General Guideline Principles for Introduction of Occupational

Work-Related Asthma for workers compensation patients

]The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Introduction of Occupational_Work-Related Asthma.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Introduction of Occupational Work Related Asthma

To cause airflow blockage, bronchial hyperresponsiveness, and underlying inflammation, asthma is a prevalent chronic condition of the airways. It is usual to experience increased airway reactivity to various stimuli.

Asthma symptoms that start or worsen at work are the hallmark of work-related asthma (WRA), typically brought on by exposure to a new chemical or environmental alteration. Occupational asthma (OA) and work-related asthma (WRA) are also included (WEA).

OA contains sensitizer-induced asthma, which develops occupational antigen sensitization, and irritant-induced asthma, which develops reactive airway disease brought on by irritating exposures. Each has a sizable risk of acute morbidity, a long-term impairment risk, and dangerous social and economic effects.

Occupational Asthma (OA)

The term “OA” refers to workplace asthma that has just started, and it can be brought on by exposure to either an irritant or a sensitizer. OA can also be divided into types with and without delay.

OA With Latency

  • All conditions of immunologically (sensitizer) caused asthma display OA with latency.

  • Agents known as sensitizers start an allergic (immunologic) reaction.

  • The latency period, or the interval between the initial exposure and the onset of symptoms, can last a few weeks to many years. It displays the period of time needed to induce an immune reaction to the allergen at work.

  • The time between the initial exposure and being sensitized, which causes asthma symptoms with reexposure, is occasionally a few months.

This division between high and low molecular weight substances helps to characterize the typical asthma mechanism, symptoms, and latency.

  • Long-term exposure to low-level irritants can potentially cause late-onset OA.

OA Without latency

  • Exposure to irritants (gasses, fumes, vapors, and aerosols) causes an inflammatory reaction rather than an allergic one.

  • After getting exposed to irritating gasses, fumes, or chemicals such as nitrogen oxide, ammonia, and chloride, OA without latency may develop.

Work-Exacerbated Asthma (WEA)

When people with asthma are already present or currently experiencing it become more sensitive to certain irritants at work, such as:

  • Aerosols

  • Fumes

  • Vapors

  • Gases

Table 1. Specific High and Low Weight Chemicals (Sensitizers) and Occupations










The main symptoms of asthma are airway inflammation and responsiveness. The three main gestures of asthma are coughing, wheezing, and sporadic breathing difficulties.

Diagnosis of Work-Related Asthma

Signs and Symptoms of Work-Related Asthma

The main symptoms of asthma are airway inflammation and responsiveness. While coughing and sputum production are the main signs of bronchitis, episodic shortness of breath, wheezing, and coughing are also the main signs of asthma.

To diagnose OA, complete pulmonary history and diagnostic history are needed. American College of Cardiology For determining a diagnosis of WRA, doctors published the following criteria in 1995 (doi:10.1378/chest.108.4.1084), all of which must be met:

  • a background suggestive of occupational asthma.

  • airflow restriction is present and is reversible.

  • the existence of non-specific airway hyperresponsiveness when there is no airflow restriction.

  • The factual proof is that asthma is tied to a job.

Complications and Comorbid Conditions Relevant to Work

With a variety of secondary symptoms and issues that have an impact on everyday life and work, asthma can appear in complex ways. For instance, asthma may cause a persistent cough and secondary hoarseness, which may negatively affect certain occupations (e.g voice changes or the ability to carry on a conversation).

The condition known as gastroesophageal reflux disease (GERD), which can be worse by the effects of bronchodilator drugs on the lower esophageal sphincter, is frequently linked to asthma.

Although vocal cord dysfunction is not the same as asthma, it often coexists with it and can also be brought on by GERD or exposure to irritants.

Occupational / Work-Related Asthma

History Taking and Physical Exam of Occupational Work-Related Asthma

The foundation for diagnosis and treatment programs is laid forth by the history of occupational exposure, the symptoms, and the findings of diagnostic screening tests.

History of Present Illness

There should be documentation in the History of Present Illness (HPI).

