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AHRQ releases evidence reports on work-related asthma and other topics

The Agency for Healthcare Research and Quality recently released evidence reports and summaries on the diagnosis and management of work-related asthma, the effects of omega-3 fatty acids on eye health and child and maternal health, the use of spirometry for chronic obstructive pulmonary disease, evaluation and treatment of acute stroke, and impaired glucose tolerance and fasting glucose.

The reports were prepared by Evidence-based Practice Centers (EPCs) supported by AHRQ. There are 13 AHRQ-supported EPCs. They systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments.

The goal is to inform health plans, providers, purchasers, and the health care system as a whole by providing essential information to improve health care quality. All of AHRQ's EPC reports and technical reviews that have been published to date are available online and through the ARHQ Clearinghouse. Go to http://www.ahrq.gov/clinic/epcix.htm.

Diagnosis and Management of Work-related Asthma. Evidence Report/Technology Assessment No. 129 (AHRQ Publication No. 06-E003-1, summary, and 06-E003-2, full report). Available from the AHRQ Publications Clearinghouse.

Occupational asthma has become the most prevalent occupational lung disease in developed countries. More than 250 asthma-causing agents have been identified, and new causes are identified each year. Approaches to managing the illness range from pharmacological treatment to removing the worker completely from the site of exposure. Decisions about treatment have important economic implications for workers, industry, health care providers, and society as a whole.

The American College of Chest Physicians requested this study, and proposed to translate the findings into an evidence-based guideline for health care providers and consumers. Researchers at the University of Alberta EPC conducted a systematic review of the scientific literature and found that additional research is needed to guide clinicians in the diagnosis and management of work-related asthma.

There is no definitive diagnostic test for the condition. Highly specific tests for particular asthma-causing agents, called "specific inhalation challenges," are often cited as a "gold standard" for diagnosis. These tests, where the patient is exposed to the suspected asthma-causing agent, are not widely available and cannot be used with some patients or in situations where the asthma-causing agent has not been identified. The researchers concluded that, in situations where a specific inhalation challenge cannot be performed, other diagnostic tests could be used. For example, specific skin prick tests or a nonspecific bronchial provocation challenge may help support or rule out a diagnosis, but no single test yet yielded results that would warrant its use as a substitute for a specific inhalation challenge. A review of the literature found support for combined testing (such as using the specific skin prick test to enhance the specificity of a non-specific bronchial provocation challenge); however, more research is needed to determine which combination of tests would be an adequate replacement for a specific inhalation challenge.

Researchers also found that workers who remain exposed to the agents that cause asthma will experience decreasing lung capacity over time. Workers whose exposure ceases will generally experience improvement, but many will continue to have symptoms and need medical treatment. The evidence is insufficient to draw conclusions about those workers who reduce rather than cease their exposure.

Other recent reports have been issued on the following topics:

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