Background: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease. Methods: A systematic review of the published literature on the symptomatic and functional outcomes of occupational asthma was carried out after avoidance of exposure to the causative agent. Through a full search of electronic and bibliographic sources, original studies documenting complete recovery from asthma (n = 39,1681 patients) or improvement in non-specific bronchial hyper-responsiveness (NSBHR; n = 28,695 patients) were identified. The median duration of follow-up was 31 (range 6-240) months for studies of symptomatic recovery and 37 (6-240) months for studies of NSBHR. Most studies were of patients recruited from special clinics. Results: Reported rates of symptomatic recovery varied from 0% to 100%, with a pooled estimate of 32% (95% CI 26% to 38%). These rates were lower with increasing age (p = 0.019) and among clinic based populations (p = 0.053). Patients with the shortest durations of exposure ((76 months) had the highest rate of recovery (36%; 95% CI 25% to 50%), but the effect was not linear. The pooled prevalence of persistent NSBHR at follow-up was 73% (95% CI 66% to 79%). This figure was higher among patients whose disease was due to high-molecular-weight agents (p = 0.006) and, less clearly, those from clinic-based populations (p = 0.561). In between-study comparisons, no clear patterns of improvement relating to total duration of exposure or follow-up were found. From within-study comparisons there was some evidence that a shorter duration of symptoms was associated with a higher rate of symptomatic recovery. Conclusion: The available data on the prognosis of occupational asthma are insufficiently consistent to allow confident advice to be given to patients with the disease. Clinicians and epidemiologists with an interest in this disease should consider a collaborative and carefully standardised study of the prognosis of occupational asthma.

PurposeMassage therapy is very popular in the U.S. and rated by patients as helpful self-care modality. It is used for a variety of conditions: most commonly for chronic pain and musculoskeletal problems, but also to alleviate stress, anxiety, and depression. It has been reported that changes in regional cerebral blood flow measured by PET scanning when palm-pressure back massage was applied to subjects in prone position. However, the mechanism of massage therapy effect is not yet known. Therefore, we sought to examine the effects of massage on the acute stress response in healthy subjects using functional imaging and plasma catecholamines measurements. MethodsSeven healthy right-handed young males, naïve to massage therapy, qualified for the study. Exclusion criteria ranged from having depression to cardiovascular diseases. The study used a within-subject design and the cold pressor test (CPT) to trigger the acute stress response before and after a 20 minute-standardized verum or sham foot massage. Blood samples were collected at each step of the protocol. fMRI data were collected using the arterial spin labeling technique to allow for quantification of cerebral blood flow. The functional paradigm included collection of baseline (rest) and CPT both before and after massage. ResultsThere was a significant decrease in activity during stress after massage compared with pre-massage in the left caudate nucleus, rectus gyrus (Brodmann Area 11), and bilaterally in the inferior frontal gyrus. A decrease in the epinephrine and norepinephrine levels was also observed after the massage session. ConclusionThe decreased response following massage suggests a calming of the limbic-prefrontal cortical circuit that is activated during stress and effects on the sympathetic nervous system. These results provide preliminary evidence for the mechanism of massage therapy effects related to pain processing being related to reduction in a sympathetic response.