Occupational asthma – an occupational disease with uncertain prognosis

Česká verze

Authors: S. Perečinský; A. Jančová
Authors place of work: Klinika pracovného lekárstva a klinickej toxikológie, Lekárskej Fakulty Univerzity P. J. Šafárika a Univerzitnej nemocnice L. Pasteura, Košice prednosta doc. MUDr. Ľubomír Legáth, PhD.
Published in the journal: Pracov. Lék., 68, 2016, No. 4, s. 132-136.
Category: Původní práce

Summary

Introduction:
Bronchial asthma belongs to most frequent diseases with estimated 300 million patients in the world. About 2–15% of cases originate in the occupation, but the data are not homogeneous. Occupational asthma is the most frequent occupational disease of respiratory tract in industrially developed countries and the second most frequent ion the developing countries. Occupational asthma differs from the non-occupational one in various aspects, for instance in etiology, pathogenesis and diagnostic methods. The differences in clinical picture and prognosis of the disease are not clear yet. The aim of our investigation was to find out, whether are any differences in the seriousness of occupational asthma and the response to therapy as compared with the non-occupational asthma.

Methods:
The patients with acknowledged occupational asthma (27 patients) were retrospectively compared with patients with asthma of non-occupational etiology who were monitored at our workplace for other diagnoses (28 patients). Differences in seriousness of asthma among individual groups were compared according to degree pf bronchial asthma. The degree of asthma was classified as light (including an intermittent and light persisting asthma (mild asthma)), moderate asthma and severe persistent asthma. Moreover, we followed pharmacotherapy and occasional changes in treatment in the meaning of intensification. In the group of patients with occupational asthma patients with moderate asthma were predominant. The occurrence of severe persistent asthma was relatively frequent in this group. In patients with non-occupational asthma the moderate asthma was also most frequent, but severe persistent asthma was not encountered

Results:
In the group of patients with occupational asthma as well as the non-occupational asthma, patients with moderate asthma predominated. The occurrence of severe persistent asthma was relatively frequent in the occupational asthma (26%). In the patients with non-occupational asthma, however, the severe persistent asthma did not occur in any case. In the standard treatment of asthma (bronchial dilatation, inhalation corticosteroids, antileukotrienes and theophylline), both groups were not markedly different. In contrast, oral corticosteroid (15%) and biological treatment (7.5%) were applied in patients with occupational asthma only.

Conclusions:
Results of this study demonstrated a higher seriousness of occupational asthma as compared with non-occupational etiology. It is documented by relatively high frequency of severe persistent asthma in the group with occupational etiology and the need of permanent treatment with oral corticosteroids. The study made it clear that occupational asthma is an important, often progressing disease with uncertain prognosis.

Key words:
bronchial asthma – occupational asthma – severe persistent asthma

Zdroje

1. Baur, X., Bakehe, P., Vellguth, H. Bronchial asthma and COPD due to irritants in the workplace - an evidence-based approach. J. Occup. Med. Toxicol. 2012 roč. 7, č. 1, s. 19.

2. Darrow, L. A., Hess, J., Rogers, C. A., Tolbert, P. E., Klein, M., Sarnat, S. E. Ambient pollen concentrations and emergency department visits for asthma and wheeze. J. Allergy Clin. Immunol., 2012, roč. 130, č. 3, s. 630–638.

3. Global initiave for asthma. Pocket Guide for Asthma Management and Prevention in Children 5 Years and Younger. 2012.

4. Haselkorn, T., Borish, L., Miller, D. P., Weiss, S. T., Wong, D. A. High prevalence of skin test positivity in severe or difficult-to-treat asthma. J. Asthma, 2006, roč. 43, č. 10, s. 745–752.

5. Ito, K., Weinberger, K. R., Robinson, G. S. et al. The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012. Environ. Health, 2015, roč. 27, č. 14, s. 71.

6. Jeebhay, M. F., Quirce, S. Occupational asthma in the developing and industrialised world: a review. Int. J. Tuberc. Lung. Dis., 2007, roč. 11, č. 2, s. 122–133.

7. Le Moual, N., Carsin, A. E., Siroux, V. et al. Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II. Eur. Respir. J., 2014, roč. 43, č. 2, s. 374–386.

8. Legáth, Ľ. Súčasnosť a trendy chorôb z povolania v Slovenskej republike. I-med., 2012, ISSN 1338-4392.

9. Legáth, Ľ. Úskalia diagnostiky profesionálnej astmy. I-med., 2013, ISSN 1338-4392.

10. Miranda, C., Busacker, A., Balzar, S., Trudeau, J., Wenzel, S. E. Distinguishing severe asthma phenotypes: role of age at onset and eosinophilic inflammation. J. Allergy Clin. Immunol., 2004, roč. 113, č. 1, s. 101–108.

11. Moore, W. C., Bleecker, E. R., Curran-Everett, D. et. al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J. Allergy Clin. Immunol., 2007, roč. 119, č. 2, s. 405–413.

12. Peters, S. P. Asthma phenotypes: nonallergic (intrinsic) asthma. J. Allergy Clin. Immunol. Pract., 2014, roč. 2, č. 6, s. 650–652.

13. Pružinec, P., Hančinská, J. Foster a jeho efekt na život pacientov s astmou bronchiale v slovenskej populácii. Klinická imunológia a alergológia, 2008, roč. 18, č. 3, s. 17–23.

14. Rozborilová, E. Manažment astmy u pacientov v stave nekontrolovaného ochorenia MAPNEO. Respiro, 2016, roč. 14, č. 3, s. 32–38.

15. Sun, X., Waller, A., Yeatts, K. B., Thie, L. Pollen concentration and asthma exacerbations in Wake County, North Carolina, 2006–2012. Sci Total Environ, 2016, roč. 544, 15 feb, s. 185–191.

16. Tarlo, S. M., Liss, G. M. Occupational asthma: an approach to diagnosis and management. CMAJ, 2003, roč. 168, č. 7, s. 867–871.

17. ten Brinke, A., Zwinderman, AH., Sterk, PJ., Rabe, KF., Bel, EH. Factors associated with persistent airflow limitation in severe asthma. Am. J. Respir. Crit. Care Med., 2001, roč. 164, č. 5, s. 744–748.

18. Teřl, M., Rybníček, O. Asthma bronchiale v příčinách a klinických obrazech. 1. vydanie. Praha: Geum 2006. ISBN 80-86256-45-6.

19. The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. European Network for Understanding Mechanisms of Severe Asthma. Eur. Respir. J., 2003, roč. 22, č. 3, s. 470–477.

20. Toren, K., Blanc, P. D. Asthma caused by occupational exposures is common – a systematic analysis of estimates of the population-attributable fraction. BMC Pulm. Med., 2009, roč. 9, č. 7, s. 1–10.

21. Varga, M., Legáth, Ľ. Incidencia profesionálnej astmy v SR. Pracov. Lék., 2008, roč. 60, č. 3, s. 139–140.

22. von Bülow, A., Kriegbaum, M., Backer, V., Porsbjerg, C. The prevalence of severe asthma and low asthma control among Danish adults. J. Allergy Clin. Immunol. Pract., 2014, roč. 2, č. 6, s. 759–767.

23. Wenzel, S. Severe asthma in adults. Am. J. Respir. Crit. Care Med., 2005, roč. 172, č. 2, s. 149–160.

24. Wenzel, S. E. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat. Med., 2012, roč. 18, č. 5, s 716.