2. Which agents cause reactive airways dysfunction syndrome (RADS)? Which agents cause reactive airways dysfunction syndrome (RADS)? M. S. Shakeri, F. D. Dick and J. G. Ayres 2008 Dr.salmani

3. Aim: To identify agents associated with RADS. Method: A systematic review Keywords: Asthma; irritant-induced asthma; reactive airways dysfunction

4. Background: Brooks (20 years ago): – RADS – Symptoms within 24 h of a single, massive, chemical exposure. SWORD: – prevalence of asthma : intensity and length of acute exposure the duration of follow-up suspected agent

6. Methods: Methods: systematic review of RADS using Brooks' criteria searching MEDLINE, EMBASE and CINAHL from 1985 to 2005 search was complemented (hand-searching) :  conference abstracts published in the American Review of Respiratory & Critical Care Medicine  European Respiratory Journal and Thorax

7. Results:  84 articles and abstracts were found but 25 of the articles were excluded:  no cases meeting RADS criteria  duplicate publications  follow-up studies

8. Results... 633 cases in the 59 articles: – 63 cases met Brooks' criteria – 570 had insufficient data 63 RADS cases: – 38 (60%) male – 12 (19%) female – 13 (21%) gender was not reported. mean age: – 37.8 (SD 11.6) years – age was not reported for 7 people

9. Results... Agents: – chlorine (9 subjects) – TDI (6 subjects) – oxides of nitrogen (5 subjects) – Acetic acid (4 subjects) – sulphur dioxide (4 subjects) – paint (4 subjects)

10. Results... location of exposure: workplace (n = 51) environment (8 subjects), home (3 subjects) not reported (1 subject)

11. Results... Atopic: – The proportion of non-atopic patients was higher than atopic patients – 41% of RADS group atopic status was not reported.

12. Results... Symptoms: – common symptoms: Dyspnoea, cough & wheeze. 71% dyspnoea (n = 45) 65% cough (n = 41) 43% wheeze (n = 31) 43% chest tightness (n = 27) 29% upper respiratory irritation (n = 18) 25% eye irritation (n = 16) 16% mucus production (n = 10) 6% cyanosis (n = 4)

13. Results... symptom duration: The median and interquartile range (IQR) for symptom duration in patients who met Brooks' criteria was 13 (6.5–43.5) months.

14. Results... In 63 RADS: – 19 (30%): smokers – 21 (33%) patients were non-smokers – 7 patients (11%): ex-smokers – 16 (25%): no information

15. Summery: most agents: Chlorine, TDI, oxides of nitrogen Most exposures: in the workplace and affected men (60%). commonest symptoms: Dyspnoea (71%) and cough (65%) Median symptom duration: 13 months