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Mwanga HH, Dumas O, Migueres N, Le Moual N, Jeebhay MF. Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00214-9. [PMID: 38432401 DOI: 10.1016/j.jaip.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.
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Affiliation(s)
- Hussein H Mwanga
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Nicolas Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France; UMR 7357 Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie ICUBE, Strasbourg, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
| | - Mohamed F Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
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Suarthana E, Le Moual N, Lemière C, Bousquet J, Pierre S, Sousa-Pinto B, Afadiyanti Parfi A, Van Brussel P, Nassiri Kigloo H, Vandenplas O, Henneberger PK. Work-Related Asthma and Its Impact on Quality of Life and Work Productivity. J Allergy Clin Immunol Pract 2024; 12:372-382.e2. [PMID: 37918649 PMCID: PMC10922585 DOI: 10.1016/j.jaip.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The impact of work-related asthma (WRA) on quality of life (QoL) and work productivity remains largely neglected/uncertain despite its high prevalence. OBJECTIVE To investigate the association of WRA with QoL and work productivity as compared with subjects with non-WRA and those without asthma and rhinitis. METHODS A cross-sectional survey was carried out among workers during their periodic occupational health visit in Belgium. The Mini Asthma Quality of Life Questionnaire, the 8-item Medical Outcome Study Short Form instrument, and the Work Productivity and Activity Impairment-General Health questionnaire were administered. Survey participants were divided into 3 groups: (1) WRA (current asthma with ≥2 respiratory symptoms at work; n = 89); (2) non-WRA (current asthma without work-related respiratory symptoms; n = 119); and (3) the reference group (no asthma and no lower respiratory, nasal, or eye symptoms; n = 815). Associations of QoL and work productivity with WRA were evaluated by multivariable regression analyses. RESULTS WRA and having poor asthma control were significantly associated with lower global Mini Asthma Quality of Life Questionnaire scores compared with non-WRA. Asthmatic subjects had significantly lower physical and mental health component scores of the 8-item Medical Outcome Study Short Form instrument and overall work productivity compared with the reference group, with greater impairment in workers with WRA than in those without WRA. Moreover, workers with WRA had higher percentages of doctor visits and income reduction because of respiratory symptoms than those with non-WRA. Work-related rhinitis and depression were associated with reduced QoL, independent of the effect of WRA. CONCLUSIONS WRA should be managed comprehensively to reduce the worsening of QoL and work productivity of those affected.
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Affiliation(s)
- Eva Suarthana
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada.
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ Paris-Sud, INSERM, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Catherine Lemière
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Jean Bousquet
- Institute of Allergology, Charite Universit€ atsmedizin Berlin, Corporate Member of Freie Universit€ at Berlin and Humboldt-Universtat zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Stephie Pierre
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal; RISE-Health Research Network, University of Porto, Porto, Portugal
| | - Alfi Afadiyanti Parfi
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Philippe Van Brussel
- Service de Prévention et Protection au Travail-Centre de Service Interentreprises (CESI), Brussels, Belgium
| | - Hormoz Nassiri Kigloo
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada; Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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3
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da Paz ER, de Lima CMF, Felix SN, Schaeffer B, Galvão CES, Correia AT, Righetti RF, de Arruda Martins M, de Fátima Lopes Calvo Tibério I, Saraiva-Romanholo BM. Airway inflammatory profile among cleaning workers from different workplaces. BMC Pulm Med 2022; 22:170. [PMID: 35488256 PMCID: PMC9052628 DOI: 10.1186/s12890-022-01949-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/11/2022] [Indexed: 01/01/2023] Open
Abstract
Background Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles. Methods We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey—ECRS and the International Study of Asthma and Allergies in Childhood—ISAAC). Results Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group. Conclusions Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01949-5.
