Which agents cause reactive airways dysfunction syndrome (RADS)? Which agents cause reactive airways...
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Transcript of Which agents cause reactive airways dysfunction syndrome (RADS)? Which agents cause reactive airways...
Which agents cause reactive airways Which agents cause reactive airways dysfunction syndrome dysfunction syndrome (RADS)?(RADS)?
M. S. Shakeri , F. D. Dick and J. G. Ayres 2008
Dr.salmaniDr.salmani
Aim: To identify agents associated with RADS.
Method: A systematic review
Keywords: Asthma; irritant-induced asthma; reactive airways dysfunction
Background:Background:• Brooks(20 years ago):
– RADS – Symptoms within 24 h of a single, massive, chemical
exposure.
• SWORD:– prevalence of asthma :• intensity and length of acute exposure• the duration of follow-up • suspected agent
Methods:Methods:
systematic review of RADS using Brooks' criteria
searching MEDLINE, EMBASE and CINAHL from 1985 to 2005
search was complemented (hand-searching) : conference abstracts published in the American
Review of Respiratory & Critical Care Medicine European Respiratory Journal and Thorax
Results:Results:
84 articles and abstracts were found but 25 of the articles were excluded:
no cases meeting RADS criteria
duplicate publications follow-up studies
Results...Results...
• 633 cases in the 59 articles: – 63 cases met Brooks' criteria – 570 had insufficient data
• 63 RADS cases:– 38 (60%) male– 12 (19%) female – 13 (21%) gender was not reported.
• mean age:– 37.8 (SD 11.6) years– age was not reported for 7 people
Results...Results...
Agents:
– chlorine (9 subjects)
– TDI (6 subjects)– oxides of nitrogen (5 subjects)– Acetic acid (4 subjects)– sulphur dioxide (4 subjects) – paint (4 subjects)
Results...Results...
location of exposure:
workplace (n = 51) environment (8 subjects), home (3 subjects) not reported (1 subject)
Results...Results...
• Atopic:
–The proportion of non-atopic patients was higher than atopic patients
– 41% of RADS group atopic status was not reported.
Results...Results...
Symptoms:– common symptoms: Dyspnoea, cough & wheeze.
• 71% dyspnoea (n = 45)• 65% cough (n = 41)• 43% wheeze (n = 31)• 43% chest tightness (n = 27)• 29% upper respiratory irritation (n = 18)• 25% eye irritation (n = 16)• 16% mucus production (n = 10)• 6% cyanosis (n = 4)
Results...Results...
• symptom duration:
The median and interquartile range (IQR) for symptom duration in patients who met Brooks' criteria was 13 (6.5–43.5) months.
Results...Results...
• In 63 RADS:
– 19 (30%): smokers
– 21 (33%) patients were non-smokers– 7 patients (11%): ex-smokers – 16 (25%): no information
Summery:Summery:
most agents: Chlorine, TDI , oxides of nitrogen
Most exposures: in the workplace and affected men (60%).
commonest symptoms: Dyspnoea (71%) and cough (65%)
Median symptom duration: 13 months