Quality of occupational history assessments in working age adults with newly diagnosed asthma.
BACKGROUND
Approximately 10 to 15% of new-onset asthma in adults is attributable to occupational exposure. The occupational history is the most important instrument in the diagnosis of occupational asthma (OA).


OBJECTIVE
To assess the quality of occupational histories obtained by health-care providers and to measure the prevalence of clinician-diagnosed OA in a population at elevated risk for OA.


METHODS
An academic US Department of Veteran Affairs medical center.


METHODS
One hundred ninety-seven adults (age range, 18 to 55 years) with newly diagnosed asthma who had completed pulmonary function testing (PFT) and a structured respiratory health questionnaire.


METHODS
We conducted a structured retrospective comparison of occupational respiratory health history documented by clinicians with data documented by patients on a structured questionnaire. We analyzed PFT results to assess physiologic impairment. We also conducted a structured examination of the actions taken by health-care providers based on their occupational history assessments.


RESULTS
Patient self-reports of respiratory exposures and symptoms were common. A job title was documented by one or more clinicians in 75% of patient medical records. Additional occupational history data were charted much less frequently. A diagnosis of OA was made in only 2% of patients. Clinical action to address OA was documented for only one patient.


CONCLUSIONS
Clinicians who manage adults with newly diagnosed asthma take incomplete occupational histories. We detected discordance between the occupational exposure histories documented by patients and those charted by clinicians. OA may go unrecognized and possibly undermanaged by clinicians.
Shofer
Scott
S
Department of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, USA.
Haus
Brian M
BM
Kuschner
Ware G
WG
D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D016273:Occupational Exposure; D016272:Occupational Health; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires