Long-term outcomes (median 8.5 years) of 274 patients with work-related asthma (WRA) after specific inhalation challenge (SIC), comparing remission rates and predictors of difficult-to-treat asthma between SIC-positive (occupational asthma, n=110) and SIC-negative (n=164) groups.
Clinical asthma remission off-treatment was rare (4%; n=12), and 32% (n=87) had difficult-to-treat asthma — with no significant difference between SIC-positive and SIC-negative groups. Strongest predictor of difficult-to-treat asthma at follow-up was having difficult-to-treat asthma at diagnosis (adjusted OR 5.73; 95% CI 2.66–12.35); other predictors included age ≥45.8 years, poor Asthma Control Test score (<20), and GINA Steps 4–5 medication use at diagnosis.
Response rate was only 44% (274/618), raising concern for non-response bias. The study lacked a non-WRA control group. Outcomes relied on self-reported questionnaire data without objective pulmonary function confirmation at follow-up.
Patients with work-related asthma rarely achieve full clinical remission, so long-term follow-up is essential. Clinicians should flag patients with poorly controlled asthma at diagnosis — especially older patients on high-step therapy — for closer monitoring and proactive support.
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