Update of the British Occupational Health Research Foundation (BOHRF) guidelines on occupational asthma.

Background: Occupational asthma (OA) is an important public health issue preventable by elimination of the causal agents at work. However, new occupational asthmagens are constantly introduced at work requiring updated knowledge among health professionals. Aims and objectives: Our aim was to update the 2010 BOHRF guidelines on OA to take into account new occupational asthmagens, and improve early recognition, and so prevention of new OA cases. Methods: A literature systematic review (Embase and Medline) was conducted, from 2010 to 2016, using MeSH and free-text terms for combinations of ‘work’ and ‘asthma’. The retrieved references were blindly evaluated by paired reviewers, and critically appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) scoring system to link evidence-quality evaluations to clinical recommendations. Results: From the 2,424 references retrieved, 133 met the inclusion criteria (see PRISMA flow-chart diagram). Briefly, most of the occupations already known at higher OA risk, such as bakers, and painters, were confirmed, but new ones emerged such as cleaners, suggesting also underlying irritant-mediated causal mechanisms. Also, new potential frameworks for better OA management and health surveillance arose. Conclusions: Updated evidence-based guidelines on OA are key to help health professionals improving early diagnosis, and so prevention of OA.