Romero-Mesones C, Cruz MJ, Alobid I et al. J Allergy Clin Immunol Pract. 2023 Jun 28:S2213-2198(23)00706-7. doi: 10.1016/j.jaip.2023.06.040. Epub ahead of print.
HIGHLIGHTS
What is already known about this topic?
Exposure to certain agents in the workplace can trigger occupational asthma or work-exacerbated asthma, both of which come under the heading of work-related asthma. Up to 16% of the patients who attend specialized asthma units present work-related asthma.
What does this article add to our knowledge?
80% of the patients who continued to work, and 96% of those who did not, had moderate or severe asthma.
The highest risk professions are cleaners, both domestic and industrial, and workers in the metal industry.
How does this study impact current management guidelines?
Because we found little difference in the severity of asthma, treatment administered, changes in lung function, or number of exacerbations between employed and unemployed workers with WRA, any advice regarding job change or changes in workplace exposures should be customized to the individual situation.
ABSTRACT
Background
Exposure to certain agents in the workplace can trigger occupational asthma (OA) or work-exacerbated asthma (WEA), both of which come under the heading of work-related asthma (WRA). Understanding the burden that WRA represents can help in the management of these patients.
Objective
The objective of the present study is to assess the influence of occupation on asthma in real life and to analyze the characteristics of the patients with WRA included in an asthma cohort.
Methods
Prospective multicenter study of a cohort of consecutive patients with asthma. A standardized clinical history was completed. Patients were classified as having WRA or Non-WRA. All patients underwent respiratory function tests, fraction of exhaled nitric oxide (FeNO) and methacholine challenge (PC20) at the beginning of the study. They were classified into two groups depending on their employment status: employed (Group 1) or unemployed (Group 2).
Results
Eighty-two (17%) of the 480 patients included in the cohort were diagnosed with WRA. Fifty-seven patients (70%) were still working. Mean age (SD) was 46 (10.69) years in Group 1 and 57 (9.91) years in Group 2 (p<0.0001). Significant differences were observed in adherence to treatment, 64.9% in Group 1 vs 88% in Group 2 (p= 0.0354) and in severe asthma exacerbations (35.7% in Group 1 vs 0% in Group 2; p= 0.0172). No significant differences were observed in the rest of the variables analyzed.
Conclusions
The burden of WRA in specialized Asthma Units is not negligible. The absence of any differences in the severity of asthma, the treatment administered, alterations in lung function or the number of exacerbations in those working versus not working, may support the idea that job change advice should be customized to each individual patient.