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Bernstein DI, Pacheco K, Lemiere C. How Allergists Can Perform an Occupational History in Every Patient. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1951-1958. [PMID: 38761860 DOI: 10.1016/j.jaip.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Abstract
The occupational history is often neglected in the routine evaluation of new patients with asthma, chronic rhinitis, or dermatologic complaints. Such omissions are inadvertent because work-related conditions are often not prioritized. There also may be lack of awareness of the scope of respiratory or cutaneous allergens capable of inducing occupational asthma (OA) or work-related contact dermatitis. Evidence exists suggesting that the occupational history is often neglected among primary care physicians and specialists. Failure to diagnose OA in a timely fashion by identifying occupational sources of exposure, for example, may result in unnecessary morbidity in workers whose exposure is not modified. In this commentary, we propose a brief intake survey to be administered to all patients coming to an allergy practice to quickly screen for possible work-related respiratory symptoms and another for occupational dermatitis. This would require minimal physician time and could be self-administered at the initial encounter and incorporated into the medical record. A positive response to either survey should trigger a more detailed evaluation by the allergy specialist. More detailed approaches for stepwise clinical evaluation of the worker suspected of OA and contact dermatitis are discussed.
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Affiliation(s)
- David I Bernstein
- Division of Immunology, Rheumatology and Allergy, University of Cincinnati, Cincinnati, Ohio.
| | - Karin Pacheco
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colo
| | - Catherine Lemiere
- Department of Environmental and Occupational Health, Université de Montréal, Montreal, QC, Canada
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Barber CM, Cullinan P, Feary J, Fishwick D, Hoyle J, Mainman H, Walters GI. British Thoracic Society Clinical Statement on occupational asthma. Thorax 2022; 77:433-442. [DOI: 10.1136/thoraxjnl-2021-218597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Classification of chemicals as respiratory allergens based on human data: Requirements and practical considerations. Regul Toxicol Pharmacol 2021; 123:104925. [PMID: 33831493 DOI: 10.1016/j.yrtph.2021.104925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 02/01/2023]
Abstract
Occupational asthma is an important health problem that can include exacerbation of existing asthma, or induce new asthma either through allergic sensitisation, or non-immunological mechanisms. While allergic sensitisation of the respiratory tract can be acquired to proteins, or to low molecular weight chemicals (chemical respiratory allergens) this article is on the latter exclusively. Chemical respiratory allergy resulting in occupational asthma is associated with high levels of morbidity and there is a need, therefore, that chemicals which can cause sensitisation of the respiratory tract are identified accurately. However, there are available no validated, or even widely accepted, predictive test methods (in vivo, in vitro or in silico) that have achieved regulatory acceptance for identifying respiratory sensitising hazards. For this reason there is an important reliance on human data for the identification of chemical respiratory allergens, and for distinguishing these from chemicals that cause occupational asthma through non-immunological mechanisms. In this article the reasons why it is important that care is taken in designating chemicals as respiratory allergens are reviewed. The value and limitations of human data that can aid the accurate identification of chemical respiratory allergens are explored, including exposure conditions, response characteristics in specific inhalation challenge tests, and immunological investigations.
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Transforming growth factor-β1 and eosinophil-derived neurotoxins contribute to the development of work-related respiratory symptoms in bakery workers. World Allergy Organ J 2019; 12:100058. [PMID: 31641406 PMCID: PMC6796779 DOI: 10.1016/j.waojou.2019.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 02/08/2023] Open
Abstract
Background In baker's asthma previous studies suggest that adaptive and innate immunity are involved in the development of work-related respiratory symptoms (WRS), where we hypothesized that epithelial cells derive airway inflammation through modulating the release of inflammatory cytokines. Thus, we conducted this study to investigate the role of epithelial cell-derived cytokines in the development of WRS among bakery workers. Methods We recruited 385 wheat-exposed subjects with WRS (WRS+)/without WRS (WRS-) working in a single industry and 243 unexposed controls from Ajou Medical Center (Suwon, South Korea). Levels of epithelial cell-derived cytokines (interleukin [IL-8], transforming growth factor-β1 [TGF-β1], eotaxin-2) and inflammatory mediators (eosinophil-derived neurotoxins [EDN]) in sera or cell-free supernatants were measured by ELISA. Human airway epithelial cells (HAECs), A549, were stimulated by wheat flour extracts and co-cultured with peripheral blood neutrophils isolated from 4 asthmatic patients. Results Serum TGF-β1 levels were significantly lower in exposed subjects than in unexposed controls, in the WRS+ group than in the WRS- group (P < 0.001 for each). The WRS+ group had a significantly higher level of serum EDN than the WRS- group (P < 0.001). Serum TGF-β1 and EDN levels predicted the development of WRS in exposed subjects (area under the curve [AUC] = 0.719, 72.4% sensitivity/70% specificity; AUC = 0.759, 78.6% sensitivity/60% specificity). From wheat-stimulated HAECs, TGF-β1 release peaked at 6 hours after wheat exposure, while eotaxin-2 peaked at 12 hours. Co-culture of HAECs with neutrophils did not affect TGF-β1 release. Conclusions Our results suggest that TGF-β1 may contribute to develop type-2 airway inflammation and WRS. Serum TGF-β1/EDN levels may be potential serum biomarkers for predicting WRS among bakery workers.