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Affiliation(s)
- Edinéia Rosa da Paz
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil
| | | | - Soraia Nogueira Felix
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil.
| | - Bruna Schaeffer
- Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Aristides Tadeu Correia
- Departamento de Cardiopneumologia, Instituto do Coração, InCor-HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil.,Laboratório de Investigação Médica- LIM 61, Serviço de Cirurgia Torácica, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Renato Fraga Righetti
- Hospital Sírio-Libanês, Serviço de Reabilitação, Sao Paulo, SP, Brazil.,Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milton de Arruda Martins
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Beatriz Mangueira Saraiva-Romanholo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil.,Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.,Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
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4
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De Troeyer K, De Man J, Vandebroek E, Vanoirbeek JA, Hoet PH, Nemery B, Vanroelen C, Casas L, Ronsmans S. Identifying cleaning products associated with short-term work-related respiratory symptoms: A workforce-based study in domestic cleaners. Environ Int 2022; 162:107170. [PMID: 35272140 DOI: 10.1016/j.envint.2022.107170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Domestic cleaners have an increased risk of asthma-like and other respiratory symptoms and conditions. Uncertainty exists about which products are most hazardous. We aimed to investigate, among professional domestic cleaners, the associations of ocular/respiratory outcomes with using specific types of products at work and with the ability to choose their own products. Among domestic cleaners employed by "service vouchers" companies in Belgium, we administered an online questionnaire on ocular/respiratory symptoms (frequency and time relation to workdays), frequency of use of 40 types of products, and ability to choose one's own products. Work-relatedness was defined as symptoms improving/disappearing on days off-work. We studied associations between frequency of product-use with work-related outcomes (eye irritation, rhinitis symptoms, sore throat, laryngeal symptoms, asthma symptoms, cough) and with chronic bronchitis, using multivariable logistic and elastic net regression. Adjusted odds ratios (OR) with 95%-confidence intervals were obtained per time a product was used per week. Among 1,586 domestic cleaners (99% women), the number of times sprays were used (median 13/week) was significantly associated with all outcomes (ORs between 1.012 and 1.024 per time sprays were used per week). Bleach/disinfectant-containing liquid products were associated with all outcomes, except for laryngeal symptoms (ORs 1.086 to 1.150); ammonia with work-related upper airway symptoms and chronic bronchitis. Cleaners able to choose their own products had fewer work-related eye symptoms (OR 0.728;0.556-0.954), rhinitis (OR 0.735;0.571-0.946) and cough (OR 0.671;0.520-0.865). Using elastic net regression, work-related rhinitis was most strongly associated with mould removal spray (OR 1.108;1.006-1.248), carpet/seat/curtain spray (OR 1.099;1.001-1.304) and ammonia (OR 1.081;1.002-1.372); work-related asthma with carpet/seat/curtain spray (OR 1.103;1.017-1.322), mould removal spray (OR 1.029;0.995-1.199) and drain cleaner (OR 1.023;0.979-1.302). In a large group of domestic cleaners, we documented that cleaning products have a range of adverse respiratory effects. Empowering cleaners to choose their products may reduce the burden of symptoms.
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Affiliation(s)
- Katrien De Troeyer
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Eline Vandebroek
- Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; Premed, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Jeroen A Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Peter Hm Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Vanroelen
- Interface Demography, Sociology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lidia Casas
- Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
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5
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James E, Linde B, Redlich CA. Master Clinician and Public Health Practitioner: Selected Occupational and Environmental Pulmonary Cases. Clin Chest Med 2021; 41:567-580. [PMID: 33153680 DOI: 10.1016/j.ccm.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contributing factors. Mastering occupational and environmental medicine clinical decision making requires specialized clinical skills. These skills include obtaining an appropriate work and exposure history; making an assessment of the magnitude and relevance of exposures and their contribution to a patient's respiratory disease; utilizing appropriate resources for evaluation and management of exposure-related disease; and considering socioeconomic and public health factors.
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Affiliation(s)
- Efia James
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, 367 Cedar Street, ESHA 2nd Floor, New Haven, CT 06510, USA.
