title: Workplace interventions for treatment of occupational asthma.
abstract: BACKGROUND
  The impact of workplace interventions on the outcome of occupational asthma is not well-understood.
  
  
  OBJECTIVE
  To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011.
  
  
  METHODS
  Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma.
  
  
  METHODS
  Two authors independently assessed study eligibility and trial quality, and extracted data.
  
  
  RESULTS
  We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons.In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21).In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32).In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84).Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure.Overall the quality of the evidence was very low.
  
  
  CONCLUSIONS
  There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure.Reducing exposure also improves symptoms, but seems not as effective as complete removal.However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit.
authors.affiliation: Netherlands Center of Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center, PO Box 22660, Amsterdam, Netherlands, 1100 DD.
authors.forename: Gerda J
authors.initials: GJ
authors.lastname: de Groene
authors.forename: Teake M
authors.initials: TM
authors.lastname: Pal
authors.forename: Jeremy
authors.initials: J
authors.lastname: Beach
authors.forename: Susan M
authors.initials: SM
authors.lastname: Tarlo
authors.forename: Dick
authors.initials: D
authors.lastname: Spreeuwers
authors.forename: Monique Hw
authors.initials: MH
authors.lastname: Frings-Dresen
authors.forename: Stefano
authors.initials: S
authors.lastname: Mattioli
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
mesh_terms: D001249:Asthma / Q000209:etiology / Q000517:prevention & control*; D016022:Case-Control Studies; D006801:Humans; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control*; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011482:Protective Devices; D012306:Risk; D014478:Unemployment; D017132:Workplace