dekor tikas i

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Decortication is a surgical procedure that removes a restrictive layer of fibrous

tissue overlying the lung, chest wall, and diaphragm. The aim of decortication isto remove this layer and allow the lung to reexpand. When the peel is removed,compliance in the chest wall returns, the lung is able to expand and deflate, and

patient symptoms improve rapidly.[1]

n most people, the pleural space is less than 1 mm thic!. When this space isviolated by any number of pathological disorders, the distribution of certain cellsand fluid can be altered, with serious medical conse"uences. [#] $ne common

pathological process that affects the pleural space is fibrothorax, which is anabnormal accumulation of fibrous tissues over the lung or visceral pleura. Thefibrous tissues that deposit over the lung parenchyma can be so intense that the

underlying lung fails to expand. $ver time, the lung becomes entrapped orencased.[1]

%lthough decortication is an effective surgical procedure for this condition, itssuccess depends on careful selection of patients. %s in all thoracic surgery

procedures, the preoperative wor!up should be thorough and the surgery should be done at a particular timed interval. &oreover, the surgeon should also betechnically s!illed at entering the chest and removing the peel. n some cases, theintercostal space is fused and it is almost impossible to enter the chest cavity.

'ee the images below.

% #()year)old man

with a stab to the right chest presented 1 wee! later with fever, chills, and


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dyspnea. The radiograph shows an inflammatory process that did not drain via aneedle.

*T scan showing alarge collection in the right chest. The collection is surrounded by a thic! peel thatis typical of empyema.

Indications

The primary indication for decortication in a patient with fibrothorax is presenceof symptoms due to lung restriction resulting from development of a thic!fibrinous peel.[(] The timing of surgery is vital for success. n many cases, the peel

may spontaneously resolve and the symptoms may subside.[+]

&ost surgeons will perform a decortication for the following conditions

• The pleural peel has been present for more than +)- wee!s

• ung symptoms are disabling

• There is radiological evidence of a trapped lung

Decortication is fre"uently necessary when other minor interventions /eg, chesttube0 have not resulted in clearance of the infection or hemothorax. Tuberculousempyema is usually first treated with drugs and decortication is only underta!enafter long)term drug therapy fails.

Contraindications

$ther than the physiological fitness of the patient, there are no absolutecontraindications to decortication. n some patients who also have underlying lungdisease, removal of the peel may not help the lung expand and thus surgery would

be futile.


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$ther conditions that may ma!e decortication futile include the presence of a pleural space infection and large airway stenosis. n such cases, the lung will not

expand to fill the pleural space. % more extensive pleuropneumonectomy may bethe only option, but only if the patient has been wor!ed up preoperatively.leuropneumonectomy is a ma2or underta!ing with a very high mortality.

Decortication may not be possible in presence of uncontrolled lung infection orcontralateral lung disease, or for a chronically debilitated patient. &edicaloptimi3ation may be re"uired prior to underta!ing surgery in these patients.deally, the patient4s nutritional status should first be normali3ed /with nasogastricfeedings if necessary0 and sepsis should be controlled with appropriate antibiotictherapy.

$ther relative contraindications include coagulopathy, severe chest wall infection,and terminal disease.

Technical Considerations

Decortication gives the best results in patients who see! early treatment.5ibrothorax is a time)dependent process and can be prevented. Depending on thecause, insertion of a chest tube to remove an effusion or hemothorax may preventthe development of fibrothorax.

%mong patients with chest trauma who suffer a hemothorax, placement of a chesttube and complete drainage usually prevents development of fibrothorax. 6umerous studies have shown that early and complete evacuation of clottedhemothorax and parapneumonic effusions leads to decreased morbidity andmortality.

'ome of the reasons that may explain an incomplete return of lung volumeinclude elevation of the diaphragm, mediastinal shift, intercostal muscle fibrosis,or decrease in si3e of the thoracic cavity. 'ome experts believe that the longer theempyema is allowed to progress, the less the li!elihood that lung function willreturn bac! to normal. %lthough some authors report an association between

shorter course of disease and improved outcomes, this is not a universal findingamong all surgeons.

7ven though no studies have been done to explain failure of the lung to expandafter so)called successful decortication, the most li!ely reason is either technicaldifficulties or incomplete removal of the peel. n many cases, the plane ofdissection can be difficult. Too much persistence in removing the thin peel canalso in2ure the underlying lung parenchyma and result in massive air lea!s.

nability to define the plane of dissection between the peel and the visceral pleurais an especially troublesome technical challenge that can adversely affect results.

f visceral pleurectomy is performed, air lea!age and postoperative hemorrhage


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may compromise pulmonary function. *are must be ta!en throughout theoperation to protect the phrenic nerve from in2ury8 fortunately, this usually is not

an issue, because the mediastinal pleura is rarely involved in the inflammatory process. ncomplete parietal pleurectomy or inability to free the diaphragm mayalso compromise results.

f patients are appropriately selected, complete reexpansion of the lung afterdecortication can usually be achieved. $ccasionally, however, an issue related toresidual pleural space might arise after an otherwise technically satisfactorydecortication. f this space is not obliterated, failure is inevitable.

Outcomes

The results after decortication are often fruitful. The morbidity and mortality aftera decortication is dependent on the patient age, underlying comorbidities, anddevelopment of complications from the surgery. Decortication in general has anexcellent outcome in young people.

n younger patients with benign causes of fibrothorax, the outcome is excellentand "uality of life is much improved.[9] &ost patients begin to feel relief ofsymptoms soon after surgery. n elderly patients with multiple comorbidities,recovery is often slow but symptom relief is also better. The ma2ority of patientsregain their previous exercise endurance and are able to return bac! to their

original wor!.

:owever, when the procedure is done in patients with compromised lungfunction, the morbidity can be high. ;esides surgery itself, the thoracic incisionand general anesthesia also carry a high morbidity in people with no lung reserve.$ld data suggest that the overall mortality in healthy people is less than 1< butmay run as high as +)-< in individuals with underlying lung disease. :oweverwith video)assisted thoracoscopic surgery /=%Ts0, the current mortality rates areslightly lower.[-, >, ?]

To avoid complications, the surgeon has to pay attention to detail. The peel should

be removed with great care and in2ury to nearby organs should be avoided. f thedecortication is done ade"uately, lung function improvement is remar!able.:owever, the ultimate return of lung function depends on preoperative lungdisease.

f the lung parenchyma was normal prior to surgery, then complete reexpansion of the lung and obliteration of the pleural space is certainly possible. n most cases,lung volumes improve after decortication, but it is rare to see return to

preoperative values.

Anatomic Considerations

http://emedicine.medscape.com/article/1271543-overviewhttp://emedicine.medscape.com/article/1271543-overview


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The boundaries of the pleural space are the visceral pleura, which envelops thelungs, and the parietal pleura, which is the inner lining of the thoracic cavity.[@]

The goal of decortication is to remove all the fibrinous peel and necrotic tissue,and help the lung reexpand and e"ually important not to leave any residual airspaces.[1A]

The two most common problems encountered when performing decortication area pleural cavity infection and fibrosis.[11] t is difficult for the underlying lung toexpand when there is a thic! peel overlying the parenchyma. *onse"uently, thereis a large residual space left in the chest cavity that almost always gets infected.Therefore, for the surgeon to have good success with decortication, timing ofsurgery is crucial.

f the disease has been chronic, the rib spaces are often fused and the chest cavityis severely constricted. 7ntry into the chest can be very difficult. f the peel is verythic! and adherent, in2ury to the lung parenchyma can occur with moderate airlea!. f the lung has an inherent disorder, the possibility of reexpansion may notoccur. 5inally, decortication is not a trivial procedure and can be very bloody8thus, the patient must also be physiological fit to undergo the procedure. %ll thesefactors must be considered when planning a decortication.[1#]

&oreover, once inside the chest cavity, no lung may initially be visible because ofthe thic! fibrous peel. The peel can vary in thic!ness from a few millimeters tofew centimeters. $ne may also find necrotic debris and abscess along the chestcavity. t is important to avoid dissection along the medial border of the lung

because the heart chambers are close by. The dissection should be started onlateral aspects or near the fissures. n most cases, the lower lobe is fused with thediaphragm and one can easily enter the abdominal cavity if the dissection is toodeep.

