Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement

This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each...

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Bibliographic Details
Published in:	The European respiratory journal Vol. 43; no. 6; pp. 1573 - 1587
Main Authors:	VANDENPLAS, Olivier, SUOJALEHTO, Hille, MOSCATO, Gianna, SASTRE, Joaquin, SIGSGAARD, Torben, SUURONEN, Katri, WALUSIAK-SKORUPA, Jolanta, CULLMAN, Paul, AASEN, Tor B, BAUR, Xaver, SHERWOOD BURGE, P, DE BLAY, Frederic, FISHWICK, David, HOYLE, Jennifer, MAESTRELLI, Piero, MUNOZ, Xavier
Format:	Journal Article
Language:	English
Published:	Leeds Maney 01-06-2014
Subjects:	Asthma, Occupational - diagnosis Biological and medical sciences Bronchi - physiopathology Bronchial Hyperreactivity - diagnosis Bronchial Provocation Tests - standards Chronic obstructive pulmonary disease, asthma Europe False Negative Reactions False Positive Reactions Humans Inflammation Medical sciences Monitoring, Physiologic Occupational Diseases - diagnosis Pneumology Pulmonary Medicine - standards Societies, Medical Europe Lung disease Respiratory disease Bronchus disease Obstructive pulmonary disease Diagnosis Consensus Occupational medicine Asthma Inhalation
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Summary:	This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 s ≥ 15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0903-1936 1399-3003
DOI:	10.1183/09031936.00180313