New guidance launched today calls on doctors to explore the potential job-related causes of asthma when diagnosing patients. An estimated one in six cases of asthma in people of working age is either caused or aggravated by work-related factors.[i]
The guidance, produced by the Royal College of Physicians (RCP) and funded by NHS Plus, advises hospital doctors to question patients with respiratory problems about their job, the materials they work with and whether their symptoms improve when they are away from work. They also need to be aware of those that carry particular risks, such as laboratory workers, and workers in the chemical industry. Doctors are also being urged to not solely rely on the patient’s history, but to conduct tests such as peak flow measurements at work and away from work, and skin-prick tests for allergy to substances that could potentially be causing the illness.
Over 200 substances have been shown to cause occupational asthma; these include plant substances, chemicals and certain metals, with contributing factors such as cigarette smoking making some workers more susceptible.
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.
Professor John Harrison, director of NHS Plus, said:
About 70% of the UK workforce does not have access to occupational health care. This makes it vital that hospital doctors and respiratory specialists are assessing asthma patients for potential work-related causes and advising appropriate treatment and preventative measures. By following this guidance they will offer their patients the best chance of recovery. The guidelines will benefit all doctors and healthcare professionals caring for people of working age, a long standing goal of NHS Plus.
Dr Sian Williams, clinical director of the RCP Health and Work Development Unit, said:
Whilst failing to spot the disease early can hinder a patient’s recovery, an incorrect diagnosis of occupational asthma can also have negative consequences; the worker may be required to change their ways of working, or even their job. We recommend that doctors assess their patient’s symptoms, history and conduct tests so they can make a fully informed diagnosis.
The guidance, published in the Journal of Clinical Medicine, recommends that doctors seek consent from sufferers to communicate with the employer to advise them of the diagnosis and of the need to protect the patient from further exposure.
For further information, please contact Andrew McCracken, RCP Communications and New Media Adviser, on +44 (0)203 075 1354 / 07990 745 608, or email andrew.mccracken@rcplondon.ac.uk
[i]Toren K, Blanc P. Asthma caused by occupational exposures is common: a systematic analysis of estimates of the population-attributable fraction. BMC Pulm Med 2009;9:7.
- Download Concise guidance: diagnosis, management and prevention of occupational asthma
- Occupational asthma is a prescribed disease for the purpose of Industrial Injuries Disablement Benefit. Access information about this benefit on the direct.gov.uk website.