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Work-Related Asthma: The Dawn of Knowledge?
Asma relacionada con el trabajo: ¿en los albores del conocimiento?
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "177" "paginaFinal" => "179" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fenotipos del asma, ¿son importantes?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1792 "Ancho" => 2700 "Tamanyo" => 390383 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical phenotypes of asthma and treatment. Phenotypes are represented according to the age of onset, severity of the disease, Th2 or non-Th2-dependent inflammation and influence of genetic background. 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "180" "paginaFinal" => "181" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Jesús Cruz, Xavier Muñoz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "María Jesús" "apellidos" => "Cruz" "email" => array:1 [ 0 => "mj.cruz@vhir.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Xavier" "apellidos" => "Muñoz" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asma relacionada con el trabajo: ¿en los albores del conocimiento?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is a potentially serious disease that is growing in prevalence in most developed countries.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> One of the factors that might have prompted this trend is the greater number of cases of asthma that develop in adults.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> In addition to a possible allergic origin, as occurs in childhood asthma, epidemiological studies indicate that occupational exposure may be the cause of up to 25% of all cases of adult-onset asthma.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> Asthma caused by exposure to a specific substance in the workplace is known as occupational asthma (OA), while pre-existing or concomitant asthma which is intensified by stimuli present in the workplace is known as work-exacerbated asthma (WEA). OA can be further subclassified as immunological and non-immunological, depending on the mechanisms causing the disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> Immunological OA requires time for sensitization to the causative agent to develop, while non-immunological OA refers to patients whose asthma is caused by irritants, the most obvious example of which is reactive airway dysfunction syndrome or RADS.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> RADS is caused by a single or multiple exposure to high doses of an irritant. In general, there is no latency period, since symptoms appear within 24<span class="elsevierStyleHsp" style=""></span>h after exposure. The term “work-related asthma” (WRA) has been around for many years, but interest in this entity has been growing in the last decade. This term includes both OA and WEA.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although it has been estimated that OA is the most prevalent chronic occupational disease in many countries, and that WEA may account for 21% of cases of asthma among the working population,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">5,6</span></a> the diagnosis, prognosis and treatment of this disease are complex and controversial.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> For a correct diagnosis, a high degree of suspicion is necessary, and the patient should be asked about the temporal relationship between symptoms and work. It is unsurprising, then, that a recent study performed in primary care centers in Catalonia found that WRA is underdiagnosed, a situation exacerbated by the fact that many workers are unaware that their job may cause their disease or make it worse.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> In Spain, underdiagnosis means that WRA often remains undetected and undiagnosed as such by the specialized departments of the occupational health system, the risk prevention units of companies, and the Workplace Accident and Occupational Diseases Insurance area of the Spanish Social Security (MATEPSS), and ends up being diagnosed and treated as a common illness within the primary care network.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A recent study suggests that OA and WEA can be distinguished by certain functional and biological differences, although the methods most commonly used for diagnosing WRA do not always expose these differences.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> Taking into account the general agreement that a patient with a previous diagnosis of asthma may develop OA, and that the concomitant onset of asthma associated with work does not rule out that it is a WEA, it appears that the specific provocation testing is the only method capable of clearly differentiating between both entities.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> One of the recommendations of a recent European Respiratory Society (ERS) task force was that this test must always be done if there are doubts regarding an OA diagnosis established using the conventional methods.