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Gandhi SA, Heinzerling A, Flattery J, Cummings KJ. Occupational Contributions to Respiratory Health Disparities. Clin Chest Med 2023; 44:635-649. [PMID: 37517841 PMCID: PMC10861114 DOI: 10.1016/j.ccm.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.
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Affiliation(s)
- Sheiphali A Gandhi
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, 2330 Post St Ste 460, San Francisco, CA 94115, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA.
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Moloney M, Digby G, MacKinnon M, Morra A, Barber D, Queenan J, Gupta S, To T, Lougheed MD. Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement. Allergy Asthma Clin Immunol 2023; 19:3. [PMID: 36650578 PMCID: PMC9843861 DOI: 10.1186/s13223-022-00755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Viable knowledge translation (KT) strategies are increasingly sought to improve asthma diagnosis, particularly in primary care. Despite this understanding, practical KT tools to support primary care practitioners are not widely available. Electronic medical records (EMRs) offer an opportunity to optimize the diagnosis and surveillance of chronic diseases such as asthma, and support quality improvement initiatives that increase adherence to guideline-recommended care. This review aims to describe the current state of electronic KT electronic tools (eTools) and surveillance systems for asthma and identify opportunities to increase adherence to asthma diagnostic guidelines by implementing digital KT eTools. METHODS Systematic literature searches were conducted on Ovid MEDLINE that included the search terms: asthma, asthma diagnosis, asthma surveillance, electronic health records, translational medical research, quality improvement, professional practice gaps, and primary health care published in the previous 10 years. In total, the searches returned 971 articles, 163 of which were considered relevant and read in full. An additional 28 articles were considered after reviewing the references from selected articles. 75 articles were included in this narrative review. RESULTS Established KT eTools for asthma such as electronic questionnaires, computerized clinical decision support systems (CDSS), chronic disease surveillance networks, and asthma registries have been effective in improving the quality of asthma diagnosis and care. As well, chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes. However, lack of use and/or documentation of objective measures of lung function, challenges in identifying asthma cases in EMRs, and limitations of data sources have created barriers in the development of KT eTools. Existing digital KT eTools that overcome these data quality limitations could provide an opportunity to improve adherence to best-practice guidelines for asthma diagnosis and management. CONCLUSION Future initiatives in the development of KT eTools for asthma care should focus on strategies that assist healthcare providers in accurately diagnosing and documenting cases of asthma. A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR.
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Affiliation(s)
- Max Moloney
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Geneviève Digby
- grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Madison MacKinnon
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Alison Morra
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - David Barber
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada ,Canadian Primary Care Sentinel Surveillance Network (Eastern Ontario Network), Kingston, ON Canada
| | - John Queenan
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada
| | - Samir Gupta
- grid.415502.7Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Teresa To
- grid.42327.300000 0004 0473 9646Child Health Evaluative Science, Research Institute, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
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MacKinnon M, Moloney M, Bullock E, Morra A, To T, Lemiere C, Lougheed MD. Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study. JMIR Form Res 2022; 6:e37503. [PMID: 35964327 PMCID: PMC9523520 DOI: 10.2196/37503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background A work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun. Objective This study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L). Methods This study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities. Results A total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee. Conclusions Stakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation.