5or safe decortication, the chest cavity is best entered at the 9thB-th intercostalspace and dissection should be started where the peel is the thinnest and easilyremoved. t is important to reassess the anatomy every few minutes to preventin2ury to the organs. ;lind digital peeling should be avoided, especially near the

apex of the lung. This area is best approached when the upper lobe can beretracted inferiorly and the lung apex is visible. 'evere bleeding from in2ury to thesubclavian vessels and pulmonary artery has been reported.

;ecause extensive decortication or radical pleurectomy can be associated with airlea!s, methods have been described to reconstruct the diaphragm to help lower theincidence of postoperative complications.[1(, 1+, ?]

When performing a =%T' procedure, one must be aware of the ad2acent structuresto avoid in2ury. $n the superior aspect, the subclavian vessels can be found lyingdeep to the pleura but clearly visible. %long the medial border, one may come

across the thymus, trachea, heart, phrenic nerve, aorta /on right0, vena cava /on


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left0, and the esophagus /posteriorly0. n the posterolateral chest, one may comeacross the sympathetic chain, a3ygous vein, and the diaphragm /inferiorly0.[1, @]

BRITTLE ASTHMA

;rittle asthma &anagement

atients with brittle asthma pose difficult and complex management problems. Con%yres identifies possible management strategies for these patients.

Jon Ayres, BSc, MD, FRCP, is Professor of Resiratory Medicine !"ni#ersity

of $ar%ic&' in the Deartment of Resiratory Medicine, Birmin(ham

)eartlands )osital, Birmin(ham*

The term 4brittle asthma4 was first used by Turner)Warwic! /1@>>0 to describe patients with asthma whose pea! expiratory flow /750 varied 4chaotically48 a pattern which could lead to death from an acute severe, attac! /;ateman and*lar!e, 1@>@8 Westerman et al, 1@>@0. &orbidity from brittle asthma isconsiderable, and this review aims to identify possible causes and managementstrategies for this group of patients.

Definitions

'ince 1@>>, the term brittle asthma has been used in different ways by different physicians, leading to some confusion over whether such a group is truly

separable from other patients at the severe end of the asthma spectrum. n order totry and clarify this area we have suggested a classification of brittle asthma intotwo types8 a feature of both types being a susceptibility to repeated severe attac!sresulting in hospital admission.

Tye +

atients who consistently demonstrate wide pea! flow variation /greater than +A<diurnal variation for at least 9A< of days0, despite maximal medical therapyincluding at least 19AA gBday of inhaled beclomethasone or e"uivalent, areclassified as having type 1 brittle asthma.

t is crucial that pea! flow readings are corrected for non)linearity /&iller et al,1@@#0 when calculating diurnal variation in type 1 brittle asthma. These patientsare typically female /+1 in our clinic0 and aged between 19 and 99 years.

Tye

atients with type # brittle asthma appear to be well controlled between attac!swhich are often sudden in onset /occurring within minutes0 and are associatedwith loss of or disturbed consciousness on at least one occasion.

The patient may not have been mechanically ventilated as a result of the attac! but

is very li!ely to exhibit a severe respiratory acidosis in an attac! and, if ventilated,


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needs support for relatively short time periods /Wasserfallen et al, 1@@A0. Type # brittle asthma seems to be e"ually prevalent in men and women.

&orbidity

Type 1 brittle asthma is a cause of significant morbidity associated with fre"uentaccident and emergency attendances and hospital admissions and the resultant useof considerable amounts of medication. *onse"uently, side effects of therapy,

particularly oral corticosteroids, are common, e.g. osteoporosis, weight gain andoesophageal reflux /&iles et al, 1@@(0. n addition, this can result in thedevelopment of obstructive sleep apnoea which may remain unsuspected because

poor sleep "uality tends to be attributed to asthma, even though the symptom pattern is exactly the same in these patients compared to isolated sleep apnoea.

Within our clinic 1#< of sub2ects suffer from sleep apnoea and are treated withnasal continuous positive airway pressure.

Eis! factors

Atoy

$ver @A< of patients with type brittle asthma are strongly atopic /&iles et al,1@@90, despite which over two)thirds !eep pets at home, so continuing exposure toaeroallergens may be important in maintaining symptoms in this group, especiallyas they spend more time at home and indoors.

Food intolerance

$ver -A < of type patients report at least one food or drin! which ma!es theirasthma worse. Double blind placebo)controlled food challenge /;a!er et al, 1@@-0has confirmed a prevalence of food allergy at over 9A< in type brittle asthmawith wheat and dairy products being the most important triggers /Table 10.

Ta-le +. ositive 5ood *hallenges in ;rittle %sthma

5ood < ositive Eesponse

Dairy roducts 9A

Wheat 9A5ish (>

*itrus (+

7gg (+

otato #-

'oya #(

eanut 1-

Feast 1(

Psychosocial factors

sychosocial factors are important in type brittle asthma /Garden and %yres,


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1@@(0, with a high incidence of depression and fre"uent evidence of bro!enrelationships and physical and sexual abuse in our experience. Cust as common are

abnormal coping strategies for managing deteriorating asthma, where panicfre"uently supervenes /&iles et al, 1@@>0. :owever, it is difficult to be certainwhether brittle asthma is associated primarily with personality disorder, orwhether the threat of severe asthma induces psychological instability.

Steroid resonsi#eness

atients with type brittle asthma are usually treated with high doses ofinhaledBoral steroids, yet their asthma often remains poorly controlled suggestingthat there may be a degree of resistance to the anti)inflammatory effects ofsteroids /;arnes and %dcoc!. 1@@90.

&anagement Type brittle asthma

These patients are, by definition, extremely difficult to manage. &any of themhave fallen out with their doctor, who perhaps understandably. has run out of ideasand, often, patience. &anagement should be holistic, trying to approach all areaswhich impact on an individual4s symptoms. This involves identifying causalfactors and dealing where possible with psychosocial factors, before attempting towrestle with polypharmacy. Trying to identify psychosocial factors and dealingwith them /including help with Disability iving %llowance, for instance0 canhelp significantly, and group therapy has been of some use in patients who areable to meet on a regular basis, by providing an auto)support networ!.

Aller(en e/osure

Eemoval of animals and determined efforts to reduce house dust mite exposurewould seem logical but there is no evidence to suggest that such control measuresare effective in this group. ndeed, given their psychosocial problems, these

patients invariably believe that their animals are more reliable than people, andsuggesting that their animals should be removed is invariably greeted with bluntrefusal.

Where foods are identified as allergic triggers they should be avoided. n some

cases such avoidance can be remar!ably effective while in others the benefit islimited, but compliance with what is often a difficult diet may not always be good.Good dietary advice and support is crucial as ;a!er and colleagues /1@@90 haveshown that the diets of these patients are very often deficient in minerals such asselenium and magnesium and in the anti)oxidant vitamins %, * and ;. This is

probably because their diet lac!s food that they are avoiding because ofintolerance and a desperate need to lose weight with conse"uent reduction incalorie inta!e.