| | - Brian Linde
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, 367 Cedar Street, ESHA 2nd Floor, New Haven, CT 06510, USA
| | - Carrie A Redlich
- Department of Medicine, Yale Occupational and Environmental Medicine Program, Yale School of Medicine, 367 Cedar Street, ESHA 2nd Floor, New Haven, CT 06510, USA
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6
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Tuza FADA, de Sá PM, Castro HA, Lopes AJ, de Melo PL. Combined forced oscillation and fractional-order modeling in patients with work-related asthma: a case-control study analyzing respiratory biomechanics and diagnostic accuracy. Biomed Eng Online 2020; 19:93. [PMID: 33298072 PMCID: PMC7724713 DOI: 10.1186/s12938-020-00836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Fractional-order (FrOr) models have a high potential to improve pulmonary science. These models could be useful for biomechanical studies and diagnostic purposes, offering accurate models with an improved ability to describe nature. This paper evaluates the performance of the Forced Oscillation (FO) associated with integer (InOr) and FrOr models in the analysis of respiratory alterations in work-related asthma (WRA). METHODS Sixty-two individuals were evaluated: 31 healthy and 31 with WRA with mild obstruction. Patients were analyzed pre- and post-bronchodilation. The diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUC). To evaluate how well do the studied models correspond to observed data, we analyzed the mean square root of the sum (MSEt) and the relative distance (Rd) of the estimated model values to the measured resistance and reactance measured values. RESULTS AND DISCUSSION Initially, the use of InOr and FrOr models increased our understanding of the WRA physiopathology, showing increased peripheral resistance, damping, and hysteresivity. The FrOr model (AUC = 0.970) outperformed standard FO (AUC = 0.929), as well as InOr modeling (AUC = 0.838) in the diagnosis of respiratory changes, achieving high accuracy. FrOr improved the curve fitting (MSEt = 0.156 ± 0.340; Rd = 3.026 ± 1.072) in comparison with the InOr model (MSEt = 0.367 ± 0.991; Rd = 3.363 ± 1.098). Finally, we demonstrated that bronchodilator use increased dynamic compliance, as well as reduced damping and peripheral resistance. CONCLUSIONS Taken together, these results show clear evidence of the utility of FO associated with fractional-order modeling in patients with WRA, improving our knowledge of the biomechanical abnormalities and the diagnostic accuracy in this disease.
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Affiliation(s)
- Fábio Augusto D Alegria Tuza
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Haroldo Lisboa da Cunha Pavilion Number 104 and 105, São Francisco Xavier Street 524 Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
- BioVasc Research Laboratory, Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Morisco de Sá
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Haroldo Lisboa da Cunha Pavilion Number 104 and 105, São Francisco Xavier Street 524 Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
- BioVasc Research Laboratory, Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hermano A Castro
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- School of Medical Sciences, Pulmonary Function Testing Laboratory, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Haroldo Lisboa da Cunha Pavilion Number 104 and 105, São Francisco Xavier Street 524 Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil.
- BioVasc Research Laboratory, Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Tarlo SM, Quirce S. Impact of Identification of Clinical Phenotypes in Occupational Asthma. J Allergy Clin Immunol Pract 2020; 8:3277-3282. [PMID: 32561498 DOI: 10.1016/j.jaip.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022]
Abstract
Phenotypic differences and similarities in the spectrum of occupational asthma (OA) subtypes reflect the underlying mechanisms of the diverse forms of the disease, and these phenotypes provide information as to diagnostic steps and approaches to management. In large part, the phenotype reflects the existence of immunologic mechanisms and the presence or absence of a specific IgE-antibody response to a work sensitizer. However, further differences occur between OA from high- and low-molecular-weight sensitizers (chemical sensitizers), which potentially might be relevant for nonoccupational asthma. Chemical sensitizers cause a specific response that is more likely to be a late asthmatic response and specific IgE can be identified only in a minority. Irritant-induced asthma is most easily recognized when it occurs with 1 or more high-level respiratory irritant exposure(s) but is also possible with chronic low-level exposures as in cleaners, farmers, and woodworkers, as suggested from epidemiologic studies. OA chronic obstructive pulmonary disease overlap is more common in older patients and with OA from low-molecular-weight sensitizers. Removal from exposure to the causative agent is currently advised for those with OA from sensitization: further studies with omalizumab and other biologic agents are needed to determine whether these might allow return to the same exposure.
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Affiliation(s)
- Susan M Tarlo
- Respiratory Division, Department of Medicine, University Health Network, Toronto Western Hospital, University of Toronto Department of Medicine and Dalla Lana Department of Public Health, Toronto, ON, Canada.
