Occupational Asthma Reference

Perecinský S, Murínová L, Kalanin P, Jancová A, Legáth L, Changes in occupational asthma during four decades in Slovakia, Central Europe, Ann Agric Environ Med, 2018;25:437-442,DOI: https://doi.org/10.26444/aaem/89647
(Plain text: Perecinsky S, Murinova L, Kalanin P, Jancova A, Legath L, Changes in occupational asthma during four decades in Slovakia, Central Europe, Ann Agric Environ Med)

Keywords: OA, surveillance, Slovakia, cleaning, prick test

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Occupational asthma (OA) is the most common occupational lung disease in industrialized countries; however, in Western Europe, a decline in the prevalence of OA and changes in etiological factors has been recorded. Data from Central Europe, where in the past healthcare and economy sectors were different, are rare.

The aim of this study was to discover the changes related to OA during a four decade long period in the Slovak Republic.

Material and methods:
The study included patients whom OA was reported during 1980–2016. All cases of OA were divided into four decades. The prevalence of OA, changes in etiological factors and key diagnostic methods were evaluated. All decades were analysed separately and compared to one another.

During 1980–2016, OA was reported in 155 patients. OA was most often found in the second decade (6.4 cases per year), the lowest number of cases was diagnosed in the third decade (2.1 cases per year). Since 1988, an increasing prevalence of OA was observed with the peak in 1992, followed by the significantly progressive decrease during subsequent years. In the fourth decade, a mild increase in OA causes was recorded again. In the first and second decades, agricultural allergens were the dominant agents, which were replaced by chemical factors in the last decade. The most frequently used key diagnostic methods in 1980–2009 were skin tests, during the fourth decade the importance of this method declined. However, specific BPT a serial BPT were more frequently used in the fourth decade

The number of OA cases induced by agricultural allergens declined, which was connected with a decrease of total OA cases. The current problem is the OA induced by the chemicals, which increased significantly in the last decade, even the possibility of underdiagnosed OA cases still exists.

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The study included the patients with OA who were in the database of the Department of Occupational Medicine and Clinical Toxicology at the Louis Pasteur University
Hospital in Košice, Slovakia. The database comprises patients who had been diagnosed with OA and reported by this department during the period 1980–2016. At
present, the standard procedure for the confirmation of asthma is initiated by the admission of the patient who suffers from respiratory problems at work to the ambulance or department of occupational medicine. In the Slovak Republic, the centre for occupational respiratory diseases is the Department of Occupational Medicine and Clinical Toxicology of Louis Pasteur University Hospital in Košice.
On admission, all patients undergo a basic examination by a specialist, followed by lung function tests. An immunoallergological examination is then performed. This consists of confirmation of sensitization to a suspected allergen of the occupational environment, if available. Simultaneously, the sensitization to common inhalant airborne allergens is tested, and skin prick tests or serum specific IgE antibodies test are performed. Positivity of skin tests (prick test or epicutaneous tests) or blood tests with the history of typical respiratory symptoms at the workplace makes the diagnosis of occupational asthma very probable. After the assessment of work conditions by the hygienic worker, it should be decided
whether bronchial asthma is considered an occupational. Another diagnostic method is the elimination/resume test. The results of elimination/resume test are considered positive if the clinical symptoms are absent while the patient is out
of the workplace, and the worsening of the clinical state is observed after repeated exposition.

Table 3. List of chemical agents inducing OA in each decade
Decade First Second Third Fourth
Hairdressing chemicals 2 - - -
Formaldehyde - 1 - -
Acids 1 - - -
Isocyanates - 1 - 2
Metals - 1 1 1
Organic solvents - 1 - 2
Cleaning products - 1 2 9
and Disinfectants -
Glutaraldehyde - - 2 -
Nitric gases - - 1 -
Mineral oils - - 1 -
Calcium carbonate - - - 3
Aromatic carbohydrates - - - 1
Cyanoacrylate - - - 1
Welding fumes 1 - - -
Nonspecific - 1 - -

cobalt, aluminium; b chlorine-releasing, chloramine, potassium hydroxide

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