Tuesday, March 17, 2015
Canadian Health Care Management
Health-care workers with OA from NRL have been able to safely return to work in settings where they avoid the personal use of NRL products, and where coworkers use powder-free, low-protein gloves. However, placing workers with toluene diisocyanate-induced asthma in environments with low-level exposures has not been as successful; overall, there is limited evidence for using this approach.
Continued exposure may lead to greater airway inflammation and potentially more airway remodeling and lower FEV1. When patients are unwilling or unable to leave a job, the initiation of antiinflammatory and bronchodilator therapy may be the only management option available to the clinician, although the patient should be educated to understand that continued exposure may lead to a worse outcome; it is essential that patients have careful medical monitoring so that any worsening of asthma can be detected early and further interventions applied. Similarly, close monitoring is needed if patients continue to be exposed to a relevant work sensitizer while awaiting the outcome of a compensation claim.
Limited data exist on the effect of the cessation of exposure in patients with irritant-induced OA.
One report of three patients with repetitive exposure to irritants at work suggested a benefit for removal from the exposure.
Unlike workers with sensitizer-induced OA, however, workers with irritant-induced OA may be able to continue in their usual jobs if the risk of a similar high-level exposure to the inciting agent is diminished via engineering controls and similar means are employed to prevent subsequent WEA, including the appropriate use of respiratory protective devices.
The rationale for this approach is based on the unproven assumption that irritant-induced airway inflammation in patients with irritant-induced OA will diminish with a reduction of exposure that is analogous to what may occur in patients with occupational or tobacco smoke-related chronic bronchitis with a reduction in exposure.
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