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Review
. 2019 Oct 8;10(10):CD006308.
doi: 10.1002/14651858.CD006308.pub4.

Workplace interventions for treatment of occupational asthma

Paul K Henneberger  1 , Jenil R Patel, Gerda J de Groene, Jeremy Beach, Susan M Tarlo, Teake M Pal, Stefania Curti
Affiliations
Review

Workplace interventions for treatment of occupational asthma

Paul K Henneberger et al. Cochrane Database Syst Rev. .

Abstract

Background: The impact of workplace interventions on the outcome of occupational asthma is not well understood.

Objectives: To evaluate the effectiveness of workplace interventions on occupational asthma.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019.

Selection criteria: We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma.

Data collection and analysis: Two authors independently assessed study eligibility and risk of bias, and extracted data.

Main results: We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes.

Authors' conclusions: Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.

PubMed Disclaimer

Conflict of interest statement

Paul K Henneberger: None known.

Jenil R Patel: None known.

Gerda J de Groene: None known.

Jeremy Beach: None known.

Susan M Tarlo: None known.

Teake M Pal: None known.

Stefania Curti: None known.

Figures

1
1
PRISMA diagram for number of studies in review * Studies identified in second phase of update ** Studies identified in third phase of update *** Studies included in de Groene 2011 Cochrane Review **** The final 26 studies include Dressel 2009, which was excluded in de Groene 2011 but included in the update.
2
2
Funnel plot of comparison: 1 Removal from exposure versus continued exposure, outcome: 1.1 Absense of asthma symptoms.
3
3
Funnel plot of comparison: 2 Reduction of exposure versus continued exposure, outcome: 2.1 Absence of asthma symptoms.
4
4
Funnel plot of comparison: 3 Removal from exposure versus reduction of exposure, outcome: 3.1 Absence of asthma symptoms.
1.1
1.1. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 1 Absence of asthma symptoms.
1.2
1.2. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 2 Improvement of asthma symptoms.
1.3
1.3. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 3 Change in FEV1 % predicted: follow‐up minus baseline values.
1.4
1.4. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 4 Change in NSBH: follow‐up minus baseline values.
1.5
1.5. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 5 FEV1 % predicted: baseline.
1.6
1.6. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 6 FEV1 % predicted: follow up.
1.7
1.7. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 7 NSBH: baseline.
1.8
1.8. Analysis
Comparison 1 Removal from exposure versus continued exposure, Outcome 8 NSBH: follow up.
2.1
2.1. Analysis
Comparison 2 Reduction of exposure versus continued exposure, Outcome 1 Absence of asthma symptoms.
2.2
2.2. Analysis
Comparison 2 Reduction of exposure versus continued exposure, Outcome 2 Change in FEV1 % predicted: follow‐up minus baseline values.
2.3
2.3. Analysis
Comparison 2 Reduction of exposure versus continued exposure, Outcome 3 FEV1 % predicted: baseline.
2.4
2.4. Analysis
Comparison 2 Reduction of exposure versus continued exposure, Outcome 4 FEV1 % predicted: follow up.
3.1
3.1. Analysis
Comparison 3 Removal from exposure versus reduction of exposure, Outcome 1 Absence of asthma symptoms.
3.2
3.2. Analysis
Comparison 3 Removal from exposure versus reduction of exposure, Outcome 2 Improvement of asthma symptoms.
3.3
3.3. Analysis
Comparison 3 Removal from exposure versus reduction of exposure, Outcome 3 Change in FEV1 % predicted: follow‐up minus baseline values.
3.4
3.4. Analysis
Comparison 3 Removal from exposure versus reduction of exposure, Outcome 4 Being unemployed.
3.5
3.5. Analysis
Comparison 3 Removal from exposure versus reduction of exposure, Outcome 5 FEV1 % predicted: baseline.
3.6
3.6. Analysis
Comparison 3 Removal from exposure versus reduction of exposure, Outcome 6 FEV1 % predicted: follow up.
See this image and copyright information in PMC

Update of

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Antao 2011 {published data only}
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