UK GP's failing to recognize occupational asthma

A new report published this month in the scientific journal, Occupational Medicine, finds that many people who develop work related asthma are not correctly diagnosed by GPs at least in the UK. Work related factors cause one in ten cases of asthma in adults but an audit of patient records suggests that GPs do not recognize this in three quarters of patients.

Every year up to 3000 people in the develop asthma because they are exposed to materials at work. Early diagnosis of occupational asthma and avoidance of further exposure can lead to complete recovery. However, failures to diagnose the condition and delays in accessing specialist advice mean that two thirds of sufferers never make a full recovery.

Researchers at the Institute of Occupational and Environmental Medicine, University of Birmingham conducted an audit of the electronic patient records of working age asthmatics. Occupation was only recorded in 14% of the cases and in nearly all cases (98%) GPs failed to record if they had asked simple screening questions about whether their asthma symptoms improved at weekends and on holiday.

Dr Gareth Walters, the lead author, said “Most workers with new asthma symptoms present to their GPs first, so it is important for health care professionals working in primary care to recognize when these symptoms might be caused by or related to work. Currently occupational asthma is very costly to the NHS and to society - and an early diagnosis can prevent on-going debilitating symptoms, time off work and financial loss for the worker.”

The Society of Occupational Medicine who published the study urged GPs to always question patients who present with respiratory problems about their job, the materials they work with and whether their symptoms improve when they are away from work. They should also be aware of those trades that carry particular risks such as vehicle paint sprayers, bakers, laboratory workers and workers in the chemical industry. The commonest causative agents are isocyanates, flour, cutting oils, laboratory animals and insects, enzymes and wood dusts.

“Highlighting the prevalence of occupational asthma is absolutely key, as too often work-related factors are overlooked,” said Dr Richard Heron, President of the Society of Occupational Medicine. “About 70% of the UK workforce does not have access to occupational health care. This makes it vital that general practitioners are assessing asthma patients for potential work-related causes and referring to specialists where appropriate. More importantly, employers need to be aware of those substances that may cause asthma and where possible remove them or minimize exposure.”