BACKGROUND: The impact of workplace interventions on the outcome of occupational asthma is not well-understood. OBJECTIVES: To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011. SELECTION CRITERIA: Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and trial quality, and extracted data. MAIN RESULTS: We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons.In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21).In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32).In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84).Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure.Overall the quality of the evidence was very low. AUTHORS' CONCLUSIONS: There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure.Reducing exposure also improves symptoms, but seems not as effective as complete removal.However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit.
BACKGROUND: The impact of workplace interventions on the outcome of occupational asthma is not well-understood. OBJECTIVES: To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011. SELECTION CRITERIA: Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and trial quality, and extracted data. MAIN RESULTS: We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons.In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21).In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32).In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84).Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure.Overall the quality of the evidence was very low. AUTHORS' CONCLUSIONS: There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure.Reducing exposure also improves symptoms, but seems not as effective as complete removal.However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit.
Authors: Jean-Luc Malo; Susan M Tarlo; Joaquin Sastre; James Martin; Mohamed F Jeebhay; Nicole Le Moual; Dick Heederik; Thomas Platts-Mills; Paul D Blanc; Olivier Vandenplas; Gianna Moscato; Frédéric de Blay; André Cartier Journal: Ann Am Thorac Soc Date: 2015-07
Authors: Paul K Henneberger; Jenil R Patel; Gerda J de Groene; Jeremy Beach; Susan M Tarlo; Teake M Pal; Stefania Curti Journal: Am J Ind Med Date: 2020-12-29 Impact factor: 3.079
Authors: Sara De Matteis; Dick Heederik; Alex Burdorf; Claudio Colosio; Paul Cullinan; Paul K Henneberger; Ann Olsson; Anne Raynal; Jos Rooijackers; Tiina Santonen; Joaquin Sastre; Vivi Schlünssen; Martie van Tongeren; Torben Sigsgaard Journal: Eur Respir Rev Date: 2017-11-15
Authors: Nikolaos G Papadopoulos; Ioana Agache; Sevim Bavbek; Beatrice M Bilo; Fulvio Braido; Victoria Cardona; Adnan Custovic; Jan Demonchy; Pascal Demoly; Philippe Eigenmann; Jacques Gayraud; Clive Grattan; Enrico Heffler; Peter W Hellings; Marek Jutel; Edward Knol; Jan Lötvall; Antonella Muraro; Lars K Poulsen; Graham Roberts; Peter Schmid-Grendelmeier; Chrysanthi Skevaki; Massimo Triggiani; Ronald Vanree; Thomas Werfel; Breda Flood; Susanna Palkonen; Roberta Savli; Pia Allegri; Isabella Annesi-Maesano; Francesco Annunziato; Dario Antolin-Amerigo; Christian Apfelbacher; Miguel Blanca; Ewa Bogacka; Patrizia Bonadonna; Matteo Bonini; Onur Boyman; Knut Brockow; Peter Burney; Jeroen Buters; Indre Butiene; Moises Calderon; Lars Olaf Cardell; Jean-Christoph Caubet; Sevcan Celenk; Ewa Cichocka-Jarosz; Cemal Cingi; Mariana Couto; Nicolette Dejong; Stefano Del Giacco; Nikolaos Douladiris; Filippo Fassio; Jean-Luc Fauquert; Javier Fernandez; Montserrat Fernandez Rivas; Marta Ferrer; Carsten Flohr; James Gardner; Jon Genuneit; Philippe Gevaert; Anna Groblewska; Eckard Hamelmann; Hans Jürgen Hoffmann; Karin Hoffmann-Sommergruber; Lilit Hovhannisyan; Valérie Hox; Frode L Jahnsen; Omer Kalayci; Ayse Füsun Kalpaklioglu; Jörg Kleine-Tebbe; George Konstantinou; Marcin Kurowski; Susanne Lau; Roger Lauener; Antti Lauerma; Kirsty Logan; Antoine Magnan; Joanna Makowska; Heidi Makrinioti; Paraskevi Mangina; Felicia Manole; Adriano Mari; Angel Mazon; Clare Mills; Ervinç Mingomataj; Bodo Niggemann; Gunnar Nilsson; Markus Ollert; Liam O'Mahony; Serena O'Neil; Gianni Pala; Alberto Papi; Gianni Passalacqua; Michael Perkin; Oliver Pfaar; Constantinos Pitsios; Santiago Quirce; Ulrike Raap; Monika Raulf-Heimsoth; Claudio Rhyner; Paula Robson-Ansley; Rodrigo Rodrigues Alves; Zeljka Roje; Carmen Rondon; Odilija Rudzeviciene; Franziska Ruëff; Maia Rukhadze; Gabriele Rumi; Cansin Sackesen; Alexandra F Santos; Annalisa Santucci; Christian Scharf; Carsten Schmidt-Weber; Benno Schnyder; Jürgen Schwarze; Gianenrico Senna; Svetlana Sergejeva; Sven Seys; Andrea Siracusa; Isabel Skypala; Milena Sokolowska; Francois Spertini; Radoslaw Spiewak; Aline Sprikkelman; Gunter Sturm; Ines Swoboda; Ingrid Terreehorst; Elina Toskala; Claudia Traidl-Hoffmann; Carina Venter; Berber Vlieg-Boerstra; Paul Whitacker; Margitta Worm; Paraskevi Xepapadaki; Cezmi A Akdis Journal: Clin Transl Allergy Date: 2012-11-02 Impact factor: 5.871