1. RECOGNITION OF OCCUPATIONAL ASTHMA IN SLOVENIA RECOGNITION OF OCCUPATIONAL ASTHMA IN SLOVENIA Assist. Prof. Alenka Franko, MD, PhD

2. There is no conflict of interest to declare There is no conflict of interest to declare

3. Occupational asthma is one of the most frequent occupational lung diseases 2 to 15% of all asthma cases are attributed to occupational exposures OCCUPATIONAL ASTHMA

4. a disease characterized by a variable obstruction of the respiratory passages and/or bronchial hyperresponsiveness caused by the factors and circumstances typical of a particular working environment and not stimuli encountered outside the workplace OCCUPATIONAL ASTHMA

5. ASTHMA

6. Immunological 2 TYPES Non-immunological

7. IMMUNOLOGICAL TYPE OF ASTHMA caused by most high- and certain low molecular-weight agents for which immunological mechanism (mostly IgE mediated) has been proven Appearance after a latency

8. may occur after single or multiple exposure to non-specific irritants may occur after single or multiple exposure to non-specific irritants NON-IMMUNOLOGICAL TYPE OF ASTHMA Irritant induced asthma

9. OCCUPATIONAL ASTHMA high-molecular-weight agents (> 5000 d): latex, enzymes, natural high-molecular-weight agents (> 5000 d): latex, enzymes, natural rubber low-molecular-weight agents: isocyanates, platinum salts, penicillin acting as hapten in conjugation with immunologic proteins to induce immune response low-molecular-weight agents: isocyanates, platinum salts, penicillin acting as hapten in conjugation with immunologic proteins to induce immune response irritant agents: chlorine, ammonium, acids etc. FACTORS

10. THE AIM OF THIS LECTURE is to present the guidelines for the recognition of occupational asthma in Slovenia and the verification procedure with the focus on finding the association between asthma and exposure to the agents in the workplace is to present the guidelines for the recognition of occupational asthma in Slovenia and the verification procedure with the focus on finding the association between asthma and exposure to the agents in the workplace

11. METHODS The guidelines for the recognition of occupational asthma in Slovenia were set at the Clinical Institute of Occupational Medicine, Ljubljana, and were based on a systematic review of studies and articles on this matter and following legislation The guidelines for the recognition of occupational asthma in Slovenia were set at the Clinical Institute of Occupational Medicine, Ljubljana, and were based on a systematic review of studies and articles on this matter and following legislation

12. OCCUPATIONAL ASTHMA 1. diagnosis of asthma has to be confirmed by a pulmonologist GUIDELINES FOR RECOGNITION GUIDELINES FOR RECOGNITION

13. OCCUPATIONAL ASTHMA 2. determination of association between asthma and occupational exposures to allergen or irritant performed by a specialist of occupational medicine GUIDELINES FOR RECOGNITION GUIDELINES FOR RECOGNITION

14. GUIDELINES FOR RECOGNITION 2.1 The work history and risk assessment of the workplace which confirms the occupational exposure to hazards that my cause asthma 2.1 The work history and risk assessment of the workplace which confirms the occupational exposure to hazards that my cause asthma 2. Association between asthma and occupational exposures

15. GUIDELINES FOR RECOGNITION 2.2 2.2 Serial measurements of peak expiratory flow rate (PEF) or forced expiratory volume in the first second (FEV1) during working period and period while away from work. A diurnal variation of at least 20% on PEF or FEV1 is needed to confirm occupational asthma 2. Association between asthma and occupational exposures

16. ELECTRONIC PEAK FLOW METER

17. GUIDELINES FOR RECOGNITION 2.3 2.3 Minimum intensity of exposure: - Immunological type: it is not determined as there is no dose-response relationship - Non-immunological type: it may occur after single or multiple exposure to non- specific irritants 2. Association between asthma and occupational exposures

18. GUIDELINES FOR RECOGNITION 2.4 2.4 Minimum duration of exposure: - Immunological type: sensibilisation occurs after few weeks or months - Non-immunological type: it may appear already after a single exposure 2. Association between asthma and occupational exposures

19. GUIDELINES FOR RECOGNITION 2.5 2.5 Latent period (the interval between the last exposure to allergen or irritant and development of disease): - Immunological type: 3 days - Non-immunological type: there is no latent period 2. Association between asthma and occupational exposures

20. GUIDELINES FOR RECOGNITION 2.6 2.6 Induction period: (the interval between the first exposure to allergen or irritant and development of disease): - Immunological type: isolated immediate/early response: within 30 minutes after exposure; isolated late response 3-8 hours after exposure; repetitive response may cause episodes of bronchospasm for several days after exposure - Non-immunological type: there is no induction period 2. Association between asthma and occupational exposures

21. GUIDELINES FOR RECOGNITION 2.7 2.7 Additional tests (not obligatory): - immunological tests - controlled laboratory challenge testing etc. 2. Association between asthma and occupational exposures

22. SLOVENIA the verification criteria are clearly stated and also published the verification criteria are clearly stated and also published asthma is Slovenia is still very seldom recognised as occupation disease asthma is Slovenia is still very seldom recognised as occupation disease

23. THE PENSION AND DISABILITY INSURANCE INSTITUTE OF SLOVENIA is in charge for determination of disability and its causality is in charge for determination of disability and its causality three categories are possible three categories are possible

24. THE PENSION AND DISABILITY INSURANCE INSTITUTE OF SLOVENIA: ASTHMA, OCCUPATIONAL EXPOSURE

25. OCCUPATIONAL ASTHMA an unofficial consultation group for occupational lung diseases: specialists of occupational medicine and pulmonologists an unofficial consultation group for occupational lung diseases: specialists of occupational medicine and pulmonologists the group meets approximately 6 times per year and discusses the cases of possible occupational lung diseases, mostly asthma the group meets approximately 6 times per year and discusses the cases of possible occupational lung diseases, mostly asthma Among approximately 100 patients with suspected occupational asthma, only two decided to proceed in further recognition procedure Among approximately 100 patients with suspected occupational asthma, only two decided to proceed in further recognition procedure

26. CONCLUSIONS The recognition of occupational asthma still represents an important problem in Slovenia The recognition of occupational asthma still represents an important problem in Slovenia Although the guidelines for the verification of occupational asthma and also other diseases are clearly stated, the implementation of recognition of occupational asthma in practice remains a major problem Although the guidelines for the verification of occupational asthma and also other diseases are clearly stated, the implementation of recognition of occupational asthma in practice remains a major problem

27. CONCLUSIONS primarily a dysfunctional funding system of verifications of occupational diseases primarily a dysfunctional funding system of verifications of occupational diseases Slovenia: employers are responsible for detecting and payment of verifications of occupational diseases and have no interest to the verification of occupational asthma in the worker', although there is a high risk that asthma is diagnosed by several workers (clusters of asthma in certain working environments) Slovenia: employers are responsible for detecting and payment of verifications of occupational diseases and have no interest to the verification of occupational asthma in the worker', although there is a high risk that asthma is diagnosed by several workers (clusters of asthma in certain working environments) REASONS

28. CONCLUSIONS the workers' fear of losing their jobs the workers' fear of losing their jobs REASONS

29. CONCLUSIONS We expect that the new policy on the list of occupational diseases, verification and registration of occupational diseases, will improve the situation in this area and more workers will apply for verification of occupational diseases, including occupational asthma

30. THANK YOU FOR YOUR AT TENTION