A 42-year-old woman with a 3-year history of intermittent asthma presents to occupational medicine clinic. She works as a quality control technician at a chemical manufacturing plant with regular exposure to toluene diisocyanate (TDI) fumes. Over the past 6 months, she has noticed progressive wheezing, dyspnea, and nocturnal cough that occur exclusively during her 4-day work weeks and completely resolve during her 3-day weekends and 2-week annual vacation. She denies symptoms on days she calls in sick. Physical examination reveals mild end-expiratory wheeze bilaterally. Spirometry performed at 8 AM after a weekend off shows FEV1 of 92% predicted. Spirometry repeated at 5 PM on a work day shows FEV1 of 68% predicted. She has never smoked and has no atopic history. Which of the following is the most appropriate initial management?

1. A)Initiate high-dose inhaled corticosteroid-long-acting beta-2 agonist therapy to achieve baseline FEV1 control regardless of workplace exposure
2. B)Refer for intradermal skin testing with serial TDI conjugate concentrations to establish specific sensitization threshold
3. C)Implement environmental controls, use respiratory protection when exposure cannot be avoided, and monitor pulmonary function at baseline and during work exposureGABARITO
4. D)Recommend immediate cessation of employment and expedite disability benefits to prevent irreversible airway remodeling
5. E)Prescribe as-needed short-acting beta-2 agonist inhalers to use only when symptoms develop during work shifts