L’asthme professionnel et l’asthme aggravé par le travail. Quelles différences en termes de facteurs de risque et d’aptitude au travail ?

Abstract

IntroductionAllergic 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 and work is often subject to re-evaluation. Aim to studyThe 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 compare occupational asthma (OA) and work exacerbated asthma (WEA) in terms of associated professional and extra-professional factors and in terms of repercussions on aptitude. MethodsExhaustive retrospective descriptive study of all work-related allergic asthma files (OA and WEA), collected from the Department of Occupational Medicine and Occupational Pathologies of the University Hospital La Rabta in Tunis during the period from 1 January 2000 to December 31, 2020. ResultsThis 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% of cases. 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. The sectors that provided the most asthma were the textile sector (10%) and the health sector (10.9%). The clinical symptoms were dominated by paroxysmal wheezing dyspnea (51.5%), punctuated by work. in the majority (86.6%). The responsible agents were high molecular weight allergens (HMW) in particular vegetable 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 justified a 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 and length of service were higher in the OA group, (P=0.002) and (P=0.005). In addition, this group was also associated with the grade of unskilled worker (P=0.035), exposure to HMW allergens (P=0.008), as well as the prescription for a job transfer (P≤10-3). In addition, WEA was associated with a history of personal and family atopy with respectively (P≤10–3) and (P=0.017), work in the transport sector (P≤10-3) as well as prescription temporary unfitness for the post (P≤10–3). ConclusionThe etiologies of OA and WEA differ. Indeed, the etiologies of WEA are essentially respiratory irritants while in the OA are HMW allergens. In terms of aptitude, the impact on OA is more pejorative than WEA involving more mutation.