Comliance

The most important factor to identify is compliance with treatment but it should

be remembered that these patients appear to have wide variations in pea! flow and


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symptoms before they opt not to ta!e treatment as we would wish. 6on)compliance is not a cause of the severe asthma itself. Where identified this should

be openly addressed with the patient and their carer.

Dru( theray

The ;' guidelines /;ritish Thoracic 'ociety et al, 1@@-0 are of limited help inthese patients. They are already ta!ing large doses of inhaled steroids leaving anincrease in, or resumption of oral steroids as the next therapeutic step whensymptoms deteriorate, which many resist because of side effects. *onse"uently,many patients simply increase their beta)# /1)#0 agonist use /&iles et al, 1@@>0 inan attempt to avoid oral steroids and hospital admission. Whether alternativeimmunomodulatory treatment, such as methotrexate or cyclosporin, will beeffective is not yet certain but is worth trying in individual cases.

Su-cutaneous 0 a(onists

Type patients with brittle asthma can be treated with long)term continuoussubcutaneous infusion of H# agonist, usually terbutaline /*'T0 /$4Driscoll et al,1@??8 %yres, 1@@#0. Ising this techni"ue, around half of patients with type brittleasthma show mar!ed improvements in symptoms, variation in 75 /5igure 10 anduse of other asthma medication, including oral steroid use. %round #9 < showsome improvement in symptoms but less improvement in 75 while theremainder do not respond. *hronic steroid)dependent asthmatics without intrinsic75 variability do not respond to this form of therapy.

Fi(ure +. ea! flow readings /before and after bronchodilator0 in a patient withtype 1 brittle asthma

Before Su-cutaneous Ter-utaline

'albutamol nh.x nrednisolone 9mg'albutamol 'E ?mg b.d.Iniphylline ?AAmg nocteulmicort ii ".d.sntal 9 iii ".d.s


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On Continuous Su-cutaneous Ter-utaline

'albutamol ii p.m.

ulmicort ii ".d.sntal 9 ii ".d.s

On Ter-utaline su-cutaneously in 1 daily di#ided doses*

'albutamol ii p.m.ulmicort ii ".d.sntal 9 ii ".d.s

The infusions are given through a battery)powered syringe driver /such as theGraseby &'#-, Graseby td, IJ0 which need to be provided in successful caseson a long)term basis. f provision of a pump is not possible then the daily dose can

be delivered by divided doses, albeit with slightly less effective control /5igure 10.The best tolerated subcutaneous needles are the 'of)'et and the Disetronicsneedles /%pplied &edical Technology, *ambridge, IJ0, which although moreexpensive than the standard butterfly, last much longer8 one needle often remainsin situ for a wee! or more compared to +? hours or less for the butterfly needle.

The usual dose needed ranges between - and 19mg a day, mean blood levels ofterbutaline achieved by this techni"ue are around 19A nmolBlitre, the normaltherapeutic range for oral terbutaline treatment />.9 mg twice daily0 being 1A)#AnmolBlitre but despite this, significant changes in serum potassium or glucoseconcentrations are rare as, surprisingly, is tremor which may suggest the

development of tolerance to the side effects of this form of treatment. &uscle


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cramps are common and may sometimes be severe, with elevation of plasmacreatinine phospho!inase /'y!es et al, 1@@10 although levels of the myocardial

fraction are normal. 'ome patients complain of an effect on memory and ability toconcentrate and occasionally menorrhagia is seen but this is not usually severe.

The main problem is the development of subcutaneous inflammatory nodules.When biopsied these show an eosinophilic infiltrate /ewis et al, 1@?>0. Theseusually settle down once that area of s!in is avoided, but often leave a fibroticnodule. &ore recently a more aggressive type of lesion has been demonstratedwhich sometimes leads on to fran! abscess formation, the pus from which isusually sterile. The formulation of the drug has not changed nor have the

preservatives, so the reason for these reactions remains elusive. %lthough usingnebuli3er solution rather than the in2ectable form of terbutaline may help, in some

the s!in changes are so severe that administration has to be changed to continuousintravenous infusion via an indwelling line such as a ortacath or :ic!man line,although in those patients who have had many hospital admissions, such vascularaccess may also be needed because of lac! of useable veins.

2on(3actin( inhaled 0 a(onists

n our experience, salmeterol has proved to be disappointing in these patients forreasons that are not clear. Whether formoterol, which is a full agonist may bemore useful than salmeterol, a partial agonist, remains to be determined.

&anagement Type # brittle asthma

&anagement of type # patients is less difficult. n view of the rapid onset ofattac!s each patient should be provided with a medic alert bracelet or e"uivalent.%gain identification of inhaled or ingested triggers, e.g. peanuts /o3a and;rostoff, 1@@90, is crucial, but the mainstay of self treatment for these attac!s isadrenaline. %lthough these patients often appear to be relatively symptom free

between attac!s in some cases significant pea! flow variability is seen which isnot matched by perceived symptoms, which may explain the appearance ofsudden attac!s occurring on the bac!ground of significant but undetected airwaynarrowing.

Adrenaline

%drenaline may have theoretical advantages over selective 1(# agonists, becauseof its action as an alpha adrenoceptor against reducing airway oedema asdiscussed in the section on acute airway narrowing above. reloaded syringes/7pi)en, %J, IJ8 %na en, %llerayde, IJ0 should be provided for emergencytreatment. nhaled adrenaline may be more effective than a selective 1(# agonistinhaler. $nce adrenaline has been in2ected the patient should be encouraged to usea dose of nebuli3ed salbutamol or terbutaline and go to casualty. $ne problemwith these patients is that, once they arrive in casualty, their symptoms have oftenimproved such that they are told either that they do not have asthma or are 2ust

hyperventilating4. Eapid onset attac!s such as these are often e"ually "uic! to


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resolve leading to the opportunity for inade"uate assessment of severity in thesecases.

*onclusion

atients with brittle asthma, whether type 1 or type #, pose difficult and complexmanagement problems. Trying to classify these severe patients will help todetermine the differing factors involved and, while this classification will notembrace all patients with severe asthma, it will provide a framewor! for

beginning to unravel aetiology and treatment of this high morbidity group. $nceidentified, dealing with individual factors may in themselves have only a smallimpact on their condition but these can be cumulative, and even if these result inonly modest improvements in control, the patient will believe that some

improvement can after all be achieved.

Eeferences

Ayres J4 !+55'

'ubcutaneous terbutaline in the managemeni of brittle asthma. ;r C :osp &ed +>9-@)>1

Ba&er JS, Tunnicliffe $S, Duncanson RC, Ayres J4 !+556'

Eeduced dietary inta!es of magnesium, selenium and vitamins %, * and 5 in patients with brittle asthma. Thorax 9A %>9

Ba&er JC, Tunnicliffe $S, Duncanson RC, Ayres J4 !+557'

Double blind placebo controlled food challenge in type and type # brittle asthma.Thorax 91 %#

Barnes PJ, Adcoc& IM !+556'

'teroid resistant asthma. K C &ed ?? +99)-?

