Reply to “Both Quality of Life and Exacerbation Are Important Outcomes of Work-Related Asthma.”

Details

• Personal Author:
  Henneberger, Paul K. ; Kigloo HN ; Le Moual N ; Suarthana, Eva ; Vandenplas O
• Description:
  We greatly appreciated the comments and suggestions raised by Jang et al in this issue of The Journal of Allergy and Clinical Immunology In Practice about our survey of the impact of work-related asthma (WRA). We agree that there is a need to further characterize the determinants of asthma exacerbations, a key component of asthma control, and their impact on the burden of WRA. In our survey, we did not use the World Health Organization consensus definition of severe asthma exacerbations (requiring oral systemic corticosteroids for more than 3 days) because our study was initiated before its publication. Our survey and findings were based on validated questionnaires that may have led to asthma under- or overdiagnosis. However, asthma is a heterogeneous inflammatory disease of the airways, and a simple pulmonary function test is unlikely to have substantially improved the accuracy of asthma identification. A more accurate diagnosis of asthma would require the documentation of variable airflow obstruction or bronchial hyperresponsiveness and assessment of inflammatory biomarkers. Jang et al seem to suggest that ''asthma in some participants would not be related to work'' because: (1) ''WRA needs exposure in a specific work environment that has worksite irritants'' and (2) 50% of the subjects were employed in industrial sectors (ie, business activities, education, and health and social care) where ''a causative irritant would be difficult to specify.'' First, WRA is a broad term that refers to asthma that is induced (occupational asthma [OA]) or exacerbated (work-exacerbated asthma [WEA]) by inhalation exposures in the workplace according to the American College of Chest Physicians Consensus Statement. This widely acknowledged definition does not imply ''exposure in a specific work environment that has worksite irritants'' because WRA encompasses OA caused by both sensitizing agents (sensitizer-induced OA) and irritants (irritant-induced OA). Second, an American Thoracic Society Statement on WEA concluded that ''a wide variety of conditions at work can exacerbate asthma symptoms, including irritant chemicals, dusts, second-hand smoke, common allergens that may be present at work, and other 'exposures' such as emotional stress, worksite temperature, and physical exertion.'' Our questionnaire collected information on the following workplace exposures: ''vapors/gases/dusts/fumes,'' ''respiratory allergens,'' smoking, cleaning materials, and disinfecting products, along with the frequency of exposure (daily, once a month, once a week, and never). In addition, workplace exposures were assessed by linking the International Standard Classification of Occupations (ISCO)-88 occupational codes with the Asthma-specific Job Exposure Matrix that assigns, for every job code, 3 grades of exposure (none, low, and high) to 30 sensitizers and irritants. The workers with WRA in our survey were significantly more exposed to high-, low-, and mixed-molecular-weight agents, irritants, microbial agents, mites, highly reactive chemicals, and/or biocide than those without WRA. Workers with multiple exposures had a 5.6-fold higher probability of having WRA (odds ratio: 5.63; 95% confidence interval: 2.69-11.79; P < .001) (Table I). To conclude, whatever the accuracy of asthma diagnosis in our survey, the findings indicate that reporting 2 or more WRA symptoms was associated with an incremental impact on quality of life and work productivity. [Description provided by NIOSH]
• Subjects:
  Asthma, Occupational Occupational Health Respiratory System Safety Surveys And Questionnaires
• Keywords:
  Cross Sectional Studies Occupational Asthma Quality Of Life Questionnaires Respiratory Health Work Performance
• ISSN:
  2213-2198
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  12
• Issue:
  3
• NIOSHTIC Number:
  nn:20069359
• Citation:
  J Allergy Clin Immunol Pract 2024 Mar; 12(3):804-805
• Contact Point Address:
  Eva Suarthana, MD, MSc, PhD, Research Institute of the McGill University Health Center, Royal Victoria Hospital-Glen Site, 1001 Decarie Blvd, Rm D05.2543, Montreal, QC H4A 3J1, Canada
• Email:
  eva.suarthana@mcgill.ca
• Federal Fiscal Year:
  2024
• Peer Reviewed:
  False
• Source Full Name:
  Journal of Allergy and Clinical Immunology: In Practice
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c35bc6928f17321bf6169a7e9029e2f12c4083f3797fac9bad87cc0405d44156d7f5f1a6a14cd636ae689c706c70648e214a9892717205d15cc78615d2ccda8c
• Download URL:
  https://stacks.cdc.gov/view/cdc/207853/cdc_207853_DS1.pdf
• File Type:
  [PDF - 116.50 KB ]