RESUMO
OBJECTIVE: Description of three cases of work-related asthma. DESIGN: Retrospective clinical observations. SETTING: Primary care clinics in the centre of the metropolitan health area of Madrid. PATIENTS: A 19-year old male who worked in the manufacture of Psyllium and reported one month's evolution of an irritative cough on getting up in the morning. A 33-year-old male who worked as a car mechanic and reported episodes of respiratory difficulty while at work. A 17-year-old male employed by a bread manufacturer who attended because of a catarrhal condition accompanied by respiratory difficulty. MEASUREMENTS AND MAIN RESULTS: The maximum expiratory flow monitor (MEFM) was used to measure maximum expiratory flow (MEF) in two patients. The third was temporarily separated from his work environment. The monitoring of the MEF showed a slow fall of 25% in the patient who worked with Psyllium and a rapid fall of 36% in the mechanic, which coincided with the symptoms. The patient with asthma probably caused by flour evolved favourably while off work and deteriorated again on returning to work. The allergological study showed sensitivity to Psyllium, Isocyanate and flour, respectively. The three patients stayed asymptomatic on being separated from the catalysing substances. CONCLUSIONS: The early diagnosis of work-related asthma requires a high level of diagnostic awareness. It is extremely important to separate the patient from the catalysing agent. The MEFM is a very useful instrument of diagnosis for the primary care doctor.
