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Management of sensitizer-induced occupational asthma: avoidance or reduction of exposure?

Birdi, Kamwardeep; Beach, Jeremy

Current Opinion in Allergy and Clinical Immunology: April 2013 - Volume 13 - Issue 2 - p 132–137
doi: 10.1097/ACI.0b013e32835ea249
OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli

Purpose of review To address the following question: in the management of occupational asthma does current evidence support complete avoidance of further exposure to the causative agent, or is reduction in exposure sufficient to control asthma and less likely to result in loss of income or job loss?

Recent findings A recently published Cochrane review of workplace interventions in the management of occupational asthma compared complete removal from exposure to the causative agent with reduction of exposure and continued exposure. Results suggested that complete removal from exposure resulted in the best outcome in terms of symptoms, lung function, and airway hyper-responsiveness. Reduction of exposure appeared to be less effective in terms of improving asthma but was also less likely to result in loss of income or unemployment. A second systematic review reported similar results.

Summary There is no single solution to the question about ongoing workplace exposure for an individual with occupational asthma. There are good reasons for removing an individual from exposure in terms of clinical improvement, but this may have consequences in terms of income and employment. It is necessary to consider all these aspects when advising patients if their health is to be maximized.

aDivision of Pulmonary Medicine

bDivision of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Correspondence to Jeremy Beach, MBBS, MD, Division of Preventive Medicine, University of Alberta, 5-30 University Terrace, 8303 112 Street, Edmonton, AB T6G 2T4, Canada. Tel: +1 780 492 6291; fax: +1 780 492 9677; e-mail:

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