title: Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement.
abstract: This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 s ≥ 15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma.
authors.affiliation: Dept of Chest Medicine, Mont-Godinne Hospital, Université Catholique de Louvain, Yvoir, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vandenplas
authors.affiliation: Occupational Medicine Team, Finnish Institute of Occupational Health, Helsinki, Finland H. Suojalehto and P. Cullinan are Task Force co-chairs hille.suojalehto@ttl.fi.
authors.forename: Hille
authors.initials: H
authors.lastname: Suojalehto
authors.affiliation: Dept of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Tor B
authors.initials: TB
authors.lastname: Aasen
authors.affiliation: Institute for Occupational Medicine, Charité University, Berlin, Germany.
authors.forename: Xaver
authors.initials: X
authors.lastname: Baur
authors.affiliation: Dept of Respiratory Medicine, Heart of England NHS Foundation Trust, Birmingham.
authors.forename: P Sherwood
authors.initials: PS
authors.lastname: Burge
authors.affiliation: Division of Asthma and Allergy, Dept of Chest Diseases, University Hospital of Strasbourg, Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: de Blay
authors.affiliation: Dept of Respiratory Medicine, Royal Hallamshire Hospital, Sheffield Dept of Respiratory Medicine, North Manchester General Hospital, Manchester.
authors.forename: David
authors.initials: D
authors.lastname: Fishwick
authors.affiliation: Dept of Respiratory Medicine, North Manchester General Hospital, Manchester.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hoyle
authors.affiliation: Dept of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova.
authors.forename: Piero
authors.initials: P
authors.lastname: Maestrelli
authors.affiliation: Pulmonology Dept, Hospital Vall d'Hebron, Barcelona CIBER de Enfermedades Respiratorias (CIBERES), Madrid.
authors.forename: Xavier
authors.initials: X
authors.lastname: Muñoz
authors.affiliation: Dept of Public Health, Experimental and Forensic Medicine of the University of Pavia, Pavia, Italy.
authors.forename: Gianna
authors.initials: G
authors.lastname: Moscato
authors.affiliation: CIBER de Enfermedades Respiratorias (CIBERES), Madrid Allergy Dept, Fundacion Jimenez Diaz-Capio, Madrid, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Sastre
authors.affiliation: Dept of Public Health, Section of Environment, Occupation and Health, Aarhus University, Aarhus, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.affiliation: Occupational Medicine Team, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Suuronen
authors.affiliation: Dept of Occupational Diseases, Nofer Institute of Occupational Medicine, Łodz, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Walusiak-Skorupa
authors.affiliation: Dept of Occupational and Environmental Medicine, Imperial College, National Heart and Lung Institute, London, UK H. Suojalehto and P. Cullinan are Task Force co-chairs.
authors.forename: Paul
authors.initials: P
authors.lastname: Cullinan
mesh_terms: D059366:Asthma, Occupational / Q000175:diagnosis*; D001980:Bronchi / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000592:standards*; D005060:Europe; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007249:Inflammation; D008991:Monitoring, Physiologic; D009784:Occupational Diseases / Q000175:diagnosis*; D015272:Pulmonary Medicine / Q000592:standards*; D012955:Societies, Medical