Complete removal from exposure produces the best health and worst financial outcomes in occupational asthma

This is an attempt to use Cochrane methodology to estimate the effects of remaining exposed, exposure reduction and cessation of exposure in workers with occupational asthma. Cochrane analysis works best for randomised trials which are clearly unethical when the choice is between loosing you job and staying at work. Within the limits of Cochrane analysing non-randomised trials, the risk ratios for removal compared with staying exposed were 4.8 for absence of asthma symptoms, 2.47 for improvement and a mean 4.2% improvement in FEV1. Related to continuing exposure the figures for exposure reduction were 2.65 (no asthma symptoms), 1.1 (improvement) and 2.6% (NS) improvement in FEV1. The risks of unemployment were 14.3 for removal of exposure with an average income loss of 20-50%. This doesn't take us much further than what we knew before, the challenge is to remove the worker from exposure as soon as possible. This requires identifying the cause if relocation with the same employer is a realistic option for the employer. Cochrane advise high quality studies but provide little advice about methodology apart from increasing sample size

References

	Henneberger PK, Patel JR, de Groene GJ, Beach J, Tarlo SM, Pal TM, Curti S. , Workplace interventions for treatment of occupational asthma., Cochrane Database Syst Rev., 2019;:10:CD006308,10.1002/14651858.CD006308.pub4

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