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Occupational Asthma PowerPoint Presentation

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Published on : Dec 06, 2013
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Occupational Asthma Presentation Transcript

Slide 1 -

Occupational Asthma Tee L. Guidotti The George Washington University

Slide 2 -

Presentation of Occ Asthma Immediate hypersensitivity reaction Immediate bronchospasm Isolated late response (usually sensitizer-induced) Sleep disorder Variable/dual response

Slide 3 -

Types of Occupational Asthma New Onset - Sensitizer-induced - Irritant induced Aggravation of underlying asthma Reactive airways dysfunction syndrome (RADS) Cold air- or exercise-induced syndrome Airways reactivity secondary to hypersensitivity pneumonitis

Slide 4 -

Occupational Asthma Sensitizer-induced Specific antigen Minimal exposure Stereotyped response PPE often insufficient to control symptoms Medical removal usually necessary Irritant-induced Any irritant Moderate to heavy exposure Often variable PPE often effective in preventing episodes Medical removal the last resort

Slide 5 -

Sensitizer-Induced Occ Asthma Sensitization to a specific antigen - low molecular-weight, “hapten” - high molecular weight Reaginic Ab, mostly IgE, mediated Presentation variable - late phase reactivity - immediate sensitivity - dual or variable responsiveness

Slide 6 -

Sensitizer-Induced Asthma 2 Sensitization may occur at

Slide 7 -

Common Sensitizers(Incomplete List!) Low MW Isocyanates Anhydrides Metal salts Epoxy resins Fluxes Persulfate Aldehydes High MW Pharmaceuticals Animal proteins Latex Cereals Seafood Proteolytic enzymes Wood constituents

Slide 8 -

Irritant-Induced Occupational Asthma More common, clinically, than sensitizer-induced Often represents clinical expression of airways hyperactivity + irritant exposure May be induced by any irritating exposure Usually history of intolerance to second-hand tobacco smoke Some irritant exposures may also be sensitizing: CHO, TDI,TMA Classic example is “hot wire” asthma

Slide 9 -

RADS Acute onset following exposure to irritant Generally exposure of moderate severity Prognosis good but may have several years of airway hyperactivity and sequelae Often associated with: upper airway problems sleep disorder Independent of prior history of airways reactivity Conventional management

Slide 10 -

Aggravational Asthma Very common Existing airways reactivity: asthma hay fever and rhinitis other airways disease (e.g. COPD) Initial condition not occupational Moderate irritant exposure Provokes airways response Usually self-limited

Slide 11 -

Patterns of Airways Response

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Immediate response Same shift, rapid onset Reaginic antibody if sensitizer-induced Acute mediators Responds to conventional asthma Rx Often difficult to distinguish from conventional asthma Irritant-induced tends to be milder

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Late Responders Onset of bronchospasm hours after exposure Usually wheezing post-shift Often presents as a sleep disorder If isolated, usually associated with certain antigens (Western red cedar, TDI) Often combined

Slide 14 -

Dual/Variable effects Dual responders may combine immediate + late responses Variations may include cyclic bronchospasm (esp. Western red cedar) May be prolonged, sustained response (TDI, byssinosis) Usually slow recovery, relatively refractory to conventional Rx

Slide 15 -

Special Cases The following subsets of occupational asthma have special features: Laboratory animal sensitivity (high risk of anaphylaxis) Cotton dust, byssinosis Grain dust Hypersensitivity pneumonitis may have an airways component

Slide 16 -

Cold Air / Exercise-Induced Asthma May be associated with: dry cold air exertion hyperventilation Work in cold, dry climates Immediate response, short duration Further exercise may improve airflow! Mechanism: airway drying and cooling stimulates vagal receptors histamine, mediator release from mast cells

Slide 17 -

Principles of Evaluation Demonstrate airways reactivity - History - Presence of wheezing Spirometry Methacholine challenge Bronchoprovocation or substitute - Symptom diary - Pre/post shift

Slide 18 -

Methacholine Challenge + Test confirms airways reactivity only A functional test not specific for asthma - atopy - transient reactivity Bronchoprovocation with with specific antigen preferable to diagnose sensitizer-induced asthma -Tests can occur with quiescent occ asthma

Slide 19 -

Risks of Bronchoprovocation Anaphylaxis Iatrogenic reaction Sensitization

Slide 20 -

Ancillary Tests Clinical immunology - skin prick tests - RAST - ELISA PEF or FEV1, symptom and medication diary Pre/post shift and/or holiday PFTs Work place HHE

Slide 21 -

Management Conventional Rx for asthma Medical removal – consider options Physician’s First Report Impairment Assessment (c.f. AMA guidelines) Avoid irritants Evaluate PPE

Slide 22 -

Compensation Management Document causation Document impairment (episodic?) Medical removal required? Claimant factors - degree of impairment - age - retraining Impairment – Disability

Slide 23 -

Pop Health Management Treat as “Sentinel event” Surveillance Identification of specific hazard when possible Hazard Control - engineering controls - PPE

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