Bateman JRM, Clar&e S$ !+585'

'udden death in asthma. Thorax (+ +A)(

British Thoracic Society, British Paediatric Association, Royal Colle(e of

Physicians of 2ondon et al !+557'

Guidelines on the management of asthma. Thorax 9# /'uppl0 '1)#+

4arden 4MF, Ayres J4 !+559'

The psychiatric and social aspects of brittle asthma. Thorax +? 9A1)9

2e%is 2D, O:Driscoll BRC, )artley RB, Cochrane 4M !+5;8'

%n unusual local reaction to continuous subcutaneous infused terbutaline inunstable asthmatics. ;r C Dis *hest ?1 1?@)@(


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2o1>()?-

$asserfallen JB, Schaller MD, Feihl F, Perret C) !+55?'

'udden asphyxic asthma a distinct entityL %m Eev Eespir Dis 1+# 1A?)11

$esterman D@* Benatar SR* Pori(ieter PD* Fer(uson AD !+585'

dentification of high ris! asthmatic patients. %m C &ed -- 9-9)>#

Jey oints

• ;rittle asthma is relatively uncommon and conse"uently has been

characteri3ed in clinical terms.

• Two types at least can be identified, type 1 characteri3ed by wide pea!

flow variation despite maximal therapy and type # by very sudden attac!s.

• Type 1 brittle asthma is associated with the female sex, atopy, high

psychosocial disturbance and food intolerance. Treatment has to beholistic.


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• Type # brittle asthma is best treated with self)in2ectable adrenaline and

avoidance of recogni3ed triggers.

OCC ASTHMA

Occupational asthmaFrom Wikipedia, the free encycopedia

Occupational asthma

Classifcation and external resources

MedlinePlus !!!""!

Patient UK Occ#pationa a$thma

MeSH %!&'())

*edit on Wikidata+

Occuational asthma is an occupational lung disease and a type of asthma. i!e

other types of asthma, it is characteri3ed by airway inflammation, reversible

airways obstruction, and bronchospasm, but it is caused by something in the

wor!place environment.[1]

'ymptoms include shortness of breath, tightness of the chest, nasal irritation,

coughing and whee3ing. The first person to use it in reference to a medical

condition was :ippocrates, and he believed that tailors, anglers and metalwor!ers

were more li!ely to be affected by the disease. %lthough much research has been

done since, the inflammatory component of asthma was recogni3ed only in the

1@-As.

Today, asthma affects as much as 19< of the *anadian population,[#] a statistic

reflective of other developed countries, and has increased fourfold in the last #A

years. =arious reasons can be identified for this increase, including increase

environmental pollution, better diagnostic ability, and greater awareness.

%pproximately #1< of the adults affected by asthma report an aggravation of

their symptoms while at wor! and an improvement when away, which implies that

they may be suffering from occupational asthma. n the Inited 'tates,

occupational asthma is the most common occupational lung disease.[(] %t present,

over +AA wor!place substances have been identified as having asthmagenic or

allergenic properties.[+]

Their existence and magnitude vary by region and industry

https://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000110.htmhttps://en.wikipedia.org/wiki/Patient_UKhttp://patient.info/doctor/occupational-asthmahttps://en.wikipedia.org/wiki/Medical_Subject_Headingshttps://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?field=uid&term=D059366https://www.wikidata.org/wiki/Q2551913https://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Occupational_lung_diseasehttps://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:1-1https://en.wikipedia.org/wiki/Shortness_of_breathhttps://en.wikipedia.org/wiki/Coughinghttps://en.wikipedia.org/wiki/Wheezinghttps://en.wikipedia.org/wiki/Wheezinghttps://en.wikipedia.org/wiki/Hippocrateshttps://en.wikipedia.org/wiki/Tailorshttps://en.wikipedia.org/wiki/Fishermanhttps://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-2https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-2https://en.wikipedia.org/wiki/Developed_countrieshttps://en.wikipedia.org/wiki/Adultshttps://en.wikipedia.org/wiki/Symptomshttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-4https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-4https://en.wikipedia.org/wiki/Industryhttps://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000110.htmhttps://en.wikipedia.org/wiki/Patient_UKhttp://patient.info/doctor/occupational-asthmahttps://en.wikipedia.org/wiki/Medical_Subject_Headingshttps://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?field=uid&term=D059366https://www.wikidata.org/wiki/Q2551913https://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Occupational_lung_diseasehttps://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:1-1https://en.wikipedia.org/wiki/Shortness_of_breathhttps://en.wikipedia.org/wiki/Coughinghttps://en.wikipedia.org/wiki/Wheezinghttps://en.wikipedia.org/wiki/Hippocrateshttps://en.wikipedia.org/wiki/Tailorshttps://en.wikipedia.org/wiki/Fishermanhttps://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-2https://en.wikipedia.org/wiki/Developed_countrieshttps://en.wikipedia.org/wiki/Adultshttps://en.wikipedia.org/wiki/Symptomshttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-4https://en.wikipedia.org/wiki/Industry


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and can include diisocyanates, acid anhydrides, plicatic acid, and platinum salts

/all low molecular weight agents0, and animal protein, en3ymes, wheat, and latex

/high)molecular weight agents0.[(][1] 5or example, in 5rance the industries most

affected are ba!eries and ca!e)shops, automobile industry and hairdressers,[9]

whereas in *anada the principal cause is wood dust, followed by isocyanates.

5urthermore, the most common cause of occupational asthma in the wor!place are

isocyanates.[-] socyanates are used in the production of motor vehicles. [>]

:ypersensitivity pneumonitis is a related condition, with many occupational

examples /e.g. floc! wor!er4s lung, farmer4s lung, and indium lung0. :owever,

although overlapping in many cases, hypersensitivity pneumonitis may be

distinguished from occupational asthma in that it isn4t restricted to onlyoccupational exposure, and involves type hypersensitivity and type =

hypersensitivity[?] rather than the type hypersensitivity [@][1A] of asthma. %lso,

unli!e asthma, hypersensitivity pneumonitis targets lung alveoli rather than

bronchi.[11]

