Occupational asthma: Definition: Occupational asthma can be defined as "variable airways narrowing, causally related to exposure in the working

environment to airborne dusts, gases, vapours or fumes". Two elements in this definition are important. The agent (identified or not) should be specific to the workplace and be causally related to the disease .This definition thus excludes asthma triggered by irritant mechanisms, such as cold air or exercise. A previous history of asthma does not exclude the diagnosis of occupational asthma Newman Taylor AJ. Occupational asthma. 1980. Important features from patients history that lead to diagnosis: a complaint of frequent episodes of chest tightness, wheezing and coughing. These episodes would occur at work and at home after a work shift, during exercise and when she is exposed to non-specific irritants. developed frequent episodes of runny nose and watery eyes 6 months after employment Physical Examination: occasional wheezes on both lung fields Respiratory Rate=24

DIAGNOSIS is based on following: History should identify any temporal relationships between asthma symptoms and work, and should detail information about work status and exposure characteristics Respiratory symptoms present in Work Related Asthma patients (ie, cough, wheeze, shortness of breath, and chest tightness) are identical to those present in non-OA patients. They may be accompanied by or preceded by symptoms of rhinitis and/or conjunctivitis. Specific inquiry should be made to determine any relationship between the workplace and symptoms. Improvement in symptoms typically occurs during times away from work (eg, on weekends and during vacations) and worsens on days with regular or intermittent exposures at work reference DIAGNOSIS AND MANAGEMENT OF WORK-RELATED ASTHMA: ACCP CONSENSUS STATEMENT The concomitant occurrence of rhinoconjunctivitis at work and, occasionally, of skin rash (urticaria), especially in a worker exposed to high molecular weight chemicals who develops asthma, is surely suggestive of occupational asthma. CHAN-YEUNG and co-workers

Role of history in diagnosis of asthma: A necessary first step in evaluating patients with asthma of working age is to obtain a detailed and accurate history. history is not sufficient to make the diagnosis: questionnaires are sensitive but not specific tools. The diagnosis of occupational asthma should be based on objective means and cannot rely on history alone or even on confirming the presence of asthma.

Diagnostic procedures: Spirometry-monitor FEV ,FVC Immunological testing Monitoring of peak expiratory flows and nonallergic bronchial responsiveness Ref-Definition and diagnosis of occupational asthma. A. Cartier. ERS Journals Ltd 1994.