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Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Max Moloney
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Emma Bullock
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Alison Morra
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine Lemiere
- Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, ON, Canada
- Faculty of Medicine, University of Montreal, Montreal, ON, Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Belloumi N, Mersni M, Fenniche S, Bani M, Bachouche I, Chermiti Ben Abdallah F, Nouaigui H. [A questionnaire assessing knowledge level concerning occupational asthma]. Rev Mal Respir 2020; 37:710-721. [PMID: 33069502 DOI: 10.1016/j.rmr.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Screening for occupational asthma is should still be promoted. In order to improve the efficiency of any educational intervention we need to evaluate the patient's knowledge of the disease. OBJECTIVES The aims were to evaluate objectively the knowledge level of Tunisian asthmatic patients concerning occupational asthma using a self-questionnaire in Arabic Tunisian dialect, then to conduct a validation process of the questionnaire. METHODS We followed De Vellis's rules during all stages of redaction of the self-questionnaire. It contained 18 items allocated in 4 dimensions: knowledge about asthma; knowledge about occupational asthma; prognosis of occupational asthma; prevention of occupational asthma. A pre-test was conducted on 18 asthmatic patients to assess the clarity and comprehensibility of all the questions. The questionnaire was then applied to 107 asthmatic patients. RESULTS The statistical analysis proved the discrimination value in 14 of the 18 items. The internal consistency of the questionnaire was demonstrated by a KR20 index of 0.731. Factorial analysis of the principal components showed the reliability of the questionnaire and of its uni-dimensional structure. The statistical findings proved the positive correlation between the mean scores of all its dimensions. CONCLUSIONS Using this questionnaire in daily practice should inform health care providers about the level of knowledge of occupational asthma in the targeted population and improve the effectiveness of any further educational intervention.
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Affiliation(s)
- N Belloumi
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie.
| | - M Mersni
- Service de médecine de travail et des maladies professionnelles, institut de santé et de sécurité de travail, Tunis, Tunisie
| | - S Fenniche
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - M Bani
- Service de médecine de travail et des maladies professionnelles, institut de santé et de sécurité de travail, Tunis, Tunisie
| | - I Bachouche
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - F Chermiti Ben Abdallah
- Service de pneumologie, pavillon 4, hôpital Abderrahmen Mami, Ariana, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
| | - H Nouaigui
- Service de médecine de travail et des maladies professionnelles, institut de santé et de sécurité de travail, Tunis, Tunisie; Faculté de médecine de Tunis, université de Tunis El Manar, Tunis, Tunisie
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MacKinnon M, To T, Ramsey C, Lemière C, Lougheed MD. Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation. Allergy Asthma Clin Immunol 2020; 16:73. [PMID: 32922457 PMCID: PMC7477867 DOI: 10.1186/s13223-020-00470-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/29/2020] [Indexed: 12/04/2022] Open
Abstract
Background Work-related asthma (WRA) accounts for up to 25% of all adults with asthma. Early diagnosis is key for optimal management as delays in diagnosis are associated with worse outcomes. However, WRA is significantly underreported and the median time to diagnosis is 4 years. The objective of this review is to identify the gaps in awareness and reporting of WRA and identify gaps in current knowledge translation strategies for chronic disease in general, and asthma specifically. This will identify reasons for delays in WRA diagnosis, as well inform suggestions to improve knowledge translation strategies for dissemination and implementation of WRA prevention and management guidelines. Methods Non-systematic literature reviews were conducted on PubMed with a focus on work-related asthma screening and diagnosis, and knowledge translation or translational medicine research in asthma and chronic disease. In total, 3571 titles and abstracts were reviewed with no restriction on date published. Of those, 207 were relevant and fully read. Another 37 articles were included and reviewed after citation reviews of articles from the initial search and from suggestions from editors. In total, 63 articles were included in the final review. Results Patients, employers, and healthcare professionals lack awareness and under-report WRA which contribute to the delayed diagnosis of WRA, primarily through lack of education, stigma associated with WRA, and lack of awareness and screening in primary care. Knowledge translation strategies for asthma research typically involve the creation of guidelines for diagnosis of the disease, asthma care plans and tools for education and management. While there are some prevention programs in place for certain industries, gaps in knowledge translation strategies including lack of screening tools currently available for WRA, poor education of employers and physicians in identifying WRA, and education of patients is often done post-diagnosis and focuses on management rather than prevention or screening. Conclusion Future knowledge translation strategies should focus on educating employees and employers well before potential exposure to agents associated with WRA and screening for WRA in primary care to enable health care providers to recognize and diagnose WRA.
