Occupational caution for young men with severe asthma

Research from Finland shows that men who have severe asthma by early adulthood are vulnerable to the effects of current work and exposure to asthma-aggravating factors on asthma outcomes in middle age.

However, this association was less strong among men who had mild to moderate asthma when they were younger.

“On the basis of our findings, it is advisable to take asthma severity into account in the vocational guidance of young asthmatic men,” say authors Irmeli Lindström (Finnish Institute of Occupational Health, Helsinki) and colleagues.

However, “it seems unjustified to guide those with a relatively mild form of the disease to restrict their careers,” they add.

Their study involved 232 men with mild or moderate asthma who were approved for obligatory military service in Finland between the ages of 19 to 21 years in the late 1980s, and 161 men who were excused from military duty on the basis of severe asthma. Additionally, there were 608 controls who entered the military at around the same time without a diagnosis of asthma.

In 2009 (18 to 23 years later), the researchers found that, among those who had severe asthma in their youth, being a manual worker or self-employed was significantly associated with a 4.5-fold greater odds for asthma exacerbation in the past 12 months compared with nonmanual workers.

Additionally, being currently unemployed and experiencing relief from asthma symptoms on days off work were associated with significantly increased odds for both poorly controlled asthma, according to the Asthma Control Test (odds ratio [OR]=3.5 and 2.4), and asthma exacerbations (OR=4.9 and 3.2).

And self-reported occupational exposure to dust or chemical agents, gases or fumes, abnormal temperatures, bad indoor air quality, and physically strenuous work all showed a trend toward an association with asthma exacerbations in this group, but this did not reach statistical significance.

By contrast, the authors found a much smaller effect of occupation and exposure on asthma outcomes in men who had mild to moderate asthma in youth. The only significant relationships were between improvement in asthma symptoms on days off and exacerbations (OR=3.0), and an increased odds for poor asthma control in obese men (OR=4.2).

Writing in the Journal of Occupational & Environmental Medicine, the authors say that their findings support the recommendations of the Finnish Allergy Program, which encourages men with severe asthma to avoid occupational exposure to respiratory irritants.

They add that “occupational health care professionals should frequently assess asthmatic men who are already working and are exposed through their work to respiratory irritants, abnormal temperatures, or physically strenuous tasks.”

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