Are we failing workers with symptoms suggestive of occupational asthma?

Abstract

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.

What's in this issue

“…The paper by Fishwick et al in this issue is therefore a challenge to all of us who work in primary care. 8 Ninetyseven consecutive patients from six secondary care centres with a special interest in occupational asthma were recruited into the study. 96% had consulted their GP at least once with work-related respiratory symptoms.…”

Management of work-related asthma: guidelines and challenges

“…Systematic research on incidence rates, health impact and socioeconomic burden of occupational asthma is sparse and national estimates are difficult to compare [5][6][7]. Work-related asthma imposes a significant financial cost that is mainly borne by affected employees and government [8,9]. On top of physical impairment, the patient faces problems regarding employment [10] and other psychosocial problems [11].…”

“…When studying the delaying factors in the diagnostic course [9,[33][34][35], starting symptomatic asthma therapy without being aware of the causal link with occupational exposure is one of the main reasons of delay [36,37]. In this respect, the availability of effective medication for the control of asthma often results in the fact that physicians do not sufficiently look for an occupational (or other) aetiology in their asthmatic patients!…”

Knowledge and utilisation of occupational asthma guidelines in primary care

“…[9][10][11][12] Studies from a range of countries, however, have identified average delays of several years in the patient journey for symptomatic workers, which in part relate to the condition being under-recognised in primary care. [13][14][15][16] National published guidelines for the prevention, The full version of this paper, with online Appendix, is available at www.thepcrj.org …”

“…PRIMARY CARE RESPIRATORY JOURNAL www.thepcrj.org [13][14][15][16] which may in part relate to deficiencies in undergraduate and postgraduate occupational training. This is highly relevant for affected workers, since early and accurate diagnosis linked with exposure modification offers the best prognosis, both for health and socioeconomic outcomes.…”