Chest
Volume 131, Issue 6, June 2007, Pages 1768-1775
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ORIGINAL RESEARCH
ASTHMA
Occupational Asthma and Work-Exacerbated Asthma: Factors Associated With Time to Diagnostic Steps

https://doi.org/10.1378/chest.06-2487Get rights and content

Background

Little is known regarding the factors associated with the times for patients' first physician visit, the first physician suspicion of work-related asthma (WRA), and final diagnosis after the onset of WRA symptoms. This study examined individual and work-related factors that are associated with longer times to these diagnostic milestones among groups with occupational asthma (OA) and work-exacerbated asthma (WEA).

Method

Suspected WRA cases were identified from an occupational lung disease clinic and claimants to the Ontario Workplace Safety and Insurance Board (100 patients each). Questionnaire administration and chart review were undertaken.

Results

Eighty participants were classified as having sensitizer-induced OA and 87 as having WEA. For the OA group, the risk factors for delay included male sex, being unmarried, low education, and lack of awareness of association of symptoms with work. Other factors included older age, being the sole income earner, and lack of knowledge of the Workplace Hazardous Materials Information System program. For WEA, lower household income, lower education, absence of a health-and-safety program at work, absence of a union, and lack of awareness of OA and of agents at work that could affect asthma significantly increased the time to diagnostic milestones.

Conclusions

Different factors affect the diagnostic milestones for OA and WEA. Findings suggest a need for educational programs for workers who are at risk of OA and WEA and a need for further primary care physician education on WRA.

Section snippets

Materials and Methods

The Research Ethics Board, the University Health Network, and the University of Toronto provided study approval. Patients with suspected WRA from a occupational lung disease clinic of a teaching hospital, with clinical visits from 2002 to 2004, and additional Ontario WSIB claimants from the same time period completed a questionnaire, which was slightly modified from that used in our pilot study.13 The questionnaire included age, education level, self-perception of work conditions, and physician

Results

From 200 participants, 100 were recruited from among 102 consecutive eligible patients in the occupational lung disease clinic, and 100 others from consecutive Ontario WSIB asthma claimants. Eighty participants (40%; 60 clinic patients and 20 WSIB claimants) were classified as having sensitizer-induced OA, as follows: definite sensitizer-induced OA, 23 participants; probable sensitizer-induced OA, 26 participants; and possible sensitizer-induced OA, 31 participants, The most common agents to

Discussion

Potential interventions to reduce the time to the diagnosis of WRA include changing regulatory or enforcement policies, better access to compensation, employer education, education of primary treating physicians, and education of pulmonary specialists on the diagnosis and management of WRA. This study extends previous findings13 by assessing larger groups, including both OA and WEA patients, from populations in clinics and persons who had filed workers compensation claims. Personal and work

ACKNOWLEDGMENT

The authors wish to thank Maya Obadia for assistance with extraction of file data.

References (14)

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Presented in part at the 2005 American Thoracic Society Meeting, San Diego, May 2005.

Funded by a research grant provided by the Research Advisory Council of the Workplace Safety and Insurance Board (Ontario).

Dr. Tarlo has provided consultation to the Ontario Workplace Safety and Insurance Board (WSIB) and has assessed Ontario WSIB claimants at the request of the Ontario WSIB. The WSIB Research Advisory Council is an independent committee awarding research funds for the Ontario WSIB; this is not thought by the author to be a conflict of interest. Drs. Santos, Peyrovi, Lou, and Liss, and Ms. Jung have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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