title: Diisocyanate-induced asthma in Switzerland: long-term course and patients' self-assessment after a 12-year follow-up.
abstract: BACKGROUND
  Isocyanates are among the most common causes of occupational asthma (OA) in Switzerland. Patients with OA have been shown to have unfavourable medical, socioeconomic and psychological outcomes. We investigated long-term asthma and the socio-economic outcomes of diisocyanate-induced asthma (DIA) in Switzerland.
  
  
  METHODS
  We conducted an observational study on 49 patients with DIA and followed 35 of these patients over a mean exposure-free interval of 12 ± 0.5 (range 11.0-13.0) years. At the initial and follow-up examinations, we recorded data on respiratory symptoms and asthma medication; measured the lung function; and tested for bronchial hyperreactivity. We allowed the patients to assess their state of health and overall satisfaction using a visual analogue scale (VAS) at these visits.
  
  
  RESULTS
  The 35 patients whom we could follow had a median symptomatic exposure time of 12 months, interquartile range (IQR) 26 months and a median overall exposure time of 51 (IQR 104) months. Their subjective symptoms (p < 0.001) and the use of asthma medication (p = 0.002), particularly the use of inhaled corticosteroids (p < 0.001), decreased by nearly 50%. At the same time, the self-assessment of the patients' state of health and overall satisfaction increased considerably according to both symptomatology and income. In contrast, slight reductions in terms of FVC% predicted from 102% to 96% (p = 0.04), of FEV1% predicted from 91% to 87% (p = 0.06) and of the FEV1/FVC ratio of 3%; (p = 0.01) were observed while NSBHR positivity did not change significantly. In univariate as well as multivariate logistic analyses we showed significant associations between age, duration of exposure and FEV1/FVC ratio with persistent asthma symptoms and NSBHR.
  
  
  CONCLUSIONS
  We found that the patients' symptoms, the extent of their therapy and the decrease in their lung volumes during the follow-up period were similar to the findings in the literature. The same hold true for some prognostic factors, whereas the patients' self-assessment of their state of health and overall satisfaction improved considerably.
authors.affiliation: Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Rüegger
authors.affiliation: Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland.
authors.forename: Doreen
authors.initials: D
authors.lastname: Droste
authors.affiliation: Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Hofmann
authors.affiliation: Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Jost
authors.affiliation: Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Miedinger
keywords: Diisocyanate asthma; Long-term follow-up; Occupational asthma; Self-assessment