Guideline sources The following summarized guidelines for the evaluation and management of work-related asthma are prepared by our editorial team based on guidelines from the European Respiratory Society (ERS 2012). 1 Guidelines 1. Screening and diagnosis Screening: obtain questionnaire-based identification for surveillance of asthma in all workers at risk of developing work-related asthma. A Show 5 more Diagnosis: attempt early recognition and diagnosis of work-related asthma because a shorter symptomatic period after diagnosis is associated with a better outcome. A Show 3 more 2. Classification and risk stratification Risk stratification: https://web.pathway.md/diseases/rec7ACMRUXUZcvESq 1/3 6/29/23, 3:16 AM Work-related asthma Pathway Consider using diagnostic models for risk stratification during medical surveillance to select exposed workers for further medical evaluation. B Do not take into account smoking habits and atopy in the assessment of prognosis for medical legal purposes. D 3. Diagnostic investigations Occupational history: ask adult patients with new, recurrent, or deteriorating symptoms of asthma, COPD, or rhinitis about their job, the materials with which they work, and whether they improve when away from work. A Challenge testing: obtain specific bronchial challenge testing if the diagnosis of occupational asthma is not clear, the cause of occupational asthma is new, or it is necessary for the management of the individual worker. B Show 2 more 4. Medical management Pharmacotherapy: Do not offer anti-asthma medications as a reasonable alternative to environmental interventions. D Adapt pharmacological treatment of patients with work-related asthma to the level of asthma control, in accordance with the general recommendations for asthma. B 5. Nonpharmacologic interventions Allergen and irritant avoidance: Inform patients: the risk of work-related asthma is higher in case of atopy or preexisting asthma or pre- employment sensitization B persistence of exposure to the causal agent is likely to result in a deterioration of asthma symptoms and airway obstruction B complete avoidance of exposure is associated with the highest probability of improvement, but may not lead to a complete recovery from asthma. B Show 4 more Respiratory protective equipment: do not advise using respiratory protective equipment as a safe approach, especially in the long-term and in patients with severe asthma. D 6. Preventative measures Primary prevention: eliminate exposure as the best preventive measure to reduce the disease burden of work-related asthma and the preferred approach for primary prevention. A Show 3 more https://web.pathway.md/diseases/rec7ACMRUXUZcvESq 2/3 6/29/23, 3:16 AM Work-related asthma Pathway 7. Follow-up and surveillance Follow-up: obtain follow-up evaluation by a specialist including monitoring of spirometry, serial measurements of peak expiratory flow or spirometry, nonspecific bronchial hyperresponsiveness and allergy testing, if the diagnosis is still equivocal after full investigation. B Clinical findings Symptoms Past medical history Cough Atopy Feeling of chest heaviness or tightness Rhinitis Respiratory exam Shortness of breath Wheezing Social history Current cigarette smoking Exposure to dust Exposure to irritans References 1. X Baur, T Sigsgaard, T B Aasen et al. Guidelines for the management of work-related asthma. Eur Respir J. 2012 Mar;39 3 529 45. Open https://web.pathway.md/diseases/rec7ACMRUXUZcvESq 3/3