Severe Occupational Asthma: Insights From a Multicenter European Cohort.

Adrenergic beta-2 Receptor Agonists / therapeutic use Adult Asthma, Occupational / drug therapy Europe Female Forced Expiratory Volume Humans Male Middle Aged Occupational Exposure / adverse effects Odds Ratio Retrospective Studies Risk Factors Severity of Illness Index

Airflow obstruction Asthma control Asthma exacerbations Occupational asthma Severe asthma

Journal

The journal of allergy and clinical immunology. In practice

ISSN: 2213-2201

Titre abrégé: J Allergy Clin Immunol Pract

Pays: United States

ID NLM: 101597220

Informations de publication

Date de publication:

Historique:

received: 18 12 2018

revised: 13 02 2019

accepted: 08 03 2019

pubmed: 28 3 2019

medline: 6 10 2020

entrez: 28 3 2019

Statut: ppublish

Résumé

Although sensitizer-induced occupational asthma (OA) accounts for an appreciable fraction of adult asthma, the severity of OA has received little attention. The aim of this study was to characterize the burden and determinants of severe OA in a large multicenter cohort of subjects with OA. This retrospective study included 997 subjects with OA ascertained by a positive specific inhalation challenge completed in 20 tertiary centers in 11 European countries during the period 2006 to 2015. Severe asthma was defined by a high level of treatment and any 1 of the following criteria: (1) daily need for a reliever medication, (2) 2 or more severe exacerbations in the previous year, or (3) airflow obstruction. Overall, 162 (16.2%; 95% CI, 14.0%-18.7%) subjects were classified as having severe OA. Multivariable logistic regression analysis revealed that severe OA was associated with persistent (vs reduced) exposure to the causal agent at work (odds ratio [OR], 2.78; 95% CI, 1.50-5.60); a longer duration of the disease (OR, 1.04; 95% CI, 1.00-1.07); a low level of education (OR, 2.69; 95% CI, 1.73-4.18); childhood asthma (OR, 2.92; 95% CI, 1.13-7.36); and sputum production (OR, 2.86; 95% CI, 1.87-4.38). In subjects removed from exposure, severe OA was associated only with sputum production (OR, 3.68; 95% CI, 1.87-7.40); a low education level (OR, 3.41; 95% CI, 1.72-6.80); and obesity (OR, 1.98; 95% CI, 0.97-3.97). This study indicates that a substantial proportion of subjects with OA experience severe asthma and identifies potentially modifiable risk factors for severe OA that should be targeted to reduce the adverse impacts of the disease.

Sections du résumé

BACKGROUND

Although sensitizer-induced occupational asthma (OA) accounts for an appreciable fraction of adult asthma, the severity of OA has received little attention.

OBJECTIVE

The aim of this study was to characterize the burden and determinants of severe OA in a large multicenter cohort of subjects with OA.

METHODS

This retrospective study included 997 subjects with OA ascertained by a positive specific inhalation challenge completed in 20 tertiary centers in 11 European countries during the period 2006 to 2015. Severe asthma was defined by a high level of treatment and any 1 of the following criteria: (1) daily need for a reliever medication, (2) 2 or more severe exacerbations in the previous year, or (3) airflow obstruction.

RESULTS

Overall, 162 (16.2%; 95% CI, 14.0%-18.7%) subjects were classified as having severe OA. Multivariable logistic regression analysis revealed that severe OA was associated with persistent (vs reduced) exposure to the causal agent at work (odds ratio [OR], 2.78; 95% CI, 1.50-5.60); a longer duration of the disease (OR, 1.04; 95% CI, 1.00-1.07); a low level of education (OR, 2.69; 95% CI, 1.73-4.18); childhood asthma (OR, 2.92; 95% CI, 1.13-7.36); and sputum production (OR, 2.86; 95% CI, 1.87-4.38). In subjects removed from exposure, severe OA was associated only with sputum production (OR, 3.68; 95% CI, 1.87-7.40); a low education level (OR, 3.41; 95% CI, 1.72-6.80); and obesity (OR, 1.98; 95% CI, 0.97-3.97).

CONCLUSIONS

This study indicates that a substantial proportion of subjects with OA experience severe asthma and identifies potentially modifiable risk factors for severe OA that should be targeted to reduce the adverse impacts of the disease.

Identifiants

DOI: 10.1016/j.jaip.2019.03.017 PMID: 30914232

pubmed: 30914232

pii: S2213-2198(19)30281-8

doi: 10.1016/j.jaip.2019.03.017

pii:

doi:

Substances chimiques

Adrenergic beta-2 Receptor Agonists 0

Types de publication

Journal Article Multicenter Study Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

2309-2318.e4

Subventions

Organisme : Medical Research Council

ID : MR/S019669/1

Pays : United Kingdom

Investigateurs

Olivier Vandenplas (O)

Catherine Rifflart (C)

Pavlina Klusackova (P)

David Sherson (D)

Hille Suojalehto (H)

Pirjo Hölttä (P)

Paula Kauppi (P)

Frédéric de Blay (F)

Laura Hurdubaea (L)

Rolf Merget (R)

Alexandra M Preisser (AM)

Volker Harth (V)

Piero Maestrelli (P)

Paola Mason (P)

Gianna Moscato (G)

Patrizia Pignatti (P)

Pierluigi Paggiaro (P)

Donatella Talini (D)

Marco dell'Omo (M)

Ilenia Foletti (I)

Cecilie Svanes (C)

Jorunn Kirkeleit (J)

Jolanta Walusiak-Skorupa (J)

Marta Wiszniewska (M)

Xavier Munoz (X)

Christian Romero-Mesones (C)

Joaquin Sastre (J)

Mar Fernandez-Nieto (M)

Santiago Quirce (S)

Marta Sanchez-Jareno (M)

Paul Cullinan (P)

Julie Cannon (J)

Sherwood Burge (S)

Vicky Moore (V)

Jennifer Hoyle (J)