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Reactive Airways Dysfunction Syndrome (RADS): diagnostic criteria and forensic issues.

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Key Words: Reactive Airways Dysfunction Syndrome (RADS), Irritant-Induced Asthma (IIA)

Abstract

Reactive Airways Dysfunction Syndrome (RADS) is a pulmonary disorder characterized by the sudden appearance of new-onset asthma--or in some cases, aggravation of preexisting asthma--following exposure to a pulmonary tract irritant. When first described in the United States in 1985, RADS was defined as a new onset of asthmatic symptoms occurring within 24 hours following a single exposure to a very high concentration of a respiratory tract irritant, followed closely by demonstrable nonspecific Bronchial hyper-responsiveness. Over the years, the diagnostic criteria for RADS have been modified by a number of investigators to include the not-so-sudden onset of symptoms following either single or multiple exposures to an airborne irritant. This not-so-sudden onset asthma is now referred to as Irritant Induced Asthma (IIA).

Introduction

Reactive Airways Dysfunction Syndrome (RADS) and Irritant-Induced Asthma (IIA) are both new-onset, irritant-induced asthma. Legal representatives of both defendants and clients have displayed an increased forensic interest in these pulmonary conditions.

RADS is new-onset asthma--or in some cases, reactivation of preexisting, albeit quiescent asthma--caused by a relatively brief exposure to a very high concentration of an airborne lower-pulmonary-tract irritant. Undoubtedly, RADS has been with us for a very long time. In 1970 the Medical Journal of Australia published what might have been the first description of this condition in medical literature as defined by Australian physician Brian Gandevia, who referred to the condition as Acute Inflammatory Bronchoconstriction. Stuart Brooks and his associates are generally credited with defining the criteria for irritant-induced asthma and designating the illness as RADS (Brooks, Weiss, & Bernstein, 1995). These investigators initially listed the following eight clinical criteria for the diagnosis of RADS:

1.) A documented absence of preceding respiratory complaints.

2.) The onset of symptoms occurred after a single specific exposure incident or accident.

3.) The exposure was to a gas, smoke, fume, or vapor, which was present in very high concentrations and had irritant qualities to its nature.

4.) The...