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Taghiakbari M, Pralong JA, Lemière C, Moullec G, Saha-Chaudhuri P, Cartier A, Castano R, Suarthana E. Novel clinical scores for occupational asthma due to exposure to high-molecular-weight agents. Occup Environ Med 2019; 76:495-501. [PMID: 31005857 DOI: 10.1136/oemed-2018-105593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/15/2019] [Accepted: 03/02/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Specific inhalation challenge (SIC) as the reference diagnostic test for occupational asthma (OA) is not widely available worldwide. We aimed to develop non-SIC-based models for OA. METHODS Of 427 workers who were exposed to high-molecular-weight agents and referred to OA clinic at Montréal Sacré-Cœur Hospital between 1983 and 2016, we analysed 160 workers who completed non-specific bronchial hyper-responsiveness (NSBHR) tests and still worked 1 month before SIC. OA was defined as positive SIC. Logistic regression models were developed. The accuracy of the models was quantified using calibration and discrimination measures. Their internal validity was evaluated with bootstrapping procedures. The final models were translated into clinical scores and stratified into probability groups. RESULTS The final model, which included age ≤40 years, rhinoconjunctivitis, inhaled corticosteroid use, agent type, NSBHR, and work-specific sensitisation had a reasonable internal validity. The area under the receiver operating characteristics curve (AUC) was 0.91 (95% CI 0.86 to 0.95), statistically significantly higher than the combination of positive NSBHR and work-specific sensitisation (AUC=0.84). The top 70% of the clinical scores (ie, the high probability group) showed a significantly higher sensitivity (96.4%vs86.9%) and negative predictive value (93.6%vs84.1%) than the combination of positive NSBHR and work-specific sensitisation (p value <0.001). CONCLUSIONS We developed novel scores for OA induced by high-molecular-weight agents with excellent discrimination. It could be helpful for secondary-care physicians who have access to pulmonary function test and allergy testing in identifying subjects at a high risk of having OA and in deciding on appropriate referral to a tertiary centre.
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Affiliation(s)
- Mahsa Taghiakbari
- Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jacques-André Pralong
- Service de pneumologie, Institute for Work and Health, Epalinges-Lausanne, Switzerland
| | - Catherine Lemière
- Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Gregory Moullec
- Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Paramita Saha-Chaudhuri
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - André Cartier
- Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Roberto Castano
- Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Eva Suarthana
- Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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de Genaro IS, de Almeida FM, Hizume-Kunzler DC, Moriya HT, Silva RA, Cruz JCG, Lopes RB, Righetti RF, de Paula Vieira R, Saiki M, Martins MA, Tibério IDFLC, Arantes-Costa FM, Saraiva-Romanholo BM. Low dose of chlorine exposure exacerbates nasal and pulmonary allergic inflammation in mice. Sci Rep 2018; 8:12636. [PMID: 30135462 PMCID: PMC6105688 DOI: 10.1038/s41598-018-30851-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/31/2018] [Indexed: 01/22/2023] Open
Abstract
Work-exacerbated asthma (WEA) is defined as preexisting asthma that worsens with exposure to irritants [e.g., chlorine (Cl2) derivatives] in the workplace. The maximum allowable concentration in the workplace of Cl2 exposure is 3 mg/ m3 (described in OSHA). We investigated in an experimental asthma model in mice the effects of a single exposure to a sodium hypochlorite dose with this allowed chlorine concentration and a tenfold higher dose. Acute chlorine exposure at 3.3 mg/m3 in the OVA-sensitized group increased eosinophils in the peribronquial infiltrate, cytokine production, nasal mucus production and the number of iNOS positive cells in the distal lung compared to only sensitized mice. The exposure to a higher dose of 33.3 mg/m3 in the OVA-sensitized group resulted in an increase in respiratory system elastance, in the total and differential numbers of inflammatory cells in bronchoalveolar lavage fluid, IL-4, IL-5, and IL-17 in the lungs, eosinophils in peribronquial infiltrate and mucus content in nasal compared to non-exposed and sensitized animals. In this asthma model, chorine exposures at an allowable dose, contributed to the potentiation of Th2 responses. The functional alterations were associated with increased iNOS and ROCK-2 activation in the distal lung.
