General Guideline Principles for Management of Occupational
Asthma (OA) 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 Management of Occupational Asthma (OA).
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.
Management of Irritant-Induced Asthma (Reduction of Exposure) are recommended – the Treatment aims to reduce work exposures (e.g., by restricting sources of exposure, increasing ventilation) and optimise routine medical management with non-work environmental control measures and pharmaceutical treatment in order to reduce asthma exacerbations.
Depending on the severity of the asthma and the extent of the exacerbating factors at work, the patient may be able to continue working at the same job with reduced exposures, but if this approach is ineffective in preventing work-related exacerbation of symptoms, a job change to a place of employment with fewer triggers may be required.
The clinician and patient should carefully weigh the potential benefits of removal from work against the benefits (financial and psychological) of continuing to work when a patient with WEA can no longer handle a work environment.
To avoid further endangering the asthmatic condition, the medical therapy of OA, however, includes steps targeted at early detection and early avoidance of additional exposure, either by relocating the worker or substituting the hazard.
Similar to how other forms of asthma are treated pharmacologically, occupational asthma should be managed in accordance with well-established, widely-publicised medical standards. In addition to normal asthma care, patients with sensitizer-induced OA should not be exposed to the causal substance again.
If medical evacuation is not an option, worker relocation should be used to reduce exposure as much as feasible. Increased medical monitoring should be provided to relocated employees to show that no illness progression has occurred.
Even with minimal contact to the culprit, the condition of OA sufferers may still deteriorate. When the disease worsens under these conditions, removal from exposure should be advised.
A trial of reducing exposure through the use of respiratory protective equipment, in addition to giving people with irritant-induced OA asthma medicines, may be considered as the initial care.
Once more, heightened medical surveillance is advised, and removal of exposure is advocated if evidence of disease worsening is shown. In these situations, moving to a different career and setting might be an option.
Accurate knowledge of the effects of various management choices is necessary to choose the most suitable treatment for OA.
- Persistence of Exposure
Persistence of Exposure is recommended informing that persistence of exposure to the causal agent is likely to result in a deterioration of asthma symptoms and airway obstruction.
- Avoidance of Exposure
Avoidance of Exposure is recommended – informing that complete avoidance of exposure is associated with the highest probability of improvement, but may not lead to a complete recovery from asthma.
- Medical Removal
Once a diagnosis of OA is confirmed, the patient should be advised that the prognosis is improved by early and complete removal from exposure. Symptoms and functional impairment associated with OA may persist for many years after avoidance of further exposure to the causative agent.
Persistence of exposure to the agent causing occupational asthma is more likely to be associated with the persistence of asthma, and an accelerated decline in FEV1, compared with complete avoidance of exposure.
Management of Sensitizer-Induced Asthma (Reduction of Exposure)
Management of Sensitizer-Induced Asthma (Reduction of Exposure) is recommended elimination of exposure The existing research suggests that many asthma patients will get worse with continued exposure, which is the basis for the recommendation.
Management of Irritant-Induced Asthma (Reduction of Exposure)
Management of Irritant-Induced Asthma (Reduction of Exposure) is recommended exposure reduction to the lowest levels possible, including the use of personal protective equipment.
Management of Irritant-Induced Asthma (Reduction of Exposure)
Management of Irritant-Induced Asthma (Reduction of Exposure) is recommended recommended careful medical monitoring must be performed to ensure early identification of worsening asthma. Progression of the asthmatic condition should prompt total removal from exposure.
- Respiratory Protective Devices
Respiratory Protective Devices are not recommended and are considered the last level of protection from noxious exposures; especially in the long-term and in patients with severe asthma.
Respiratory Protective Devices are not recommended as a stand-alone intervention, however may be used for mild cases in lower exposure settings, on a short- term basis in conjunction with other efforts to reduce or eliminate exposure and with pharmacologic therapy, especially in irritant induced OA.
Respiratory Protective Devices are not recommended for severe or moderately severe asthma in worksites with medium or high exposures
Respiratory Protective Devices is not recommended as a stand-alone intervention
Utilisation – Appropriate medical monitoring is required keeping in mind that progression of The asthmatic condition should prompt a recommendation for avoidance of exposure.
Evaluating the ability of the worker to wear a respirator as per OSHA 1919.134 standard and selection of appropriate respirators are essential.
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