Approach to evaluation of occupational asthma in patients who are NOT working*

ssIGE: serum-specific immunoglobulin E; SIC: specific inhalation challenge; PEF: peak expiratory flow; NSBR: nonspecific bronchial (airway) responsiveness (determined by bronchoprovocation challenge).

* Algorithm for patients who are unable to return to work. Refer to separate UpToDate algorithm for evaluation of occupational asthma in patients who are working. Algorithm intended for use in parallel with UpToDate content on occupational asthma.

¶ Objective evidence of asthma includes reversible airflow limitation and/or changes in nonspecific bronchial responsiveness demonstrated by bronchoprovocation testing (eg, methacholine). Improvement in PEF away from the workplace lends supportive evidence. Bronchial hyperresponsiveness may resolve in some patients with OA who have been away from the workplace for some time (a weekend may be enough).

Δ Evidence of reactivity to agents in the patient's workplace based on skin testing and/or immunoassay indicates sensitization and increases the likelihood of OA, but is not diagnostic. Negative tests do not exclude OA. However, evidence for sensitization may resolve when not exposed, and return with re-exposure.