期刊
AMERICAN JOURNAL OF INDUSTRIAL MEDICINE
卷 64, 期 3, 页码 165-169出版社
WILEY
DOI: 10.1002/ajim.23208
关键词
asthma management; exposure reduction; exposure removal; interventions at work; work‐ related asthma
资金
- National Institute for Occupational Safety and Health, Morgantown, WV
- University of Texas Health Science Center at Houston, Houston, TX
- University of Arkansas for Medical Sciences, Little Rock, AR
- Coronel Institute of Occupational Health, Amsterdam, The Netherlands
- University of Alberta, Edmonton, Alberta, Canada
- University of Toronto, Toronto, Ontario, Canada
- University of Bologna, Bologna, Italy
This study found that stopping or reducing exposure is more beneficial for improving symptoms of occupational asthma patients compared to continued exposure. Removal of exposure is more advantageous than reduction for patients exposed to low-molecular-weight agents, but may increase the risk of unemployment.
Background The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. Methods A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and meta-analyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. Conclusions Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.
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