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ORIGINAL ARTICLE |
1 North West Lung Research Centre, Wythenshawe Hospital, Manchester, UK
2 Centre for Workplace Health, Health & Safety Laboratory, Buxton & University of Sheffield, UK
3 Royal Victoria Infirmary, Newcastle upon Tyne, UK
4 Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
5 Department of Environmental and Occupational Medicine, University of Aberdeen, UK
6 National Primary Care Research and Development Centre, University of Manchester, UK
Correspondence to:
Correspondence to:
Dr H Francis
North West Lung Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; Helen.C.Francis{at}manchester.ac.uk
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: 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 terms "sensitiser-induced asthma" and "acute irritant-induced asthma" (reactive airways dysfunction syndrome (RADS)); acute irritant-induced asthma 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.
Abbreviations: RADS, reactive airways dysfunction syndrome
This article has been cited by other articles:
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  S. M Tarlo Standards of care for occupational asthma Thorax, March 1, 2008; 63(3): 190 - 192. [Full Text] [PDF]
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D Fishwick, C M Barber, L M Bradshaw, J Harris-Roberts, M Francis, S Naylor, J Ayres, P S Burge, J M Corne, P Cullinan, et al. Standards of care for occupational asthma Thorax, March 1, 2008; 63(3): 240 - 250. [Full Text] [PDF]
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 H. C Francis and R M. Niven Authors' response Occup. Environ. Med., February 1, 2008; 65(2): 148 - 148. [Full Text] [PDF]
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