Occupational asthma - A longitudinal study on the clinical and socioeconomic outcome after diagnosis

Aim: To evaluate the clinical outcome and socioeconomic consequences of occ upational asthma (OA). Subjects a,ld methods: Twenty-five patients with OA both to high- and low-m olecular-weight agents (3 and 22, respectively) confirmed by specific inhal ation challenge were followed up for 12 months after the diagnosis. Upon di agnosis, each patient received a diary on which to report peak expiratory f low rate (PEFR), symptoms, drug consumption, expenses directly or indirectl y related to the disease, as well as information regarding personal socioec onomic status. At each follow-up visit (1, 3, 6, and 12 months), the patien ts underwent clinical examination, spirometry; methacholine (Mch) challenge , and assessment of diary-derived parameters and socioeconomic status. Asth ma severity (AS) was classified into four levels, based on symptoms, drug c onsumption, and PEFR variability. Results: At 12 months, 13 patients (group A) had ceased exposure; the remai ning 12 patients (group B) continued to be exposed At diagnosis, FEV1 perce nt and provocative dose causing a 20% fall in FEV1 (PD20) of Mch were lower in group A than in group B; patients of group A were also characterized by significantly higher basal AS levels. At 12 months, no significant variati on in FEV1 percent or PD20 was found for either group, while AS levels impr oved in both groups, the change being more marked for group A than group B. Pharmaceutical expense at 12 months significantly (p < 0.05) decreased, as compared with the first month, in group A whereas it tended to increase in group B. In group A, 9 of 13 subjects had reported a deterioration of thei r socioeconomic status as compared with 2 of 12 in group B (p < 0.01). A si gnificant loss of income uas registered in patients of group A (median 21.4 5, 25th to 75th percentiles 16.9 to 25.8 Italian liras x 10(6) on the year preceding diagnosis and 15.498, 10.65 to 21.087 Italian liras x 10(6) on th e year after diagnosis; p < 0.01), whereas no significant change was seen f or patients in group B. Conclusion: In OA, cessation of exposure to the offending agent results in a decrease in asthma severity and in pharmaceutical expenses, but it is ass ociated with a deterioration of the individual's socioeconomic status (prof essional downgrading and loss of work-derived income). There appears to be a great need for legislation that facilitates the relocation of these patie nts.