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER of Respiratory Diseases CIBERES, Madrid, Spain
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9
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Carneiro-Leão L, Carolino F, Pineda F, Miranda M, Plácido JL. A Possible New Mushroom Allergen in a Case of Occupational Asthma. J Investig Allergol Clin Immunol 2020; 29:243-244. [PMID: 31219039 DOI: 10.18176/jiaci.0367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L Carneiro-Leão
- Serviço de Imunoalergologia, Centro Hospitalar de São João, Porto, Portugal
| | - F Carolino
- Serviço de Imunoalergologia, Centro Hospitalar de São João, Porto, Portugal
| | - F Pineda
- Diater Laboratories, Madrid, Spain
| | - M Miranda
- Serviço de Imunoalergologia, Centro Hospitalar de São João, Porto, Portugal
| | - J L Plácido
- Serviço de Imunoalergologia, Centro Hospitalar de São João, Porto, Portugal
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Abstract
Objective: Concurrent asthma and chronic obstructive pulmonary disease (COPD) diagnoses occur in 15%-20% of patients, and have been associated with worse health outcomes than asthma or COPD alone. Work-related asthma (WRA), asthma that is caused or made worse by exposures in the workplace, is characterized by poorly controlled asthma. The objective of this study was to assess the proportion of ever-employed adults (≥18 years) with current asthma who have been diagnosed with COPD, by WRA status.Methods: Data from 23 137 respondents to the 2012-2014 Behavioral Risk Factor Surveillance System Asthma Call-back Survey from 31 states and the District of Columbia were examined. Logistic regression was used to calculate adjusted prevalence ratios (PRs), examining six disjoint categories of WRA-COPD overlap with non-WRA/no COPD as the referent category.Results: An estimated 51.9% of adults with WRA and 25.6% of adults with non-WRA had ever been diagnosed with COPD. Adults with WRA/COPD were more likely than those with non-WRA/no COPD to have an asthma attack (PR = 1.77), urgent treatment for worsening asthma (PR = 2.85), an asthma-related emergency room visit (PR = 4.21), overnight stay in a hospital because of asthma (PR = 6.57), an activity limitation on 1-13 days (PR = 2.01) or ≥14 days (PR = 5.02), and very poorly controlled asthma (PR = 3.22).Conclusions: COPD was more frequently diagnosed among adults with WRA than those with non-WRA, and adults diagnosed with both WRA and COPD appear to have more severe adverse asthma outcomes than those with non-WRA and no COPD.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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11
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Guarnieri G, Bonadonna P, Olivieri E, Schiappoli M. Occupational Asthma Induced by Exposure to Quinoa. J Investig Allergol Clin Immunol 2019; 29:451-452. [PMID: 31283525 DOI: 10.18176/jiaci.0432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G Guarnieri
- Occupational Medicine, Department of Cardiologic, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - P Bonadonna
- Allergy Unit and Asthma Center, Hospital and University of Verona, Verona, Italy
| | - E Olivieri
- Allergy Unit and Asthma Center, Hospital and University of Verona, Verona, Italy
| | - M Schiappoli
- Allergy Unit and Asthma Center, Hospital and University of Verona, Verona, Italy
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12
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Tarlo SM, Arif AA, Delclos GL, Henneberger P, Patel J. Opportunities and obstacles in translating evidence to policy in occupational asthma. Ann Epidemiol 2018; 28:392-400. [PMID: 28434545 PMCID: PMC5953844 DOI: 10.1016/j.annepidem.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. METHODS In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. RESULTS AND CONCLUSIONS Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.
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Affiliation(s)
- Susan M. Tarlo
- Department of Medicine, University Health Network, University of Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Ontario, Canada,Department of Public Health Sciences, University of Toronto, Ontario, Canada,Corresponding author. Toronto Western Hospital, EW7-449, 399 Bathurst Street, Toronto, Ontario, M5T 2S8. Tel.: 416 603 5177; fax 416 603 6763. (S.M. Tarlo)
| | - Ahmed A. Arif
- UNC Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - George L. Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| | | | - Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
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13
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Kurt OK, Ergun D, Basaran N. Can the ceramic industry be a new and hazardous sector for work-related asthma? Respir Med 2018; 137:176-180. [PMID: 29605202 DOI: 10.1016/j.rmed.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Work-related asthma (WRA) constitutes a significant proportion of all asthma cases and continues to be reported from different industries. The aim of the study was to identify the occupations that can be related to WRA and diagnostic steps used in suspected WRA patients. METHODS We retrospectively reviewed the clinical records of WRA suspected patients who were referred to Ankara Occupational and Environmental Diseases Hospital, Turkey from January 2015 to January 2017. Detailed occupational history, the diagnostic steps such as pulmonary function testing (PFT), peak expiratory flow (PEF) monitoring and nonspecific bronchial provocation tests (NSBPT) were recorded. RESULTS Among 160 patients, 148 were male and 12 were female. Only 2 of them were diagnosed as work-exacerbated asthma (WEA). Diagnosis of asthma was based on using reversible airflow limitation 28.8% (n = 46) or NSBPT 31.9% (n = 51). Toxicological analysis showed that 28 patients had heavy metal poisoning, 9 patients had solvent poisoning, 4 patients had both. According to occupations, 32 of them were ceramic workers (20.0%) and 27 of them were metal workers (16.9%). Plastic workers (4 ± 2.8 years), cleaners (6.2 ± 5.7 years), metal workers (7.4 ± 5.4 years), painters (10 ± 5.2 years), ceramic workers (10.8 ± 5.9 years) had the shortest exposure durations for development of occupational asthma (OA). An analysis of variance showed that the effect of heavy metal and solvent poisoning on mean time for onset of OA was not significant. CONCLUSIONS The results demonstrate that besides the sectors known to cause WRA, ceramic and metal industries can be related to important exposures related to WRA. Medical surveillance of employees in this sector is important in early detection.
