title: Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review.
abstract: BACKGROUND
  The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis.
  
  
  METHODS
  Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded.
  
  
  RESULTS
  The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated.
  
  
  CONCLUSIONS
  In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis.
authors.affiliation: Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Pavia, Servizio Autonomo di Allergologia e Immunologia Clinica, Università degli Studi di Pavia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Moscato
authors.forename: A
authors.initials: A
authors.lastname: Dellabianca
authors.forename: P
authors.initials: P
authors.lastname: Maestrelli
authors.forename: P
authors.initials: P
authors.lastname: Paggiaro
authors.forename: C
authors.initials: C
authors.lastname: Romano
authors.forename: R
authors.initials: R
authors.lastname: De Zotti
authors.forename: A
authors.initials: A
authors.lastname: Marabini
authors.forename: S
authors.initials: S
authors.lastname: Voltolini
authors.forename: M
authors.initials: M
authors.lastname: Crippa
authors.forename: M
authors.initials: M
authors.lastname: Previdi
authors.forename: B
authors.initials: B
authors.lastname: Bramé
authors.forename: R
authors.initials: R
authors.lastname: Benzon
authors.forename: A
authors.initials: A
authors.lastname: Siracusa
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000188:drug therapy / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects