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Aims: To assess the route to secondary care for patients with possible occupational asthma, and to document the duration of workrelated symptoms and referral times.Methods: Consecutive patients with suspected occupational asthma were recruited to a case series from six secondary care clinics with an interest in occupational asthma. Semi-structured interviews were performed and hospital case notes were reviewed to summarise relevant investigations and diagnosis.Results: 97 patients were recruited, with a mean age of 44.2 years (range 24-64), 51 of whom (53%) had occupational asthma confirmed as a diagnosis. Most (96%) had consulted their general practitioner (GP) at least once with work-related respiratory symptoms, although these had been present for a mean of 44.6 months (range 0-320 months) on presentation to secondary care. Patients experienced a mean delay for assessment in secondary care of 4 years (range 1-27 years) following presentation in primary care.Conclusions: Significant diagnostic delay currently occurs for patients with occupational asthma in the UK.

This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.

Objectives: To investigate the levels of agreement between expert respiratory physicians when making a diagnosis of occupational asthma. Methods: 19 cases of possible occupational asthma were identified as part of a larger national observational cohort. A case summary for each case was then circulated to 12 physicians, asking for a percentage likelihood, from the supplied information, that this case represented occupational asthma. The resulting probabilities were then compared between physicians using Spearman's rank correlation and Cohen's k coefficients.Results: Agreement between the 12 physicians for all 19 cases was generally good as assessed by Spearman's rank correlation. For all 66 physician-physician interactions, 45 were found to correlate significantly at the 5% level. The agreement assessed by k analysis was more variable, with a median k value of 0.26, (range -0.2 to +0.76), although 7 of the physicians agreed significantly (p,0.05) with >5 of their colleagues. Only in one case did the responses for probability of occupational asthma all exceed the ''on balance'' 50% threshold, although 12 of the 19 cases had an interquartile range of probabilities not including 50%, implying ''on balance'' agreement. The median probability values for each physician (all assessing the identical 19 cases) varied from 20% to 70%. Factors associated with a high probability rating were the presence of a positive serial peak expiratory flow Occupation Asthma SYStem (OASYS)-2 chart, and both the presence of bronchial hyper-reactivity and significant change in reactivity between periods of work and rest. Conclusions: Despite the importance of the diagnosis of occupational asthma and reasonable physician agreement, certain variations in diagnostic assessment were seen between UK expert centres when assessing paper cases of possible occupational asthma. Although this may in part reflect the absence of a normal clinical consultation, a more unified national approach to these patients is required.

Testing for mutations in hereditary breast/ovarian cancer genes (BRCA1/BRCA2) is appropriate for a limited group of high-risk individuals, such as some breast cancer survivors. It is not known if survivors obtain information regarding genetic testing or whether physicians play a role in the testing decision process. Our objectives were to determine if high-risk survivors speak with physicians and relatives about BRCA genetics, and to determine their knowledge, testing intentions, and preferred information sources. We conducted a population-based cross sectional study in 1/99 at Group Health Cooperative. All 276 female current enrollees initially diagnosed with breast cancer 5-10 years prior to 6/30/98 and 40-49 years old at diagnosis were mailed a survey. Of 217 respondents, 8% spoke with ph y sicians and 53% spoke with relatives. On average, women correctly responded to 2 of 7 true/false que s tions. Respondents who spoke with physicians had higher knowledge scores than those who did not (p<.001). Respondents preferred written materials (80.6 %) and discussions with physicians (79.8%) for BRCA information. In summary, survivors have limit e d BRCA knowledge, t hough they are discussing genetics with relatives. Physicians currently give little input regarding BRCA testing, but survivors would consider their involvement helpful.