Physicians should ask all adults with asthma about possible
workplace exposure to allergens, according to a recent publication
by the American College of Chest Physicians (ACCP).
An ACCP-convened expert panel consisting of allergists,
pulmonologists, and occupational medicine physicians reviewed
evidence-based practice and issued a consensus statement in
September 2008. That statement noted that about 15 percent of cases
of adult asthma are attributable to occupational factors. The panel
considered the substantial prevalence of work-related asthma as
support for screening for work-related asthma in adults with
new-onset or worsening asthma.
Further, the panel recommended follow-up, including
investigations and consideration of similarly exposed coworkers.
This proactive approach was applauded by Marcy Goldstein-Gelb of
the Massachusetts Coalition for Occupational Safety and Health
(MassCOSH), a nonprofit organization that promotes safe working
conditions. "This consensus statement focuses on prevention," she
noted. "Any individual with asthma will be seen as a warning that
workplace conditions may be hazardous."
The panel emphasized confirming the asthma diagnosis, utilizing
an occupational history to probe exposures, and exploring the
relationship between asthma and work using serial measurements of
peak flow, spirometry including methacholine responsiveness, and
immunologic tests.
Testing Recommendations
William Beckett, M.D., M.P.H., a member of the ACCP panel and a
Massachusetts internist/occupational medicine specialist,
explained, "If a specific allergen is suspected as the cause of
asthma - for example, wheat flour for a baker with new-onset asthma
- serum IgE testing for wheat or skin-prick testing with wheat
allergen can confirm sensitization."
Dr. Beckett added that when treating a patient whose asthma
might be due to workplace exposures, "the physician must decide
whether it is safe for the patient to return to work, and may also
need to consider whether the workplace represents a hazard to
others. If the asthma is occupational and a hazard is present, the
patient needs written work restrictions and the employer should be
notified of a hazard." The panel's consensus statement also
recognizes worsening of preexisting or concurrent asthma by
workplace factors. Adults with asthma due to sensitization may need
to be removed from the workplace if the exposure cannot be
eliminated. However, for individuals with work-exacerbated asthma,
treatment should be optimized and exposure to workplace triggers
should be reduced.
The statement was published as a supplement to the September
2008 issue of CHEST, and can be
downloaded at no charge.
Suspected or confirmed cases of work-related asthma in
Massachusetts must be reported to the Massachusetts Department of
Public Health.
Download reporting forms here. Physicians can suggest that
their patients contact MassCOSH (www.masscosh.org/) for ideas on
working with coworkers to improve conditions.
- Elise Pechter, M.P.H.
Occupational Health Surveillance Program Massachusetts Department
of Public Health
The American College of Chest Physicians recommends physicians
consider the following when a patient's asthma started or worsened
during his or her working life: Do asthma symptoms differ during
times away from work? Are symptoms of itching or burning eyes and
runny nose worse at work? Did changes in work processes precede the
onset of symptoms? Was there an unusual exposure in the 24 hours
before the onset of initial asthma symptoms?
