The use of a combination of examination methods in the diagnostic algorithm of occupational asthma

Perečinský S.: The use of a combination of examination methods in the diagnostic algorithm of occupational asthma

Occupational asthma is a disease that is characterized by inflammation of the airways, varying airflow limitation and hyperreactivity of the airways, which arises from causes and conditions attributable to the work environment, but not to stimuli occurring outside the work environment. Occupational asthma is often underdiagnosed and the number of patients with the reported disease is lower than the actual prevalence. The diagnostic approach to occupational asthma must therefore be comprehensive. The translated work presents a case report of a patient with admitted occupational asthma, in whom it was necessary to implement a wider spectrum of objective methods for the definitive confirmation of the disease. The 58-year-old patient, a smoker, worked for 12 years in the bakery industry. Respiratory difficulties in terms of dyspnea, non-productive cough and intermittent wheezing in the chest developed six years after starting work. The patient was sent to the Department of Occupational Medicine and Clinical Toxicology (KPL and KT) in Košice by an immunoallergist as irritable cough syndrome in the differential diagnosis without confirmation of inhalant hypersensitivity. Before hospitalization at the department, she was at sick leave for 2 months. The examinations performed during the hospitalization (negative auscultation findings, spirometric examination without clear obstructive ventilation disorder, bronchoprovocation test with methacholine, bronchodilation test with salbutamol, 24-hour monitoring of PEF peak expiratory flow) did not confirm asthma. Specific IgE antibodies showed borderline sensitization to rye flour. Subsequently, the patient was assigned to the original workplace for the purpose of performing a re-exposure test. After 2 months, she was re-examined at the KPL and KT clinic, where she reported increased respiratory symptoms, and vesicular breathing on auscultation without secondary respiratory phenomena with prolonged expiration. During the spirometric examination, the dynamic lung parameters were at the lower limit of the norm, the bronchodilation test with salbutamol was positive. PEF values compared to hospitalization were 40% lower. Due to the anamnesis of worsening symptoms in the work environment, a positive bronchodilation test, a decrease in PEF values by 40% and the positivity of specific IgE antibodies, occupational asthma with hypersensitivity to rye flour was diagnosed. The case study pointed out the necessity of implementing several diagnostic methods not only to confirm the occupational origin of the disease but also to diagnose asthma itself.