Which agents cause reactive airways dysfunction syndrome (RADS)? A systematic review

Occup Med (Lond). 2008 May;58(3):205-11. doi: 10.1093/occmed/kqn013. Epub 2008 Feb 27.


Aim: To identify those agents reported as being associated with reactive airways dysfunction syndrome (RADS).

Methods: A systematic review was undertaken. Abstracts were screened and those selected reviewed against pre-determined diagnostic criteria for RADS.

Results: Significant information gaps were identified for all measures of interest. In some articles, even the causative agent was not reported. The most commonly reported agents were chlorine (nine subjects), toluene di-isocyanate (TDI) (n = 6) and oxides of nitrogen (n = 5). Most exposures occurred in the workplace (n = 51) and affected men (60%). Dyspnoea (71%) and cough (65%) were the commonest symptoms. Median symptom duration was 13 months (interquartile range = 6.5-43.5) for RADS.

Conclusions: Although the most commonly reported agent associated with RADS was chlorine, the main finding of a general lack of adequate information on exposure, investigation and outcome suggests that to better explore RADS a more structured approach to gathering information is required. A minimum data set for reporting RADS cases is proposed.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Acetic Acid / adverse effects
  • Adult
  • Air Pollutants, Occupational / adverse effects*
  • Chlorine / adverse effects
  • Environmental Exposure
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nitrogen Oxides / adverse effects
  • Occupational Diseases / chemically induced*
  • Occupational Exposure
  • Paint
  • Respiratory Hypersensitivity / chemically induced*
  • Sulfur Dioxide / adverse effects
  • Toluene 2,4-Diisocyanate / adverse effects


  • Air Pollutants, Occupational
  • Nitrogen Oxides
  • Sulfur Dioxide
  • Toluene 2,4-Diisocyanate
  • Chlorine
  • Acetic Acid