Occupational Asthma More Likely to Be Delayed, Missed

Many intrinsic and extrinsic factors hinder primary health care professionals from identifying a patient as having occupational asthma.

Occupational asthma (OA) is often overlooked as a diagnosis in patients due to lack of organization and delivery of primary asthma care, negative OA-related beliefs, lack of formal education among primary health care professionals (HCPs), and limited exposure to OA, research published in BMJ Open Respiratory Research reveals.

Although OA accounts for 1 in 6 cases of adult-onset asthma, many cases of OA fail to be identified, which leads to lung function loss and poor employment-related outcomes. This finding is borne out in primary care, as the prevalence of clinician-diagnosed OA is far lower than expected among certain populations.

Time pressure, lack of expertise, and restricted access to specialists contribute to a lack of enquiry about patients’ work and work-related symptoms by their primary HCPs, emphasized the investigators.

The current study served to examine organizational factors, beliefs, and behaviors among HCPs that may impede the identification of OA in primary care.

Investigators conducted 20- to 45-minute interviews with 11 primary HCPs, including general practitioners and practice nurses, from urban and rural settings in West Midlands, United Kingdom. Training and experience, perceptions and beliefs, systems constraints, and variation in individual practice were identified as the 4 primary themes that influenced the identification of OA.

Findings showed that HCPs had been inadequately educated about OA at every stage of training and practice and had limited clinical exposure to the condition. A lack of formal education during training as well as a variance of clinical exposure to OA are likely to influence disease-specific beliefs among HCPs, the study authors wrote.

Beliefs about OA and clinical behavior with working-age individuals with asthma varied among the HCPs interviewed, too, with some thinking that OA has little impact on society, locality, or individual practice. Negative beliefs regarding OA make HCPs less likely to enquire about the condition, noted the authors.

Some HCPs reported that although OA was mentioned during their undergraduate study, more emphasis was placed on diagnosis and treatment of asthma rather than causation. Others reported feeling anxiety when making OA diagnoses,due to fear of subjecting the patient to job loss, difficulty finding unexposed work, and false diagnoses leading to avoidable job loss.

In addition, time and referral pressure, lack of continuity, use of guidelines and templates, and external targets were identified as issues regarding poor organization of asthma care.

Patients have the best chance of a full recovery from OA if the condition is recognized early and the patient is removed from the causative exposure, the authors concluded. In the United Kingdom, asthma guidelines recommend that HCPs ask patients with new-onset or reactivated childhood asthma symptoms about the nature of their work to rule out OA as a possible causation.

However, despite specific guidelines set in place regarding identification and referral of suspected OA, many limitations exist that impede identification and subsequent referral of a patient with OA to a specialist. Further investigation into whether screening patients with asthma in primary care for OA is beneficial and what the optimal tool would be for doing so are needed.

Reference

Walters GI, Barber CM. Barriers to identifying occupational asthma among primary healthcare professionals: a qualitative study. BMJ Open Respir Res. Published online August 8, 2021. doi:10.1136/bmjresp-2021-000938