Diagnosis and Management of Work-Related Asthma. Chest. 2008; 134:1S-41. 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 and Julia Heitzer, MS. Read more.

*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.
Abstract 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.