title: Use of objective testing in the diagnosis of work-related asthma by physician specialty.
abstract: BACKGROUND
  Although early and accurate diagnosis of work-related asthma is critical to avoid unnecessary medical, legal, social, and economic consequences, little is currently known about the diagnostic practices of physicians treating workers with work-related asthma.
  
  
  OBJECTIVE
  To characterize the use of objective diagnostic testing for work-related asthma by physician specialty.
  
  
  METHODS
  A cross-sectional, descriptive, comparative evaluation was conducted of 301 workers' compensation claimants with work-related asthma.
  
  
  RESULTS
  A few claimants (36.9%) were treated by specialists in work-related asthma (allergists, pulmonologists, or occupational medicine physicians) either initially or through the course of their claim. Workers with occupational asthma were more likely to have seen a specialist than those with work-aggravated asthma (47.9% vs 23.0%; P < .001). Less than half of the claimants with work-related asthma (43.2%) had received an objective evaluation of pulmonary function, through either pulmonary function testing or testing for reversible airflow limitation, for the evaluation of their work-related asthma. Claimants treated by specialists were significantly more likely to have received diagnostic testing during evaluation of their disease than those treated solely by generalists (82.9% vs 20.0%; P < .001).
  
  
  CONCLUSIONS
  The results of this study point to the lack of appropriate diagnostic care received by workers with work-related asthma. Physicians who may have questions about diagnostic procedures should consider referral to a specialist. The development of referral networks for work-related asthma may be warranted and should be explored.
authors.affiliation: Safety & Health Assessment & Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington 98504-4330, USA. cure235@lni.wa.gov
authors.forename: Christy C
authors.initials: CC
authors.lastname: Curwick
authors.forename: David K
authors.initials: DK
authors.lastname: Bonauto
authors.forename: Darrin A
authors.initials: DA
authors.lastname: Adams
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational; D001249:Asthma / Q000175:diagnosis* / Q000276:immunology*; D019937:Diagnostic Techniques and Procedures; D006801:Humans; D008511:Medicine / Q000145:classification*; D010818:Practice Patterns, Physicians'; D013038:Specialization; D016896:Treatment Outcome
chemical_list: D000395:Air Pollutants, Occupational