Page 140 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
To the Editor
We thank Burge et al.1 for their relevant commentary on our recently published ar cle.2 They introduce an interes ng hypothesis about the possible in uence of occupa onal exposure on the rapid increase of asthma severity in adults with recent onset asthma in our study. They speci cally ask for any data related to possible occupa onal asthma.
In our cohort we have collected data about current occupa on and its in uence on asthma symptoms and poten al contribu on to asthma onset. The speci c ques ons asked to the pa ents were: “What do you think the possible cause of your asthma could have been (e.g. work)?” and “Did your work in uence your asthma symptoms?”. If these ques ons were answered posi vely, pa ents were interviewed more in depth about the details of their job and job history and what the possible causa ve agent could have been.
Ten percent (n=13) of the pa ents who par cipated in our follow-up study were considered to have possible occupa onal asthma. Remarkably, none of these pa ents showed an increase in asthma severity over the two year follow-up period. On the contrary, 8 out of 13 pa ents (61.5%) with poten al occupa onal asthma showed an improvement in asthma severity. Four of these pa ents appeared to have switched jobs because of their asthma symptoms. Unfortunately, we did not have more extensive data about the other half of the pa ents.
Our observa on of improvement of asthma severity ts in with the ndings of Burge and colleagues that accelerated FEV1 decline in pa ents with occupa onal asthma returns to normal rates of decline a er exposure ceases.3 Discon nua on or at least decrease of exposure to the causa ve agent is in line with the currently recommended management strategy for occupa onal asthma, as this has a possible bene cial in uence on the outcome.4 However, even a er stopping exposure a persistent e ect can be seen, although the prognosis probably depends on early asthma diagnosis, the dura on of exposure and the severity of asthma.5
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