Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement.
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.
Tarlo
Susan M
SM
University of Toronto, Toronto, ON, Canada. Electronic address: susan.tarlo@utoronto.ca.
Balmes
John
J
University of California San Francisco, San Francisco, CA.
Balkissoon
Ronald
R
National Jewish Medical and Research Center, Denver, CO.
Beach
Jeremy
J
University of Alberta, Calgary, AB, Canada.
Beckett
William
W
University of Rochester School of Medicine and Dentistry, Rochester, NY.
Bernstein
David
D
University of Cincinnati, Cincinnati, OH.
Blanc
Paul D
PD
University of California San Francisco, San Francisco, CA.
Brooks
Stuart M
SM
University of South Florida, Tampa, FL.
Cowl
Clayton T
CT
Mayo Clinic, Rochester, MN.
Daroowalla
Feroza
F
State University of New York, Stony Brook, NY.
Harber
Philip
P
University of California, Los Angeles, Los Angeles, CA.
Lemiere
Catherine
C
Université de Montréal, Montréal, QC, Canada.
Liss
Gary M
GM
University of Toronto, Toronto, ON, Canada.
Pacheco
Karin A
KA
National Jewish Medical and Research Center, Denver, CO.
Redlich
Carrie A
CA
Yale University School of Medicine, New Haven, CT.
Rowe
Brian
B
University of Alberta, Calgary, AB, Canada.
Heitzer
Julia
J
American College of Chest Physicians, Northbrook, IL.
D001249:Asthma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003245:Consensus Statements as Topic; D006801:Humans; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D014481:United States