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Occupational Asthma

Wake Forest Baptist Approach As the largest center for the diagnosis and treatment of primary immuno-deficiency in Western North Carolina and Southwestern Virginia, allowing us to have more options and resources for diagnosis and treatment. Wake Forest Baptist is one of eight centers in the country, and the only one in the South, that is part of the Asthma Clinical Research Network (ACRN), which evaluates new treatments for asthma. We have the ability to perform methacholine and exercise challenges on site, as well as Spirometry.  When scheduled ahead of time CT scans and X-rays can also be performed on site. The asthma clinic has three certified RN asthma educators who spend extensive one-on-one time with each asthma patient, or for pediatric patients with the family, to ensure they understand disease management, triggers, avoidance measures, and disease monitoring. Wake Forest Baptist faculty conducts numerous clinical trials dealing with the role of genetics and inheritance in asthma. Many of these trails are done in conjunction with Wake Forest’s Center for Human Genomics, which was established in June 2000. Its primary purpose is to investigate genetic mechanisms in the development and progression of complex human diseases, including cardiovascular disease, diabetes, prostate cancer and pulmonary diseases such as allergies and asthma Physician comments: “We want to understand what is wrong in patients with severe asthma and apply what we learn to help them,” said Wendy Moore, M.D., a specialist in pulmonary medicine. “The long-term goal is to develop new ways to evaluate a patient’s asthma to allow us to design individualized therapy for that patient based on the type of inflammation in their lungs or the genes they have,” said Moore. “We are trying to answer important questions about asthma, to evaluate new and existing therapies and to get the results out quickly so patients can benefit,” said Stephen Peters, M.D., Ph.D., research director and professor of pulmonary and critical care medicine.     Occupational asthma Spirometry Respiratory system Definition: Occupational asthma is a lung disorder in which various substances found in the workplace lead to breathing difficulties. See also: Asthma Alternative Names: Asthma - occupational exposure; Irritant-induced reactive airways disease Causes, incidence, and risk factors: Many substances in the workplace can cause occupational asthma. The most common triggers are wood dust, grain dust, animal dander, fungi, or other chemicals (especially diisocyanates). Though the actual rate of occurrence of occupational asthma is unknown, it is suspected to cause 2 - 20% of all asthma cases in industrialized nations. The following workers are at higher risk: Bakers Detergent manufacturers Drug manufacturers Farmers Grain elevator workers Laboratory workers Metal workers Millers Plastics workers Woodworkers Symptoms: Symptoms are usually due to swelling of the airways and spasms of the muscles lining the airways. This reduces the amount of air that can pass through, and can lead to wheezing sounds. Symptoms usually occur shortly after you are exposed to the offending substance, and often improve or go away when you leave work. Some people may not have symptoms until 12 or more hours after being exposed to the allergen. Symptoms usually get worse toward the end of the work week and may (but not always) go away on weekends or vacations. In general, symptoms include: Coughing Tight feeling in the chest Shortness of breath Wheezing Signs and tests: The health care provider will perform a physical exam and ask questions about your medical history. Your symptoms may have a pattern of getting worse with a specific workplace environment or substance. The health care provider may hear wheezing when listening to the chest with a stethoscope. The following tests may be used to diagnose this condition: Blood tests to detect specific antibodies to the suspected substance Bronchial provocation test (test measuring reaction to the suspected allergen) Chest x-ray Complete blood count Peak expiratory flow rate Pulmonary function tests Treatment: Avoiding exposure to the substance that is causing your asthma is the best treatment. The best option is to change jobs, but this may be difficult to do. Moving to a different location at the job where there is less exposure to the substance may help, but it does not seem to make a difference for many people. Over time, even a very small amount of the substance can trigger an asthma attack. Using a respiratory device to protect or reduce your exposure may help. Asthma medicines (almost always inhalers) may help you manage your symptoms. Talk to your doctor about these medicines. Asthma quick-relief drugs help relax the muscles of your airways. They are called bronchodilators. Asthma control drugs are taken every day to prevent symptoms. Support Groups: See: Asthma and allergy - support group Expectations (prognosis): Occupational asthma may continue to get worse if you continue to be exposed to the substance that is causing the problem, even if medicines improve your symptoms. In some instances, symptoms may continue even when the source of exposure is removed. In general, the outcome for people with asthma is good. However, symptoms may continue for years after workplace exposure has been eliminated. Complications: Negative impact on personal finances and career for people who need to change jobs Respiratory fatigue Side effects of asthma medications Calling your health care provider: Call your health care provider if you have symptoms of asthma. Prevention: You can reduce asthma symptoms by avoiding known allergens and airway irritants. References: Dykewicz MS. Occupational asthma: current concepts in pathogenesis, diagnosis, and management. J Allergy Clin Immunol. 2009;123:519-528.

Review Date:5/21/2009 Reviewed By:Allen J. Blaivas, D.O., Division of Pulmonary and Critical Care Medicine, UMDNJ-New Jersey Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.