Follow-up survey of patients with occupational asthma

Abstract

Background Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual’s career and income can be significant. Aims We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. Methods Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. Results We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8–48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. Conclusions The negative impact of OA on people’s careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health.

British Thoracic Society Clinical Statement on occupational asthma

“…Health surveillance is a form of secondary prevention (similar in concept to health screening) that aims to identify workers with OA at an early stage, reducing the severity and impact of the disease 15 16. When workers are part of a health surveillance programme, there is some evidence that the diagnostic process is shorter and that the cases identified are less severe 17 18. Unfortunately, most patients developing OA are not identified early through this process, as only ~30% of British workers have access to occupational health 19…”

“…Any communication requires explicit consent (preferably in writing) and patients should have the opportunity to comment on the factual content of letters or medical reports prior to their being sent. In general, communication is easier, and outcomes are often better, where access to an occupational health service is available 18…”

Occupational Asthma: The Knowledge Needs for a Better Management

“…A reduced delay between the symptoms onset and diagnosis of OA can influence the subsequent course of the disease. Patients with the shortest durations of employment had the highest rate of recovery ( Rachiotis et al , 2007 ) and an early detection of OA and care in specialist centers are associated with a more favorable prognosis ( Feary et al , 2020 ). Asthma from LMW agents nearly always has an onset within the first 2 or 3 years of exposure ( Lau and Tarlo, 2019 ), while asthma for HMW agents is recognized with a longer interval between the beginning of exposure the onset of symptoms in the workplace, and the diagnosis of OA ( Miedinger et al , 2010 ; Vandenplas et al , 2019 ).…”

“…Furthermore, additional information is needed regarding the best education methods to increase patients’ awareness about inducers and triggers ( Walters et al , 2015 ) for these two types of OA. It has been shown that referral to an occupational health service may also improve the OA outcomes ( Feary et al , 2020 ).…”

“…Related to the importance of early detection and appropriate treatment of OA ( Vandenplas et al , 2012 ; Tarlo and Lemiere, 2014 ; Cormier and Lemière, 2020 ; Tiotiu et al , 2020 ), information regarding the need for pharmacological treatment to achieve asthma control and, eventually, specific immunotherapy or other therapeutic options to modify the natural history of the disease is useful when assessing OA patients. The diagnosis and evolution of OA may affect worker’s career, income and, sometimes, can lead to unemployment ( Feary et al , 2020 ). The fear of losing work and income may make workers reluctant to report respiratory symptoms in the workplace and may delay the OA diagnosis and treatment.…”