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Dissertation zugänglich unter
Bronchial Asthma and COPD due to Irritants in the Workplace – an evidence-based Approach
Asthma bronchiale und COPD verursacht durch Irritanzien am Arbeitsplatz – ein evidenzbasierter Ansatz
Dokument 1.pdf (1.790 KB)
Bronchialasthma , Berufskrankheit , Obstruktive Ventilationsstörung
Freie Schlagwörter (Deutsch):
Lungenfunktion, Bronchiale Hyperreagilibität , Lungenerkrankung
Freie Schlagwörter (Englisch):
Bronchial Asthma , COPD , Occupational Asthma , Irritants , Work Related Asthma , Pulmonary Disease
Baur, Xaver (Prof. Dr.)
Tag der mündlichen Prüfung:
Kurzfassung auf Englisch:
WRA is a frequent occupational lung disease in an industrialized environment. It is subdivided into OA and work-aggravated asthma. The main objective of this study was to give an evidence-based overview of the literature on irritative agents, professions or work-sites causing irritant-induced OA and/or occupational COPD.
The key question of this study was: Which respiratory airborne agents cause irritant-induced OA or occupational COPD, and on what level of evidence can such findings be supported?
A database search provided 450 studies dealing with irritant-induced OA or occupational COPD.
An evidence-based approach was realized by applying two suitable grading systems. The modified SIGN grading was used for rating the quality of all considered studies individually. The modified RCGP three-star system was applied for grading each irritant agent with regard to cause irritant-induced OA or occupational COPD. This permitted all study types of different scientific strength.
Irritant-induced OA was the focus of most studies and was the predominant diagnosis. Different ways of confirming irritant-induced OA were used by the author. SIC and lung function tests were the most important diagnostic instruments. Occupational COPD was mainly not the specified target. Some studies described respiratory symptoms such as chronic bronchitis which may be associated with COPD. One of the few studies which focused on occupational COPD was a large retrospective cohort study on diesel exhaust.
According to the SIGN grading system more than half of the publications represent non-scientific studies and were rated with the lowest level, this comprises case reports/case series and occupational disease statistics. The highest level realized by SIGN grading was 2+, which means a well-conducted scientific study with a low risk of confounding or bias. On the basis of the modified RCGP three-star grading, strengths of evidence of the individual/ mixed agent, profession or work-site could be identified. The highest evidence achieved was two stars.
Only a few agents, professions or work-sites were found with moderate evidence level for causing irritant-induced OA or occupational COPD. These include chlorine, welding fumes or construction work (see Table 5, chapter “Results”). For most agents only limited evidence was found, e.g. for acids, acrylates or diesel exhaust (see Table 7, chapter “Results”).
It is possible that not all relevant studies were found in the literature search. Other limitations of this work may be due to the possibility that selection and information bias cannot be totally excluded.
In conclusion, the diagnosis of irritant-induced OA should be especially considered if there has been a single or repeated exposures to high concentration or chronic exposures to moderate (in the TLV ranges) concentrations of an identified irritative agent without evidence of an IgE-mediated pathomechanism.
The diagnosis of occupational COPD should be considered if there have been mainly chronic exposures to an agent capable of causing occupational COPD, not reversible chronic airway disease is found, there is a temporal relationship between the period of exposure and development of COPD, and no other cause of COPD is obviously present.
Based on the estimated population-attributable risk due to occupational exposures for OA and occupational COPD, which are still considerably underreported occupational diseases, strategies designed to prevent these disorders should receive high priority in global efforts to reduce their burden. This study might amplify adequate diagnostic procedures and may help to optimize primary and secondary prevention. Since there is still a lack of knowledge on the causative role of irritant agents and conditions, more research should focus on this issue in order to improve further respective evidence-based diagnostic procedures and preventive strategies.