Question:
In evaluating occupational asthma, how do you determine maximal medical improvement and how do you apportion impairment in people who continue to smoke?
Answer:
While smoking is known to cause chronic obstructive lung disease, it has not been shown to be a risk factor for the development of occupational asthma—it does not increase the likelihood of allergic sensitization. In fact, in Western Red Cedar induced asthma, studies have shown smoking to be protective (a decreased incidence of asthma).
Tobacco smoke is a lung irritant and frequently aggravates asthma. Someone who smokes, despite being told of its effect on her asthma, may not be at maximal medical improvement (MMI). People frequently continue to smoke despite adverse consequences and physician advice. Physicians should not refuse to rate impairment of smokers, even though their condition could be improved by smoking...
