GPs to check for work-related asthma
MedWire News: GPs have been reminded to check for work-related causes of asthma in new guidance published by the Royal College of Physicians.
Over 200 substances such as chemicals, plant extracts and certain metals can trigger occupational asthma. GPs are advised to ask patients about such potential triggers and whether their asthma improves on days when they are off work, before referring them for specialist care.
The guidance stresses the importance of avoiding an inaccurate diagnosis, given the potential impact on the patient's future employment. Thus occupational asthma should not be diagnosed on the basis of a positive history alone, but based on serial peak flow measurements both at and away from work, as well as specific IgE or skin-prick tests for causative agents with a clear immunological mechanism.
GPs should also obtain the patient's written consent when communicating with an employer to inform them of the diagnosis and the need to protect the patient from further exposure.
According to the guidance, around one in six cases of asthma in people of working age is caused, or aggravated, by their work environment. Early diagnosis and early avoidance of exposure to the causative agents offer the best chance of recovery - yet half of the UK workforce is employed by small- and medium-sized enterprises that tend not to provide occupational healthcare.
Dr Paul Nicholson, lead author of the guidance, said: "Highlighting the prevalence of occupational asthma is absolutely key, as too often work-related factors are overlooked leading to unnecessary delays in proper investigation and management. When a patient displays signs of asthma, doctors should be enquiring about the patient's job, the materials they work with, and whether their symptoms improve regularly when away from work."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Caroline Price