Theme no. 1

Discussion of this session focused on:

1. the distinct types of inflammation caused by irritants and sensitizers.
2. the various effects on airways that can be better identified by specific inhalation challenges;
3. the propensity of a substance to have an irritant or a sensitizing effect by using a structure-activity analysis;
4. the modification of the working environment that is essential in the management.

Presentations of the theme:

• Occupational asthma in cleaners
• Cleaning agents and disinfectants as irritants and sensitizers including in swimming pools) - Catalysing the discussion
• Cleanings agents and disinfectants as irritants and sensitizers - How to evaluate types of bronchial reaction - How to reduce the risks

Theme no. 2

After a review on population-based studies of asthma in the workplace, proposal was made to improve asthma phenotypes and characterization of exposure. Also, ways to examine the impact of low participation and assess representativeness were presented.

Presentations of the theme:

• Recurrent asthma phenotype in birth cohort studies
• Population based studies - Discussion points
• Population-based studies of occupational obstructive diseases - Use of databanks, advantages and pitfalls, strategies to adjust for biases and confounding

Theme no. 3

In this session, the effect of chronic and acute exposures to molds as well as working in recycling processes were reviewed. The mechanism of this effect is still hypothetical.

Presentations of the theme:

• Tool to Determine if a Home Assessment is Warranted for Mold and Dampness
• Indoor occupational risk-factor in non-industrial settings and work-related asthma. - A systematic review
• Damp environments and moulds: health effects, mechanisms and causality

Theme no. 4

In this session there was discussion of advantages and disadvantages of new techniques that may be used in diagnosis of IgE antibody responses to occupational sensitizers to improve sensitivity and specificity of allergy skin tests and in-vitro tests of specific IgE for the diagnosis of occupational allergic airways disease. Purified and recombinant allergens can be used as part of in-vivo test (skin prick tests) or in-vitro assays of specific IgE antibodies. Basophil activation tests, when feasible may be useful when specific IgE antibodies cannot be identified, and nasal secretion tryptase was discussed as a possible “point-of-care” test.

Presentations of the theme:

• Diagnosis of Occupational Asthma: HMW Allergens
• Diagnosis of occupational asthma and rhinitis: usefulness of recombinant allergens (component resolved diagnosis), metabolomics and other new aspects. (Gianna Moscato)
• Diagnosis of occupational asthma and rhinitis: usefulness of recombinant allergens (component resolved diagnosis), metabolomics and other new aspects. (Monika Raulf)

Theme no. 5

Mechanisms by which allergic responses and asthma may be induced or worsened by these exposures were the focus of this session. Although common in work environments most relevant research on mechanisms on these reactions has come from cellular or animal studies with limited human exposure studies. Recent controlled human exposure studies with diesel exhaust particles may reflect effects in occupational settings.

Presentations of the theme:

• How does exposure to gas, dust and fumes enhance sensitization and asthma?
• Why do we care about mechanisms? Developing Countries Perspective
• Long term pathologic consequences of acute irritant-induced asthma

Theme no. 6

Some issues presented for discussion included:

1. differences between an epidemiologic versus a clinical case definition of occupational COPD,
2. causes and the range of individuals and populations at increased risk – should risks be assessed from specific occupations or from self-reported or job-exposure matrix exposures to vapour, gas, dust or fumes (VGDF)?,
3. difficulties in clinical diagnoses raised by confounding factors/ underlying risk factors such as smoking, atopy, alpha-one antitrypsin deficiency and other factors,
4. difficulties in clinical diagnosis in the presence of overlap syndromes such as asthma/COPD overlap or overlap with bronchiolitis or bronchiectasis.

Presentations of the theme:

• Occupational COPD
• How to determine probability of occupational causality in COPD