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Affiliation(s)
- Isabella Santos de Genaro
- Public Employee of Sao Paulo Hospital (IAMSPE), Sao Paulo, Brazil.,Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Deborah Camargo Hizume-Kunzler
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Department of Physical Therapy (LaPEx), State University of Santa Catarina, Florianopolis, Brazil
| | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politecnica, University of Sao Paulo, Sao Paulo, Brazil
| | - Ronaldo Aparecido Silva
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Renato Fraga Righetti
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Sírio-Libanês Hospital, Sao Paulo, Brazil
| | - Rodolfo de Paula Vieira
- Universidade Brasil, Post-graduation Program in Bioengenering, São Paulo, Brazil and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | - Mitiko Saiki
- Nuclear and Energy Research Institute, IPEN-CNEN/SP, Sao Paulo, Brazil
| | - Milton Arruda Martins
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Beatriz Mangueira Saraiva-Romanholo
- Public Employee of Sao Paulo Hospital (IAMSPE), Sao Paulo, Brazil. .,Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. .,University City of Sao Paulo (UNICID), Sao Paulo, Brazil.
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8
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Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy 2016; 9:171-181. [PMID: 27703382 PMCID: PMC5036552 DOI: 10.2147/jaa.s81540] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.
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Affiliation(s)
| | - Andréa Gimenez
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Lilian Kuranishi
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Karin Storrer
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
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9
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Abstract
BACKGROUND The link between asthma and inhaled workplace exposures has been long appreciated, and yet aggravation of asthma symptoms by work conditions, known as work-aggravated asthma (WAA), remains relatively common. SOURCES OF DATA A review of the literature published over the last 3 years was carried out, and additional key articles were included from outside this timeframe. AGREEMENT WAA is commonly reported by workers with asthma. One published assessment of 12 studies identified a median prevalence of 21.5% among workers with asthma. Commonly reported causes included a variety of inhaled dusts, smoke, vapours, fumes, gases and mists, common and workplace-specific aeroallergens, physical environmental factors including temperature and humidity and physical activity at work. CONTROVERSY Remains in relation to definition, and how to distinguish WAA from occupational asthma in which there is sensitization to an agent in the workplace. Both these areas, and the development of workplace interventions to reduce WAA, are timely topics for future research.
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Affiliation(s)
- David Fishwick
- Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, S5 7AU, UK
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10
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Long-term socioprofessional and psychological status in workers investigated for occupational asthma in quebec. J Occup Environ Med 2014; 55:1052-64. [PMID: 23969504 DOI: 10.1097/jom.0b013e31829904ab] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the long-term status of workers with occupational asthma (OA) with those of subjects with work-exacerbated asthma (WEA) and nonasthmatic (NA) workers. METHODS We contacted 179 subjects investigated for suspected OA at Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada, from 1997 to 2007. Participants completed questionnaires on psychological and functional status, followed by a telephone interview about socioprofessional outcomes and health care utilization. RESULTS The OA workers are more likely to have been removed from the workplace than the WEA workers. The health-related quality of life of all workers was still impaired. A high prevalence of psychiatric disorders was found among OA and WEA workers. Compared with WEA and OA workers, the NA group showed a higher rate of physician consultations for all causes. CONCLUSIONS Regardless of the diagnosis they received, these workers need to benefit from psychosocial support in the period after investigation for suspicion of OA.
