Abstract
Health care providers frequently are asked to advise patients with asthma about the circumstances in which they can work or pursue high-risk activities. Several national organizations have developed guidelines to aid the practitioner in addressing this task. The most widely disseminated policy statement, the Guidelines for the Diagnosis and Management of Asthma developed by the National Asthma Education and Prevention Program (NAEPP) (1,2), focuses mainly on nonoccupational risk factors. Although a special section gives additional brief guidance on the management of occupational asthma, issues concerning what activities patients with asthma should avoid or undertake with extreme caution are not addressed. In addition to the NAEPP guidelines, there are several other consensus or policy statements on the management of asthma in various settings (3-6). Most of these focus on the pharmacologic management of asthma, either in preventing exacerbation or in rescue management. The American College of Chest Physicians (3) consensus statement takes the most comprehensive approach to workplace asthma, focusing on diagnosis and management of the sick worker, rather than preventing exacerbations in someone with preexisting asthma. Health providers need more detailed guidelines to counsel and advise individuals with asthma on how to live their lives fully, while minimizing their risk for significant illness. The specific goals of this statement are to review public health, ethical, legal, policy, and behavioral issues that impact on asthma management; develop a consensus approach to evaluating a patient with asthma considering employment in a specific workplace; outline the medical, behavioral, workplace, and management issues that should be considered in assessing an individual's fitness for work, school, or recreation; create a basis for school and parent groups to be advocates for environmental health; provide guidelines for recommending accommodations in the workplace that incorporate the provisions of the Americans with Disabilities Act and establish guidelines for special activities that may impact adversely on patients with asthma. The target audience for these guidelines includes all health care practitioners, workplace managers, school administrators, and the general public.
