Irritant-Induced Asthma
Irritant-Induced Asthma
Because RADS is usually precipitated by an unforeseen industrial accident, removal of the worker is automatic. Emergency treatment might require inhaled beta2 agonists, systemic steroids, and oxygen depending on the severity. Once the acute episode has been managed appropriately, treatment of the ongoing asthmatic situation using a combination of inhaled corticosteroid and bronchodilators is mandatory. Long-term inhaled corticosteroids may be appropriate in reducing the severity of nonspecific bronchial hyperresponsiveness (NSBH). Reduction of exposures to workplace irritants, passive smoking, vehicle emissions, outdoor pollutants, and temperature or humidity extremes is also important. Unfortunately, many patients with RADS find that their symptoms respond poorly to standard asthma medications. Varney et al. described the first use of high-dose vitamin D in a patient with RADS who was refractory to conventional treatments. The presence of vitamin D receptors in the airways and their capability to inhibit proinflammatory cytokines might explain the improvement in this case and may be consistent with a questioned role for vitamin D deficiency in asthma causation.
Management
Because RADS is usually precipitated by an unforeseen industrial accident, removal of the worker is automatic. Emergency treatment might require inhaled beta2 agonists, systemic steroids, and oxygen depending on the severity. Once the acute episode has been managed appropriately, treatment of the ongoing asthmatic situation using a combination of inhaled corticosteroid and bronchodilators is mandatory. Long-term inhaled corticosteroids may be appropriate in reducing the severity of nonspecific bronchial hyperresponsiveness (NSBH). Reduction of exposures to workplace irritants, passive smoking, vehicle emissions, outdoor pollutants, and temperature or humidity extremes is also important. Unfortunately, many patients with RADS find that their symptoms respond poorly to standard asthma medications. Varney et al. described the first use of high-dose vitamin D in a patient with RADS who was refractory to conventional treatments. The presence of vitamin D receptors in the airways and their capability to inhibit proinflammatory cytokines might explain the improvement in this case and may be consistent with a questioned role for vitamin D deficiency in asthma causation.