Royal College of Physicians advises on occupational asthma

Hospital doctors should question patients with respiratory problems about their job, the materials they work with and whether or not their symptoms improve when they are away from work, new guidance developed by the Royal College of Physicians (RCP) has recommended.

The guidance has been funded by NHS Plus and urges doctors to explore the potential job-related causes of asthma when diagnosing patients, with one in six cases of asthma in people of working age estimated either to be caused or aggravated by work-related factors.

Doctors are also being advised not to rely solely on patient history, but to conduct tests such as peak flow measurements at work and away from work, and skin-prick tests for allergies to substances that could potentially be causing the illness.

They also need to be aware of those jobs that carry particular risks, such as laboratory workers.

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 whether their symptoms improve regularly when away from work,” he added.

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.”

Dr Sian Williams, clinical director of the RCP’s 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 and history, and conduct tests so they can make a fully informed diagnosis.”

The guidance also recommends that doctors seek consent from sufferers to communicate with their employer to advise them of the diagnosis and of the need to protect the patient from further exposure.

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