Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence.

TY - JOUR

T1 - Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence.

AU - Vandenplas, O

AU - Dressel, H

AU - Wilken, Dennis

AU - Jamart, J

AU - Heederik, D

AU - Maestrelli, P

AU - Sigsgaard, T

AU - Henneberger, P

AU - Baur, Xaver

PY - 2011

Y1 - 2011

N2 - Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition. The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes. A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent. The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03-0.91) and recovery (OR 0.30, 95% CI 0.11-0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97-35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11-28.82), compared with complete avoidance of exposure. This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach.

AB - Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition. The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes. A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent. The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03-0.91) and recovery (OR 0.30, 95% CI 0.11-0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97-35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11-28.82), compared with complete avoidance of exposure. This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach.

KW - Humans

KW - Occupational Health

KW - Asthma/etiology/prevention & control

KW - Evidence-Based Practice/methods

KW - Occupational Diseases/etiology/prevention & control

KW - Occupational Exposure/adverse effects/prevention & control

KW - Humans

KW - Occupational Health

KW - Asthma/etiology/prevention & control

KW - Evidence-Based Practice/methods

KW - Occupational Diseases/etiology/prevention & control

KW - Occupational Exposure/adverse effects/prevention & control

M3 - SCORING: Journal article

VL - 38

SP - 804

EP - 811

JO - EUR RESPIR J

JF - EUR RESPIR J

SN - 0903-1936

IS - 4

M1 - 4

ER -