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Song GW, Ban GY, Nam YH, Park HS, Ye YM. Case report of occupational asthma induced by polyvinyl chloride and nickel. J Korean Med Sci 2013; 28:1540-2. [PMID: 24133363 PMCID: PMC3792612 DOI: 10.3346/jkms.2013.28.10.1540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/28/2013] [Indexed: 11/20/2022] Open
Abstract
Polyvinyl chloride (PVC) is a widely used chemical for production of plastics. However occupational asthma (OA) caused by PVC has been reported only rarely. We report a 34-yr-old male wallpaper factory worker with OA due to PVC and nickel (Ni) whose job was mixing PVC with plasticizers. He visited the emergency room due to an asthma attack with moderate airflow obstruction and markedly increased sputum eosinophil numbers. A methacholine challenge test was positive (PC20 2.5 mg/mL). Bronchoprovocation tests with both PVC and Ni showed early and late asthmatic responses, respectively. Moreover, the fractional concentration of exhaled nitric oxide (FeNO) was increased after challenge with PVC. To our knowledge, this is the first case of OA in Korea induced by exposure to both PVC and Ni. We suggest that eosinophilic inflammation may be involved in the pathogenesis of PVC-induced OA and that FeNO monitoring can be used for its diagnosis.
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Affiliation(s)
- Ga-Won Song
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Hee Nam
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Lai K, Pan J, Chen R, Liu B, Luo W, Zhong N. Epidemiology of cough in relation to China. COUGH 2013; 9:18. [PMID: 23835047 PMCID: PMC3711853 DOI: 10.1186/1745-9974-9-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/22/2013] [Indexed: 01/08/2023]
Abstract
Cough is one of the most common complaints for which patients seek medical attention. Misdiagnosis and mistreatment of cough exist commonly in China. The prevalence of acute cough caused by upper airway infection fluctuates between 9% and 64% in the community, for chronic cough, the prevalence >10% in most surveys, ranging from 7.2%-33%. The common causes of chronic cough are upper airway cough syndrome (previously called as post nasal drip syndrome [PNDS]), cough variant asthma (CVA), gastroesophageal reflux related cough (GERD) and eosinophilic bronchitis (EB). There is a regional discrepancy regarding the prevalence of common causes of cough and distribution of gender among China, UK, USA, the most common cause of chronic cough in China are CVA, followed by UACS, EB and atopic cough (AC), the male is almost equal to female in numbers in China. The risk factors for cough includes cold air, smoking, environmental pollutants, noxious substances and allergens, and unreasonable diet habits.
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Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Diseases, 1st Affiliated Hospital, Guangzhou Medical College, Guangzhou, GZ, China.
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Jares EJ, Baena-Cagnani CE, Gómez RM. Diagnosis of occupational asthma: an update. Curr Allergy Asthma Rep 2013; 12:221-31. [PMID: 22467203 DOI: 10.1007/s11882-012-0259-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, "Does asthma improve away from work?" is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.
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Affiliation(s)
- Edgardo J Jares
- Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Pcia de Buenos Aires, Argentina.
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The current diagnostic role of the specific occupational laboratory challenge test. Curr Opin Allergy Clin Immunol 2012; 12:119-25. [PMID: 22391752 DOI: 10.1097/aci.0b013e328351137c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Classically, the specific occupational challenge test has been considered as the reference test in the diagnosis of occupational asthma. The present study assesses the usefulness of this test for diagnosing this disease and compares it with other diagnostic methods. RECENT FINDINGS Occupational asthma is the most frequent work-related respiratory disease in developed countries. Its correct diagnosis is vitally important not only from the medical point of view, but also in view of the disease's major socio-economic repercussions both for the patient and for society as a whole. Diagnosis is based on clinical suspicion of bronchial asthma and of a possible association with the patient's occupation. Various diagnostic strategies have been proposed, including clinical history, immunological test, spirometry, the study of peak flow, the methacholine test and the specific occupational challenge test, as well as studies of bronchial inflammation using noninvasive methods. SUMMARY The specific occupational challenge test remains the reference test for the diagnosis of occupational asthma for causal agents of both high and low molecular weight.
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