Contents

• " Sin$ and $ymptom$

• - %iano$i$

• ( .re/ention and treatment

o (0" .re/ention

o (0- Treatment and Reco/ery

o (0( Medica and pharmacooica treatment

• 1 Society and c#t#re

o 10" Compen$ation

• & Occ#pation$ at ri$k

• ) Epidemiooy

• 2 See a$o

• 3 Reference$

• ' E4terna ink$

https://en.wikipedia.org/wiki/Diisocyanatehttps://en.wikipedia.org/wiki/Acid_anhydrideshttps://en.wikipedia.org/wiki/Acid_anhydrideshttps://en.wikipedia.org/wiki/Plicatic_acidhttps://en.wikipedia.org/wiki/Plicatic_acidhttps://en.wikipedia.org/wiki/Platinumhttps://en.wikipedia.org/wiki/Platinumhttps://en.wikipedia.org/wiki/Enzymeshttps://en.wikipedia.org/wiki/Wheathttps://en.wikipedia.org/wiki/Wheathttps://en.wikipedia.org/wiki/Latexhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:1-1https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:1-1https://en.wikipedia.org/wiki/Francehttps://en.wikipedia.org/wiki/Automobile_industryhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-5https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-5https://en.wikipedia.org/wiki/Isocyanateshttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-6https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-7https://en.wikipedia.org/wiki/Hypersensitivity_pneumonitishttps://en.wikipedia.org/wiki/Flock_worker's_lunghttps://en.wikipedia.org/wiki/Farmer's_lunghttps://en.wikipedia.org/wiki/Indium_lunghttps://en.wikipedia.org/wiki/Type_III_hypersensitivityhttps://en.wikipedia.org/wiki/Type_III_hypersensitivityhttps://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttps://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-pmid15316440-8https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-pmid15316440-8https://en.wikipedia.org/wiki/Type_I_hypersensitivityhttps://en.wikipedia.org/wiki/Type_I_hypersensitivityhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-urlLecture_14:_Hypersensitivity-9https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-urlAllergy_.26_Asthma_Disease_Management_Center:_Ask_the_Expert-10https://en.wikipedia.org/wiki/Lung_alveolihttps://en.wikipedia.org/wiki/Bronchihttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-Kumar503-11https://en.wikipedia.org/wiki/Occupational_asthma#Signs_and_symptomshttps://en.wikipedia.org/wiki/Occupational_asthma#Diagnosishttps://en.wikipedia.org/wiki/Occupational_asthma#Prevention_and_treatmenthttps://en.wikipedia.org/wiki/Occupational_asthma#Preventionhttps://en.wikipedia.org/wiki/Occupational_asthma#Treatment_and_Recoveryhttps://en.wikipedia.org/wiki/Occupational_asthma#Medical_and_pharmacological_treatmenthttps://en.wikipedia.org/wiki/Occupational_asthma#Society_and_culturehttps://en.wikipedia.org/wiki/Occupational_asthma#Compensationhttps://en.wikipedia.org/wiki/Occupational_asthma#Occupations_at_riskhttps://en.wikipedia.org/wiki/Occupational_asthma#Epidemiologyhttps://en.wikipedia.org/wiki/Occupational_asthma#See_alsohttps://en.wikipedia.org/wiki/Occupational_asthma#Referenceshttps://en.wikipedia.org/wiki/Occupational_asthma#External_linkshttps://en.wikipedia.org/wiki/Diisocyanatehttps://en.wikipedia.org/wiki/Acid_anhydrideshttps://en.wikipedia.org/wiki/Plicatic_acidhttps://en.wikipedia.org/wiki/Platinumhttps://en.wikipedia.org/wiki/Enzymeshttps://en.wikipedia.org/wiki/Wheathttps://en.wikipedia.org/wiki/Latexhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:1-1https://en.wikipedia.org/wiki/Francehttps://en.wikipedia.org/wiki/Automobile_industryhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-5https://en.wikipedia.org/wiki/Isocyanateshttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-6https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-7https://en.wikipedia.org/wiki/Hypersensitivity_pneumonitishttps://en.wikipedia.org/wiki/Flock_worker's_lunghttps://en.wikipedia.org/wiki/Farmer's_lunghttps://en.wikipedia.org/wiki/Indium_lunghttps://en.wikipedia.org/wiki/Type_III_hypersensitivityhttps://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttps://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-pmid15316440-8https://en.wikipedia.org/wiki/Type_I_hypersensitivityhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-urlLecture_14:_Hypersensitivity-9https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-urlAllergy_.26_Asthma_Disease_Management_Center:_Ask_the_Expert-10https://en.wikipedia.org/wiki/Lung_alveolihttps://en.wikipedia.org/wiki/Bronchihttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-Kumar503-11https://en.wikipedia.org/wiki/Occupational_asthma#Signs_and_symptomshttps://en.wikipedia.org/wiki/Occupational_asthma#Diagnosishttps://en.wikipedia.org/wiki/Occupational_asthma#Prevention_and_treatmenthttps://en.wikipedia.org/wiki/Occupational_asthma#Preventionhttps://en.wikipedia.org/wiki/Occupational_asthma#Treatment_and_Recoveryhttps://en.wikipedia.org/wiki/Occupational_asthma#Medical_and_pharmacological_treatmenthttps://en.wikipedia.org/wiki/Occupational_asthma#Society_and_culturehttps://en.wikipedia.org/wiki/Occupational_asthma#Compensationhttps://en.wikipedia.org/wiki/Occupational_asthma#Occupations_at_riskhttps://en.wikipedia.org/wiki/Occupational_asthma#Epidemiologyhttps://en.wikipedia.org/wiki/Occupational_asthma#See_alsohttps://en.wikipedia.org/wiki/Occupational_asthma#Referenceshttps://en.wikipedia.org/wiki/Occupational_asthma#External_links


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Signs and symptoms

ess than five years of exposure or a single exposure to a high)concentration

agent can result in symptoms. *oughing, whee3ing, nasal irritation, shortness of

breath, and chest tightness are the most common symptoms, all of which worsen

after wor! and improve during time away from wor!. re)existing asthma can be

exacerbated by similar agents.[citation needed ]

Diagnosis

Diagnosis of occupational asthma uses several techni"ues.[(]

% non)specific bronchial hyperreactivity test can be used to help diagnose

occupational asthma. t involves testing with methacoline, after which the forcedexpiratory volume in 1 second /57=10 of the patient is measured. This test is often

used for measuring the intensity of a person4s asthma and to confirm that the

person needs to be treated for asthma.[(]

$ther non specific tests could re"uire the patient to run for a few minutes at a

continuous pace. n this case, the individualMs pea! expiratory flow rate /75E0 is

measured, showing how fast a person can exhale.[1#][unreliable medical source?] 75E can

also be measured at wor! to see if there is a difference from the 75E in a

controlled environment. &easuring 75E at wor! is a highly reliable test for

occupational asthma.

% s!in pric! test is usually performed on the inner forearm where a grid is mar!ed

and a drop of the allergens to be tested are placed on the arm in the grid. $nce this

has been done, the s!in is pric!ed through the drop using a lancet. Eeactions, if

any, occur within 1A to 19 minutes and these results can then be analy3ed. [1(]

[unreliable medical source?]

mmunoglobulin 7 is an antibody found in human blood and is effective against

toxins. 'ince it can also trigger allergic reactions to specific allergens li!e pollen,the g7 test is performed to evaluate whether the sub2ect is allergic to these

substances.[1+][(]

% spirometer is a device used to measure timed expired and inspired volumes, and

can be used to help diagnose occupational asthma. [19][unreliable medical source?]

'pecific inhalation challenges test for reactions to substances found in the

wor!place. $ne method is a whole body sealed chamber where the patient is

exposed to articles that are present in their wor!place. This method has the

advantage of being able to assess, albeit highly sub2ectively, ocular and nasal

https://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttps://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Bronchial_hyperreactivityhttps://en.wikipedia.org/wiki/Methacolinehttps://en.wikipedia.org/wiki/Forced_expiratory_volumehttps://en.wikipedia.org/wiki/Forced_expiratory_volumehttps://en.wikipedia.org/wiki/Forced_expiratory_volumehttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Peak_expiratory_flow_ratehttps://en.wikipedia.org/wiki/Peak_expiratory_flow_ratehttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-12https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-13https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Immunoglobulin_Ehttps://en.wikipedia.org/wiki/Allergenshttps://en.wikipedia.org/wiki/Pollenhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-14https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Spirometerhttps://en.wikipedia.org/wiki/Spirometerhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-15https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Bronchial_hyperreactivityhttps://en.wikipedia.org/wiki/Methacolinehttps://en.wikipedia.org/wiki/Forced_expiratory_volumehttps://en.wikipedia.org/wiki/Forced_expiratory_volumehttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Peak_expiratory_flow_ratehttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-12https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-13https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)https://en.wikipedia.org/wiki/Immunoglobulin_Ehttps://en.wikipedia.org/wiki/Allergenshttps://en.wikipedia.org/wiki/Pollenhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-14https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Spirometerhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-15https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine)


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symptoms as well as a reduction in 57=1. %nother test re"uires the patient to

breathe aerosols of the suspected asthmagens through an oro)facial mas!. These

asthmagens are aerosoli3ed using closed circuit chambers, and the "uantities and

concentrations administered are minute and extremely stable, to minimi3e the ris!

of exaggerated responses.[citation needed ]

Prevention and treatment.re/ention

revention of occupational asthma can be accomplished through better education

of wor!ers, management, unions and medical professionals. This will enable them

to identify the ris! factors and put in place preventive measures, including

respiratory protection and exposure limits.[(]

Treatment and Reco/ery

Eecovery is directly dependent on the duration and level of exposure to the

causative agent. Depending on the severity of the case, the condition of the patient

can improve dramatically during the first year after removal from exposure.

