title: Review of Diagnostic Challenges in Occupational Asthma.
abstract: OBJECTIVE
  Occupational asthma (OA) is one of the most frequent occupational diseases and its diagnosis is often difficult. This review summarizes its current diagnostic challenges.
  
  
  RESULTS
  OA is associated with significant health and socio-economic burden. It is underdiagnosed and physicians need to adopt a stepwise approach to confirm the diagnosis. Although early removal from exposure to the offending agent is associated with a better prognosis, physicians should try to confirm the diagnosis of work-related asthma before taking a worker off work. A proper occupational and medical history is very important but is not enough to make the diagnosis of OA. Objective evidence of work-related asthma is required and this represents a serious challenge to most physicians. Measurement of non-specific bronchial responsiveness (NSBR) and spirometry may confirm the diagnosis of asthma but do not confirm the diagnosis of OA. Serial monitoring of peak expiratory flows (PEF), NSBR, and airway inflammation at and off work may confirm the diagnosis of OA but are often difficult to perform. Confirming sensitization by skin prick tests or specific IgE may help to support the diagnosis of OA. Specific inhalation challenges (SIC) in the lab or at work are considered the reference standard but are of limited access. Medical surveillance programs along with primary prevention (reducing exposure) may help to reduce the burden of OA, but the ideal program has yet to be defined. The diagnostic workup of OA remains a challenge and needs a rigorous stepwise evaluation.
authors.affiliation: Institute for Work and Health, Route de la Corniche 2, 1066, Epalinges, Switzerland.|Division of Pulmonary Diseases, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Jacques A
authors.initials: JA
authors.lastname: Pralong
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montréal, QC, H4J 1C5, Canada. andre.cartier@umontreal.ca.
authors.forename: Andre
authors.initials: A
authors.lastname: Cartier
mesh_terms: D059366:Asthma, Occupational / Q000175:diagnosis*; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects*; D012882:Skin Tests / Q000379:methods
keywords: Monitoring; Occupational asthma; Peak expiratory flow; Specific inhalation challenges