Follow-up survey of patients with occupational asthma

Long-term outcome of occupational asthma with different etiology

PURPOSE OF REVIEW

This review summarizes the recent literature on the long-term outcome of sensitizer-induced and irritant-induced occupational asthma.

RECENT FINDINGS

Recent studies of sensitizer-induced occupational asthma show that after the offending exposure has ceased, most patients report at least partial relief of symptoms. However, in the long term, the diagnosis may negatively impact their careers, incomes, and quality of life. The studies also offer new insights into diisocyanate-induced occupational asthma phenotypes and asthma remission rates. One third of these cases were in remission in long-term after reduction or cessation of exposure. The long-term prognosis of irritant-induced occupational asthma was demonstrated to be poorer than sensitizer-induced occupational asthma. Older age, low fractional exhaled nitric oxide levels and uncontrolled asthma at the time of diagnosis predicted uncontrolled asthma in the long term in patients with irritant and low-molecular-weight sensitizer induced occupational asthma.

SUMMARY

Recent studies provide further evidence of the long-term outcome of different occupational asthma phenotypes and the factors that affect them. These findings help us identify patients at risk of poor asthma outcomes, who need close monitoring and support. It should also be borne in mind that occupational asthma diagnosis may have wider-ranging negative impacts on patients' lives.

Aziz SF, Aizad Za’bah AK, Dapari R, Hassan MR, Che Dom N, Syed Abdul Rahim SS. Factors associated with occupational asthma among food industry workers: A systematic review

INTRODUCTION

Occupational asthma (OA) is a type of Work-Related Asthma characterised by variable airflow limitation and/or inflammation due to causes and conditions attributable to a particular occupational environment, and not to stimuli encountered outside the workplace. There is an increasing need to extend the depth of knowledge of OA to better manage this condition, especially among food industry workers who are affected by it.

OBJECTIVE

This systematic review aimed to determine the factors associated with occupational asthma among food industry workers by electronically collecting articles from two databases (Medline and Scopus).

METHODS

This systematic review was prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) updated guideline. Two independent reviewers screened the titles and abstracts of the collected data, which were then stored in Endnote20 based on the inclusion and exclusion criteria. The included articles have been critically appraised to assess the quality of the studies using the Mixed Methods Appraisal Tool (MMAT).

RESULT

The search yielded 82 articles from Medline and 85 from SCOPUS, resulting in 167 unique hits. Only 22 articles have been included in the full-text assessment following a rigorous selection screening. Of the 22 articles identified, five were included in the final review. Several factors were found to have contributed to occupational asthma among food industry workers. They were classified into two categories: (1) work environment-related factors; and (2) individual factors.

CONCLUSION

Several work environment and individual-related factors were found to be associated with OA among food industry workers. A better understanding of the development of the disease and its potential risk factors is needed because it can affect worker's quality of life. Pre-employment and periodic medical surveillance should be conducted to assess and detect any possible risk of developing occupational asthma among workers.

[Occupational obstructive airway diseases: How can early diagnosis be made to avoid chronic courses?]

Since abolishing the obligation to terminate the harmful professional activity from January 1st, 2021 onwards for some occupational diseases including obstructive respiratory diseases in Germany, the recognition of occupational diseases coded under 4301, 4302 and 1315 according the Occupational Diseases Ordinance has increased significantly. By the time these diseasese are recognized, they are usually already at an advanced stage. Therefore, early detection will play a greater role in the future, as the statutory accident insurance can offer individual preventive measures in order to minimize the consequences of illness and thus also the socio-economic burden. However, precursors of such obstructive airway diseases are often overlooked. For optimizing early detection, the statutory accident insurance worked out an early notification procedure for the respiratory tract - comparable to the already well-established dermatological procedure. "Early cases" from the pilot regions can be reported there; to qualify for being reported as early cases, patients must persue insured professional activity with potential effects on the respiratory tract and suffer from a disease of the upper or lower respiratory tract according to the ICD-10 code (e.g. J31.0 chronic rhinitis).

Impact of occupational asthma on health and employment status: a long-term follow-up study

OBJECTIVES

The aim of this study was to assess the predictors of a favourable prognosis of occupational asthma (OA) and the employment status of patients with OA at least 2 years after diagnosis.