Three basic types of procedures are used for treating the affected wor!ers

reducing a wor!er4s exposure, removing a wor!er from the environment with the

asthma)causing agent, and treatment with asthma medications.[1-][(] *ompletely

stopping exposure is more effective treatment than reducing exposure.[(] ;y

reducing exposure, the probability of suffering another reaction is lowered.

&ethods of reducing exposure include transferring an affected wor!er to a

position without the relevant asthmagen, use of respiratory protection, and

engineering controls. n 1@?+ innovator David *ornell discovered and invented

effective control e"uipment in the IJ for the removal of many harmful wor!place

fumes. 4;$5%4 extraction products are now found in over 1AA countries

worldwide.[1>]

eople affected by occupational asthma that occurred after a latency period,

whether a few months or years, should be immediately removed from exposure to

the causative agent. :owever, this can entail severe socio)economic conse"uences

for the wor!er as well as the employer due to loss of 2ob, unemployment,

compensation issues, "uasi)permanent medical expenditures, and hiring and re)

training of new personnel. This can be mitigated by transferring the wor!er within

a company.[(]

Medica and pharmacooica treatment

https://en.wikipedia.org/wiki/Aerosolshttps://en.wikipedia.org/wiki/Asthmagenhttps://en.wikipedia.org/wiki/Asthmagenhttps://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttps://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-EvidenceReport-16https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-17https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Aerosolshttps://en.wikipedia.org/wiki/Asthmagenhttps://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-EvidenceReport-16https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-17https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3


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'hort)acting beta)agonists li!e salbutamol or terbutaline or long)acting beta)

agonists li!e salmeterol and formoterol dilate airways which relieve the symptoms

thus reducing the severity of the reaction. 'ome patients also use it 2ust before

wor! to avoid a drop in the 57=1.

%nti)inflammatory agents li!e corticosteroids, JTE% or mast cell stabili3ers can

also be used depending on the severity of the case.

Society and cultureCompen$ation

When a person is diagnosed with occupational asthma, it can result in serious

socio)economic conse"uences not only for the wor!ers but also for the employer

and the healthcare system because the wor!er must change positions. [(] The

probability of being re)employed is lower for those with occupational asthma

compared to those with normal asthma. The employer not only pays compensation

to the employee, but will also have to spend a considerable amount of time and

energy and funds for hiring and training new personnel. [1?][1@] n the Inited 'tates,

it was estimated that the direct cost of occupational asthma in 1@@- was N1.#

billion and the indirect cost NA.+ billion, for a total cost of N1.- billion. [#A]

Occupations at risk The following tables show occupations that are !nown to be at ris! for

occupational asthma, and main substances involved.[#1]

The occupations most at ris! are adhesive handlers /e.g. acrylate0, animal

handlers and veterinarians /animal proteins0, ba!ers and millers /cereal grains0,

carpet ma!ers /gums0, electronics wor!ers /soldering resin0, forest wor!ers,

carpenters and cabinetma!ers /wood dust0, hairdressers /e.g. persulfate0, health

care wor!ers /latex and chemicals such as glutaraldehyde0, 2anitors and cleaning

staff /e.g. chloramine)T0, pharmaceutical wor!ers /drugs, en3ymes0, seafood

processors, shellac handlers /e.g. amines0, solderers and refiners /metals0, spray

painters, insulation installers, plastics and foam industry wor!ers /e.g.

diisocyanates0, textile wor!ers /dyes0 and users of plastics and epoxy resins /e.g.

anhydrides0[##]

4rains, flours, lants and (ums

Occuation [#1] A(ent [#1]

;a!ers, millers Wheat

Isocyanates and metals


;oat builders, foam TD

https://en.wikipedia.org/wiki/Beta-agonisthttps://en.wikipedia.org/wiki/Salbutamolhttps://en.wikipedia.org/wiki/Terbutalinehttps://en.wikipedia.org/wiki/Salmeterolhttps://en.wikipedia.org/wiki/Formoterolhttps://en.wikipedia.org/wiki/Corticosteroidhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-18https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-19https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-20https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Acrylatehttps://en.wikipedia.org/wiki/Resinhttps://en.wikipedia.org/wiki/Persulfatehttps://en.wikipedia.org/wiki/Persulfatehttps://en.wikipedia.org/wiki/Glutaraldehydehttps://en.wikipedia.org/wiki/Chloramine-Thttps://en.wikipedia.org/wiki/Diisocyanatehttps://en.wikipedia.org/wiki/Anhydrideshttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-22https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Toluene_diisocyanatehttps://en.wikipedia.org/wiki/Beta-agonisthttps://en.wikipedia.org/wiki/Salbutamolhttps://en.wikipedia.org/wiki/Terbutalinehttps://en.wikipedia.org/wiki/Salmeterolhttps://en.wikipedia.org/wiki/Formoterolhttps://en.wikipedia.org/wiki/Corticosteroidhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-18https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-19https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-20https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Acrylatehttps://en.wikipedia.org/wiki/Resinhttps://en.wikipedia.org/wiki/Persulfatehttps://en.wikipedia.org/wiki/Glutaraldehydehttps://en.wikipedia.org/wiki/Chloramine-Thttps://en.wikipedia.org/wiki/Diisocyanatehttps://en.wikipedia.org/wiki/Anhydrideshttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-22https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Toluene_diisocyanate


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*hemists, coffee bean baggers and handlers,

