Occupational Asthma Reference

Ellis PR, Walters GI, Missed opportunities to identify occupational asthma in acute secondary care, Occup Med, 2018;68:56-59,https://doi.org/10.1093/occmed/kqx167

Keywords: OA, diagnosis, history,UK

Known Authors

Gareth Walters, Heartlands Gareth Walters

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Abstract

Background
Occupational asthma (OA) accounts for one in six cases of new-onset adult asthma. Despite this it remains under-recognized in the UK. Delayed and missed diagnoses of OA lead to poor health outcomes for workers at significant cost to the UK economy. The burden of occupational aetiology on hospital admissions with asthma is not known.

Aims
To measure how frequently medical professionals consider occupational aetiology in patients presenting to secondary care with acute asthma symptoms.

Methods
We reviewed electronic records of working-age patients with asthma symptoms, presenting to three sites at a large West Midlands acute hospital NHS trust. We searched emergency department (ED) and acute medical unit (AMU) admission documents, looking specifically at documentation of employment status, job role and work effect on symptoms. We also examined the effect of using a prompt for enquiry about occupation contained within the clerking pro-forma.

Results
We searched 100 ED and 100 AMU admission documents. Employment status was established in only 20–31% of patients and none were asked about the effect of their work on current asthma symptoms. The use of a clerking pro-forma, including a prompt for occupation, increased documentation to 63% from 10 to 14% where an enhanced pro-forma was not used.

Conclusions
Enquiry into employment status and work effect in working-age patients with asthma symptoms presenting to the ED and the AMU is poor. These may be missed opportunities to identify OA. We propose medical education about high-risk exposures and the use of pro-formas including prompts about occupational exposures.

Plain text: Background Occupational asthma (OA) accounts for one in six cases of new-onset adult asthma. Despite this it remains under-recognized in the UK. Delayed and missed diagnoses of OA lead to poor health outcomes for workers at significant cost to the UK economy. The burden of occupational aetiology on hospital admissions with asthma is not known. Aims To measure how frequently medical professionals consider occupational aetiology in patients presenting to secondary care with acute asthma symptoms. Methods We reviewed electronic records of working-age patients with asthma symptoms, presenting to three sites at a large West Midlands acute hospital NHS trust. We searched emergency department (ED) and acute medical unit (AMU) admission documents, looking specifically at documentation of employment status, job role and work effect on symptoms. We also examined the effect of using a prompt for enquiry about occupation contained within the clerking pro-forma. Results We searched 100 ED and 100 AMU admission documents. Employment status was established in only 20-31% of patients and none were asked about the effect of their work on current asthma symptoms. The use of a clerking pro-forma, including a prompt for occupation, increased documentation to 63% from 10 to 14% where an enhanced pro-forma was not used. Conclusions Enquiry into employment status and work effect in working-age patients with asthma symptoms presenting to the ED and the AMU is poor. These may be missed opportunities to identify OA. We propose medical education about high-risk exposures and the use of pro-formas including prompts about occupational exposures.

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Associated Questions

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What is the sensitivity and specificity of respiratory questionnaires in the diagnosis of validated cases of occupational asthma?
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Comments

A patient's occupation seems far from the minds of physicians and nurses seeing patients with acute asthma in emergency and hospital admission services, despite the significance of occupation as a cause of the asthma in 15-20% and the consequences of having poorly controlled asthma in all those in employment. A survey of acute asthma in patients 16-64 years old showed that occupation was recorded in 10-14% when there was no prompt on the admission proformas, increasing to 63% when there was a specific item on the proforma. despite this there were no records of work-relationship in any of the 200 studied.
10/26/2018

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