1. Occupational Asthma (included in work related asthma) WHO-MOH August 2015 Damascus

3. Work Exacerbated Asthma Has asthma, but exacerbated by the exposure. Had asthma and reappeared

4. Occupational Asthma

5. Table 1—Classification of Occupational Respiratory Tract Disease Industrial Bronchitis/Rhinitis Airway diseases Work-related asthma Work-exacerbated asthma Occupational asthma Endotoxin/grain dust inhalation Byssinosis Acute toxic inhalations Metal fume fever Polymer fume fever Toxic pneumonitis (bronchiolitis obliterans) Combustible/smoke inhalation Pneumoconioses Asbestosis Silicosis Coal-worker’s pneumoconiosis (Black Lung) Hypersensitivity pneumonitis (extrinsic allergic alveolitis) Occupational infections Occupational neoplasms

7. أهم المهن المسببة كثيرة وأهمها : الكوافير, عمال الأخشاب، الرسام، الخباز ،العامل الصحي : عمال الصيانه والبلاستيك هناك المحسسات والمخرشات

8. Diagnosis of occupational asthma Since occupational asthma present the same symptomatically and functionally as other asthma, the clinician should keep in mind this etiology in order to act

9. Detailed medical history about occupation of each asthma patients, because same presentation:1.2% of incident asthma are occupational Work related asthma is: -Work exacerbated asthma -Occupational asthma: sensitizers, irritants

10. In addition,: the history should include whether or not the patient participated in prior military service or is/was involved in any secondary jobs or hobbies that involve(d) significant environmental exposure

11. Occupational asthma Work related asthma: Latency after exposure in a new work for weeks to months. Irritant induced asthma: Appear within hours Including “ Reactive airway dysfunction syndrome”RADS”

12. Diagnosis Pre-existing atopy, family history Clinical history: every new asthma should lead to explore occupational exposure 1.2% of new asthma. appear after exposure, diminishes when holidays or weeK ends Lung Function: Variability of Peak Expiratory Flow Rate(PEFR), of Forced Expiratory volume in one second (FEV1) NSCT: Metacholine test at work and after work SIC: reference test, specific inhalation of causal agent Immunological tests : Specific skin test, Specific IgE(RAST)

13. Lung Functions Spirometry: Variability, reversibility of FEV1. Could be normal. Do it in work or just after work and in holidays ( Specific challenge test SIC) PEFR ; variability of 20%; 4 PEFR during work every day for two weeks, and 4PEFR every day two weeks out of work BHR to specific challenge test if Lung Function normal

14. Prognosis Once occupational asthma appear it continues If we remove the patient, the hope for asthma to cure is low, but will improve, continue treatment and watch

15. How to proceed Treat as asthma Ask for MSD from the employer Preferably change work place, take the individual out of work If not, May be reduce exposure, respiratory protection, or ventilation improvement/ engineering

16. MSD of products in the work place Material Safety Data Sheets  Employers must make sure that all controlled products have an up-to-date (less than 3 years old) MSDS when they enter the workplace. Since the MSDS must be readily available to workers who are exposed to the controlled product (for businesses employing more than approximately 15 employees, depending on the locality),  any treating medical provider or the patient should be able to obtain this information from the employer.

17. Compensation There is a variety of jurisdictions for each type of compensation system, each with specific plan language and definitions. Workers’ compensation refers to a no-fault insurance that provides compensation of medical care for employees who are injured in the

18. There is a variety of jurisdictions for each type of compensation system, each with specific plan language and definitions. Workers’ compensation refers to a no-fault insurance that provides compensation of medical care for employees who are injured in the