Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

sensitizer-induced

1st line – avoidance of further sensitizer exposure

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ACUTE
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sensitizer-induced
1st line – 

avoidance of further sensitizer exposure

Early diagnosis of sensitizer-induced occupational asthma (OA) and avoidance of further exposure to the causative agent offers the best chance of recovery.[22]​​[36]​​​​​​[71][91][94]

If the patient remains at the workplace, strategies to avoid exposure include elimination or substitution of the causative agent, or relocation away from the area of exposure.

Approximately 25% to 30% of OA patients removed from exposure can expect to make a full recovery; an additional 30% to 35% will report a reduction in symptoms.[91][22]​​​​ Much of the improvement occurs within the first 2 years following cessation of exposure.[22]​​​​

The likelihood of improvement or resolution of symptoms is greater in those workers who have relatively normal lung function, and shorter duration of symptoms, at the time of diagnosis.[22]​​[95]​​​

As there is no clear safe level of exposure for sensitized workers, neither the reduction of the level of exposure nor the use of respiratory protection is recommended as an effective control measure.[36][71]

Plus – patient education and environmental control

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ACUTE
|
sensitizer-induced
Plus – 

patient education and environmental control

Treatment recommended for ALL patients in selected patient group

As for other patients with asthma, exposure to additional asthma triggers should be controlled, such as exposure to relevant common allergens and irritant agents.

Patient education as to appropriate exposure control measures, medication use, and recognition of poor control is essential.[57]

Plus – inhaled corticosteroids

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ACUTE
|
sensitizer-induced
Plus – 

inhaled corticosteroids

Treatment recommended for ALL patients in selected patient group

In addition to removal of the exposure and other pharmacologic treatments for asthma, early treatment with inhaled corticosteroids may be of benefit in patients with sensitizer-induced OA.[36][96][97]

irritant-induced

1st line – avoidance of further irritant exposure

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ACUTE
|
irritant-induced
1st line – 

avoidance of further irritant exposure

Patients with irritant-induced asthma may be able to return to the same workplace if the chance of an exposure similar to that which initiated asthma is considered unlikely, and if protective measures are in place at work.

Work modifications for the patient will depend on the severity of ongoing asthma and the work exposure conditions. Low irritant exposures at work may cause exacerbations, and preventive measures may be needed to further reduce exposures, such as use of a respirator at times or a move to a cleaner area.[36]

Plus – patient education, environmental control, and asthma drugs

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ACUTE
|
irritant-induced
Plus – 

patient education, environmental control, and asthma drugs

Treatment recommended for ALL patients in selected patient group

As for other patients with asthma, exposure to additional asthma triggers should be controlled, such as exposure to relevant common allergens and irritant agents.

Patient education as to appropriate exposure control measures, medication use, and recognition of poor control is essential.[57]

Patients with irritant-induced occupational asthma should receive standard care of their asthma symptoms as needed.

ONGOING

symptomatic asthma

1st line – stepwise management of symptomatic asthma

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ONGOING
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symptomatic asthma
1st line – 

stepwise management of symptomatic asthma

The Global Initiative for Asthma (GINA) guidelines recommend a stepwise approach, whereby medication is stepped up or stepped down based on disease severity and adequacy of asthma control.[57]

The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.

Patients may start at any step, and drugs can be added (stepped up) if needed.

Patient's asthma control should be regularly assessed with the aim of stepping down treatment if disease has been well controlled for at least 3 months.[57]

See Acute asthma exacerbation in adults and Asthma in adults.

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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