consider using diagnostic models for risk stratification during medical surveillance to select exposed workers for further medical evaluation.
B
Do not take into account smoking habits and atopy in the assessment of prognosis for medical legal purposes.
D

3.Diagnostic investigations

Occupational history: ask adult patients with new, recurrent, or deteriorating symptoms of asthma, COPD, or rhinitis about their job, the materials with which they work, and whether they improve when away from work.
A

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4.Medical management

Pharmacotherapy
Do not offer anti-asthma medications as a reasonable alternative to environmental interventions.
D
Adapt pharmacological treatment of patients with work-related asthma to the level of asthma control, in accordance with the general recommendations for asthma.
B

5.Nonpharmacologic interventions

Allergen and irritant avoidance: inform patients:
the risk of work-related asthma is higher in case of atopy or preexisting asthma or pre-employment sensitization
B
persistence of exposure to the causal agent is likely to result in a deterioration of asthma symptoms and airway obstruction
B
complete avoidance of exposure is associated with the highest probability of improvement, but may not lead to a complete recovery from asthma.
B
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6.Preventative measures

Primary prevention: eliminate exposure as the best preventive measure to reduce the disease burden of work-related asthma and the preferred approach for primary prevention.
A
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7.Follow-up and surveillance

Follow-up: obtain follow-up evaluation by a specialist including monitoring of spirometry, serial measurements of peak expiratory flow or spirometry, nonspecific bronchial hyperresponsiveness and allergy testing, if the diagnosis is still equivocal after full investigation.
B