  • Pulmonary exposures that are both occupational and non-occupational.

  • Occupation: past/current and variety of work activities (such as dock workers veterinarians, laboratory workers and those who produce chemicals, jewels, and alloys).

  • Duration of each job, including those held years or decades ago.

Exposures to:

  • The dust includes flour, grains, and wood.

  • Metals (aluminum and Platinum salts).

  • Exposure to fumes, gases, vapors (particularly isocyanates, ammonia, and solvents) smoke, and aerosols of chemicals or substances.

  • Non-occupational exposures to these agents should be mentioned in the history of exposure together with a description of the vulnerability, its length, and its intensity.

  • Exposure intensity Ideally, this information would include environmental measures (data on industrial hygiene) or at least a qualitative description of the exposure intensity, such as daily, weekly, monthly, yearly, etc.

  • Include inquiries describing the person’s obligations and exposure (e.g did you work in the office etc.).


  • symptoms and when they first appeared

  • including grievances about:

  • throat constriction

  • breathing difficulty either during intake or expiration

  • loud breath noises

  • Sputum production from cough

  • ongoing bronchitis

  • chest constriction

The length, beginning, and frequency of symptoms

  • progression of symptoms, including

  • In relation to the workplace, the symptoms’ deterioration, and improvement

  • changes to the workplace

  • Symptoms that change in proportion to days worked and days off (particularly when they get better on the weekends or during time off from work)

  • development of symptoms

  • The pattern of the symptoms by season

Document if:

  • After a single, high-level workplace inhalation exposure to an irritating fume, vapor, gas, smoke, or aerosol, symptoms started to appear envisage and testing of the lungs.

  • Earlier therapies.

  • Relation to work This involves an assessment of the likelihood that the ailment or injury is related to the job.

  • Ability to carry out regular tasks and job responsibilities.

  • Workplace history of room dimensions, ventilation, and usage of any PPE both now and in the past.

Past Medical History

  • Past medical history, which may or may not include pulmonary exposures and treatments (such as childhood asthma, bronchitis susceptibility, hay fever, pneumonia, and eczema).

  • Symptoms of endocrine, neoplastic, neurologic, dermatologic, rheumatologic, and other systemic disorders are included in the review of systems, although they are not the only ones.

  • The detailed history of smoking (including marijuana, vaping, etc.)

  • A thorough medical history including usage of beta-blockers, beta-converting enzyme inhibitors, and pulmonary medicines.

  • Both professional and recreational activities.

  • Imaging tests are done earlier.

  • Past surgical experience.

  • History of atopic disease in the family.

  • History of allergies (as well as a history of atopy).

Physical Examination of Occupational Work-Related Asthma
The following aspects of an occupational pulmonary physical examination should be present:

  • Vital indicators, such as calculated respiration rate and oxygen saturation

  • Generally speaking, functional abilities include being able to move easily, walk, change positions, dress, and undress while evaluating dyspnea symptoms and indicators.

  • Evaluation of the respiratory condition (e.g. use of accessory muscles, depth, nasal flaring, and rate).

  • Examination for pulmonary illness stigmata and probable causes, such as:

  • anomalies of the mucous membranes

  • Nasal edema, discharge, and polyps

  • clubbing Chest diameter from anterior to posterior

  • Palpation for:

  • anomalies of the chest wall

  • neck lumps and adenoma

  • Use of percussion to detect resonance

  • The diaphragm

  • Aeration

  • Consolidation or fluid interface suggestion

  • Auscultation for:

  • The ratio of inspiration to expiry

  • unexpected breath sounds (wheeze, rhonchi, crackles, rales)

  • Pleural rubs, in addition to the timing, place, and persistence of lung findings

  • Cardiac examination paying close attention to heart failure and cor pulmonale results

  • Examining the skin for illness symptoms, such as erythema nodosum (Sarcoidosis).

  • Cardiac examination paying close attention to heart failure and cor pulmonale results

What our office can do if you have workers compensation Injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.
We are orthopedic surgeons and do not treat chest diseases. We will refer you to someone in your area who does treat respiratory symptoms.

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No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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