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Evidence based guidelines for the prevention, identification, and management of occupational asthma
  1. P J Nicholson1,
  2. P Cullinan2,
  3. A J Newman Taylor2,
  4. P S Burge3,
  5. C Boyle4
  1. 1Procter & Gamble, Whitehall Lane, Egham, Surrey, UK
  2. 2National Heart & Lung Institute, Manresa Road, London, UK
  3. 3Heartlands Hospital, Bordesley Green East, Birmingham, UK
  4. 4Health & Safety Executive, Magdalen Court, Bootle, UK
  1. Correspondence to:
 Dr P J Nicholson
 British Occupational Health Research Foundation, 6 St Andrews Place, Regents Park, London NW1 4LB, UK;


Background: Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010.

Aim: The guidelines aim to improve the prevention, identification, and management of occupational asthma by providing evidence based recommendations on which future practice can be based.

Methods: The literature was searched systematically using Medline and Embase for articles published in all languages up to the end of June 2004. Evidence based statements and recommendations were graded according to the Royal College of General Practitioner’s star system and the revised Scottish Intercollegiate Guidelines Network grading system.

Results: A total of 474 original studies were selected for appraisal from over 2500 abstracts. The systematic review produced 52 graded evidence statements and 22 recommendations based on 223 studies.

Discussion: Evidence based guidelines have become benchmarks for practice in healthcare and the process used to prepare them is well established. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification, and management of occupational asthma, based on and using the best available medical evidence. The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed for the early identification of symptoms, including occupational rhinitis, with additional functional and immunological tests where appropriate. Effective management of workers suspected to have occupational asthma involves the identification and investigation of symptoms suggestive of asthma immediately they occur. Those workers who are confirmed to have occupational asthma should be advised to avoid further exposure completely and early in the course of their disease to offer the best chance of recovery.

  • BOHRF, British Occupational Health Research Foundation
  • ES, evidence statement
  • HMW, high molecular weight
  • LMW, low molecular weight
  • OA, occupational asthma
  • PEF, peak expiratory flow
  • RCT, randomised controlled trial
  • RCGP, Royal College of General Practitioners
  • RPE, respiratory protective equipment
  • SIGN, Scottish Intercollegiate Guidelines Network
  • SBPT, specific bronchial provocation testing
  • occupational asthma
  • evidence based medicine
  • prevention

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  • Financial support: This study was supported by a grant from the British Occupational Health Research Foundation, 6 St Andrew’s Place, London NW1 4LB. Catherine Boyle was funded by the Health & Safety Executive.

  • Competing interests: none

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