gardeners, millers, oil

industry wor!ers, farmers

*astor

beans

*igarette factory wor!ersTobacco

dust

Drug manufacturers, mold

ma!ers in sweet factories,

printers

Gum acacia

5armers, grain handlers Grain dust

Gum manufacturers, sweet

ma!ers

Gum

tragacanth

'trawberry growers'trawberry

pollen

Tea sifters and pac!ers Tea dust

Tobacco farmersTobacco

leaf

Woollen industry wor!ers Wool

Animals, insects and fun(i


;ird fanciers %vian proteins

*osmetic

manufacturers*armine

7ntomologists &oths, butterflies

5eather pluc!ers 5eathers

5ield contact *ric!ets

manufacturers, office

wor!ers, plastics

factory wor!ers,

refrigerator

manufacturers, TD

manufacturersBusers,

printers, laminators,

tinners, toy ma!ers

;oiler cleaners, gas

turbine cleaners=anadium

*ar sprayers:examethylene

diisocyanate

*ement wor!ersotassium

dichromate

*hrome platers,

chrome polishers

'odium

bichromate,

chromic acid,

potassiumchromate

6ic!el platers 6ic!el sulphate

latinum chemists*hloroplatinic

acid

latinum refiners latinum salts

olyurethane foammanufacturers,

printers, laminators

Diphenylmethane

diisocyanate

Eubber wor!ers 6aphthalene

diisocyanate

Tungsten carbide

grinders*obalt

Welders 'tainless steel

https://en.wikipedia.org/wiki/Castor_beanhttps://en.wikipedia.org/wiki/Castor_beanhttps://en.wikipedia.org/w/index.php?title=Tobacco_dust&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Tobacco_dust&action=edit&redlink=1https://en.wikipedia.org/wiki/Gum_acaciahttps://en.wikipedia.org/wiki/Grain_dusthttps://en.wikipedia.org/wiki/Tragacanthhttps://en.wikipedia.org/w/index.php?title=Strawberry_pollen&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Strawberry_pollen&action=edit&redlink=1https://en.wikipedia.org/wiki/Tea_dusthttps://en.wikipedia.org/wiki/Tobacco_leafhttps://en.wikipedia.org/wiki/Tobacco_leafhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/w/index.php?title=Avian_protein&action=edit&redlink=1https://en.wikipedia.org/wiki/Carminehttps://en.wikipedia.org/wiki/Entomologistshttps://en.wikipedia.org/wiki/Crickethttps://en.wikipedia.org/wiki/Toluene_diisocyanatehttps://en.wikipedia.org/wiki/Vanadiumhttps://en.wikipedia.org/wiki/Hexamethylene_diisocyanatehttps://en.wikipedia.org/wiki/Hexamethylene_diisocyanatehttps://en.wikipedia.org/wiki/Potassium_dichromatehttps://en.wikipedia.org/wiki/Potassium_dichromatehttps://en.wikipedia.org/wiki/Sodium_bichromatehttps://en.wikipedia.org/wiki/Sodium_bichromatehttps://en.wikipedia.org/wiki/Sodium_bichromatehttps://en.wikipedia.org/wiki/Chromic_acidhttps://en.wikipedia.org/wiki/Potassium_chromatehttps://en.wikipedia.org/wiki/Potassium_chromatehttps://en.wikipedia.org/wiki/Nickel_sulphatehttps://en.wikipedia.org/wiki/Chloroplatinic_acidhttps://en.wikipedia.org/wiki/Chloroplatinic_acidhttps://en.wikipedia.org/w/index.php?title=Platinum_salts&action=edit&redlink=1https://en.wikipedia.org/wiki/Diphenylmethane_diisocyanatehttps://en.wikipedia.org/wiki/Diphenylmethane_diisocyanatehttps://en.wikipedia.org/w/index.php?title=Naphthalene_diisocyanate&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Naphthalene_diisocyanate&action=edit&redlink=1https://en.wikipedia.org/wiki/Cobalthttps://en.wikipedia.org/wiki/Stainless_steelhttps://en.wikipedia.org/wiki/Castor_beanhttps://en.wikipedia.org/wiki/Castor_beanhttps://en.wikipedia.org/w/index.php?title=Tobacco_dust&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Tobacco_dust&action=edit&redlink=1https://en.wikipedia.org/wiki/Gum_acaciahttps://en.wikipedia.org/wiki/Grain_dusthttps://en.wikipedia.org/wiki/Tragacanthhttps://en.wikipedia.org/w/index.php?title=Strawberry_pollen&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Strawberry_pollen&action=edit&redlink=1https://en.wikipedia.org/wiki/Tea_dusthttps://en.wikipedia.org/wiki/Tobacco_leafhttps://en.wikipedia.org/wiki/Tobacco_leafhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/w/index.php?title=Avian_protein&action=edit&redlink=1https://en.wikipedia.org/wiki/Carminehttps://en.wikipedia.org/wiki/Entomologistshttps://en.wikipedia.org/wiki/Crickethttps://en.wikipedia.org/wiki/Toluene_diisocyanatehttps://en.wikipedia.org/wiki/Vanadiumhttps://en.wikipedia.org/wiki/Hexamethylene_diisocyanatehttps://en.wikipedia.org/wiki/Hexamethylene_diisocyanatehttps://en.wikipedia.org/wiki/Potassium_dichromatehttps://en.wikipedia.org/wiki/Potassium_dichromatehttps://en.wikipedia.org/wiki/Sodium_bichromatehttps://en.wikipedia.org/wiki/Sodium_bichromatehttps://en.wikipedia.org/wiki/Chromic_acidhttps://en.wikipedia.org/wiki/Potassium_chromatehttps://en.wikipedia.org/wiki/Potassium_chromatehttps://en.wikipedia.org/wiki/Nickel_sulphatehttps://en.wikipedia.org/wiki/Chloroplatinic_acidhttps://en.wikipedia.org/wiki/Chloroplatinic_acidhttps://en.wikipedia.org/w/index.php?title=Platinum_salts&action=edit&redlink=1https://en.wikipedia.org/wiki/Diphenylmethane_diisocyanatehttps://en.wikipedia.org/wiki/Diphenylmethane_diisocyanatehttps://en.wikipedia.org/w/index.php?title=Naphthalene_diisocyanate&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Naphthalene_diisocyanate&action=edit&redlink=1https://en.wikipedia.org/wiki/Cobalthttps://en.wikipedia.org/wiki/Stainless_steel


20/24

wor!ers

5ish bait breeders ;ee moths

5lour mill wor!ers,

ba!ers, farm

wor!ers, grain

handlers

Grain storage mites,

alternaria,

aspergillus

aboratory wor!ers

ocusts,

coc!roaches, grain

weevils, rats, mice,

guinea pigs, rabbits

&ushroom

cultivators&ushroom spores

$yster farmers'ea pineapples

/:oya0

ea sorters&exican bean

weevils

igeon breeders igeons

oultry wor!ers *hic!ens

rawn processors rawns

'il!worm

sericulturers'il!worms

Ooological museum

curators;eetles

ChemicalsMaterials

Occuation [#1]

A(ent [#1]

