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• DIAGNOSIS• MONITORING
ASSESSMENT OF OCCUPATIONAL
ASTHMA
History of exposure to sensitizing agentsAbsence of asthma symptoms before
beginning employmentDocumented relationship between symptoms
and workplace (improving symptom when away from work & worsening symptoms upon return to work
HISTORY
32/99
WHAT SYMPTOMS SHOULD YOU LOOK OUT FOR?
The symptoms start as · runny eyes and nose
· itchy eyes and nose
and may develop into the more serious problems of asthma
· breathlessness
· wheezing
· tightness of chest
· coughing
DIAGNOSING OCCUPATIONAL ASTHMA
HistoryInvestigation
Detailed history of past & present occupational exposures
Cough – at work/ end of shift, precedes wheezing
Concurrent – rhinorrhoea, nasal congestion,
lacrimation, conjunctivitis
Symptoms improve – at weekends & holidays, persist – advanced stage.
Diagram – SpirometryParametersProcedureDiagnosis
SPIROMETRY
FEV1 (Forced expiratory volume in 1 second)Forced Vital Capacity (FVC)FEV1/FVC ratio
PARAMETERS
Marked reduced in FEV1Reduced in FVCThe FEV1/ FVC ratio is reducedSignificant improvement of the FEV
1 (>12%) following administration of a bronchodilator
Diurnal variability
DIAGNOSIS
Measure expirationEasySteps
PEAK EXPIRATORY FLOW METER
STEPS TO USE PEAK EXPIRATORY FLOW METER
1. Stand up or sit up straight.2. Make sure the indicator is at the bottom of the
meter (zero).3. Take a deep breath in, fi lling the lungs completely.4. Place the mouthpiece in your mouth; lightly bite
with your teeth and close your lips on it. Be sure your tongue is away from the mouthpiece.
5. Blast the air out as hard and as fast as possible in a single blow.
6. Remove the meter from your mouth.7. Record the number that appears on the meter and
then repeat steps one through seven two times.8. Record the highest of the three readings in an
asthma diary. This reading is your peak expiratory flow (PEF).
Similar with asthmaDiffers according to the severity :
1. PEF > 75% of predicted or best value (MILD)
2. PEF between 50% – 75% of predicted or best value (MODERATE)
3. PEF < 50% of predicted or best value (SEVERE)
4. PEF < 30% of predicted or best value Reversibility testing
DIAGNOSIS
Pharmacological therapy for OA is identical to therapy for other forms of asthma, but it is not substitute for adequate avoidance
PHARMACOLOGICAL THERAPY
(Bateman, et al, 2008)
PHARMACOLOGICAL THERAPY Treatment
Controllers Relievers
1) Inhaled glucocorticosteroids 1) Rapid-acting inhaled b2-agonists
2) Leukotriene modifiers 2) Anticholinergics
3) Long-acting inhaled b2-agonists 3) Short-acting oral b2-agonists
4) Theophylline
5) Anti-IgE
6) Others Systemic glucocorticosteroidsOral anti-allergic compounds
162/99
OCCUPATIONAL ASTHMA CHECKLIST
Reminder, if you have trouble with wheezing, coughing or shortness of breath at work, you could have occupational asthma:
· Consult your physician. He or she may suggest a lung function test.
· See your work supervisor for details about potential hazards in your work environment.
· Have the tests and evaluation required to prove the suspected occupational asthma and its cause.
· Seek your physician's advice about therapy for occupational asthma.
Pre employment stage: asked about pre existing asthma (not suitable for this work)
Lung function test and referral for immunological blood test or skin prick test may be appropriate
Frequent health surveillance indicated First few years of exposure (OA risk greatest during early
years) Workers with pre existing asthma Workers who develop rhinitis & workplace exposure should
be investigated and reduced
HEALTH SURVEILLANCE