title: May the reduction of exposure to specific sensitizers be an alternative to work cessation in occupational asthma? Results from a follow-up study.
abstract: BACKGROUND
  Few data are reported on the effects of a reduction of exposure to specific sensitizers in occupational asthma (OA). The objective of this study was to evaluate the clinical outcome of subjects with OA, comparing the effect of a reduction with that of the persistence or cessation of occupational exposure to the specific sensitizer.
  
  
  METHODS
  Forty-one subjects with OA due to different sensitizers were diagnosed via a specific inhalation challenge. After a follow-up interval of 3.5 years, subjects were reexamined by clinical assessment, bronchial hyperresponsiveness (BH) and induced sputum.
  
  
  RESULTS
  At follow-up, subjects who had reduced occupational exposure (n = 22) showed a significant improvement in BH and a nonsignificant improvement in sputum eosinophilia (from 5.3 to 1.1%, n.s.), while subjects still exposed (n = 10) showed a significant decrease in FEV(1). Subjects who ceased work (n = 9) showed a trend of improvement in BH and sputum eosinophilia. Logistic analysis showed that the major determinant of improvement in BH at follow-up was the severity of BH at diagnosis, with a minimal contribution from the duration of exposure and treatment with inhaled corticosteroids during follow-up; reduction of work exposure did not enter into any model.
  
  
  CONCLUSIONS
  The reduction of occupational exposure could not be considered to be as effective as work cessation, which remained the best treatment for OA. However, it was not associated with a deterioration of FEV(1) as observed in subjects with persistent exposure.
authors: Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy. d.talini@usl5.toscana.it
authors: D
authors: D
authors: Talini
authors: F
authors: F
authors: Novelli
authors: L
authors: L
authors: Melosini
authors: E
authors: E
authors: Bacci
authors: M L
authors: ML
authors: Bartoli
authors: S
authors: S
authors: Cianchetti
authors: F L
authors: FL
authors: Dente
authors: A
authors: A
authors: Di Franco
authors: B
authors: B
authors: Vagaggini
authors: P L
authors: PL
authors: Paggiaro
mesh_terms: D000328:Adult; D059366:Asthma, Occupational / Q000175:diagnosis / Q000517:prevention & control*; D001985:Bronchial Provocation Tests; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012129:Respiratory Function Tests; D018582:Sick Leave; D055815:Young Adult