%ircraft fitters Triethyltetramine

fumes

Dru(s and en


21/24

%luminum

cable solderers%minoethylethanolamine

%luminum pot

room wor!ers5luorine

%utobody

wor!ers

%crylates /resins, glues,

sealants, adhesives0

;rewery

wor!ers*hloramine)T

*hemical plant

wor!ers, pulp

mill wor!ers

*hlorine

Dye weighers

evafix brilliant yellow,

drimarene brilliant

yellow and blue,

cibachrome brilliant

scarlet

7lectronics

wor!ers*olophony

7poxy resin

manufacturers

Tetrachlorophthalic

anhydride

5oundry mold

ma!ers

5uran)based resin binder

systems

5ur dyers ara)phenylenediamine

:airdressers ersulphate salts

:ealth care

wor!ersGlutaraldehyde, latex

aboratory

wor!ers,

nurses,

phenolic resin

5ormaldehyde

wor!ers

$oods


*arpenters,

timber millers,

woodwor!ers

Western red cedar ,

cedar of ebanon,

iro!o, *alifornia

redwood, ramin,

%frican 3ebrawood

'awmill wor!ers,

pattern ma!ers

&ansonia, oa! ,

mahogany, abiruana

Wood finishers *ocabolla

Wood machinists Je2aat

https://en.wikipedia.org/wiki/Aminoethylethanolaminehttps://en.wikipedia.org/wiki/Fluorinehttps://en.wikipedia.org/wiki/Acrylateshttps://en.wikipedia.org/wiki/Resinshttps://en.wikipedia.org/wiki/Gluehttps://en.wikipedia.org/wiki/Gluehttps://en.wikipedia.org/wiki/Sealanthttps://en.wikipedia.org/wiki/Adhesivehttps://en.wikipedia.org/wiki/Adhesivehttps://en.wikipedia.org/wiki/Chloramine-Thttps://en.wikipedia.org/wiki/Chlorinehttps://en.wikipedia.org/w/index.php?title=Levafix_brilliant_yellow&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_yellow&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_yellow&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_blue&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_blue&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Cibachrome_brilliant_scarlet&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Cibachrome_brilliant_scarlet&action=edit&redlink=1https://en.wikipedia.org/wiki/Colophonyhttps://en.wikipedia.org/w/index.php?title=Tetrachlorophthalic_anhydride&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Tetrachlorophthalic_anhydride&action=edit&redlink=1https://en.wikipedia.org/wiki/Furanhttps://en.wikipedia.org/w/index.php?title=Resin_binder_systems&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Resin_binder_systems&action=edit&redlink=1https://en.wikipedia.org/wiki/Para-phenylenediaminehttps://en.wikipedia.org/wiki/Persulphate_salthttps://en.wikipedia.org/wiki/Glutaraldehydehttps://en.wikipedia.org/wiki/Latexhttps://en.wikipedia.org/wiki/Latexhttps://en.wikipedia.org/wiki/Phenolic_resinhttps://en.wikipedia.org/wiki/Formaldehydehttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Western_red_cedarhttps://en.wikipedia.org/wiki/Cedar_of_Lebanonhttps://en.wikipedia.org/wiki/Iroko_(hardwood)https://en.wikipedia.org/wiki/California_redwoodhttps://en.wikipedia.org/wiki/California_redwoodhttps://en.wikipedia.org/wiki/California_redwoodhttps://en.wikipedia.org/wiki/Raminhttps://en.wikipedia.org/w/index.php?title=African_zebrawood&action=edit&redlink=1https://en.wikipedia.org/wiki/Mansoniahttps://en.wikipedia.org/wiki/Oakhttps://en.wikipedia.org/wiki/Oakhttps://en.wikipedia.org/wiki/Mahoganyhttps://en.wikipedia.org/w/index.php?title=Abiruana&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Cocabolla&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Kejaat&action=edit&redlink=1https://en.wikipedia.org/wiki/Aminoethylethanolaminehttps://en.wikipedia.org/wiki/Fluorinehttps://en.wikipedia.org/wiki/Acrylateshttps://en.wikipedia.org/wiki/Resinshttps://en.wikipedia.org/wiki/Gluehttps://en.wikipedia.org/wiki/Sealanthttps://en.wikipedia.org/wiki/Adhesivehttps://en.wikipedia.org/wiki/Chloramine-Thttps://en.wikipedia.org/wiki/Chlorinehttps://en.wikipedia.org/w/index.php?title=Levafix_brilliant_yellow&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_yellow&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_yellow&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Drimarene_brilliant_blue&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Cibachrome_brilliant_scarlet&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Cibachrome_brilliant_scarlet&action=edit&redlink=1https://en.wikipedia.org/wiki/Colophonyhttps://en.wikipedia.org/w/index.php?title=Tetrachlorophthalic_anhydride&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Tetrachlorophthalic_anhydride&action=edit&redlink=1https://en.wikipedia.org/wiki/Furanhttps://en.wikipedia.org/w/index.php?title=Resin_binder_systems&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Resin_binder_systems&action=edit&redlink=1https://en.wikipedia.org/wiki/Para-phenylenediaminehttps://en.wikipedia.org/wiki/Persulphate_salthttps://en.wikipedia.org/wiki/Glutaraldehydehttps://en.wikipedia.org/wiki/Latexhttps://en.wikipedia.org/wiki/Phenolic_resinhttps://en.wikipedia.org/wiki/Formaldehydehttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-osh-21https://en.wikipedia.org/wiki/Western_red_cedarhttps://en.wikipedia.org/wiki/Cedar_of_Lebanonhttps://en.wikipedia.org/wiki/Iroko_(hardwood)https://en.wikipedia.org/wiki/California_redwoodhttps://en.wikipedia.org/wiki/California_redwoodhttps://en.wikipedia.org/wiki/Raminhttps://en.wikipedia.org/w/index.php?title=African_zebrawood&action=edit&redlink=1https://en.wikipedia.org/wiki/Mansoniahttps://en.wikipedia.org/wiki/Oakhttps://en.wikipedia.org/wiki/Mahoganyhttps://en.wikipedia.org/w/index.php?title=Abiruana&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Cocabolla&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Kejaat&action=edit&redlink=1


22/24

molders

&eat wrappers olyvinyl chloride vapour

aint

manufacturers,

plastic

molders, tool

setters

hthalic anhydride

aint sprayers Dimethylethanolamine

hotographic

wor!ers,

shellac

manufacturers

7thylenediamine

Eefrigeration

industry

wor!ers

*5*s

'olderersolyether alcohol,

polypropylene glycol

pidemiology

$ccupational asthma is the most common occupational lung disease.[(]

See also

• A$thma

• Chronic o5$tr#cti/e p#monary di$ea$e 6CO.%7

• Speci8c inhaation chaene

!e"erences

"0

"Asthma & Allergies". NIOSH. April 3, 2012.

C9Heath: A$thma in Canada6-!!27

https://en.wikipedia.org/wiki/Polyvinyl_chloridehttps://en.wikipedia.org/wiki/Phthalic_anhydridehttps://en.wikipedia.org/wiki/Dimethylethanolaminehttps://en.wikipedia.org/wiki/Shellachttps://en.wikipedia.org/wiki/Ethylenediaminehttps://en.wikipedia.org/wiki/CFCshttps://en.wikipedia.org/w/index.php?title=Solderer&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Polyether_alcohol&action=edit&redlink=1https://en.wikipedia.org/wiki/Polypropylene_glycolhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_diseasehttps://en.wikipedia.org/wiki/Specific_inhalation_challengehttp://www.cdc.gov/niosh/topics/asthma/http://chealth.canoe.ca/channel_section_details.asp?text_id=3370&channel_id=2014&relation_id=18604/https://en.wikipedia.org/wiki/Polyvinyl_chloridehttps://en.wikipedia.org/wiki/Phthalic_anhydridehttps://en.wikipedia.org/wiki/Dimethylethanolaminehttps://en.wikipedia.org/wiki/Shellachttps://en.wikipedia.org/wiki/Ethylenediaminehttps://en.wikipedia.org/wiki/CFCshttps://en.wikipedia.org/w/index.php?title=Solderer&action=edit&redlink=1https://en.wikipedia.org/w/index.php?title=Polyether_alcohol&action=edit&redlink=1https://en.wikipedia.org/wiki/Polypropylene_glycolhttps://en.wikipedia.org/wiki/Occupational_asthma#cite_note-:0-3https://en.wikipedia.org/wiki/Asthmahttps://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_diseasehttps://en.wikipedia.org/wiki/Specific_inhalation_challengehttp://www.cdc.gov/niosh/topics/asthma/http://chealth.canoe.ca/channel_section_details.asp?text_id=3370&channel_id=2014&relation_id=18604/


23/24

de Groene, Gerda J. !al, ea#e $. %eah, Jerem' arlo, S(san

$. Spree()ers, *i# +rings*resen, $oni-(e H) $attioli, Steano

/eree#, Jos H. 2011. "or#plae inter4entions or treatment oo(pational asthma". he 5ohrane *ataase o S'stemati 6e4ie)s

78 5*00930:. doi810.1002;1


24/24

Aery Society of So#th Africa0 The Skin .rick Te$t0 Toerien

A,.otter . C, B#y$ C

Speci8c Te$t Technooy A$$e$$ment n#m5er "-'0 Beach ?, Ro;e B, Bit@ S,

Cr#mey E, Hooton =, R#$$e >;;;05ofa0co0#k>hi$tory0a$p

Medine.#$ Medica Encycopedia: .eak e4piratory o; rate

*e)itte J*, 5hanBe(ng $, $alo JC $a' 1==

dekor tikas i

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