FEV1 decline in occupational asthma

Background: In occupational asthma continued workplace exposure to the causative agent is associated with a poor prognosis. However, there is little information available on how rapidly lung function declines in those who continue to be exposed, nor how removal from exposure affects lung function. Methods: Forced expiratory volume in 1 second (FEV1) was studied in 156 consecutive subjects with occupational asthma (87% due to low molecular weight agents) using simple regression analyses to provide estimates of the decline in FEV1 before and after removal from exposure. Results: In 90 subjects in whom FEV1 measurements had been performed for at least 1 year before removal from exposure (median 2.9 years), the mean (SE) rate of decline in FEV1 was 100.9 (17.7) ml/ year. One year after removal from exposure FEV1 had improved by a mean (SE) of 12.3 (31.6) ml. The mean (SE) decline in FEV1 was 26.6 (18.0) ml/ year in 86 subjects in whom measurements were made for at least 1 year (median 2.6 years) following removal from exposure. The decline in FEV1 was not significantly worse in current smokers than in never smokers, nor was it affected by the use of inhaled corticosteroids. Conclusion: FEV1 declines rapidly in exposed workers with occupational asthma. Following removal from exposure, FEV1 continued to decline but at a slower rate, similar to the rate of decline in healthy adults.