title: Occupational asthma: an assessment of diagnostic agreement between physicians.
abstract: OBJECTIVE
  To investigate the levels of agreement between expert respiratory physicians when making a diagnosis of occupational asthma.
  
  
  METHODS
  19 cases of possible occupational asthma were identified as part of a larger national observational cohort. A case summary for each case was then circulated to 12 physicians, asking for a percentage likelihood, from the supplied information, that this case represented occupational asthma. The resulting probabilities were then compared between physicians using Spearman's rank correlation and Cohen's kappa coefficients.
  
  
  RESULTS
  Agreement between the 12 physicians for all 19 cases was generally good as assessed by Spearman's rank correlation. For all 66 physician-physician interactions, 45 were found to correlate significantly at the 5% level. The agreement assessed by kappa analysis was more variable, with a median kappa value of 0.26, (range -0.2 to +0.76), although 7 of the physicians agreed significantly (p<0.05) with >or=5 of their colleagues. Only in one case did the responses for probability of occupational asthma all exceed the "on balance" 50% threshold, although 12 of the 19 cases had an interquartile range of probabilities not including 50%, implying "on balance" agreement. The median probability values for each physician (all assessing the identical 19 cases) varied from 20% to 70%. Factors associated with a high probability rating were the presence of a positive serial peak expiratory flow Occupation Asthma SYStem (OASYS)-2 chart, and both the presence of bronchial hyper-reactivity and significant change in reactivity between periods of work and rest.
  
  
  CONCLUSIONS
  Despite the importance of the diagnosis of occupational asthma and reasonable physician agreement, certain variations in diagnostic assessment were seen between UK expert centres when assessing paper cases of possible occupational asthma. Although this may in part reflect the absence of a normal clinical consultation, a more unified national approach to these patients is required.
authors.affiliation: Centre for Workplace Health, Health & Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK. d.fishwick@sheffield.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Fishwick
authors.forename: Lisa
authors.initials: L
authors.lastname: Bradshaw
authors.forename: Mandy
authors.initials: M
authors.lastname: Henson
authors.forename: Chris
authors.initials: C
authors.lastname: Stenton
authors.forename: David
authors.initials: D
authors.lastname: Hendrick
authors.forename: Sherwood
authors.initials: S
authors.lastname: Burge
authors.forename: Rob
authors.initials: R
authors.lastname: Niven
authors.forename: Chris
authors.initials: C
authors.lastname: Warburton
authors.forename: Trevor
authors.initials: T
authors.lastname: Rogers
authors.forename: Roger
authors.initials: R
authors.lastname: Rawbone
authors.forename: Paul
authors.initials: P
authors.lastname: Cullinan
authors.forename: Chris
authors.initials: C
authors.lastname: Barber
authors.forename: Tony
authors.initials: T
authors.lastname: Pickering
authors.forename: Nerys
authors.initials: N
authors.lastname: Williams
authors.forename: Jon
authors.initials: J
authors.lastname: Ayres
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Curran
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D010820:Physicians