Answer to Question 1.1:

Asthma caused by isocyanates, acrylates, chromium salts.

Answer to Question 1.2:

- Asthma or allergic alveolitis caused by wood dusts (specify wood type)
- Asthma caused by isocyanates.

Answer to Question 1.3:

Asthma caused by latex, sterilisation agents aerosols (e.g. gluteraldehyde), psyllium, antibiotics (penicillins/cephalosporins), enzymes, formaldhyde .

Answer to Question 1.4:

Asthma caused by sulphites and persulphates, vegetable gums, formaldehyde, sericin, henna.

Answer to Question 1.5:

Asthma caused by chromium salts, nickel.

Answer to Question 2.1:

It is possible that his symptoms could be work-related, although one would want to exclude other common chest problems such as tuberculosis and chronic obstructive disease (smoking history) etc. and heart problems such as cardiac failure.

Establish work-relatedness of symptoms:

• The worker denies having symptoms prior to working at the current workplace.
• The worker complains of work-related symptoms which may or may not deteriorate over the working day or working week.
• The symptoms improve when the worker is away from current work on weekends and extended leave.
• The worker is exposed to excessive dust in his job e.g dough making.

(Back to Question #2)

Answer to Question 2.2:

• Lung function spirometry, including test for reversibility e.g. post-bronchodilator test.
• Serial Peak expiratory flow rates over 3 weeks (at work, away from work and return to work).
• May require test for non-specific bronchial hyperresponsiveness.
• Skin prick test or RAST for common flour dust allergens e.g. wheat, rye, fungal alpha-amylase.

(Back to Question #2)

Answer to Question 2.3:

Have another look at the spirometry test results?

• Obstructive loop.
• FEV1/FVC=55% (airway obstruction).
• Significant airway reversibility (14% increase post bronchodilator) suggests asthma.
• FEV1 70% of predicted (mild impairment).

(Back to Question #2)

Answer to Question 2.4:

Have another look at the skin prick test results?

Positive SPT to flour extracts (wheat, rye, barley, soya, corn, oats) and fungal alpha amylase.

(Back to Question #2)

Answer to Question 2.5:

Bakers' asthma.

(Back to Question #2)

Answer to Question 2.6:

• Remove the patient from exposure.
• Treat the asthma (early use of inhaled steroids improve prognosis).
• Interim measures while awaiting placement: respirators.

(Back to Question #2)

Answer to Question 2.7:

• Submit a claim for compensation (under COIDA).
• Submit first medical report to the regional Inspector of Labour (under OHSA).

(Back to Question #2)