0
Diagnosis and Management of Work-Related Asthma: ACCP Consenus Statement: DIAGNOSIS AND MANAGEMENT OF WORK-RELATED ASTHMA: ACCP CONSENSUS STATEMENT |

Diagnosis and Management of Work-Related Asthma: American College of Chest Physicians Consensus Statement

Susan M. Tarlo, MBBS, FCCP; John Balmes, MD, FCCP; Ronald Balkissoon, MD; Jeremy Beach, MD; William Beckett, MD, MPH, FCCP; David Bernstein, MD; Paul D. Blanc, MD, FCCP; Stuart M. Brooks, MD; Clayton T. Cowl, MD, MS, FCCP; Feroza Daroowalla, MD, MPH, FCCP; Philip Harber, MD, MPH; Catherine Lemiere, MD, MSc; Gary M. Liss, MD, MS; Karin A. Pacheco, MD, MSPH; Carrie A. Redlich, MD, MPH, FCCP; Brian Rowe, MD, FCCP; Julia Heitzer, MS
Author and Funding Information

*From the University of Toronto (Drs. Tarlo and Liss), Toronto, ON, Canada; the University of California San Francisco (Drs. Balmes and Blanc), San Francisco, CA; National Jewish Medical and Research Center (Drs. Balkissoon and Pacheco), Denver, CO; the University of Alberta (Drs. Beach and Rowe), Calgary, AB, Canada; the University of Rochester School of Medicine and Dentistry (Dr. Beckett), Rochester, NY; the University of Cincinnati (Dr. Bernstein), Cincinnati, OH; the University of South Florida (Dr. Brooks), Tampa, FL; Mayo Clinic (Dr. Cowl), Rochester, MN; the State University of New York (Dr. Daroowalla), Stony Brook, NY; the University of California, Los Angeles (Dr. Harber), Los Angeles, CA; the Université de Montréal (Dr. Lemiere), Montréal, QC, Canada; the Yale University School of Medicine (Dr. Redlich), New Haven, CT; and the American College of Chest Physicians (Ms. Heitzer), Northbrook, IL.

Correspondence to: Susan M. Tarlo, MBBS, FCCP, Toronto Western Hospital EW7-449, 399 Bathurst St, Toronto, ON, Canada M5T 2S8; e-mail: susan.tarlo@utoronto.ca


As part of the practice of occupational pulmonary medicine, most of the panel members have served as consultants or medical experts in workers' compensation or other cases of suspected work-related asthma, and/or have provided other consulting services involving possible work-related asthma. In addition, Dr. Tarlo has received research funding for studies in work-related asthma from the Ontario Thoracic Society, and both Drs. Tarlo and Liss have received research funding from the Ontario Workplace Safety and Insurance Board Research Advisory Council for studies including work-related asthma. Dr. Tarlo has also served the following organizations with a direct interest in occupational asthma: the American Thoracic Society (Committee on Work-Exacerbated Asthma); the American Academy of Asthma, Allergy and Immunology Occupational Disease Committee; and the Canadian Thoracic Society Asthma Committee. Dr. Balmes has served organizations with a direct interest in occupational asthma, including the American Thoracic Society (Committee on Asthma Impairment and Committee on Occupational Contribution to the Burden of Obstructive Airway Disease) and the Centers for Disease Control and Prevention (CDC)-NIOSH (Study Section). Dr. Beckett has received funding from the Association for Occupational and Environmental Clinics and NIOSH to review the literature and provide written reports on issues related to occupational lung diseases, including occupational asthma. Dr. Beach has received research funding from the Alberta Workers' Compensation Board Research Program. Dr. Bernstein has received CDC-NIOSH research funding. Dr. Blanc has served organizations with a direct interest in occupational asthma, including the American Thoracic Society (Committee on Occupational Contribution to the Burden of Obstructive Airway Disease) and the Institute of Medicine committee reviewing respiratory disease programs at CDC-NIOSH. Dr. Brooks has received CDC-NIOSH research funding. Dr. Harber has served the following organizations with a direct interest in occupational asthma: the American College of Occupational and Environmental Medicine (Board of Directors, Pulmonary Committee, and Treatment Guidelines Committee); the American Thoracic Society (the Asthma Impairment Committee and the Committee on Work Exacerbated Asthma); the American Medical Association (guidelines reviewer); and CDC-NIOSH (the Committee on Work Exacerbated Asthma, Study Section). He has received research funding from CDC-NIOSH for projects related to the recognition and prevention of occupational lung diseases such as asthma. Dr. Lemiere has received research funds from the Institut de Recherche en Sante et Sécurité au Travail (or IRSST) Robert Sauve and from CDC-NIOSH, and is a member of the American Thoracic Society Committee on Work Exacerbated Asthma and Canadian Thoracic Society Asthma Committee. Dr. Pacheco has received research funding from the National Institutes of Health (NIH) for projects related to occupational asthma, and is also a member of the American Academy of Asthma, Allergy, and Immunology Occupational Disease Committee. Dr. Redlich has received research funding from the NIH and CDC-NIOSH for projects related to occupational asthma, and has also served organizations with a direct interest in occupational asthma, including the American Thoracic Society (Committee on Work Exacerbated Asthma), American Medical Association (guidelines reviewer) and CDC-NIOSH (grant reviewer). Dr. Rowe is supported by a 21st Century Research Chair from the Government of Canada (Ottawa, ON, Canada) and has received funding for work-related asthma research from the Agency for Healthcare Quality and Research (Bethesda, MD). Drs. Balkissoon, Cowl, and Daroowalla have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. None of the authors has received funding from tobacco companies.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(3_suppl):1S-41S. doi:10.1378/chest.08-0201
Text Size: A A A
Published online

Background:  A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA).

Methods:  A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007.

Results:  The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed.

Conclusions:  The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
The Outcome of Asthma Related to Workplace Irritant Exposures*: A Comparison of Irritant-Induced Asthma and Irritant Aggravation of Asthma
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543