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Asthmatic Subjects Symptomatically Worse at Work^*

Prevalence and Characterization Among a General Asthma Clinic Population

^* From the Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada.

Correspondence to: Susan M. Tarlo, MBBS, FCCP, Gage Occupational and Environmental Health Unit, 223 College St, Toronto, Ontario M5T 1R4, Canada; e-mail: susan.tarlo{at}utoronto.ca

Study objectives: To assess the prevalence of a historical occupational component to asthma in an adult asthma clinic and to compare characteristics of asthmatic subjects with and without work-attributed symptoms.

Design: A retrospective review of data obtained from a physician-administered questionnaire, answers to which were obtained at the initial patient visit of asthmatic subjects, and which included specific questions regarding the relationship of work to symptoms. Chart review data were used to supplement information on workplace exposures and investigations.

Setting: A university-based secondary- and tertiary-referral asthma clinic.

Patients: Seven hundred thirty-one adult asthmatic subjects who were referred for assessment and management of asthma.

Interventions: Statistical analyses of asthmatic subjects with and without work-attributed symptoms and a determination, from chart review, of the likelihood of causes for symptomatic worsening of asthma at work.

Measurements and results: Sixty percent of the patients (435) had adult onset of asthma, among whom 310 patients (71%) were employed at the time of their visit. Fifty-one patients reported their asthma to be worse at work (ie, 16% of adult-onset working asthmatic subjects). Sixteen of these patients (31%) had likely or possible sensitizer-induced occupational asthma (OA), and 49% likely had aggravation of underlying asthma. The other 20% of patients had possible OA or aggravation of underlying asthma at work.

Conclusions: Adult-onset asthmatic subjects commonly report a worsening of asthma at work, more commonly on the basis of likely aggravation of underlying asthma than on the basis of likely or possible OA.

Key Words: asthma • asthma prevalence • occupational

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