Approach to evaluation of occupational asthma (OA) in patients who are working*

MIC: methacholine challenge; PFT: pulmonary function test; PEF: peak expiratory flow; NSBR: nonspecific bronchial responsiveness (eg, based on methacholine challenge); ssIGE: serum-specific immunoglobulin E; IgE: immunoglobulin E; EB: eosinophilic bronchitis; PC20: provocative dose resulting in a 20% fall in the FEV1.

* This algorithm is intended for use with UpToDate content on occupational asthma. If patient is not working, refer to separate algorithm for evaluation of occupational asthma in patients who are not working.

¶ Objective evidence of asthma: Spirometry showing reversible airflow limitation or bronchoprovocation challenge (eg, methacholine) showing increased NSBR. NSBR should be measured at the end of a working period (eg, end of work week, as a weekend away may be enough to normalize NSBR).

Δ Serial PEF and NSBR are usually concordant, but discordance does not rule out the diagnosis of OA.

References:

Girard F, Chaboillez S, Cartier A, et al. An effective strategy for diagnosing occupational asthma: use of induced sputum. Am J Respir Crit Care Med 2004; 170: 845.
Cockcroft DW, Mink JT. Isocyanate-induced asthma in an automobile spray painter. Can Med Assoc J 1979; 121: 602.
Leroyer C, Perfetti L, Trudeau C, et al. Comparison of serial monitoring of peak expiratory flow and FEV1 in the diagnosis of occupational asthma. Am Journal Respir Crit Care Med 1998; 158:827.

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Approach to evaluation of occupational asthma (OA) in patients who are working*