ORIGINAL ARTICLE

Defining and investigating occupational asthma: a consensus approach

H C Francis¹, C O Prys-Picard¹, D Fishwick², C Stenton³, P S Burge⁴, L M Bradshaw², J G Ayres⁵, S M Campbell⁶ and R McL Niven¹

¹ North West Lung Research Centre, Wythenshawe Hospital, Manchester, UK
² Centre for Workplace Health, Health & Safety Laboratory, Buxton & University of Sheffield, UK
³ Royal Victoria Infirmary, Newcastle upon Tyne, UK
⁴ Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
⁵ Department of Environmental and Occupational Medicine, University of Aberdeen, UK
⁶ National Primary Care Research and Development Centre, University of Manchester, UK

Correspondence to:
Correspondence to:
Dr H Francis
North West Lung Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; Helen.C.Francis{at}manchester.ac.uk

Background: At present there is no internationally agreed definition of occupational asthma and there is a lack of guidance regarding the resources that should be readily available to physicians running specialist occupational asthma services.

Aims: To agree a working definition of occupational asthma and to develop a framework of resources necessary to run a specialist occupational asthma clinic.

Method: A modified RAND appropriateness method was used to gain a consensus of opinion from an expert panel of clinicians running specialist occupational asthma clinics in the UK.

Results: Consensus was reached over 10 terms defining occupational asthma including: occupational asthma is defined as asthma induced by exposure in the working environment to airborne dusts vapours or fumes, with or without pre-existing asthma; occupational asthma encompasses the terms "sensitiser-induced asthma" and "acute irritant-induced asthma" (reactive airways dysfunction syndrome (RADS)); acute irritant-induced asthma is a type of occupational asthma where there is no latency and no immunological sensitisation and should only be used when a single high exposure has occurred; and the term "work-related asthma" can be used to include occupational asthma, acute irritant-induced asthma (RADS) and aggravation of pre-existing asthma. Disagreement arose on whether low dose irritant-induced asthma existed, but the panel agreed that if it did exist they would include it in the definition of "work-related asthma". The panel agreed on a set of 18 resources which should be available to a specialist occupational asthma service. These included pre-bronchodilator FEV₁ and FVC (% predicted); peak flow monitoring (and plotting of results, OASYS II analysis); non-specific provocation challenge in the laboratory and specific IgE to a wide variety of occupational agents.

Conclusion: It is hoped that the outcome of this process will improve uniformity of definition and investigation of occupational asthma across the UK.

Abbreviations: RADS, reactive airways dysfunction syndrome

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