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Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, 72 Stuart Street, Kingston, ON K7L 2V7 Canada.,Division of Respirology, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, ON K7L 2V6 Canada
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Dalla Lana School of Public Health, University of Toronto, 686 Bay St, Toronto, ON Canada
| | - Clare Ramsey
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 810 Sherbrook St., Winnipeg, MB R3A1R9 Canada
| | - Catherine Lemière
- Department of Chest Medicine, CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montreal, QC H4J 1C5 Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, 72 Stuart Street, Kingston, ON K7L 2V7 Canada.,Division of Respirology, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, ON K7L 2V6 Canada
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Lau A, Tarlo SM. Update on the Management of Occupational Asthma and Work-Exacerbated Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:188-200. [PMID: 30661311 PMCID: PMC6340795 DOI: 10.4168/aair.2019.11.2.188] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 12/16/2022]
Abstract
Work-related asthma is the most common occupational lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%-33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of asthma is the first step to managing occupational asthma, which can be sensitizer-induced or irritant-induced asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced asthma and rapid-onset a defining feature of irritant-induced asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for irritant-induced asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related asthma. Primary prevention remains the preferred method of reducing the burden of occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.
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Affiliation(s)
- Ambrose Lau
- Respiratory Division, Department of Medicine, Toronto Western Hospital and St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Respiratory Division, Department of Medicine, Toronto Western Hospital and St. Michael's Hospital, Toronto, Ontario, Canada.
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Occupational exposure and asthma. Ann Allergy Asthma Immunol 2018; 120:468-475. [PMID: 29580845 DOI: 10.1016/j.anai.2018.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
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Harber P, Redlich CA, Hines S, Filios M, Storey E. Recommendations for a Clinical Decision Support System for Work-Related Asthma in Primary Care Settings. J Occup Environ Med 2017; 59:e231-e235. [PMID: 29023337 PMCID: PMC6282164 DOI: 10.1097/jom.0000000000001182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe a recommended clinical decision support (CDS) approach for work-related asthma for incorporation in electronic health records (EHRs) for primary care health care providers. METHODS Subject matter experts convened by the American Thoracic Society reviewed available guidelines and published literature to develop specific recommendations. RESULTS It is important to recognize possible work-related asthma among persons with new-onset or worsening asthma. The work group recommends incorporating three simple questions about temporal relations between asthma symptoms and work in EHR systems and identified specific clinical conditions to trigger this intervention. Patients with positive responses to the three questions should have the asthma diagnosis documented and have further evaluation, education, and possible referral. CONCLUSION An effective CDS system for improving recognition of work-related asthma may help reduce morbidity and mortality of asthma in adults.
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Affiliation(s)
- Philip Harber
- Department of Community, Environment, and Policy. Mel and Enid Zuckerman College of Public Health, University Of Arizona, Tucson, Arizona, USA
| | - Carrie A. Redlich
- Department of Medicine, Yale University School of Medicine, New Haven Connecticut USA
| | - Stella Hines
- Department of Medicine, University Of Maryland, Baltimore Maryland
| | - Margaret Filios
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Eileen Storey
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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Lipinska-Ojrzanowska AA, Wiszniewska M, Walusiak-Skorupa JM. Work-related asthma among professional cleaning women. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 72:53-60. [PMID: 26895185 DOI: 10.1080/19338244.2016.1156046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/13/2016] [Indexed: 06/05/2023]
Abstract
The job of cleaning has developed dynamically as a working service, and women constitute the majority of all professional cleaning workers. Cleaners are at an increased risk of work-related asthma (WRA). This study characterizes work-related respiratory symptoms reported by female cleaners, evaluates any associated factors of WRA, and shows diagnostic management of medical certification. The study group comprised 50 professional cleaning women referred to our Occupational Diseases Department due to suspicion of occupational asthma (OA). A questionnaire, skin prick tests, serum specific IgE antibodies, and specific inhalant challenge were performed in all of the participants. Work-related asthma was recognized in 46% of symptomatic cleaners, of whom 15 were considered as having work-exacerbated asthma (WEA) and 8 as having OA. Sensitization to latex and disinfectants played an important role as a causative agent in OA of cleaners.
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Affiliation(s)
| | - Marta Wiszniewska
- a Department of Occupational Diseases and Environmental Health , Nofer Institute of Occupational Medicine , Lodz , Poland
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