Chest
Volume 115, Issue 1, January 1999, Pages 249-256
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Occupational and Environmental Lung Disease
Occupational Asthma: A Longitudinal Study on the Clinical and Socioeconomic Outcome After Diagnosis

https://doi.org/10.1378/chest.115.1.249Get rights and content

Aim

To evaluate the clinical outcome and socioeconomic consequences of occupational asthma (OA).

Subjects and methods

Twenty-five patients with OA both to high- and low-molecular-weight agents (3 and 22, respectively) confirmed by specific inhalation challenge were followed up for 12 months after the diagnosis. Upon diagnosis, each patient received a diary on which to report peak expiratory flow rate (PEFR), symptoms, drug consumption, expenses directly or indirectly related to the disease, as well as information regarding personal socioeconomic status. At each follow-up visit (1, 3, 6, and 12 months), the patients underwent clinical examination, spirometry, methacholine (Mch) challenge, and assessment of diary-derived parameters and socioeconomic status. Asthma severity (AS) was classified into four levels, based on symptoms, drug consumption, and PEFR variability.

Results

At 12 months, 13 patients (group A) had ceased exposure; the remaining 12 patients (group B) continued to be exposed. At diagnosis, FEV1 percent and provocative dose causing a 20% fall in FEV1 (PD20) of Mch were lower in group A than in group B; patients of group A were also characterized by significantly higher basal AS levels. At 12 months, no significant variation in FEV1 percent or PD20 was found for either group, while AS levels improved in both groups, the change being more marked for group A than group B. Pharmaceutical expense at 12 months significantly (p < 0.05) decreased, as compared with the first month, in group A, whereas it tended to increase in group B. In group A, 9 of 13 subjects had reported a deterioration of their socioeconomic status as compared with 2 of 12 in group B (p < 0.01). A significant loss of income was registered in patients of group A (median 21.45, 25th to 75th percentiles 16.9 to 25.8 Italian liras × 106 on the year preceding diagnosis and 15.498, 10.65 to 21.087 Italian liras × 106 on the year after diagnosis; p < 0.01), whereas no significant change was seen for patients in group B.

Conclusions

In OA, cessation of exposure to the offending agent results in a decrease in asthma severity and in pharmaceutical expenses, but it is associated with a deterioration of the individual's socioeconomic status (professional downgrading and loss of work-derived income). There appears to be a great need for legislation that facilitates the relocation of these patients.

Section snippets

Study Design

Subjects were examined at the time of diagnosis of OA and reevaluated at 1, 3, 6, and 12 months after diagnosis. Allergy skin tests were performed at time of diagnosis. For the duration of the study, all patients reported peak expiratory flow (PEF) values on a personal asthma diary together with symptoms, drug intake, medical events, and disease-related costs (see below). At time of diagnosis and at each following visit, clinical examination, spirometry, and bronchial challenge with

Results

Three subjects refused to be enrolled in the study while four others did not come to control visits (two preferred to be followed up in another center, while two were no longer interested in participating in the study). The remaining 25 subjects completed the study. Among participants, OA was due to high-molecular-weight (HMW) agents in 3 subjects and to low-molecular-weight (LMW) agents in 22 (isocyanates in 9 of them) (Table 1). In the seven nonparticipants, the causal agents were LMW agents.

Discussion

In this prospective study, we followed up a group of subjects with OA due to various agents at regular intervals of time for 1 year after the diagnosis, recording at each time point their clinical, functional, employment, and financial status.

Removal from exposure to the offending agent is recommended as the first-line measure for the management of OA.3, 4 Our data show that in Italy7 as in other countries5, 8 where this procedure is not mandatory, this occurs only in a limited proportion of

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    Supported by grant ICS-57.3/RF92/719, from the Italian Ministry of Health.

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