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The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

  • Henneberger, Paul K.1
  • Patel, Jenil R.2, 3
  • de Groene, Gerda J.4
  • Beach, Jeremy5
  • Tarlo, Susan M.6
  • Pal, Teake M.4
  • Curti, Stefania7
  • 1 Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
  • 2 Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
  • 3 Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  • 4 Netherlands Center of Occupational Diseases, Academic Medical Center, Coronel Institute of Occupational Health, Amsterdam, The Netherlands
  • 5 Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 6 Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 7 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Published Article
American Journal of Industrial Medicine
Wiley (John Wiley & Sons)
Publication Date
Dec 29, 2020
DOI: 10.1002/ajim.23208
PMID: 33373055
PMCID: PMC7932026
PubMed Central
  • Article


Background: The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. Methods: A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and meta-analyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions . Results: Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. Conclusions: Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.

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