METHODS

We collected data from 204 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. We defined OA remission as meeting the following three criteria: no asthma symptoms, no antiasthma therapy for the last year and having normal lung function at the end of follow-up. A logistic regression analysis was performed to estimate the effects of the covariates.

RESULTS

At 10.6±7.8-year follow-up, 60 of 204 possible patients participated in the study, and among them 17 showed OA remission. When compared with the 43 patients with persistent OA, these patients exhibited at diagnosis younger age (p=0.0039), shorter duration of symptomatic exposure (p=0.0512), better lung function expressed by higher forced vital capacity (FVC%) predicted (p=0.0164), forced expiratory volume in 1 s (FEV₁) % predicted (p=0.0066) and FEV₁/FVC% (p=0.0132), and less bronchial hyper-responsiveness (p=0.0118). Nevertheless, in the multivariable model, no variables were significantly associated with OA remission. At follow-up, three individuals have retired; among the remaining 57 workers, 91.2% were still employed and 43.8% of them had continued working in the same factory after ceasing exposure to the causative agent.

CONCLUSIONS

This monocentric study did not identify a strong predictor of OA remission, but documented a high employment rate and a good job preservation over a long timeframe after diagnosis of OA mainly induced by low molecular weight agents.

Retrospective cross-sectional study of asthma severity in adult patients at the Jimma Medical Center, Ethiopia

Asthma is one of the most prevalent chronic diseases and is a public health problem worldwide. It is a long-standing condition affecting the respiratory system. Thus this study aimed to assess the severity of asthma in patients at the adult emergency department of Jimma Medical Center (JMC), Southwest Ethiopia. A one year (1 May, 2020, to 1 May, 2021) retrospective cross-sectional study was conducted among 189 patients at the adult emergency department of JMC. Data were collected between 25 July, 2021 to 25 August, 2021 by two Bachelor of Science degree holders in nursing (BSC) nurses after providing proper training. We used structured checklist that was obtained from previous studies to collect the data. Finally, data were entered into EpiData version 3.1 then exported to Stata version 15.0 for further analysis. Multinomial analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between risk factors and severity of asthma. Of 195 patients retrieved from the Health management information system (HMIS) logbook and patient profile, 189 fulfilled the eligibility criteria giving a response rate of 96.9%. The mean age of patients was 47.69 (± 19.02) years old ranging from 20 to 85. More than one third of the patients were age range of 20-39 years. Only more than half of the patients were women. Almost 46% of the patients had moderate asthma. Being male, merchant and government employees had lower odds of asthma than their counterparts whereas being daily laborers and smoking contributed to increased odds of moderate asthma. Patients' age and comorbidities had increased odds of severe asthma in relation to the participants of their reference category. Urban residents had decreased odds of severe asthma compared to their rural counterparts. This study highlights that majority of patients had moderate asthma. Health care providers should pay special attention to accurately diagnosing asthma according to its severity which is essential to the optimal management of asthma. This study calls JMC health care providers to give due attention while providing routine care for their patients in accordance to identified factors.

Occupational Asthma: The Knowledge Needs for a Better Management

The management of occupational asthma (OA) may be influenced by several factors and removal from exposure is the main tertiary prevention approach, but it is not always feasible without personal and socioeconomic consequences. Reducing the delay between the onset of suggestive symptoms of OA and the diagnosis of OA is associated with a better prognosis. Workers' education to increase awareness to trigger agents and a medical surveillance program directed especially at at-risk workers could be helpful in reducing this latency time. An early identification of workers who develop rhinitis and conjunctivitis which often precede the onset of asthma symptoms could be important for an early identification of OA. This is particularly important for cases of asthma caused by high-molecular-weight sensitizers and in the early years of employment. The availability of financial support and compensation measures for workers with OA may influence the latency time before diagnosis and, consequently, may influence the OA outcomes. In conclusion, there is a need for high-quality cohort studies that will increase knowledge about risk factor that may influence the timing of diagnosis of OA. This knowledge will be useful for implementation of future surveillance and screening programs in workplaces.