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Affiliation(s)
- Ozlem Kar Kurt
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Occupational Medicine, Ankara, Turkey.
| | - Dilek Ergun
- Occupational and Environmental Diseases Hospital, Department of Pulmonary Medicine, Ankara, Turkey
| | - Nursen Basaran
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
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14
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Abstract
PURPOSE OF REVIEW Work-related asthma is a common disorder among adult asthma patients, and in the case of occupational asthma, it is induced by workplace exposures. RECENT FINDINGS Occupational asthma provides an excellent model and benchmark for identifying and testing different allergy or inflammatory biomarkers associated with its inception or progression. Moreover, specific inhalation challenge with the incriminated agent represents an experimental setting to identify and validate potential systemic or local biomarkers. Some biomarkers are mainly blood-borne, while local airway biomarkers are derived from inflammatory or resident cells. Genetic and gene-environment interaction studies also provide an excellent framework to identify relevant profiles associated with the risk of developing these work-related conditions. Despite significant efforts to identify clinically relevant inflammatory and genomic markers for occupational asthma, apart from the documented utility of airway inflammatory biomarkers, it remains elusive to define specific markers or signatures clearly associated with different endpoints or outcomes in occupational asthma.
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15
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Mével H, Demange V, Penven E, Trontin C, Wild P, Paris C. Assessment of work-related asthma prevalence, control and severity: protocol of a field study. BMC Public Health 2016; 16:1164. [PMID: 27852249 PMCID: PMC5112681 DOI: 10.1186/s12889-016-3824-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022] Open
Abstract
Background There are still uncertainties regarding the respective prevalence, diagnosis and management of occupational asthma (OA) and work-exacerbated asthma (WEA). There is as yet no standardized methodology to differentiate their diagnosis. A proper management of both OA and WEA requires tools for a good phenotyping in terms of control, severity and quality of life in order to propose case-specific therapeutical and preventive measures. Moreover, there is a lack of knowledge concerning their actual costs. Methods This project aims at comparing 3 groups of asthmatic subjects at work: subjects with OA, with WEA, and with non-work-related asthma (NWRA) in terms of control, severity and quality of life on the one hand, and estimating the prevalence of OA, WEA and NWRA in active workers and the economic costs of OA and WEA, on the other hand. Control will be assessed using the Asthma Control Test questionnaire and the daily Peak Exploratory Flow variability, severity from the treatment level, and quality of life using the Asthma Quality of Life Questionnaire. A first step will be to apply a standardized diagnosis procedure of WEA and OA. This study includes an epidemiological part in occupational health services by volunteering occupational physicians, and a clinical case-study based on potentially asthmatic subjects referred to ten participating University Hospital Occupational Diseases Departments (UHODD) because of a suspected WRA. The subjects’ characterization with respect to OA and WEA is organized in three steps. In Step 1 (epidemiological part), occupational physicians screen for potentially actively asthmatics through a questionnaire given to workers seen in mandatory medical visit. In step 2 (both parts), the subjects with a suspicion of work-related respiratory symptoms answer a detailed questionnaire and perform a two-week OASYS protocol enabling us, using a specifically developed algorithm, to classify them into probably NWRA, suspected OA, suspected WEA. The two latter groups are referred to UHODD for a final harmonized diagnosis (step 3). Finally, direct and indirect disease-related costs during the year preceding the diagnosis will be explored among WRA cases, as well as these costs and the intangible costs, during the year following the diagnosis. Discussion This project is an attempt to obtain a global picture of occupational asthma in France thanks to a multidisciplinary approach. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3824-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hermine Mével
- INRS, Institut National de Recherche et de Sécurité, Vandoeuvre-lès-Nancy, France.,EA7298 INGRES, Université de Lorraine, Nancy, France
| | - Valérie Demange
- INRS, Institut National de Recherche et de Sécurité, Vandoeuvre-lès-Nancy, France.