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosing and differentiating correctly between these diseases is of great importance. For one thing, it can help advance knowledge of the causes and mechanisms involved, leading to better treatment and prevention. Moreover, this is a disease in which an incorrect diagnosis may have important socioeconomic consequences for both the patient and society, and the correct diagnosis of WRA reduces associated costs dramatically.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> We have already mentioned the study by Vila-Rigat et al.,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> conducted in a primary care setting, which suggested that among the asthma cases monitored in primary care centers of the National Health System, 33% show an association between the disease and the workplace; in 18%, this association originates from the job itself, and in 15% it is aggravated by conditions in the workplace. In WRA, economic compensation is a critical topic, and varies widely among European countries. In Spain, Royal Decree (RD) 1299/2006 of November 10, 2006 (modified on December 19, 2015) lists the occupational diseases recognized by the Social Security system, and establishes criteria for classification and registration. In this list, OA appears in group 4, which includes substances with high molecular weight (generally proteins) and low molecular weight (generally chemicals). However, while OA is recognized as an occupational disease, the same is not true of WEA, even though when correctly diagnosed it can be recognized as a workplace accident.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clearly, then, in our opinion, all professionals treating asthmatics must be made aware of the importance of determining if the disease is work-related or not. If it is, patients should be referred to centers where a clear diagnosis of either OA or WEA can be made. Databases featuring correctly diagnosed patients will help us further our knowledge of the physiopathological mechanisms involved in both entities, seek out therapeutic targets, establish the best treatments, and promote preventive measures. Right now, the critical (and legal) decision of whether or not to remove a patient from the workplace after diagnosis of OA or WEA remains unclear from a medical perspective, despite the recommendation that workers with OA be removed. If respiratory disease originating in the workplace, including WRA, were notifiable, as is the case in some countries, the health and safety of many workers might improve considerably.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cruz MJ, Muñoz X. Asma relacionada con el trabajo: ¿en los albores del conocimiento? 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 35 | 25 | 60 |
| 2024 September | 39 | 21 | 60 |
| 2024 August | 70 | 63 | 133 |
| 2024 July | 42 | 25 | 67 |
| 2024 June | 49 | 36 | 85 |
| 2024 May | 69 | 31 | 100 |
| 2024 April | 37 | 32 | 69 |
| 2024 March | 33 | 23 | 56 |
| 2024 February | 37 | 20 | 57 |
| 2023 March | 12 | 3 | 15 |
| 2023 February | 32 | 21 | 53 |
| 2023 January | 19 | 22 | 41 |
| 2022 December | 58 | 31 | 89 |
| 2022 November | 37 | 17 | 54 |
| 2022 October | 52 | 36 | 88 |
| 2022 September | 22 | 26 | 48 |
| 2022 August | 32 | 45 | 77 |
| 2022 July | 34 | 40 | 74 |
| 2022 June | 38 | 36 | 74 |
| 2022 May | 35 | 40 | 75 |
| 2022 April | 22 | 18 | 40 |
| 2022 March | 34 | 39 | 73 |
| 2022 February | 25 | 27 | 52 |
| 2022 January | 23 | 38 | 61 |
| 2021 December | 23 | 34 | 57 |
| 2021 November | 24 | 46 | 70 |
| 2021 October | 35 | 43 | 78 |
| 2021 September | 24 | 45 | 69 |
| 2021 August | 20 | 39 | 59 |
| 2021 July | 21 | 23 | 44 |
| 2021 June | 34 | 38 | 72 |
| 2021 May | 33 | 33 | 66 |
| 2021 April | 92 | 79 | 171 |
| 2021 March | 30 | 15 | 45 |
| 2021 February | 25 | 23 | 48 |
| 2021 January | 26 | 15 | 41 |
| 2020 December | 24 | 14 | 38 |
| 2020 November | 22 | 16 | 38 |
| 2020 October | 27 | 17 | 44 |
| 2020 September | 23 | 12 | 35 |
| 2020 August | 19 | 19 | 38 |
| 2020 July | 33 | 18 | 51 |
| 2020 June | 18 | 8 | 26 |
| 2020 May | 28 | 18 | 46 |
| 2020 April | 49 | 21 | 70 |
| 2020 March | 21 | 12 | 33 |
| 2020 February | 28 | 18 | 46 |
| 2020 January | 31 | 13 | 44 |
| 2019 December | 20 | 24 | 44 |
| 2019 November | 25 | 17 | 42 |
| 2019 October | 16 | 9 | 25 |
| 2019 September | 13 | 15 | 28 |
| 2019 August | 17 | 16 | 33 |
| 2019 July | 29 | 12 | 41 |
| 2019 June | 19 | 13 | 32 |
| 2019 May | 29 | 13 | 42 |
| 2019 April | 54 | 26 | 80 |
| 2019 March | 24 | 13 | 37 |
| 2019 February | 23 | 17 | 40 |
| 2019 January | 32 | 13 | 45 |
| 2018 December | 27 | 19 | 46 |
| 2018 November | 64 | 26 | 90 |
| 2018 October | 109 | 19 | 128 |
| 2018 September | 41 | 5 | 46 |
| 2018 May | 38 | 0 | 38 |
| 2018 April | 52 | 8 | 60 |
| 2018 March | 71 | 6 | 77 |
| 2018 February | 83 | 10 | 93 |
| 2018 January | 137 | 7 | 144 |
| 2017 December | 73 | 5 | 78 |
| 2017 November | 25 | 2 | 27 |
| 2017 October | 32 | 13 | 45 |
| 2017 September | 32 | 13 | 45 |
| 2017 August | 23 | 13 | 36 |
| 2017 July | 28 | 18 | 46 |
| 2017 April | 0 | 2 | 2 |
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