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Médecine du travail du personnel hospitalier

Defining and investigating occupational asthma: a consensus approach.

Occup Environ Med. 2006 Nov 27; [Epub ahead of print]
Defining and investigating occupational asthma: a consensus approach.
Francis HC, Prys-Picard C, Fishwick D, Stenton C, Burge S, Bradshaw LM, Ayres JG, Campbell S, Niven RM.
North West Lung Centre, United Kingdom.

BACKGROUND: At present there is no internationally agreed definition of occupational asthma and there is a lack of guidance regarding the resources that should be readily available to physicians running specialist occupational asthma services. AIMS: Our aim was to agree a working definition of occupational asthma and to develop a framework of resources necessary to run a specialist occupational asthma clinic. Method: A modified RAND Appropriateness Method was used to gain a consensus of opinion from an expert panel of clinicians running specialist occupational asthma clinics in the UK. RESULTS: Consensus was reached over 10 terms defining occupational asthma including: Occupational asthma is defined as asthma induced by exposure in the working environment to airborne dusts vapours or fumes, with or without pre-existing asthma; occupational asthma encompasses the term sensitiser induced asthma and acute irritant induced asthma (RADS); acute irritant induced asthma (RADS) is a type of occupational asthma where there is no latency and no immunological sensitisation and should only be used when a single high exposure has occurred; and the term work related asthma can be used to include occupational asthma, acute irritant induced asthma (RADS) and aggravation of pre-existing asthma. Disagreement arose on whether low dose irritant induced asthma existed, but the panel agreed that if it did exist they would include it in the definition of « work related asthma ». The panel agreed on a set of 18 resources which should be available to a specialist occupational asthma service. These included pre-bronchodilator FEV1 and FVC (% predicted); peak flow monitoring (and plotting of results, OASYS II analysis); non-specific provocation challenge in the laboratory and specific IgE to a wide variety of occupational agents. CONCLUSION: It is hoped that the outcome of this process will improve uniformity of definition and investigation of occupational asthma across the UK.
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