| | - Emmanuelle Penven
- EA7298 INGRES, Université de Lorraine, Nancy, France.,Occupational Diseases Department, University Hospital, Vandoeuvre-lès-Nancy, France
| | - Christian Trontin
- INRS, Institut National de Recherche et de Sécurité, Vandoeuvre-lès-Nancy, France
| | - Pascal Wild
- INRS, Institut National de Recherche et de Sécurité, Vandoeuvre-lès-Nancy, France.,EA7298 INGRES, Université de Lorraine, Nancy, France
| | - Christophe Paris
- EA7298 INGRES, Université de Lorraine, Nancy, France.,Occupational Diseases Department, University Hospital, Vandoeuvre-lès-Nancy, France
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16
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Quirce S, Campo P, Domínguez-Ortega J, Fernández-Nieto M, Gómez-Torrijos E, Martínez-Arcediano A, Mur P, Delgado J. New developments in work-related asthma. Expert Rev Clin Immunol 2016; 13:271-281. [PMID: 27653257 DOI: 10.1080/1744666x.2017.1239529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Work-related asthma includes two subtypes: occupational asthma or asthma caused by specific agents (sensitizers or irritants) in the workplace, and work-exacerbated asthma or pre-existing asthma worsened by workplace exposures. Areas covered: This review provides an update on the definitions and the clinical features of the different work-related asthma subtypes as well as new insights into their etiology and the pathophysiological mechanisms involved. The diagnosis of work-related asthma should be made on objective basis using a constellation of clinical, physiologic and allergologic tests. Specific inhalation challenge with the suspected occupational agent(s) remains as the reference standard for diagnosis. A literature search was performed using the following terms: work-related asthma, occupational asthma, work-exacerbated asthma, irritant-induced asthma and etiological agents. Expert commentary: Studies focusing on the biological effects and mechanisms of environmental exposures in the development of sensitizer-induced or irritant-induced asthma in various workplace settings are of greatest interest. An integrative approach that combines clinical parameters with component-resolved diagnosis as well as inflammatory biomarkers appears to be very promising. Occupational allergy provides a good opportunity to understand the complex relationships between exposure to allergens in the workplace, interaction with genes and the co-exposures to other factors in the working environment.
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Affiliation(s)
- Santiago Quirce
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | - Paloma Campo
- b Unidad de Gestión Clínica Allergy-IBIMA , Hospital Regional Universitario , Malaga , Spain
| | - Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | | | | | | | - Pilar Mur
- f Allergy Unit , Hospital Santa Barbara , Puertollano , Spain
| | - Julio Delgado
- g Unidad de Gestión Clínica Alergología , Hospital Virgen Macarena , Sevilla , Spain
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17
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Rosenman KD, Beckett WS. Web based listing of agents associated with new onset work-related asthma. Respir Med 2015; 109:625-31. [PMID: 25863522 DOI: 10.1016/j.rmed.2015.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/02/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Work-related asthma is common and yet remains a challenge to diagnose. Access to a listing of agents associated with work-related asthma has been suggested as useful in assisting in the diagnosis. METHODS The Association of Occupational and Environmental Clinics (AOEC) developed criteria that were used to review the peer-reviewed medical literature published in English. Based on this review, substances were designated either as a sensitizing agent or an irritant. The reviews were conducted by a board certified internist/pulmonologist/occupational medicine specialist from 2002 to 2007 and a board certified internist/occupational medicine physician from 2008- date. All reviews were then reviewed by the nine member AOEC board of directors. RESULTS The original list of agents associated with new onset work-related asthma was derived from the tables of a text book on work-related asthma. After 13 years of review, there are 327 substances designated as asthma agents on the AOEC list; 173 (52.9%) coded as sensitizers, 35 (10.7%) as generally recognized as an asthma causing agent, four (1.2%) as irritants, two (0.6%) as both a sensitizer and an irritant and 113(34.6%) agents that still need to be reviewed. CONCLUSIONS The AOEC has developed a readily available web based listing of agents associated with new onset work-related asthma in adults. The listing is based on peer-reviewed criteria. The listing is updated twice a year. Regular review of the peer-reviewed medical literature is conducted to determine whether new substances should be added to the list. Clinicians should find the list useful when considering the diagnosis of work-related asthma.
