Occupational asthma and work exacerbated asthma. What are the differences in terms of risk factors and aptitude?

Introduction Allergic asthma is currently the most frequent respiratory pathology in the workplace. Whether induced or aggravated by the work environment, the adequacy between this morbid state andwork is often subject to re-evaluation. Aim to study. - The socio-professional, clinical, para-clinical and medico-legal characteristics of allergic asthma observed in the workplace, to assess their impact on the ability to work and to compareoccupational asthma (OA) and work exacerbated asthma (WEA) in terms of associated professional andextraprofessional factors and in terms of repercussions on aptitude. Methods. - Exhaustive retrospective descriptive study of all work-related allergic asthma files (OA andWEA), collected from the Department of Occupational Medicine and Occupational Pathologies of theUniversity Hospital La Rabta in Tunis during the period from 1 January 2000 to December 31, 2020. Results. - This is a series of 232 cases of work-related allergic asthma, including 76.7% OA and 23.3% WEA. The mean age of the patients was 40.28 +/- 8.96 years. The female gender was represented in 50.9% ofcases. A personal history of atopy was reported by 16.5% of patients. The most represented professional category was that of unskilled workers (57.1%) with an average seniority of 11.43 +/- 7.96 years. Thesectors that provided the most asthma were the textile sector (10%) and the health sector (10.9%). Theclinical symptoms were dominated by paroxysmal wheezing dyspnea (51.5%), punctuated by work. inthe majority (86.6%). The responsible agents were high molecular weight allergens (HMW) in particularvegetable textile dust (9.9%), low molecular weight (LMW) such as isocyanate (11.6%), formaldehyde( 11.2%) as well as respiratory irritants, mainly mold (7.8%) and non-specific dust (3.9%). Asthma justifieda workstation adaptation in 47.8% of cases and a mutation in 40.9% of patients. Comparing the cases of work-induced asthma with those that were exacerbated, we found that age andlength of service were higher in the OA group, (P = 0.002) and (P = 0.005). In addition, this group was alsoassociated with the grade of unskilled worker (P = 0.035), exposure to HMW allergens (P = 0.008), as wellas the prescription for a job transfer (P = 10-3). In addition, WEA was associated with a history of personaland family atopy with respectively (P = 10-3) and (P = 0.017), work in the transport sector (P = 10-3) aswell as prescription temporary unfitness for the post (P = 10-3). Conclusion. - The etiologies of OA and WEA differ. Indeed, the etiologies of WEA are essentially respiratoryirritants while in the OA are HMW allergens. In terms of aptitude, the impact on OA is more pejorativethan WEA involving more mutation. (c) 2021 Elsevier Masson SAS. All rights reserved.