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Affiliation(s)
- K D Rosenman
- Michigan State University, 909 Fee Hall, Room 117 West Fee, East Lansing, MI 48824, USA.
| | - W S Beckett
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, USA
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18
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Kwon SC, Song J, Kim YK, Calvert GM. Work-Related Asthma in Korea - Findings from the Korea Work-Related Asthma Surveillance (KOWAS) program, 2004-2009. Allergy Asthma Immunol Res 2014; 7:51-9. [PMID: 25553263 PMCID: PMC4274470 DOI: 10.4168/aair.2015.7.1.51] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/23/2014] [Accepted: 07/07/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE To determine the incidence and epidemiological characteristics of work-related asthma in Korea. METHODS During 2004-2009, the Korea Work-Related Asthma Surveillance (KOWAS) program collected data on new cases of work-related asthma from occupational physicians, allergy and chest physicians, regional surveillance systems, and workers' compensation schemes. The incidence was calculated on the basis of industry, occupation, sex, age, and region. In addition, the distribution of causal agents was determined. RESULTS During the study period, 236 cases of work-related asthma were reported, with 77 cases from more than 1 source. A total of 22.0% (n=52) were reported by occupational physicians, 52.5% (n=124) by allergy and chest physicians, 24.2% (n=57) by regional surveillance systems, and 43.2% (n=102) by workers' compensation schemes. The overall average annual incidence was 3.31 cases/million workers, with a rate of 3.78/million among men and 2.58/million among women. The highest incidence was observed in the 50-59-year age group (7.74/million), in the Gyeonggi/Incheon suburb of Seoul (8.50/million), in the furniture and other instrument manufacturing industries (67.62/million), and among craft and related trades workers (17.75/million). The most common causal agents were isocyanates (46.6%), flour/grain (8.5%), metal (5.9%), reactive dyes (5.1%), and solvents (4.2%). CONCLUSIONS The incidence of work-related asthma in Korea was relatively low, and varied according to industry, occupation, gender, age, and region. Data provided by workers' compensation schemes and physician reports have been useful for determining the incidence and causes of work-related asthma.
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Affiliation(s)
- Soon-Chan Kwon
- Department of Occupational and Environmental Medicine, Hanyang University, Seoul, Korea
| | - Jaechul Song
- Department of Occupational and Environmental Medicine, Hanyang University, Seoul, Korea
| | - Yong-Kyu Kim
- Center for Occupational and Environmental medicine, Daejeon Sun Hospital, Daejeon, Korea
| | - Geoffrey M Calvert
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Abstract
In 2013, several themes emerged: (1) a dedicated search for new therapies using new mechanisms; (2) the importance of the plasticity of the immune system (eg, that molecules that mediate inflammation in one setting can promote its resolution and return to homeostasis in other circumstances); (3) the complex role of viruses in asthma exacerbations; (4) the similarities and differences among asthma, asthma in smokers, and chronic obstructive pulmonary disease; and (5) the importance of understanding asthma phenotypes and their stability over time. Once new therapeutics pass the initial clinical trials, patient-oriented and real-world research will be needed.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pa.
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20
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Abstract
Asthma is a heterogeneous syndrome of cough, wheeze, dyspnea, and chest tightness. However, in a subset of patients, these symptoms may indicate a different underlying disease process with variable responsiveness to classic asthma therapies. Disease may progress while practitioners attempt conventional asthma therapy. Additionally, some types of asthma may require alternative approaches to relieve symptoms successfully. This article describes the differential diagnosis of asthma and discusses some of the more common asthma variants and asthma mimickers.
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Affiliation(s)
- Patrick R Aguilar
- Department of Internal Medicine, Washington University, 660 Euclid, PO Box 8052, St. Louis, MO 63110, USA
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